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Culbert A, Fullerton A, Edwards K, Hitchcock K, Davenport P, Ku J, Silver NL. Effects of Tongue Strength Training on Quality of Life in Head and Neck Cancer Patients: Results From a Pilot Interventional Clinical Trial. Ann Otol Rhinol Laryngol 2024; 133:979-983. [PMID: 39158476 DOI: 10.1177/00034894241275463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Head and neck cancer (HNC) patients often have dysphagia following surgical and/or chemoradiation treatment, which can lead to reduced quality of life. Some patients suffer from decreased tongue strength and mobility that may cause discomfort and difficulty with swallowing. Our group has developed a patented genioglossus muscle strength trainer (GMST) to increase tongue protrusive force that has been used in patients with sleep apnea. We hypothesized that the GMST device would increase tongue strength in the HNC population. METHODS We conducted an IRB approved, non-randomized, interventional clinical trial of HNC patients with dysphagia to determine the effect of GMST on tongue strength. Our secondary objective was to assess dysphagia quality of life, as determined by questionnaires. Genioglossus muscle strength measurements (measured in Newtons, N) and dysphagia quality of life scores (SWAL-QoL questionnaire) were obtained from enrolled patients at baseline and following 4 weeks of intervention. Treatment was at-home GMST exercise regimen 3 times daily, 5 days per week. Compliance was assessed via review of training logs. Two-sided paired t-tests at significance level α = .05 were performed to assess difference in mean GG muscle strength pre- and post-treatment. RESULTS Out of 10 patients initially enrolled, 7 patients completed the trial. Eighty-six percent were male and the average age was 60. About 5 patients had surgery plus adjuvant radiation and 2 patients had primary radiation. All patients had baseline dysphagia as determined by patient complaint and/or objective measurement (prior modified barium swallow). No adverse events were reported. We observed a statistically significant increase in genioglossus muscle strength (mean change: 4.0 N, 95% CI 1.1-6.9, P = .015) after 4 weeks of treatment. Patients reported reduced swallowing burden and feeling of stigma around eating based on SWAL-QoL results. CONCLUSIONS Our data suggest that protrusive tongue-training exercises utilizing a novel tongue trainer device is well-tolerated and increases genioglossus muscle strength in treated HNC patients complaining of dysphagia. Patient-reported outcomes based on the SWAL-QoL survey indicate improvements in quality-of-life post-treatment, although our results are limited by small sample size. Larger studies are needed to see if this device could have clinically meaningful results for this difficult-to-treat patient population.
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Affiliation(s)
- August Culbert
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Amy Fullerton
- Department of Communication Sciences and Disorders, Jacksonville University, Jacksonville, FL, USA
| | - Kaitlyn Edwards
- Department of Otolaryngology/Head and Neck Surgery, University of Florida, Gainesville, FL, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Paul Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Jamie Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Natalie L Silver
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
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Lakshmipathy D, Allibone M, Rajasekaran K. Dysphagia in Head and Neck Cancer. Otolaryngol Clin North Am 2024; 57:635-647. [PMID: 38485539 DOI: 10.1016/j.otc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Dysphagia is a common symptom in patients with head and neck cancer that can significantly impact health outcomes and quality of life. The origin of dysphagia in these patients is often multifactorial, making diagnosis and management especially complex. The evaluating otolaryngologist should be well versed with the patient's neoplasm, comorbidities, and treatment history alongside dysphagia-specific imaging modalities. Management is often dynamic, requiring frequent monitoring, interprofessional collaboration, and a variety of supportive and invasive measures to achieve optimal outcomes.
