Change in tongue pressure and the related factors after esophagectomy: a short-term, longitudinal study

Abstract

Background Dysphagia is a prominent symptom after esophagectomy and may cause aspiration pneumonia. Swallowing evaluation after esophagectomy can predict and help control the incidence of postoperative pneumonia. The aim of this study was to clarify whether the change in tongue pressure was associated with any related factor and postoperative dysphagia/pneumonia in patients with esophageal cancer after esophagectomy. Methods Fifty-nine inpatients (41 males and 18 females; 33-77 years old) who underwent esophagectomy participated in this study. Measurement of tongue pressure and the repetitive saliva swallowing test (RSST) was performed before esophagectomy (baseline) and at 2 weeks postoperatively. The general data were collected from patients' medical records, including sex, age, type of cancer, cancer stage, location of cancer, operative approach, history of previous chemotherapy, surgical duration, amount of bleeding during surgery, incidences of postoperative complications, intubation period, period between surgery and initiation of oral alimentation, and intensive care unit (ICU) stay, blood chemical analysis, and lifestyle. Results Tongue pressure decreased significantly after esophagectomy (p = 0.011). The decrease of tongue pressure was significantly associated with length of ICU stay and preoperative tongue pressure on multiple regression analysis (p < 0.05). The decrease of tongue pressure in the RSST<3 or postoperative pneumonia (+) group was significantly greater than in the RSST≥3 (p = 0.003) or pneumonia (-) group (p = 0.021). Conclusions The decrease in tongue pressure was significantly associated with the length of ICU stay, preoperative tongue pressure, and the incidence of dysphagia and pneumonia among inpatient after esophagectomy.

Changes in Maximum Tongue Pressure and Postoperative Dysphagia in Mechanically Ventilated Patients after Cardiovascular Surgery

“…However, there was no significant difference in preoperative maximum tongue pressure between patients with and without postoperative dysphagia. In a study that compared tongue pressure before and 2 weeks after esophagectomy in patients with esophageal cancer, 15 higher preoperative tongue pressure was associated with greater postoperative reductions in tongue pressure. A history of heart failure and preoperative reduced cardiac function are risk factors for dysphagia after cardiovascular surgery.…”

“…One of the screening tools for dysphagia is the measurement of tongue pressure. Low tongue pressure and dysphagia have also been studied in patients with stroke, 13 Parkinson's disease, 14 postoperative esophageal cancer, 15 postoperative head and neck cancer, 16 and emergency patients. 17 Ichibayashi et al examined aspiration pneumonia resulting from postextubation dysphagia in patients who were receiving mechanical ventilation for at least 24 hours, at an emergency department.…”

Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol

“…Some small studies have identified impairment of oropharyngeal structures post-operatively during videofluoroscopy (VFS). Swallowing impairment following resection have been reported to include a reduction in tongue pressure, delayed initiation of the pharyngeal swallow, impaired biomechanics, RLN palsy and increased pharyngeal residue, which may increase the patients’ risk of aspirating, silently aspirating and developing pneumonia 26–28. To date there has been no systematic research using a prospective longitudinal study design in this patient group.…”

“…Swallowing impairment following resection have been reported to include a reduction in tongue pressure, delayed initiation of the pharyngeal swallow, impaired biomechanics, RLN palsy and increased pharyngeal residue, which may increase the patients' risk of aspirating, silently aspirating and developing pneumonia. [26][27][28] To date there has been no systematic research using a prospective longitudinal study design in this patient group. By determining the prevalence, nature and trajectory of dysphagia postoesophagectomy the researchers anticipate that this would inform future research and guidelines in prevention and management of dysphagia, including exercisebased dysphagia interventions, which may optimise clinical and QOL outcomes.…”

Clinical significance of sarcopenic dysphagia for patients with esophageal cancer undergoing esophagectomy: A review

“…Mayanagi et al suggested that preoperative sarcopenia and laryngeal nerve palsy were independent risk factors of postoperative dysphagia in 187 patients with esophageal cancer in a retrospective study. 25 Katsumata et al reported that a reduction in geniohyoid muscle mass caused dysphagia in patients after surgery for esophageal cancer 57 ; furthermore, Yokoi et al suggested that a decrease in tongue pressure before and after surgery was significantly associated with postoperative pneumonia among inpatients with esophageal cancer after esophagectomy 58 (Table 2 ). These findings suggested that dysphagia after esophagectomy seemed to be related to factors associated with patient characteristics; therefore, perioperative interventions for patients with esophageal cancer might improve their swallowing function.…”