Compensatory Mechanisms in Patients After a Partial or Total Glossectomy due to Oral Cancer

详细信息    查看全文

• 作者：Ludmi?a Halczy-Kowalik ; Andrzej Wiktor ; Anna Rzewuska ; Robert Kowalczyk…
• 关键词：Oral cancer ; Glossectomy ; Swallowing rehabilitation ; Video fluoroscopic evaluation ; Compensatory mechanisms
• 刊名：Dysphagia
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：30
• 期：6
• 页码：738-750
• 全文大小：542 KB
• 参考文献：1.Shah JP, Gil Z. Current concepts in management of oral cancer -Surgery. Oral Oncol. 2009;45:394-01.PubMedCentral CrossRef PubMed
  2.Mittal BB, Paulosky BR, Haraf DJ, et al. Swallowing dysfunction -preventative and rehabilitation strategies in patients with head and neck cancers treated with surgery, radiotherapy and chemotherapy. Critical view. Int J Radiation Oncol Bio Phys. 2003;57(5):1219-0.CrossRef
  3.Paulosky BR. Rehabilitation of Dysphagia Following Head and Neck Cancer. Phys Med Rehabilit Clin N Am. 2008;19(4):889-28.CrossRef
  4.Granell J, Garrido L, Millas T, Gutierrez-Fonseca R: Management of Oropharyngeal Dysphagia in Laryngeal and Hypopharyngeal Cancer. Int J of Otolaryng 2012: Article ID 157630, 2012;.
  5.Pizzorni N, Ginocchio D, Mozzanica F, Roncoroni L, Scarponil L, Schindler A. Head and neck diseases and disorders causing oropharyngeal dysphagia. J Gastroenterol Hepatol Res. 2014;3(10):1272-0.
  6.Borggreven PA, Leeuw IVD, Rinkel RN, et al. Swallowing after major surgery of the oral cavity or oropharynx: a prospective and longitudinal assessment of patients treated by microvascular soft tissue reconstruction. Head Neck. 2007;29:638-7.CrossRef PubMed
  7.Su WF, Hsia J, Ch Chang Y, et al. Functional Comparison after Reconstruction with a Radial Forearm Free Flap Or Pectoralis Major flap for Cancer of the Tongue. Otolaryngol Head Neck Surg. 2003;128:412-.CrossRef PubMed
  8.Brown L, Rieger JM, Harris J, et al. A longitudinal study of functional outcomes after surgical resection and microvascular reconstruction for oral cancer: tongue mobility and swallowing function. J Oral Maxillofacial Surg. 2010;68:2690-00.CrossRef
  9.Yu R. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck. 2004;26:1038-4.CrossRef PubMed
  10.Zuydam AC, Rogers SN, Brown JS, et al. Swallowing rehabilitation after oropharyngeal resection for squamous cell carcinoma. Brit J Oral Maxillofac Surg. 2000;38:513-.CrossRef
  11.Tei K, Maekawa K, Kitada H, et al. Recovery from postsurgical swallowing dysfunction In patients with oral cancer. J Maxillofac Surg. 2007;65:1077-3.CrossRef
  12.Paulosky BR, Rademaker AW, Logemann JA, et al. Surgical variables affecting swallowing in treated oral/oropharyngeal cancer patients. Head Neck. 2004;26:625-6.CrossRef
  13.Hirano M, Kuroiwa Y, Tanaka S, et al. Dysphagia following various degrees of surgical resection for oral cancer. Ann Otol Rhinol Laryngol. 1992;101:138-1.CrossRef PubMed
  14.Chhabra A, Anandakrishna GN, Rao G, et al. Rehabilitation of partial maxillectomy with implants hollow bulb obturator prosthesis: a case report. J Indian Prosthodontic Soc. 2012;12(2):101-.CrossRef
  15.Xin P, Chi M, Guang-yan Y, et al. Maxillary reconstruction with the Free Fibula Flap. Plast Reconstr Surg. 2005;115:1562-.CrossRef
  16.Logemann JA, Paulosky BR, Rademaker AW, et al. Speech and swallowing rehabilitation for head and neck cancer patients. Review article. Oncology. 1997;11:651-.PubMed
  17.Lazarus C, Logemann JA, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck. 1993;15:419-4.CrossRef PubMed
  18.Rasley A, Logemann JA, Kahrilas PJ, Rademaker AW, et al. Prevention of barium aspiration during videofuoroscopic swallowing studies: value of change in posture. AJR. 1993;160:1006-.CrossRef
  19.Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. Am J Roentgenol. 1990;154:953-3.CrossRef
  20.Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. Am J Roentgenol. 1990;154:965-4.CrossRef
  21.Buchholtz DW, Bosma JF, Donner MW. Adaptation, Compensation and Decompensation of the Pharyngeal Swallow. Gastrointest Radiol. 1985;10:235-.CrossRef
  22.Walther EK. Dysphagia after pharyngolaryngeal cancer surgery, part I patophysiology of postsurgical deglutition. Dysphagia. 1995;10:275-.CrossRef PubMed
  23.Herberhold C, Walter EK. Dysphagia after pharyngolaryngeal cancer surgery. part II. Implications for reconstructive procedures. Dysphagia. 1995;10:2279-1.CrossRef
  24.Furia CLB, Carrara deAngelis E, Martins N, et al. Video fluoroscopic evaluation after glossectomy. Arch Otolaryngol Neck Head Surg. 2000;126:378-3.CrossRef
  25.Halczy-Kowalik L, Sulikowski M, Wysocki R, et al. The role of epiglottis In the swallow process after partial glossectomy due to a neoplasm. Dysphagia. 2012;27(1):20-1.PubMedCentral CrossRef PubMed
  26.Sakuma T, Kida I. Relationship between ease of swallowing and deglutition related muscle activity in various postures. J Oral Rehab. 2010;37:583-.
  27.Logemann JA, Veis S, Colangelo LA. Screening procedure for oropharyngeal dysphagia. Dysphagia. 1999;14:44-1.CrossRef PubMed
  28.Halczy-Kowalik L, Posio V. Wiktor A et a: the assessment of aspiration risk resulting from swallowing In oral cancer patients. J Stomat
• 作者单位：Ludmi?a Halczy-Kowalik (1)
  Andrzej Wiktor (2)
  Anna Rzewuska (2)
  Robert Kowalczyk (2)
  Ro?cis?aw Wysocki (3)
  Violetta Posio (3)
  
