Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

Hirano, Minoru; Matsuoka, Hidetaka; Kuroiwa, Yasunao; Sato, Kiminori; Tanaka, Shinzo; Yoshida, Tetsuji

doi:10.1177/000348949210100206

Cited by 106 publications

(55 citation statements)

References 10 publications

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“…These findings are consistent with the work of Hirano et al who examined the incidence of postoperative dysphagia and found that removal of the geniohyoid (GH) or mylohyoid muscles was significantly associated with poor swallowing function as measured by diet level and the presence of aspiration [14]. Pearson and colleagues recently reported the results of structural studies modeling the physiologic function of the FoM muscles in laryngeal displacement during swallowing [15].…”

Section: Introductionsupporting

confidence: 87%

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The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics

et al. 2015

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Radiation oncologists have focused on the pharyngeal constrictors as the primary muscles of concern for dysphagia. However, our prior investigations have demonstrated that radiation dose to the geniohyoid rather than the constrictor muscles was more closely related to penetration aspiration scores (PAS). We examined the relationship between (1) radiation dose and swallowing temporal kinematics, and (2) between PAS and swallowing kinematics in these patients. Videofluoroscopic swallowing studies of 41 patients following radiation therapy for oropharyngeal cancer were analyzed for thin liquid boluses. Timing measures included duration of laryngeal vestibule closure (DLVC), duration to maximum hyoid elevation (DTMHE), duration to cricopharyngeal opening (DTCPO), and pharyngeal transit time (PTT). PAS was extracted for each swallow and considered normal if ≤ 2. As minimum and mean dose to the geniohyoid increased, DTMHE, DTCPO, and PTT increased. Worse PA scores were most strongly correlated with radiation dose received by geniohyoid (r = 0.445, p < 0.0001). Mean DLVC varied according to PAS group (normal PAS mean = 0.67 s, abnormal PAS mean = 0.13 s; p < 0.001). Similarly, DTCPO was significantly different based upon PAS (normal PAS mean = 0.22 s, abnormal PAS mean = 0.37 s, p = 0.016). As PAS increased, DTPCO and PTT increased (r = 0.208, p = 0.04; r = 0.204, p = 0.043). A negative correlation was noted between PAS and DLVC (r = -0.375, p = 0.001). Higher doses of radiation to the geniohyoid muscles are associated with increased severity of dysphagia as measured through both kinematics and PAS. Consideration of dose to the geniohyoid should be considered when planning radiation.

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Section: Introductionsupporting

confidence: 87%

“…We also hypothesized that patients with abnormal PAS would have abnormal swallowing temporal kinematics. The rationale for this hypothesis is based on studies that have reported the importance of FoM muscles in swallowing airway protection [14,15] and the effect of dose on muscle function [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics

et al. 2015

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“…In general, the swallowing difficulties exhibited by this multivaried clinical population usually vary in degree depending upon the site, size, and neuromuscular penetration of the tumor. Whereas some patients with minimal or no dysphagia at the time of diagnosis have been shown to develop swallowing complications as sequelae to surgical intervention, nonsurgical management, or various combinations of both [2][3][4][5][6][7][8], others have been noted to experience gains in swallowing proficiency as a result of such treatments [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. When dysphagia in the patient with head and neck cancer is at least partly attributable to surgical intervention, this pathophysiologic side effect is usually caused by geometric alteration and consequential weakness, paresis, and scarring of constituent components of the swallowing mechanism [23].…”

mentioning

confidence: 99%

Swallowing Function Outcomes Following Nonsurgical Therapy for Advanced-Stage Laryngeal Carcinoma

et al. 2006

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The purposes of this study were to (1) evaluate swallowing function using both subjective and objective measures in patients treated nonsurgically for stages III and IV laryngeal squamous cell carcinoma, (2) assess the effect of time from treatment completion on swallowing function, and (3) assess sequelae associated with modality of treatment. To achieve these objectives, a retrospective study of 14 patients was conducted. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed and evaluated by three independent judges for seven functional criteria: standing secretions, valleculae spillage, valleculae residue, postcricoid residue, laryngeal penetration, aspiration, and cough. Patient interviews were performed to establish patient perception of swallowing and his/her current posttreatment diet. Results revealed that each patient exhibited swallowing abnormalities in at least one of the seven objective functional categories studied. Ten patients suffered from variable degrees of dysphagia, ranging from mild to severe, on all measures. No significant differences were noted between those patients with less than or greater than 12 months posttreatment. Common treatment sequelae included PEG tube placement for nutritional supplementation, tracheostomy placement for airway security and/or pulmonary toilet, repeated episodes of aspiration pneumonia requiring hospital admission, and radiation-induced oropharyngeal stricture. Further studies using subjective and objective swallowing function measures for patients treated with alternative chemoradiation regimens versus surgery (with or without adjuvant therapies) for advanced stage laryngeal cancer are needed.

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“…When neck dissection is performed to prevent metastasis of the tumor to the lymph nodes, dysfunctions of raising and closing the larynx and opening the entry to the esophagus occur. When the range of the tumor excision is enlarged, dysphagia can be severe [9][10][11][12][13][14]. In particular, when the root of the tongue is excised, dysphagia is more likely to occur [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Swallowing Tablets during the Recovery Period following Surgery for Tongue Cancer

Yoshizumi¹,

Mikushi²

2016

Otolaryngol

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Objective: Medicinal tablets are sometimes difficult to swallow, even for healthy individuals. Accordingly, it is likely more difficult for patients to swallow tablets after oral surgery for tongue tumors. In this study, we aimed to investigate the dynamics of swallowing tablets in the recovery period following surgery for tongue tumors. Methods:Two experiments were conducted (Experiment 1 and Experiment 2). In Experiment 1, 20 tongue cancer patients swallowed simulated tablets and underwent videofluoroscopic (VF) examination of swallowing before and after surgery. The ability or inability to pass the tablet to the esophagus and the number of swallowing attempts required to ingest the tablet were evaluated. In Experiment 2, 48 similar subjects swallowed thickened barium and simulated tablets and underwent VF examination of swallowing after surgery. The ability or inability to pass the tablet to the esophagus, the number of swallows required to ingest the tablet, the tablet position after the initial and the final swallowing reflexes, and the oral transit time and pharyngeal transit time for swallowing the thickened barium solution and simulated tablets were evaluated.Results: After subtotal glossectomy, more subjects were unable to pass the tablet to the esophagus after surgery rather than before surgery. However, after surgery, patients needed more numbers of swallowing reflex attempts in order to successfully swallow tablets. Also, the tablets remained not only in the mouth, but also in the epiglottic vallecula and pyriform sinus. In the patients who could pass the tablet, the oral transit time of the thickened barium solution was shorter than in the patients who could not. Conclusion:In cases of subtotal glossectomy, tablet intake should be avoided, particularly in the recovery phase, and VF or endoscopic evaluation of swallowing should be performed when tablets are prescribed. After tongue cancer surgery, patients should be recommended to make multiple swallowing attempts when swallowing tablets.

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Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

Cited by 106 publications

References 10 publications

The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics

The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics

Swallowing Function Outcomes Following Nonsurgical Therapy for Advanced-Stage Laryngeal Carcinoma

Dynamics of Swallowing Tablets during the Recovery Period following Surgery for Tongue Cancer

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