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Affiliation(s)
- Deepak Lakshmipathy
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Melissa Allibone
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Department of Speech-Language Pathology, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
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Jang KA, Kim YR. Effects of Muscular Strength Training on Oral Health and Quality of Life: Using Korean Panel Survey Data, a Cross-Sectional Study. Healthcare (Basel) 2023; 11:2250. [PMID: 37628447 PMCID: PMC10454929 DOI: 10.3390/healthcare11162250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES The purpose of this study is to confirm the importance of muscular strength exercise by confirming the relationship between strength exercise, oral health, and quality of life. METHODS Using the 2019 and 2021 of the Korean National Health and Nutrition Examination Survey (KNHANES), 6535 people were selected as subjects. Complex sampling analysis was applied to all analyses; 2267 people were in the muscular strength training group (MSG), and 5841 people were in the non-muscular strength training group (NMSG). A multi-sample linear regression analysis was conducted to confirm the effect of muscular strength training on oral health and quality of life. RESULTS As a result of confirming the effect of muscular strength training on oral health status, problems with chewing decreased by 0.105, and problems with speaking decreased by 0.028 with MSG compared to NMSG. In addition, compared to NMSG, it was confirmed that MSG reduced chewing discomfort by 0.047, while self-perceived oral health improved by 0.0123. Finally, as a result of confirming the effect of muscular strength training on oral health and quality of life in Korean adults, there was a significant effect on quality of life despite adjusting for sociodemographic characteristics and oral-health-related factors (p < 0.05). CONCLUSIONS In this study, the relationship between muscular strength training and quality of life was confirmed. Therefore, efforts should be made to make oral health management and muscular strength training a part of life in relation to quality of life.
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Affiliation(s)
| | - Yu-Rin Kim
- Department of Dental Hygiene, Silla University, Busan 46958, Republic of Korea;
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Price K, Isbister G, Long S, Mirams J, Smithard D. Are Bubbles the Future of Dysphagia Rehabilitation: A Systematic Review Analysing Evidence on the Use of Carbonated Liquids in Dysphagia Rehabilitation. Geriatrics (Basel) 2023; 8:geriatrics8010006. [PMID: 36648911 PMCID: PMC9844419 DOI: 10.3390/geriatrics8010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Dysphagia poses a huge health issue in our ageing population, impacting patients psychologically and through risk of aspiration, malnutrition and airway obstruction. The use of carbonated liquids to provide sensory enhancement as a tool to stimulate neuromuscular activity in dysphagia rehabilitation remains an area with limited research. This article reviews current evidence. METHOD A data search of PubMed, CINAHL, EMBASE and Cochrane was undertaken with set search terms. Abstracts were reviewed and selected by two clinicians according to inclusion criteria and papers were assessed using PRISMA methodology. RESULTS Selected publications (1992-2022) involved a median of 23 participants with predominantly neurogenic dysphagia. Despite the differences in study designs all used videofluroscopy (VF) to assess outcome measures except Morishita et al. who used fiberoptic endoscopic evaluation of swallow (FEES). The studies were small scale but showed encouraging results. However, there was heterogeneity between results of specific outcome measures. One study surveyed taste which was overall positively received. CONCLUSIONS There continues to remain limited evidence to direct the use of carbonated liquids in rehabilitation of dysphagia, however its role shows some promise. The heterogeneity of not just study designs but also study participants seems to be a primary barrier. Whilst evidence is encouraging, further prospective studies standardising patient cohorts, methodologies and quantitative outcome measures must be carried out. Longitudinal studies to look at the role of carbonated liquids in secretion management is another area of potential interest. In conclusion the use of carbonated liquid in dysphagia rehabilitation may have a potential role but without firm evidence-based research, successful use in clinical practice cannot be implemented.
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Affiliation(s)
- Kathryn Price
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Grace Isbister
- Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Susannah Long
- Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | | | - David Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE9 4QH, UK
- Centre for Exercise and Active Rehabilitation, University of Greenwich, London SE9 2HB, UK
- Correspondence: ; Tel.: +44-020-836-64988
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Porto de Toledo I, Pantoja LLQ, Luchesi KF, Assad DX, De Luca Canto G, Guerra ENS. Deglutition disorders as a consequence of head and neck cancer therapies: a systematic review and meta-analysis. Support Care Cancer 2019; 27:3681-3700. [PMID: 31230120 DOI: 10.1007/s00520-019-04920-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study, we aimed to estimate the frequency of deglutition disorders in patients pre- and post-treatment for head and neck cancer (HNC). METHODS Search strategies were developed for the following databases: LILACS, PubMed, SpeechBITE, LIVIVO, Web of Science, and Scopus. Additionally, the gray literature was searched using Google Scholar, OpenGrey, and ProQuest. Only studies that conducted an evaluation of deglutition before and after cancer treatment and had sufficient quantitative data were included. We conducted a proportion of random effects meta-analysis using R statistical software. RESULTS Seventeen studies were included. Aspiration showed a high frequency in the period less than 3 months post-treatment, with 28.6% (total sample = 229). Penetration of fluids above the vocal folds and reduced laryngeal elevation were more frequent in the period less than 6 months post-treatment. CONCLUSION The frequency of deglutition disorders and its complications, such as aspiration, appears to be higher in the immediate to 6-month post-treatment period in patients with HNC. The parameter pharyngeal residue continued to increase through the period analyzed.
