Deglutição, estado nutricional e fluxo salivar em indivíduos após tratamento do câncer de cabeça e pescoço

Abstract

Deglutition, nutritional status and salivary flow in patients after treatment for head and neck cancer The treatment of head and neck cancer leads to consequences in the stomatognatic system, nourishment and nutritional condition. However, little is known concerning these factors in relation to the evolution of patients after the antineoplastic treatment is finished. The current study aimed to verify the connection among deglutition function, nutritional status and salivary flow in patients after treatment for head and neck cancer. The study has included 17 patients (14 men and 03 women), 53 years old average. The deglutition was evaluated through videofluoroscopy tests and surface electromyography on masseter muscles, orbicularis of the mouth and supra hyoids. The nutritional status was assessed through anthropometry (ICM, CMB and %GC) and diet evaluation by using a 24-hour food inventory, and the salivary flow was evaluated through mechanical stimuli. The analyses indicated that 66.7% of patients presented deglutition with functional limitations, with a waste scale of 58.3%, 66.7% and 58.3% with average of barium line in the structure to pudding, honey and liquid consistency, respectively, while laryngeal penetration reached 8.3% during liquid deglutition. For the surface electromyography, during flan deglutition, the time of muscle activity was above normal values. The values obtained from the electrical activity ampleness were similar to the studied muscles, which is not prospective in patients who do not have functional changes in deglutition. The anthropometric evaluation showed 41.2% of patients had eutrophy, according to ICM. The evaluation of muscle and adipose tissue showed eutrophy in 52.9% and 41.2%, respectively. The diet evaluation indicated that 64.7% had their energy consumption above the levels considered ideal, however, carbohydrates, proteins and lipids ingestion were normal, considering that 53.4% of patients ingested fewer micronutrients than necessary. The salivary flow test using mechanical stimulus showed that 82.3% had saliva production far below adequate. There was a significant correlation between muscle tissue reserve and time of muscle activity during deglutition, as well as Sodium and Calcium consumption with amplitude of muscular electrical activity for masseter muscles and orbicularis of the mouth, for liquid and honey consistency, respectively. No correlation between data of deglutition evaluations and salivary flow was found. Therefore, the relation between deglutition and nutritional status was established in the study, pointing that the adequate ingestion of proteins, sodium and calcium micronutrients affects muscle activities during deglutition in patients who survived head and neck cancer. Key words: Head and neck cancer. Deglutition. Nutritional Status. Xerostomia. (em RMS), porcentagem da atividade elétrica e tempo de recrutamento muscular durante a deglutição para a consistência pudim

Sintomas de disfagia orofaríngea, eficiência e segurança da deglutição em pacientes após o tratamento do câncer de cabeça e pescoço

“…Esses desafios nutricionais geralmente continuam além da fase de tratamento, podendo persistir ou ocorrer anos após a conclusão do tratamento e tornar-se crônico (CROWDER et al, 2018). Por outro lado, outro estudo encontrou pacientes após 12 meses de tratamento acima do peso ideal, sugerindo que estes indivíduos se adaptaram as suas novas condições, porém sem orientações quanto suas escolhas alimentares (CARVALHO, 2018). Além da falta de adesão a modificação da dieta, também foi observado que durante o tratamento, efeitos colaterais como dor, fadiga, secreções espessas e outras toxicidades relacionadas ao tratamento afetam a capacidade dos pacientes de concluir a proposta de reabilitação da deglutição.…”

Manual de orientação nutricional para indivíduos após tratamento de câncer de cabeça e pescoço: elaboração e validação do conteúdo

“…Adicionalmente, Carvalho (2018) mostrou existir relação entre a função deglutição e o estado nutricional nesta população, verificando que a adequada ingestão proteica se mostrou associada a atividade muscular mais eficiente durante o processo de deglutição.…”

“…A definição do tema deste manual se fez necessária após alguns estudos anteriores de Carvalho (2018) Contudo, o aumento na produção de material educativo em saúde tem assumido papel importante, principalmente diante intervenções terapêuticas nas doenças crônicas (OLIVEIRA et al, 2007;TORRES et al, 2009).…”