Predictors of severe dysphagia following radiotherapy for head and neck cancer

Aspiration prevention (AP) surgery may improve the quality of life (QOL) of patients with severe dysphagia. However, not all patients can endure this type of surgery under general anesthesia because of their poor status. Herein, we describe the cases of 2 patients with head and neck cancer (HNC) who underwent AP surgery for palliative care. Although both patients had tracheostomy due to severe dysphagia and respiratory impairment and frequently needed suction, they were successfully managed with AP surgery under local anesthesia. A tracheostoma was reshaped to be sufficiently large for an airway to be secured without a cannula. Their respiratory failure gradually improved, and suction frequency markedly decreased after surgery; thus, they could receive medical treatment at home. When patients with HNC under palliative care have a tracheal cannula and cannot vocalize, AP surgery under local anesthesia is an option to improve their QOL.

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OROPHARYNGEAL DYSPHAGIA: AN ASSOCIATION BETWEEN DYSPHAGIA LEVEL, SYMPTOMS AND COMORBIDITY

JOURNAL OF SURGICAL AND CLINICAL RESEARCH ◽

10.20398/jscr.v11i1.20955 ◽

2020 ◽

Vol 11 (1) ◽

pp. 39-45

Author(s):

Henrique de Paula Bedaque ◽

Lidiane Maria de Brito Macedo Ferreira ◽

Kallil Monteiro Fernandes ◽

Cynthia Meira de Almeida Godoy ◽

Hipólito Virgilio Magalhães Junior

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Oropharyngeal Dysphagia ◽

Bivariate Analysis ◽

Severe Dysphagia ◽

Main Complaint ◽

Mild Dysphagia

Objective: Associate levels of dysphagia according to the patient health condition. Methods: Retrospective study analyzing 149 medical records of patients who underwent Fiberoptic endoscopic evaluation of swallowing (FEES) in a tertiary hospital from 2016 to 2018. Data was collected on symptoms, comorbidities, FESS findings and oropharynx dysphagia classification. Statistical analysis was performed through descriptive and bivariate analysis using the Chi-square and Fisher's exact tests with a 5% significance level. Results: Most patients are elderly, female and with the main complaint of gagging for liquids and solids (30.9%), and gagging only for liquids was associated with the presence of mild dysphagia. The most prevalent degree of oropharynx dysphagia (OD) was mild (45%). In relation to patients' diseases, associations were identified between amyotrophic lateral sclerosis and mild dysphagia, Parkinson's disease and moderate dysphagia, and past pneumonia and / or head and neck cancer with severe dysphagia. Conclusions: The main complaint of patients with dysphagia and their pathological history should guide the treatment, without dispensing with complementary exams such as FESS, highlighting Parkinson's disease with moderate oropharynx dysphagia and past pneumonia and / or head and neck cancer as severe dysphagia.

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