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Affiliation(s)
- Isabela Porto de Toledo
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil.
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, SC, Brazil.
| | | | - Karen Fontes Luchesi
- Department of Speech-Language Therapy, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Daniele Xavier Assad
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil
- Hospital Sírio-Libanês, Brasília, Brazil
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, SC, Brazil
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília, Brasília, Brazil
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Li H, Torabi SJ, Park HS, Yarbrough WG, Mehra S, Choi R, Judson BL. Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption. Laryngoscope 2018; 129:1844-1855. [DOI: 10.1002/lary.27740] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Hong Li
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Sina J. Torabi
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Henry S. Park
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
- Department of Therapeutic Radiology; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Wendell G. Yarbrough
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Saral Mehra
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Rachel Choi
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
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Abstract
The use of culture-independent techniques has allowed us to appreciate that the upper and lower respiratory tract contain a diverse community of microbes in health and disease. Research has only recently explored the effects of the microbiome on the host immune response. The exposure of the human body to the bacterial environment is an important factor for immunological development; thus, the interaction between the microbiome and its host is critical to understanding the pathogenesis of disease. In this article, we discuss the mechanisms that determine the composition of the airway microbiome and its effects on the host immune response. With the use of ecological principles, we have learned how the lower airways constitute a unique niche subjected to frequent microbial migration (e.g., through aspiration) and constant immunological pressure. The discussion will focus on the possible inflammatory pathways that are up- and downregulated when the immune system is challenged by dysbiosis. Identification of potential markers and microbial targets to address the modulation of inflammation in early disease, when changes may have the most effect, will be critical for future therapies.
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Nemeth D, Zaleczna L, Huremovic A, Engelmann J, Poeschl PW, Strasz M, Holawe S, Kornek G, Laskus A, Sacher C, Erovic BM, Perisanidis C. Importance of chewing, saliva, and swallowing function in patients with advanced oral cancer undergoing preoperative chemoradiotherapy: a prospective study of quality of life. Int J Oral Maxillofac Surg 2017; 46:1229-1236. [PMID: 28579265 DOI: 10.1016/j.ijom.2017.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/07/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022]
Abstract
The primary objective of this study was to investigate the quality of life (QOL) of patients with oral squamous cell carcinoma (OSCC) undergoing curative neoadjuvant chemoradiotherapy followed by radical tumour resection and simultaneous oral cavity reconstruction, using two validated questionnaires. A secondary objective was to assess clinical variables predicting post-treatment dysfunction in chewing, saliva, and swallowing. Thirty-five patients with locally advanced OSCC who underwent preoperative chemoradiotherapy were recruited prospectively. All patients completed both the University of Washington Quality of Life version 4 questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy-Head & Neck version 4 questionnaire (FACT-H&N). UW-QOL and FACT-H&N items were associated with clinical variables. Nearly three-quarters of OSCC patients perceived good to excellent levels of overall QOL after preoperative chemoradiotherapy. Chewing difficulties, decreased salivary function, and swallowing dysfunction were the most frequent complaints of OSCC patients. Items related to food intake were significantly worse in OSCC patients older than 60 years and those with T4 tumours, as well as those without alcohol intake. Chewing, saliva, and swallowing are the most significant issues in patients with OSCC undergoing preoperative chemoradiotherapy. The results of this study may help guide treatment decisions for OSCC patients based on more accurate expectations of adverse effects of cancer treatment.
