Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survivors

Allison, Glenn R.; Rappaport, Irving; Sallbian, Arthur H.; McMicken, Betty L.; Shoup, June E.; Etchepare, Teresa L.; Krugman, Mark E.

doi:10.1016/0002-9610(89)90016-0

Cited by 38 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regression analysis, while controlling for the extent of resection, indicated that surgical closure group (i.e., primary closure or skin grafts versus pedicled or free flaps) had a profound impact on speech, with those patients receiving flap closure more likely to have worse speech function. This result is consistent with a body of other work, 6‐9,11 as well as earlier work from this research group 10 that demonstrates that patients undergoing reconstruction with flaps tend to have worse overall function.…”

Section: Discussionsupporting

confidence: 92%

“…Larger resection volumes and greater percentage of oral tongue resection have been correlated with reduced intelligibility and articulation 1‐5 . Other research, however, suggests that speech function depends on the method of reconstruction rather than the degree of resection 6 . Patients who underwent reconstruction with pedicled or free flaps appear to have worse postsurgical speech function than those whose resections were closed primarily or with skin grafts 7‐11 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Variables Affecting Speech in Treated Patients With Oral and Oropharyngeal Cancer

et al. 1998

View full text Add to dashboard Cite

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Surgical Variables Affecting Speech in Treated Patients With Oral and Oropharyngeal Cancer

et al. 1998

View full text Add to dashboard Cite

show abstract

“…She was also able to suck on the finger and swallow several times consecutively. This musclemass-to-mid-palate contact, which allowed the speaker to develop swallowing functions, has also been reported in other case studies [7,8,10,11] Speech was intelligible and swallow function were observed to be functional at the time of initial assessment, given food of soft and chopped consistency [9]. No additional observations of the bone and muscle structures involved in the anatomy and physiology of speech, swallowing and chewing were made at the time of initial data collection.…”

Section: Case Presentation Subjectmentioning

confidence: 65%

“…The PWCA's intraoral cavity was inspected by numerous team members of the hospital-based head and neck center. Their examination revealed a wart-like tongue rudiment in the region of the floor of the mouth [9]. The interpreting radiologist reported that there was no geniohyoid muscle visible on X-ray or present on palpation.…”

Section: Case Presentation Subjectmentioning

confidence: 99%

Speech and Swallow Kinematics of a Person with Congenital Aglossia

McMicken¹,

Berg²,

Kunihiro³

2015

Anat Physiol

View full text Add to dashboard Cite

Objective: This research study explored movement of key processes during speech and swallow of a person with congenital aglossia. It expands upon earlier studies that found a high degree of intelligibility among listeners for expressive speech by the person with congenital aglossia and seeks to identify the dynamics through which the articulators accomplish this phenomenon.Methods: Positional movements of the mandible and hyoid bone and mylohyoid and tongue base for speech and swallow were compared with those movements obtained for people without aglossia. Results:In this subject, the hyoid bone and mandible were strongly associated with movement of the pseudo tongue for both speech and swallow. This is markedly different from results of normal subjects, who show strong correlations between the hyoid bone and mandible and the tongue for swallow only. Kinematics differed significantly for speech and swallow tasks in the person with PwCA, with the exception of the hyoid bone, which behaved in a similar manner for both tasks. Movements of pseudo-tongue structures demonstrated a variety of horizontal and vertical movements, with some independent relationships between mandibular and hyoid bone motions for both oral swallow and speech. Overall, the dependent variables of mylohyoid and the base of tongue were closely related to the movement of the hyoid bone, which was the strongest determinant of vertical dependent variable movement. Results revealed that in this person with congenital aglossia, the hyoid bone and mandible were strongly associated with movement of the pseudo tongue for both speech and swallow. This is markedly different from results of normal subjects, who show strong correlations between the hyoid bone and mandible and the tongue for swallow only. Conclusion:These results suggest that speakers who present with congenital or acquired structural and/or physiological reductions to the speech mechanism may present with the capacity to capitalize on a variety of actions during eating or swallowing to optimize the more finessed actions of speech. The highly predictable correlations of muscles for deglutition and speech suggest that this speaker essentially 'bootstrapped' muscular actions (and limitations therein) developed for deglutition and used them to buttress speech and resonance. These actions are quite different from those of individuals with a tongue, who recruit a variety of muscles for the diverse acts of speaking and swallowing.

show abstract

“…Three of these four marginal failures followed prior radiotherapy (Table 3). Major recon¬ structive failure, defined as sufficient necrosis to result either in the patient's early death or that required an alternative flap, occurred in 13 patients, 12 following prior radiother¬ apy. Eleven of these patients were successfully managed with an alter¬ native replacement flap, including one patient whose eroded carotid artery was successfully ligated.…”

Section: Clinical Resultsmentioning

confidence: 99%