https://www.pmr.theclinics.com/article/S1047-9651(08)00043-0/pdf

Rehabilitation of Dysphagia Following Head and Neck Cancer

Background. Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function. Methods. Swallowing was examined with the modified barium swallow procedure in 144 patients surgically treated for oral or oropharyngeal cancer 3 months after healing. Univariate and multivariate correlations were used to examine the relation- ship between swallowing function and treatment. Results. Percent tongue base resected and total volume resected were most often correlated with swallowing function in the univariate analyses. Multivariate analyses identified the

Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer

Assessment of volume changes of radial forearm free flaps in head and neck cancer: long-term results.

Patients with head and neck cancer (HNC) are at high risk for oropharyngeal dysphagia (OD) following surgical therapy. Early identification of OD can improve outcomes and reduce economic burden. This study aimed to evaluate the validity of a water screening test using increasing volumes postsurgically for patients with HNC (N=80) regarding the early identification of OD in general, and whether there is a need for further instrumental diagnostics to investigate the presence of aspiration as well as to determine the limitations of oral intake as defined by fiberoptic endoscopic evaluation of swallowing. OD in general was identified in 65%, with aspiration in 49%, silent aspiration in 21% and limitations of oral intake in 56%. Despite a good sensitivity, for aspiration of 100% and for limitations of oral intake of 97.8%, the presented water screening test did not satisfactorily predict either of these reference criteria due to its low positive likelihood ratio (aspiration=2.6; limitations of oral intake=3.1). However, it is an accurate tool for the early identification of OD in general, with a sensitivity of 96.2% and a positive likelihood ratio of 5.4 in patients after surgery for HNC.

Water Swallow Screening Test for Patients After Surgery for Head and Neck Cancer: Early Identification of Dysphagia, Aspiration and Limitations of Oral Intake

Functional outcome after partial glossectomy with reconstruction using radial forearm free flap.

INTRODUCTION The purpose of this retrospective study was to evaluate oncological and functional results after reconstruction of the anterior floor of the mouth using free flaps. METHODS From 1992 to 1998, 30 patients with squamous cell carcinoma of the anterior floor of the mouth underwent surgical excision and primary reconstruction with either free forearm- or bone-composed flaps. Functional assessment included evaluation by the Karnofsky scale, Performance Status Scale for Head and Neck Cancer (PSS-HNC), articulation test and videofluoroscopic examination. RESULTS 16 patients underwent reconstruction with a free forearm flap, 13 with an iliac crest flap and 1 with a fibula flap. The most serious local complication was partial flap necrosis in two cases. Local control was 90% at 24 months and the specific survival rate was 92% at five years. Functional evaluation was performed on 19 patients: PSS-HNC median score for diet was 70 (range 50-100), the score for speech was 70 (range 50-100) and the score for "eating in public" was 65 (range 25-100). Patients with a major mobile tongue resection had a lower score compared to patients with minor or no mobile tongue resection. Videofluoroscopy showed swallowing alterations following large resections of soft tissues. DISCUSSION Our study confirms that wide resection of mobile tongue is associated decreased rehabilitation quality. Mandibulectomy does not influence rehabilitation.

[Reconstruction of the anterior mouth floor by surgical flap microanastomosis: oncologic and functional results].

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[Reconstruction of the anterior mouth floor by surgical flap microanastomosis: oncologic and functional results].