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Affiliation(s)
- D Nemeth
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | | | - A Huremovic
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - J Engelmann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - P W Poeschl
- Department of Oral and Maxillofacial Surgery, University Teaching Hospital, Wels, Austria
| | - M Strasz
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - S Holawe
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - G Kornek
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Laskus
- Dental Clinic Trio-Dent, Warsaw, Poland
| | - C Sacher
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - B M Erovic
- Department of Otolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - C Perisanidis
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
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Breunig C, Benter P, Seidl RO, Coordes A. Predictable swallowing function after open horizontal supraglottic partial laryngectomy. Auris Nasus Larynx 2016; 43:658-65. [DOI: 10.1016/j.anl.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/26/2015] [Accepted: 01/14/2016] [Indexed: 12/20/2022]
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Huang ZS, Chen WL, Huang ZQ, Yang ZH. Dysphagia in Tongue Cancer Patients Before and After Surgery. J Oral Maxillofac Surg 2016; 74:2067-2072. [DOI: 10.1016/j.joms.2016.03.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 01/03/2023]
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Laccourreye O, Ishoo E, de Mones E, Garcia D, Kania R, Hans S. Supracricoid Hemilaryngopharyngectomy in Patients with Invasive Squamous Cell Carcinoma of the Pyriform Sinus. Ann Otol Rhinol Laryngol 2016; 114:25-34. [PMID: 15697159 DOI: 10.1177/000348940511400106] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
On the basis of a retrospective review of an inception cohort of 135 patients, with an isolated, previously untreated, moderately differentiated to well-differentiated invasive squamous cell carcinoma of the pyriform sinus and a minimum of 3 years of follow-up, consecutively managed with a supracricoid hemilaryngopharyngectomy (SCHLP) at a single tertiary referral care center and locally controlled, the authors review in detail the surgical technique, highlight the potential technical pitfalls, and document the complications and long-term functional outcome. The overall postoperative mortality rate was 3.7%. The overall mortality rate directly related to the SCHLP was 1.5%. A significant surgical complication directly related to SCHLP completion was noted in 9.6% of cases. The mean lengths of time to removal of the tracheotomy and feeding tubes were 9 and 19 days, respectively. The mean duration of hospitalization was 25 days. Normal swallowing without aspiration by the first postoperative month was noted in 64.6% of patients. Temporary grade 1–2 aspiration and grade 3 aspiration were noted in 26.9% and 8.5% of patients, respectively. Overall, in our series, successful oral alimentation without gastrostomy or completion total laryngectomy was achieved in 91.9% of patients by the first postoperative year, and the incidences of permanent gastrostomy, completion total laryngectomy, and aspiration-related death were 0.7%, 1.5%, and 0.7%, respectively. A significant late complication related to the use of postoperative radiotherapy was noted in 26.5% of cases. From a functional point of view, such results suggest that SCHLP should be integrated among the various conservation treatment options available to patients with selected invasive squamous cell carcinoma of the pyriform sinus.
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Affiliation(s)
- Ollivier Laccourreye
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, University of Paris V, Paris, France
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Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology 2016; 34:121-128. [DOI: 10.1111/ger.12234] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ji-Su Park
- Department of Rehabilitation Science; Graduate School of Inje University; Gimhae Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy; Kyungdong University; Wonju Korea
| | - Moon-Young Chang
- Department of Occupational Therapy; College of Biomedical Science and Engineering; Inje University; Gimhae Korea
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13
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Imai T, Goto T, Matsumoto K, Kurosawa K, Asada Y, Saijo S, Matsuura K. Late-onset dysphagia caused by severe spastic peristalsis of a free jejunal graft in a case of hypopharyngeal cancer. Auris Nasus Larynx 2016; 43:693-7. [PMID: 27068782 DOI: 10.1016/j.anl.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/16/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
Free jejunal transfer is the main technique used for reconstructing a circumferential defect caused by total pharyngo-laryngo-cervical-esophagectomy in certain cancer cases. We report a rare case of severe late-onset dysphagia caused by autonomous spastic peristalsis, which led to complete obstruction of the free jejunal route. A 70-year-old man underwent treatment for hypopharyngeal cancer involving total pharyngolaryngectomy with free jejunal transfer. After uneventful peri- and postoperative recovery, he developed sudden-onset severe dysphagia 22 months later. Gastrografin fluoroscopy revealed abnormal peristalsis and contraction of the transferred jejunum, leading to complete obstruction. Nutritional treatment, application of depressants of peristalsis, and xylocaine injection into the outer space of the jejunal mucosa all failed to alleviate the dysphagia. Surgical treatment involving a longitudinal incision of the jejunal graft, and interposing a cutaneous flap, as a fixed wall, between the incised jejunal margins to prevent obstruction was performed. After further reconstructive surgery involving using a pectoralis major musculocutaneous flap and a split-thickness skin graft to close a refractory jejunum-skin fistula, the dysphagia was permanently alleviated. To our knowledge, this is the first report of severe dysphagia caused by peristalsis of a free jejunal graft.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan.
| | - Takahiro Goto
- Department of Plastic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Ko Matsumoto
- Department of Diagnostic Radiology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Koreyuki Kurosawa
- Department of Plastic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Shigeru Saijo
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
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14
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Glen P, Morrison J. Diffuse descending necrotising mediastinitis and pleural empyema secondary to acute odontogenic infection resulting in severe dysphagia. BMJ Case Rep 2016; 2016:bcr-2015-212145. [PMID: 27013653 DOI: 10.1136/bcr-2015-212145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of acute odontogenic sepsis in a 59-year-old man, presenting with diffuse, descending necrotising mediastinitis complicated by pleural empyema. Despite surviving the odds, his recovery was complicated by severe dysphagia, resulting in gastrostomy feeding for 6 months. Until now, severe dysphagia following descending necrotising mediastinitis has been unreported.
