Speech and Swallowing in Irradiated and Nonirradiated Postsurgical Oral Cancer Patients

1998 ◽  
Vol 118 (5) ◽  
pp. 616-624 ◽  
Author(s):  
Barbara Roa Pauloski ◽  
Alfred W. Rademaker ◽  
Jerilyn A. Logemann ◽  
Laura A. Colangelo
Keyword(s):  
Radiation Effects ◽  
Radiation Treatment ◽  
Salivary Flow ◽  
Tongue Base ◽  
Statistical Testing ◽  
Postoperative Radiation Therapy ◽  
Swallowing Function ◽  
Pharyngeal Wall ◽  
Pharyngeal Clearance ◽  
Pharyngeal Swallowing

The effect of radiation on speech and swallowing function was assessed for 18 patients surgically treated for oral and oropharyngeal cancer. Nine patients received surgical intervention and postoperative radiation therapy, and nine received surgery only. Patients were matched regarding percentage of oral tongue resected, percentage of tongue base resected, locus of resection, and method of reconstruction. Speech and swallowing function was assessed before and at 1, 3, 6, and 12 months after surgery following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined with videofluoroscopy. Statistical testing indicated that overall speech function did not differ between the irradiated and nonirradiated patients. Irradiated patients had significantly reduced oral and pharyngeal swallowing performance, specifically, longer oral transit times on paste boluses, lower oropharyngeal swallow efficiency, increased pharyngeal residue, and reduced cricopharyngeal opening duration. Impaired function may be the result of radiation effects such as edema, fibrosis, and reduced salivary flow. Increased use of tongue range-of-motion exercises during and after radiation treatment may reduce the formation of fibrotic tissue in the oral cavity and may improve pharyngeal clearance by maintaining adequate tongue base-to-pharyngeal wall contact. (Otolaryngol Head Neck Surg 1998;118:616–24.)

scholarly journals Adaptations to Oral and Pharyngeal Swallowing Function Induced by Injury to the Mylohyoid Muscle

2019 ◽  
Author(s):  
Suzanne N. King ◽  
Brittany Fletcher ◽  
Bradley Kimbel ◽  
Nicholas Bonomo ◽  
Teresa Pitts
Keyword(s):  
Muscle Injury ◽  
Radiation Treatment ◽  
Clinical Effects ◽  
Post Injury ◽  
Mylohyoid Muscle ◽  
Swallowing Function ◽  
Bolus Transit ◽  
Bolus Size ◽  
Pharyngeal Muscles ◽  
Pharyngeal Swallowing

AbstractMuscle injury is a frequent side effect of radiation treatment for head and neck cancer. To understand the pathophysiology of injury-related dysfunction, we investigated the effects of a single muscle injury to the mylohyoid on oropharyngeal swallowing function in the rat. The mylohyoid protects the airway from food/liquid via hyolaryngeal elevation and plays an active role during both oral and pharyngeal swallowing. We hypothesized (1) that fibrosis to the mylohyoid alters swallowing bolus flow and licking patterns; (2) that injury to the mylohyoid changes normal activity of submental, laryngeal, and pharyngeal muscles during swallowing. A chilled cryoprobe was applied to the rat mylohyoid muscle to create a localized injury. After 1- and 2-weeks post-injury, swallowing bolus transit was assessed via videofluoroscopy and licking behavior via an electrical lick sensor. The motor activity of five swallow-related muscles were analyzed immediately after injury using electromyography (EMG). Comparisons were made pre- and post-injury. Fibrosis was confirmed in the mylohyoid at 2-weeks post-injury by measuring collagen content. One-week after injury, bolus size decreased, swallowing rate reduced, and licking patterns were altered. Immediately post-injury, there was a significant depression in mylohyoid and thyropharyngeus EMG amplitudes during swallowing. Our results demonstrated that injury to the mylohyoid is sufficient to cause changes in deglutition. These disruptions in oral and pharyngeal swallowing were detected prior to long-term fibrotic changes, including delays in tongue movement, alterations in bolus flow, and changes in sensorimotor function. Therefore, injuring a single important swallowing muscle can have dramatic clinical effects.

Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

1992 ◽  
Vol 101 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Minoru Hirano ◽  
Hidetaka Matsuoka ◽  
Yasunao Kuroiwa ◽  
Kiminori Sato ◽  
Shinzo Tanaka ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Surgical Resection ◽  
Tongue Cancer ◽  
Tube Feeding ◽  
The Other ◽  
Surgical Removal ◽  
Swallowing Function ◽  
Pharyngeal Wall ◽  
Swallowing Problems ◽  
Nasogastric Tube Feeding

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.

Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

2017 ◽  
Vol 60 (4) ◽  
pp. 785-793 ◽  
Author(s):  
Lydia Muss ◽  
Janina Wilmskoetter ◽  
Kerstin Richter ◽  
Constanze Fix ◽  
Soenke Stanschus ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Posterior Pharyngeal Wall ◽  
Anterior Cervical Discectomy ◽  
Future Research ◽  
Swallowing Function ◽  
Pharyngeal Wall ◽  
Cervical Discectomy ◽  
Functional Measures ◽  
Posterior Pharyngeal Wall Thickness ◽  
The Impact

Purpose The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation. Results After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature. Conclusions ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

NOPAPROD Non-Parametric Testing on Projections from Multivariate Data. Applications to near Infrared Spectroscopy in Clinical Studies

2009 ◽  
Vol 17 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Josefina Nyström ◽  
Britta Lindholm-Sethson ◽  
Paul Geladi
Keyword(s):  
Data Reduction ◽  
Clinical Studies ◽  
Radiation Effects ◽  
Near Infrared ◽  
Radiation Treatment ◽  
Statistical Significance ◽  
Skewed Distribution ◽  
Breast Cancer Patients ◽  
Parametric Testing ◽  
Non Parametric

Clinical studies may be carried out using non-invasively collected near infrared spectra of patient skin. Two problems encountered are: (1) data reduction to go from thousands of wavelengths to some clinically relevant estimator and (2) getting statistical significance from noisy data with sometimes very skewed distributions. The problem of data reduction can usually be solved by principal component analysis to get a few meaningful components. In the space spanned by these components, a direction of discrimination may have to be found, typically discrimination between treated and control. A visual difference in a score plot is often not enough; statistical significance has to be demonstrated. Once a univariate estimator is found, non-parametric testing can show significant differences, even if the data are noisy and have an unknown and skewed distribution. The NOPRAPOD method com bines the actions of finding a direction in a reduced data space and performing the non-parametric significance testing by producing a disk of significance. Two examples are included. Example one is from a study of diabetes-related neuropathy where it is shown that significant differences show up in the NIR spectra. Example two is from a study of post-operative radiation treatment of breast cancer patients, where it is shown that radiation effects (erythema) and the effect of lotion can be determined with an indication of significance from the NIR spectra.

Effect of Swallowing Rehabilitation Protocol on Swallowing Function in Patients with Esophageal Atresia and/or Tracheoesophageal Fistula

2017 ◽  
Vol 27 (06) ◽  
pp. 526-532 ◽  
Author(s):  
Selen Serel Arslan ◽  
Numan Demir ◽  
Sule Yalcın ◽  
Ayşe Karaduman ◽  
Ibrahim Karnak ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Oral Intake ◽  
Control Group ◽  
Study Group ◽  
Start Time ◽  
Swallowing Function ◽  
Rehabilitation Protocol ◽  
Swallowing Rehabilitation ◽  
Pharyngeal Swallowing

