The purpose of this study was to help provide data to help to implement effective rehabilitation following surgery for oral cancer by comparing tongue pressure production for water and thickened water from the anterior and posterior parts of the tongue during swallowing. Ten healthy volunteers (7 men, 3 women; age 27.6 ± 1.5 years) participated in the experiments. Tongue pressure during 3 mL water and 3 mL thickened water at the anterior and posterior tongue during swallowing was measured using a sensor sheet system with five measuring points on the hard palate. The sequential order of the points, maximal magnitude and duration of tongue pressure at each point were compared based on water viscosity and tongue ingestion site. There was a common pattern in the sequential order of tongue pressure generation among the two swallowing conditions. The maximal magnitude of tongue pressure was significantly higher when swallowing thickened water than when swallowing water at all points except for the anterior-median and mid-median part. Moreover, the pressure at all sites during posterior ingestions was significantly lower than that during anterior ingestion. The present results provide mean values of tongue pressure during voluntarily triggered swallowing in anterior ingestion and posterior ingestion in young, healthy dentate individuals; these values can be clinically referenced for tongue pressure measurement in the evaluation of patients with dysphagia. The use of reference values may help streamline the diagnosis, treatment and rehabilitation of dysphagia.
Functional rehabilitation has been reported to improve swallowing. The effect of the presence or absence of such rehabilitation has yet to be compared in oral cancer patients, however. The purpose of this study was to investigate its effect on correlations between the period of hospitalization and the period of tube feeding (from the day of surgery to termination of tube feeding) and period of oral nutrition (from termination of tube feeding to discharge). Body weight was also measured on admission and discharge and the difference calculated. A correlation was observed between period of hospitalization and period of tube feeding in the rehabilitation group, and with the periods of tube feeding and oral nutrition in the non-rehabilitation group. In the rehabilitation group, the period of tube feeding appeared to affect period of hospitalization. On the other hand, termination of tube feeding did not tend to affect period of hospitalization. These results suggest that both periods were factors affecting period of hospitalization in the non-rehabilitation group. Not performing swallowing rehabilitation, therefore, resulted in the period of oral nutrition affecting the period of hospitalization. This suggests that it is essential that nutrients be ingested in moderation after termination of tube feeding, when they are only taken orally. Moreover, these results also indicate that rehabilitation is important in improving quality of life after discharge.
There are several methods of assessing dysphagia, but methods of assessing swallowing function in patients with oral cancer are not well standardized. Therefore, evaluation methods might differ across hospitals, possibly resulting in treatment-induced symptoms not being accurately reflected in the evaluation. The Mann Assessment of Swallowing Ability-Cancer (MASA-C) is a screening tool used for patients with head and neck cancers undergoing radiation monotherapy or chemoradiotherapy. It comprises 24 items to assess the severity of dysphagia and the risk of aspiration. This study evaluated the usefulness of the MASA-C tool postoperatively in patients with oral cancer. MASA-C scores were compared with evaluations performed using existing examination methods, such as video fluoroscopy and the Functional Oral Intake Scale (FOIS). The optimal MASA-C cutoff value for diagnosing aspiration was 150 points, with a sensitivity of 0.89, specificity of 0.80, and an area under the curve of 0.85. A significant correlation was observed between the FOIS and MASA-C (r = 0.624, P = 0.001). MASA-C is a useful screening tool for the evaluation of swallowing function after oral cancer surgery.
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