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Affiliation(s)
- Peter Glen
- Department of Oral and Maxillofacial Surgery, St John's Hospital, Edinburgh, UK
| | - James Morrison
- Department of Oral and Maxillofacial Surgery, St John's Hospital, Edinburgh, UK
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15
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Differences in Orofacial Muscle Strength According to Age and Sex in East Asian Healthy Adults. Am J Phys Med Rehabil 2015; 94:677-86. [DOI: 10.1097/phm.0000000000000230] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lips M, Speyer R, Zumach A, Kross KW, Kremer B. Supracricoid laryngectomy and dysphagia: A systematic literature review. Laryngoscope 2015; 125:2143-56. [DOI: 10.1002/lary.25341] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Marieke Lips
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Renée Speyer
- Department of Otorhinolaryngology and Head and Neck Surgery; Leiden University Medical Center; Leiden The Netherlands
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; James Cook University; Townsville Queensland Australia
| | - Anne Zumach
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Kenneth W. Kross
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery; Maastricht University Medical Center; Maastricht The Netherlands
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Suzuki A, Kobayashi R, Okayasu S, Kuze B, Aoki M, Mizuta K, Itoh Y. Pharmacotherapy for adverse events reduces the length of hospital stay in patients admitted to otolaryngology ward: a single arm intervention study. PLoS One 2014; 9:e115879. [PMID: 25549093 PMCID: PMC4280125 DOI: 10.1371/journal.pone.0115879] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To determine whether adverse events extend the duration of hospitalization, and to evaluate the effectiveness of medical intervention in ameliorating adverse events and reducing the prolonged hospital stay associated with adverse events. METHODS A single arm intervention study was conducted from October 2012 to March 2014 in the otolaryngology ward of a 614-bed, university-affiliated hospital. Adverse events were monitored daily by physicians, pharmacists and nurses, and recorded in the electronic medical chart for each patient. Appropriate drug management of adverse events was performed by physicians in liaison with pharmacists. The Kaplan-Meier method was used to assess the length of hospitalization of patients who underwent medical intervention for adverse events. RESULTS Of 571 patients admitted to the otolaryngology ward in a year, 219 patients (38.4%) experienced adverse events of grade ≥2. The duration of hospitalization was affected by the grade of adverse events, with a mean duration of hospital stay of 9.2, 17.2, 28.3 and 47.0 days for grades 0, 1, 2, and 3-4, respectively. Medical intervention lowered the incidence of grade ≥2 adverse events to 14.5%. The length of hospitalization was significantly shorter in patients who showed an improvement of adverse events after medical intervention than those who did not (26.4 days vs. 41.6 days, hazard ratio 1.687, 95% confidence interval: 1.260-2.259, P<0.001). A multivariate Cox proportional hazard analysis indicated that insomnia, constipation, nausea/vomiting, infection, non-cancer pain, oral mucositis, odynophagia and neutropenia were significant risk factors for prolongation of hospital stay. CONCLUSION Patients who experienced adverse events are at high risk of prolonged hospitalization. Medical intervention for adverse events was found to be effective in reducing the length of hospital stay associated with adverse events.
