Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

Postoperative swallowing problems were investigated in 20 patients who had undergone various degrees of surgical resection for oral cancer. The swallowing problems were evaluated on the basis of type of food, degree of aspiration, and duration of postoperative nasogastric tube feeding. Two patients with tongue cancer who had had hemiglossectomy without reconstruction ate normal food without aspiration within a week after operation. Eight patients who had undergone two- to three-quarter glossectomy for tongue cancer ate gruel with no or occasional liquid aspiration. Among 4 patients who had had near-total or total glossectomy for tongue cancer, 3 ate thin gruel or liquid with occasional aspiration. The other could not eat orally because of consistent severe aspiration. One patient with mouth floor cancer underwent resection of the mouth floor in combination with hemiglossectomy and she ate gruel without aspiration. Among 5 patients with mouth floor cancer who had had surgical removal accompanied by near-total or total glossectomy, 3 ate gruel with no or occasional liquid aspiration, 1 ate thin gruel with no aspiration, and the other could not eat orally. A diagnosis of T4 lesions, extensive removal of the tongue base, removal of the geniohyoid and mylohyoid muscles, and removal of the lateral pharyngeal wall were significantly related to poor swallowing function.

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A Longitudinal Study of Functional Outcomes After Surgical Resection and Microvascular Reconstruction for Oral Cancer: Tongue Mobility and Swallowing Function

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2010.05.004 ◽

2010 ◽

Vol 68 (11) ◽

pp. 2690-2700 ◽

Cited By ~ 35

Author(s):

Lindsay Brown ◽

Jana M. Rieger ◽

Jeffrey Harris ◽

Hadi Seikaly

Keyword(s):

Longitudinal Study ◽

Oral Cancer ◽

Surgical Resection ◽

Functional Outcomes ◽

Microvascular Reconstruction ◽

Swallowing Function ◽

Tongue Mobility

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Impact of nasogastric tube feeding on swallowing function in patients with dysphagia: a pilot study

Neurology Asia ◽

10.54029/2021smr ◽

2021 ◽

Vol 26 (4) ◽

pp. 809-815

Author(s):

Yu Sang Jung ◽

MinYoung Kim ◽

Kyunghoon Min ◽

Jong Moon Kim ◽

Eun Young Han ◽

...

Keyword(s):

Nasogastric Tube ◽

Tube Feeding ◽

University Hospital ◽

Diagnostic Significance ◽

Swallowing Function ◽

Videofluoroscopic Swallowing Study ◽

Swallowing Therapy ◽

Swallowing Dysfunction ◽

Nasogastric Tube Feeding

During dysphagia treatment, direct oral swallowing therapy is applied to some patients temporarily fed via nasogastric tube. However, the risk of aspiration in oral swallowing while nasogastric tube in situ may be disregarded in a standard videofluoroscopic swallowing study performed without a nasogastric tube. To evaluate the diagnostic significance of nasogastric tube in situ videofluoroscopic swallowing study of nectar and pureed diet compared to the standard videofluoroscopic swallowing study without nasogastric tube. Videofluoroscopic swallowing study records of dysphagia patients conducted between June and August 2017 in a university hospital were collected for review. Rosenbek’s penetration-aspiration scale, diagnostic criteria of aspiration were used to define aspiration. videofluoroscopic dysphagia scale for videofluoroscopic swallowing study with or without nasogastric tube were compared for nectar and pureed diet swallowing. Patients had various duration of nasogastric tube feeding. Paired T-test comparing the videofluoroscopic dysphagia scales for videofluoroscopic swallowing study with or without nasogastric tube revealed significant aggravation of swallowing dysfunction in nectar drinking while nasogastric tube in situ. This aggravation was noted in 19% (n=4) of patients who suffered from stroke regardless of nasogastric tube duration. Nasogastric tube in situ videofluoroscopic swallowing study, at least of nectar drinking could be beneficial in selecting a safe candidate for direct oral swallowing therapy in conjunction with the conventional nasogastric tube removed videofluoroscopic swallowing study.

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Comparative analysis of the functional results of tongue reconstruction with four kinds of free flaps after radical resection of tongue cancer

10.21203/rs.2.23730/v1 ◽

2020 ◽

Author(s):

yongcong cai ◽

Chao Li ◽

Dinfen Zeng ◽

ChunYan Shui ◽

RongHao Sun ◽

...

Keyword(s):

