[Cinematographic functional diagnosis of swallowing after plastic reconstruction of large tumor defects of the mouth cavity and pharynx]

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

Background

This systematic review qualitatively summarizes the current literature on diagnosis and treatment of oropharyngeal dysphagia (OD) after total laryngectomy (TLE).

Methods

Electronic databases PubMed, Embase, and the Cochrane Library were used. Two independent reviewers carried out the literature search and assessed the methodological quality of the included studies using a critical appraisal tool.

Results

Forty‐four articles met the inclusion criteria. Of these, 35 studies were on diagnosis, four on therapy, and five on both diagnosis and treatment of OD following TLE. Study aims, swallowing‐assessment methods, and main findings of the included studies were summarized and presented.

Conclusions

The reviewers found heterogeneous outcomes and serious methodological limitations, which prevented us from pooling data to identify trends that would assist in designing best clinical practice protocols for OD following TLE. Further research should focus on several remaining gaps in our knowledge on diagnosis and treatment interventions for OD following TLE.

The infrahyoid myocutaneous flap in intra-oral reconstruction as an alternative to free flaps

CONCLUSIONS

In our experience, monolateral or bilateral infrahyoid myocutaneous flap is less time-consuming and reduces the complication rate and the operation time in both small and large defects if compared with other authors' experience using a microvascular anastomosed flap.

OBJECTIVE

The aim of this study was to describe our results in reconstructive surgery after cancer ablation using the less popular infrahyoid myocutaneous flap as an alternative method to free flaps. The surgical technique and the postoperative outcomes are described.

METHODS

This was a retrospective study: 32 patients with squamous cell carcinoma of the tongue were surgically treated using a pure infrahyoid myocutaneous neurovascular flap.

RESULTS

The flap was successful in all cases without flap necrosis, fistula or complications in the donor site. After radiation therapy, flap tissues remained sufficiently soft, trophic and mobile. Ultrasound evaluation of tongue mobility, performed at the time of discharge, as well as 3 and 6 months after surgery, showed normal bolus propulsion. Cinefluoroscopy also showed good function of the reconstructed tongue.

Rehabilitation of dysphagia following head and neck cancer

Patients who have cancers of the oral cavity, pharynx, or larynx may be treated with surgery, radiotherapy, chemotherapy, or a combination of these modalities. Each treatment type may have a negative impact on posttreatment swallowing function; these effects are presented in this article. A number of rehabilitative procedures are available to the clinician to reduce or eliminate swallowing disorders in patients treated for cancer of the head and neck. The various procedures-including postures, maneuvers, modifications to bolus volume and viscosity, range-of-motion exercises, and strengthening exercises-and their efficacy in patients treated for head and neck cancer are discussed.

Swallow function and perception of dysphagia in patients with head and neck cancer

BACKGROUND

The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy +/- chemotherapy has not been well documented in the literature.

METHODS

Swallowing function in 132 patients with various lesions was evaluated using videofluoroscopy and analyzed by patient complaint of dysphagia grouping.

RESULTS

Patients with complaints of dysphagia demonstrated significantly worse swallow function as indicated by lower oropharyngeal swallow efficiency (OPSE), longer transit times, larger residues, and more swallows with aspiration. Patients with complaints of dysphagia also tended to take less of their nutrition by mouth and less variety of food consistencies in their diet compared with those without complaint.

CONCLUSIONS

Patients were able to perceive decrements in their swallowing function as dysphagia and may have limited their oral intake in response to that perception. The ability to accurately perceive swallowing function may be useful for self-monitoring changes in dysphagia status during a course of swallow therapy.