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Affiliation(s)
- Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Shinji Okayasu
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Bunya Kuze
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Medical Information Division, Gifu University Hospital, Gifu, Japan
| | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshinori Itoh
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
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Joo YH, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. Swallowing function in patients with vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma. Head Neck 2014; 38:191-5. [PMID: 25225030 DOI: 10.1002/hed.23867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term swallowing function in patients with vertical hemipharyngolaryngectomy (VHPL) for hypopharyngeal cancer. METHODS A retrospective review of 30 patients followed for more than 2 years with VHPL between 1998 and 2011 was performed. RESULTS Five patients (16.7%) experienced gastrostomy tube placement, 4 patients (13%) had pharyngoesophageal stricture, and 13 patients (45%) had aspiration pneumonia. There was a significant difference in the fraction of gastrostomy tube placement among type II VHPL (35.7%), type I VHPL (0%), and type III VHPL (0%; p = .014). Gastrostomy tube dependence was significantly associated with flap size (larger than 70 cm(2) ; p = .043) and aspiration pneumonia (p = .009). A significant positive correlation was found between current smokers and aspiration pneumonia (p = .030). CONCLUSION Type II VHPL, large flap reconstruction, and aspiration pneumonia had predictable values for gastrostomy tube dependence. Smoking status correlated with aspiration pneumonia. Better counseling and vigilance concerning swallowing difficulties may be possible.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Jae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - In-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung-Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Sik Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Erkal EY, Canoğlu D, Kaya A, Aksu G, Sarper B, Akansel G, Meydancı T, Erkal HS. Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy. Radiat Oncol 2014; 9:137. [PMID: 24928361 PMCID: PMC4073176 DOI: 10.1186/1748-717x-9-137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/07/2014] [Indexed: 11/27/2022] Open
Abstract
Backgorund The aim of this study was to evaluate dysphagia in patients with head and neck cancer (HNC) undergoing three-dimensional conformal radiation therapy using objective and subjective tools simultaneously and to associate the clinical correlates of dysphagia with dosimetric parameters. Methods Twenty patients were included in the study. The primary tumor and the involved lymph nodes (LN) were treated with 66-70 Gy, the uninvolved LN were treated with 46-50 Gy. Six swallowing structures were identified: the superior pharyngeal constrictor muscle (SPCM), the middle pharyngeal constrictor muscle (MPCM), the inferior pharyngeal constrictor muscle (IPCM), the base of tongue (BOT), the larynx and the proximal esophageal sphincter (PES). Dysphagia was evaluated using videofluoroscopy and European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ-C30) and supplemental EORTC QoL module for HNC (QLQ-H&N35). The evaluations were performed before treatment, at 3 months and at 6 months following treatment. Results On objective evaluation, the Dmax for the larynx and the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness and proximal esophageal stricture at 3 months, whereas the V65, the V70and the Dmax for the larynx was correlated with BOT weakness and the V65, the V70, the Dmax or the Dmean for the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness, reduced laryngeal elevation, reduced epiglottic inversion and aspiration at 6 months following treatment. On subjective evaluation, the V60, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 3 months, whereas the V70 for SPCM were correlated with QoL scores for HNPA and the V60, the V65, the V70, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 6 months following treatment. Conclusions The use of multiple dysphagia-related endpoints to complement eachother rather than to overlap with one another, as well as the use of multiple evaluations over time to represent a scale of early to late findings might provide a better insight in terms of the association of the clinical correlates of dysphagia with the dose-volume data for the dysphagia-related anatomical structures.
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Affiliation(s)
- Eda Yirmibeşoğlu Erkal
- Departments of Radiation Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
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Chapuy CI, Annino DJ, Tishler RB, Haddad RI, Snavely A, Goguen LA. Success of endoscopic pharyngoesophageal dilation after head and neck cancer treatment. Laryngoscope 2013; 123:3066-73. [PMID: 23775806 DOI: 10.1002/lary.24268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/02/2013] [Accepted: 05/30/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess clinical success and safety of endoscopic pharyngoesophageal dilation after chemoradiation or radiation for head and neck cancer and to identify variables associated with dilation failure. STUDY DESIGN Case series with chart review. METHODS Between 2000 and 2008, a total of 111 patients treated with chemoradiation or radiation for head and neck cancer with subsequent pharyngoesophageal stenosis requiring endoscopic dilation were identified. Patients were evaluated for endoscopic dilation technique, severity of stenosis, technical and clinical success, and intra- and postoperative complications. The Diet/GT score (range, 1-5) was utilized to measure swallow success. Variables associated with dilation failure were analyzed by univariate and multivariate logistic regression. RESULTS There were 271 dilations analyzed, with 42 combined antegrade retrograde dilations, 208 dilations over a guidewire, and 21 dilations without guidewire. Intraoperative patency and successful dilation of the stenotic segment was achieved in 95% of patients. A Diet/GT score of 5 (gastrostomy tube removed and soft/regular diet) was attained in 84 of 111 (76%) patients. Safety analysis showed complications occurred in 9% of all dilations. Perforations were noted in 4% of all procedures, with only two esophageal perforations requiring significant intervention. Multiple dilations were associated with an increased risk for perforations. Further logistic regression analyses revealed that the number of dilations was indicating a poor outcome and low Diet/GT score. CONCLUSIONS Pharyngoesophageal stenosis, occurring after chemoradiation and radiation treatment, can be successfully and safely treated with endoscopic dilation techniques. Patients with restenosis, requiring multiple dilations, have a higher risk of persistent dysphagia.