Tongue Cancer ◽

Free Flaps ◽

Radical Resection ◽

The Other ◽

Swallowing Function ◽

Donor Area ◽

Tongue Reconstruction ◽

Alt Flap ◽

Normal Speech ◽

Better Than

Abstract Background Surgery is still the treatment of choice for tongue cancer. Tongue reconstruction should be performed immediately after extensive resection of the tumor, which will affect the patient's function. The purpose of this study was to investigate the functional evaluation of four different free flaps in tongue reconstruction after a tongue cancer operation. Methods Forty-eight cases of tongue reconstruction with a radial forearm free(RFF flap), anterolateral thigh(ALT) flap, lateral upper arm free(LAF)flap and deep inferior epigastric artery perforator(DIEP)flap from 2014 to 2018 were analyzed. The speech function, swallowing function, tongue flexibility and patients' satisfaction with the donor area was investigated six months after repair. Results Twenty-one cases with RFF flaps, 18 cases with ALT flaps, 5 cases with LAF flaps and 4 cases with DIEP flaps showed complete flap survival. Speech function:39.6% of the patients exhibited normal speech, 43.8% of the patients exhibited near-normal speech, the RFF flap group was showed better recovery than did the other three groups ( p =0. 195). The degree of tongue flexibility: 37.5% of the patients with normal postoperative tongue flexibility, 43.6% of the patients with slightly limited tongue flexibility,, 16.7% of the patients with severely limited tongue flexibility, The flexibility of the RFF flap was better than that of the other three groups( p =0. 054). Swallowing function:47.9% of the patients had a regular diet, 33.3% of the patients had soft foods, 16.7% patients receive fluid diet, The RFF flap group showed better recovery than did the other three groups ( p =0. 248). Donor satisfaction: 56.2% of the patients were satisfied, 41.7% of the patients were basically satisfied, 100% of the patients with LAF and DIEP flaps were satisfied. This level of satisfaction was better than that in the RFF and ALT flap groups. ( p =0. 039). Conclusion The functional recovery of RFF flap in tongue reconstruction after middle and early stage tongue cancer surgery is better. However, ALT flap has been used more frequently for a large number of tissue defects caused by radical resection of tongue cancer in the advanced stage. Meanwhile, LAF and DIEP flaps can provide a sufficient tissue volume, a conceal scar, fewer complications in the donor area, and both function and beauty, which are easily accepted by patients.

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Etiology of Oral Cancer in the Young Patient: Is Tongue Cancer Becoming the Other Cancer in Women?

Oral and Maxillofacial Surgery Clinics of North America ◽

10.1016/j.coms.2007.01.004 ◽

2007 ◽

Vol 19 (2) ◽

pp. 163-171 ◽

Cited By ~ 9

Author(s):

Maria B. Papageorge

Keyword(s):

Oral Cancer ◽

Young Patient ◽

Tongue Cancer ◽

The Other

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Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study

Cancers ◽

10.3390/cancers12092561 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2561

Author(s):

Sriramya Lapa ◽

Johanna Quick-Weller ◽

Christiane Nasari ◽

Rainer Dziewas ◽

Florian Gessler ◽

...

Keyword(s):

Posterior Fossa ◽

Tube Feeding ◽

Oral Intake ◽

Swallowing Disorders ◽

Full Recovery ◽

Surgical Removal ◽

Imaging Data ◽

Clinical Predictors ◽

Swallowing Function ◽

Dysphagic Patients

Background: While swallowing disorders are frequent sequela following posterior fossa tumor (PFT) surgery in children, data on dysphagia frequency, severity, and outcome in adults are lacking. The aim of this study was to investigate dysphagia before and after surgical removal of PFT. Additionally, we tried to identify clinical predictors for postsurgical swallowing disorders. Furthermore, this study explored the three-month outcome of dysphagic patients. Methods: In a cohort of patients undergoing PFT surgery, dysphagia was prospectively assessed pre- and postoperatively using fiberoptic endoscopic evaluation of swallowing. Patients with severe dysphagia at discharge were re-evaluated after three months. Additionally, clinical and imaging data were collected to identify predictors for post-surgical dysphagia. Results: We included 26 patients of whom 15 had pre-operative swallowing disorders. After surgery, worsening of pre-existing dysphagia could be noticed in 7 patients whereas improvement was observed in 2 and full recovery in 3 subjects. New-onset dysphagia after surgery occurred in a minority of 3 cases. Postoperatively, 47% of dysphagic patients required nasogastric tube feeding. Re-evaluation after three months of follow-up revealed that all dysphagic patients had returned to full oral intake. Conclusion: Dysphagia is a frequent finding in patients with PFT already before surgery. Surgical intervention can infer a deterioration of impaired swallowing function placing affected patients at temporary risk for aspiration. In contrast, surgery can also accomplish beneficial results resulting in both improvement and full recovery. Overall, our findings show the need of early dysphagia assessment to define the safest feeding route for the patient.

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Speech outcome in tongue cancer surgery: objective evaluation by acoustic analysis software

Romanian Journal of Rhinology ◽

10.2478/rjr-2021-0025 ◽

2021 ◽

Vol 11 (44) ◽

pp. 143-152

Author(s):

Nicola Lombardo ◽

Giovanna Piazzetta ◽

Nadia Lobello ◽

Corrado Pelaia ◽

Francesco Longo ◽

...