  1. Independent Laboratory of Postoperative Rehabilitation In Maxillofacial Surgery, Pomeranian Medical University, 71-114 Szczecin, Al. Powstańców Wlkp. 72, Szczecin, Poland
  2. Clinic of Maxillofacial Surgery, Pomeranian Medical University, Szczecin, Poland
  3. Department of Imaging Diagnostics and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Imaging and Radiology
  Gastroenterology
  Hepatology
  
• 出版者：Springer New York
• ISSN：1432-0460

文摘

Excision of a part or the whole of tongue due to oral cancer disturbs swallowing and speech. Lower airways aspiration of the swallowed bolus in patients after such oral structures excision is a symptom of major swallowing disorder and may be the cause of aspiration pneumonia. Restoration of oral nutrition is possible after exclusion or reduction of aspiration threat in the patients. Video fluoroscopic evaluation of the swallowing performed at the beginning of the swallowing rehabilitation in 95 patients after a total or partial glossectomy due to oral cancer, who assessed their saliva swallowing as efficient on the day of examination, showed disturbances of all of the swallowing stages. The most common disturbances involved the oral stage: limited mobility of the oral tongue, impaired glossopalatal seal, and weak glossopharyngeal seal. The most serious among them involved pharyngeal stage of swallowing, as leakage into the larynx and aspiration. The patients used their own methods during barium suspension swallowing to facilitate the swallowing act. They used such methods as: changing the position of the head to the body, additional swallows, engaging the adjacent structures into sealing the oral fissure. We assumed that the compensatory mechanisms (CM) worked out by the patients before the swallowing examination will enable them efficient barium suspension swallowing. The CM were applied by 71 of 95 patients; 51 of the patients used more than one compensatory mechanism. Swallowing in 61 of the compensating patients was at least functional; swallowing in 10 of the compensating patients was non-efficient and caused recurrent aspiration. The results of our research negate the validity of multiple swallows (more than three) without apnea elongation because it may lead to aspiration. Aspiration was also recorded in patients with weak airways closure and immovable epiglottis, who complemented the impaired oral transport with gravitational oral transport by moving chin up during a swallow. The hypothesis that CM applied by the patients after oral cancer excision during saliva swallowing will be helpful in swallowing of the barium suspension was not proved. In 10 of all the patients recurring aspiration was found despite CM application. Determination of aspiration risk is the key to efficient swallowing rehabilitation. The assessment of CM applied spontaneously by the patients-maintenance validity is particularly important. Video fluoroscopic examination of swallowing allows to assess the aforementioned issue and is crucial for better comprehension of CM applied by the patients in creating a new swallowing pattern after oral cancer excision. Keywords Oral cancer Glossectomy Swallowing rehabilitation Video fluoroscopic evaluation Compensatory mechanisms