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Affiliation(s)
- Claudia I Chapuy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Heat generation and transfer behaviors of ti-coated carbon steel rod adaptable for ablation therapy of oral cancer. J Funct Biomater 2013; 4:27-37. [PMID: 24955829 PMCID: PMC4030913 DOI: 10.3390/jfb4010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 12/18/2022] Open
Abstract
For the purpose of developing a novel ablation therapy for oral cancer, the heat generation and transfer properties of a Ti-coated carbon steel rod with 20-mm length and 1.8-mm outer diameter were investigated by means of a high-frequency induction technique at 300 kHz. The heat generation measurement performed using water (15 mL) revealed that the difference of the inclination angles (θ = 0°, 45° and 90°) relative to the magnetic flux direction only slightly affects the heating behavior, exhibiting the overlapped temperature curves during an induction time of 1200 s. These results suggest that the effect of the shape magnetic anisotropy is almost eliminated, being convenient for the precise control of the ablation temperature in clinical use. In the experiments utilizing a tissue-mimicking phantom, the heat transfer concentrically occurred in the lateral direction for both the planar surface and a 10-mm deep cross-section. However, the former exhibited a considerably lower increase in temperature (ΔT), probably due to the effect of heat dissipation to the ambient air. No significant heat transfer was found to occur to the lower side of the inserted Ti-coated carbon steel rod, which is situated in the longitudinal direction.
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Jung SJ, Kim DY, Kim YW, Koh YW, Joo SY, Kim ES. Effect of decannulation on pharyngeal and laryngeal movement in post-stroke tracheostomized patients. Ann Rehabil Med 2012; 36:356-64. [PMID: 22837971 PMCID: PMC3400875 DOI: 10.5535/arm.2012.36.3.356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 05/02/2012] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate effects of tracheostomy tube on the movement of the hyoid bone and larynx during swallowing by quantitative analysis of videofluoroscopic swallowing study. Method 19 adult stroke patients with tracheostomies, who met the criteria of decannulation participated. Serial videofluroscopic swallowing studies were done over 14 days before decannulation, within 24 hours before decannulation, within 24 hours after decannulation, and over 14 days after decannulation. The kinematic parameter such as pharyngeal transition time, stage transition duration, maximal hyoid bone movement, and maximal laryngeal prominence movement were obtained by 2-D quantitative analysis of videofluoroscopic swallowing study. Results Pharyngeal transition time and stage transition duration were not significantly changed all the time. The maximal hyoid bone movement and maximal laryngeal prominence just after decannulation were improved significantly compared to just before decannulation (p<0.05), especially on vertical movement. Conclusion The hypothesis that a tracheostomy tube disturbs the hyoid bone and laryngeal movement during swallowing may be supported by this study.
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Affiliation(s)
- Soo Jin Jung
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
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Russi EG, Corvò R, Merlotti A, Alterio D, Franco P, Pergolizzi S, De Sanctis V, Ruo Redda MG, Ricardi U, Paiar F, Bonomo P, Merlano MC, Zurlo V, Chiesa F, Sanguineti G, Bernier J. Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev 2012; 38:1033-49. [PMID: 22542950 DOI: 10.1016/j.ctrv.2012.04.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 03/24/2012] [Accepted: 04/03/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE Dysphagia is a debilitating complication in head and neck cancer patients (HNCPs) that may cause a high mortality rate for aspiration pneumonia. The aims of this paper were to summarize the normal swallowing mechanism focusing on its anatomo-physiology, to review the relevant literature in order to identify the main causes of dysphagia in HNCPs and to develop recommendations to be adopted for radiation oncology patients. The chemotherapy and surgery considerations on this topic were reported in recommendations only when they were supposed to increase the adverse effects of radiotherapy on dysphagia. MATERIALS AND METHODS The review of literature was focused on studies reporting dysphagia as a pre-treatment evaluation and as cancer and cancer therapy related side-effects, respectively. Relevant literature through the primary literature search and by articles identified in references was considered. The members of the group discussed the results and elaborated recommendations according to the Oxford CRBM levels of evidence and recommendations. The recommendations were revised by external Radiation Oncology, Ear Nose and Throat (ENT), Medical Oncology and Speech Language Pathology (SLP) experts. RESULTS Recommendations on pre-treatment assessment and on patients submitted to radiotherapy were given. The effects of concurrent therapies (i.e. surgery or chemotherapy) were taken into account. CONCLUSIONS In HNCPs treatment, disease control has to be considered in tandem with functional impact on swallowing function. SLPs should be included in a multidisciplinary approach to head and neck cancer.