Aim The aim of this study was to evaluate the results of Swallowing Rehabilitation Protocol (SRP) on swallowing function (SF) of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients with pharyngeal swallowing disorder. Materials and Methods In this study, 24 children with EA-TEF who had deglutitive and respiratory problems were grouped into either study (n = 12) or control group (n = 12) by basic randomization. Study group received the SRP including neuromuscular electrical stimulation, thermal tactile stimulation, and hyolaryngeal mobilization. The control group received nonnutritive stimulations. SF was evaluated with 3 mL liquid and pudding barium by videofluoroscopic swallowing study (VFSS) before and after 20 sessions of interventions. Results No statistical differences were found between groups in terms of descriptive characteristics including age, sex, weight, height, type of atresia, repair type, repair time, and start time of oral intake (p > 0.05). There were no statistical differences between groups in term of swallowing parameters (p > 0.05), except reflux (p = 0.004) according to VFSS findings. After 20 sessions of interventions, the study group showed improvement in penetration–aspiration scale scores, oral phase dysfunction, delay in swallowing reflex, and residue in valleculae and pyriform sinuses after pudding swallow. The control group showed improvement only in oral phase dysfunction. Conclusion SRP can be recommended to improve SF in patients with EA/TEF who have pharyngeal swallowing disorders.

Effects of Head Rotation on Pharyngeal Function during Normal Swallow

1998 ◽  
Vol 107 (4) ◽  
pp. 344-348 ◽  
Author(s):  
Yukio Ohmae ◽  
Masami Ogura ◽  
Satoshi Kitahara ◽  
Takehiro Karaho ◽  
Tetsuzo Inouye
Keyword(s):  
Healthy Subjects ◽  
Head Rotation ◽  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Resting Pressure ◽  
Esophageal Sphincter ◽  
Pharyngeal Clearance ◽  
Pharyngeal Swallowing ◽  
Peak Pressures ◽  
Pharyngeal Function

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

scholarly journals Targeting Accuracy Considerations for Simultaneous Tumor Treating Fields Antimitotic Therapy During Robotic Hypofractionated Radiation Therapy

2021 ◽  
Vol 20 ◽  
pp. 153303382110391
Author(s):  
Sharmi Biswas ◽  
Irina Kapitanova ◽  
Sabrina Divekar ◽  
Jimm Grimm ◽  
Ian J. Butterwick ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Electric Fields ◽  
Radiation Effects ◽  
Radiation Treatment ◽  
Treatment Plan ◽  
Radiation Beam ◽  
Current Output ◽  
Tumor Treating Fields ◽  
Robotic Radiosurgery ◽  
Targeting Accuracy

Purpose: Tumor treating fields (TTFields) is a novel antimitotic treatment that was first proven effective for glioblastoma multiforme, now with trials for several extracranial indications underway. Several studies focused on concurrent TTFields therapy with radiation in the same time period, but were not given simultaneously. This study evaluates the targeting accuracy of simultaneous radiation therapy while TTFields arrays are in place and powered on, ensuring that radiation does not interfere with TTFields and TTFields does not interfere with radiation. This is one of several options to enable TTFields to begin several weeks sooner, and opens potential for synergistic effects of combined therapy. Methods: TTFields arrays were attached to a warm saline water bath and salt was added until the TTFields generator reached the maximal 2000 mA peak-to-peak current. A ball cube phantom containing 2 orthogonal films surrounded by fiducials was placed in the water phantom, CT scanned, and a radiation treatment plan with 58 isocentric beams was created using a 3 cm circular collimator. Fiducial tracking was used to deliver radiation, the films were scanned, and end-to-end targeting error was measured with vendor-supplied software. In addition, radiation effects on electric fields generated by the TTFields system were assessed by examining logfiles generated from the field generator. Results: With TTFields arrays in place and powered on, the robotic radiosurgery system achieved a final targeting result of 0.47 mm, which was well within the submillimeter specification. No discernible effects on TTFields current output beyond 0.3% were observed in the logfiles when the radiation beam pulsed on and off. Conclusion: A robotic radiosurgery system was used to verify that radiation targeting was not adversely affected when the TTFields arrays were in place and the TTFields delivery device was powered on. In addition, this study verified that radiation delivered simultaneously with TTFields did not interfere with the generation of the electric fields.

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