Keyword(s):

Surgical Resection ◽

Speech Intelligibility ◽

Acoustic Analysis ◽

Tongue Cancer ◽

Tumor Staging ◽

Standard Of Care ◽

Objective Evaluation ◽

Tumor Stage ◽

The Other ◽

Carcinoma Of The Tongue

Abstract BACKGROUND. Cancer of the oral cavity is one of the most common malignancies of which 60% affect the tongue. Carcinoma of the tongue causes significant alterations of the articulatory and swallowing functions. The gold standard of care remains primary surgical resection with or without postoperative adjuvant therapy. Whereas T1 and T2 tongue tumors can be treated with more conservative surgeries, as partial glossectomies, the larger tumors require total and aggressive glossectomies which increase survival, but, on the other hand, they might often make speech, chewing and swallowing impossible. MATERIAL AND METHODS. Our study was performed on a total of 21 patients with Squamous Cell Carcinoma of the tongue who underwent either partial resection or hemiglossectomy. Each subject (either surgical patients or controls) was asked to pronounce the vowels /a/, /e/, /i/, /u/, and all signals were evaluated separately by two operators. Acoustic (F0, jitter, shimmer, NHR) and vowel metric (the ratio F2i/F2u, tVSA, qVSA, FCR) features have been extracted. In order to define the speech intelligibility, all patients were evaluated by two doctors and one speech therapist and all patients received the Speech Handicap Index (SHI) translated into Italian language before recording. RESULTS. No statistically significant variations were observed, regardless of the gender, between controls and surgically resected patients when tumor staging was T1-T2. On the contrary, when patients had to undergo more extensive surgical resection due to the presence of a T3-T4 tumor, a dramatic increase of F2u could be observed. This change, together with a decrease of F2i, led to a highly significant reduction in the F2i/F2u parameter in surgically resected patients as compared to controls. The other parameters which were reduced in a statistically significant manner in T3-T4 surgically resected patients were tVSA and qVSA. Instead, two parameters increased in a statistically significant manner in T3-T4 surgically resected patients: FCR and SHI. Again, none of the above-mentioned parameters was altered in a statistically significant manner in early tumor stage resected patients, regardless of the gender. CONCLUSION. For the first time, we used a series of newly developed formant parameters, introduced by various authors for the study of the articulatory undershoot of the tongue in various neurodegenerative diseases. The statistical analysis of our results highlighted in an incontrovertible way a strong correlation and significance of each of our parameters F2 / i / / F2 / u /, FCR, tVSA, qVSA, with the entity of the TNM, and therefore of the surgical extension of the resection, and in parallel with the loss of the intelligibility of the speech that proportionally reaches higher values in the advanced stages of the disease as can be deduced from the SHI trend.

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Effect and Complication of Two Types of Nasogastric Tube Feeding for Elderly Dysphagia Patient After Stroke

Case Medical Research ◽

10.31525/ct1-nct03844139 ◽

2000 ◽

Author(s):

Keyword(s):

Nasogastric Tube ◽

Tube Feeding ◽

Nasogastric Tube Feeding

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Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02049-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chan Mi Park ◽

Wonsock Kim ◽

Hye Chang Rhim ◽

Eun Sik Lee ◽

Jong Hun Kim ◽

...

Keyword(s):

Older Adults ◽

Primary Outcome ◽

Long Term Care ◽

Functional Decline ◽

Tube Feeding ◽

Term Care ◽

Pneumonia Severity ◽

Frailty Assessment ◽

Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

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Longitudinal Changes of Tongue Thickness and Tongue Pressure in Neuromuscular Disorders

BMC Neurology ◽

10.1186/s12883-021-02225-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

George Umemoto ◽

Shinsuke Fujioka ◽

Hajime Arahata ◽

Nobutaka Sakae ◽

Naokazu Sasagasako ◽

...

Keyword(s):

Neuromuscular Disorders ◽

The Other ◽

Tongue Pressure ◽

Swallowing Function ◽

Longitudinal Changes ◽

Swallowing Dysfunction ◽

The Relationship ◽

Lateral Sclerosis

Abstract Background Swallowing dysfunction is related to major cause of adverse events and an indicator of shorter survival among patients with neuromuscular disorders (NMD). It is critical to assess the swallowing function during disease progression, however, there are limited tools that can easily evaluate swallowing function without using videofluoroscopic or videoendoscopic examination. Here, we evaluated the longitudinal changes in tongue thickness (TT) and maximum tongue pressure (MTP) among patients with amyotrophic lateral sclerosis (ALS), myotonic dystrophy type 1 (DM1), and Duchenne muscular dystrophy (DMD). Methods Between 2010 and 2020, TT and MTP were measured from 21 ALS, 30 DM1, and 14 DMD patients (mean ages of 66.9, 44.5, and 21.4 years, respectively) at intervals of more than half a year. TT was measured, by ultrasonography, as the distance from the mylohyoid muscle raphe to the tongue dorsum, and MTP was determined by measuring the maximum compression on a small balloon when pressing the tongue against the palate. Then we examined the relationship between these evaluations and patient background and swallowing function. Results Mean follow-up periods were 24.0 months in the ALS group, 47.2 months in the DM1group, and 61.1 months in the DMD group. The DMD group demonstrated larger first TT than the other groups, while the DM1 group had lower first MTP than the ALS group. The ALS group showed a greater average monthly reduction in mean TT than the DM1 group and greater monthly reductions in mean body weight (BW) and MTP than the other groups. Significant differences between the first and last BW, TT, and MTP measures were found only in the ALS group. Conclusions This study suggests that ALS is associated with more rapid degeneration of tongue function over several years compared to DMD and DM1.

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