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Affiliation(s)
- Elvio G Russi
- Radiation Oncology Department, A.O. S. Croce e Carle, Cuneo, Italy.
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Dysphagia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO), Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM, Gibson RJ, Eilers JG, Waltimo T, Bots CP, Michelet M, Sollecito TP, Rouleau TS, Sewnaik A, Bensadoun RJ, Fliedner MC, Silverman S, Spijkervet FKL. Swallowing dysfunction in cancer patients. Support Care Cancer 2012; 20:433-43. [PMID: 22205548 PMCID: PMC3271214 DOI: 10.1007/s00520-011-1342-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/29/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalence, complications, and impact on quality of life in patients with a variety of different cancers, particularly in those treated with curative chemoradiation for head and neck cancer. METHODS The literature search was limited to the English language and included both MEDLINE/PubMed and EMBASE. The search focused on papers reporting dysphagia as a side effect of cancer and cancer therapy. We identified relevant literature through the primary literature search and by articles identified in references. RESULTS A wide range of assessment tools for dysphagia was identified. Dysphagia is related to a number of factors such as direct impact of the tumor, cancer resection, chemotherapy, and radiotherapy and to newer therapies such as epidermal growth factor receptor inhibitors. Concomitant oral complications such as xerostomia may exacerbate subjective dysphagia. Most literature focuses on head and neck cancer, but dysphagia is also common in other types of cancer. CONCLUSIONS Swallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. More prospective studies on the course of dysphagia and impact on quality of life from baseline to long-term follow-up after various treatment modalities, including targeted therapies, are needed.
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Affiliation(s)
- Dysphagia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC USA
- Department of Otorhinolaryngology, Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
- School of Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
- The Nebraska Medical Center and University of Nebraska Medical Center, Omaha, NE USA
- Institute of Preventive Dentistry and Oral Microbiology School of Dental Medicine, University of Basel, Basel, Switzerland
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), and Centre for Special Care in Dentistry (SBT), Amsterdam, the Netherlands
- Department of Oral Oncology, FUNDALEU (Foundation for the Fight Against Leukemia), Buenos Aires, Argentina
- Clinical Oral Medicine, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 3400 Spruce Street, Philadelphia, PA USA
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
- Radiation Oncology Department, Poitiers University Hospital and Faculty of Medicine, Poitiers, France
- ANP Oncology, Bern University Hospital, Bern, Switzerland
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, CA USA
- Department Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Section Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
| | - Judith E. Raber-Durlacher
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
- Section Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
| | - Mike T. Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC USA
| | - Irma M. Verdonck-de Leeuw
- Department of Otorhinolaryngology, Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Rachel J. Gibson
- School of Medical Sciences, University of Adelaide, Adelaide, South Australia Australia
| | - June G. Eilers
- The Nebraska Medical Center and University of Nebraska Medical Center, Omaha, NE USA
| | - Tuomas Waltimo
- Institute of Preventive Dentistry and Oral Microbiology School of Dental Medicine, University of Basel, Basel, Switzerland
| | - Casper P. Bots
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), and Centre for Special Care in Dentistry (SBT), Amsterdam, the Netherlands
| | - Marisol Michelet
- Department of Oral Oncology, FUNDALEU (Foundation for the Fight Against Leukemia), Buenos Aires, Argentina
| | - Thomas P. Sollecito
- Clinical Oral Medicine, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 3400 Spruce Street, Philadelphia, PA USA
| | - Tanya S. Rouleau
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC USA
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rene-Jean Bensadoun
- Radiation Oncology Department, Poitiers University Hospital and Faculty of Medicine, Poitiers, France
| | | | - Sol Silverman
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, CA USA
| | - Fred K. L. Spijkervet
- Department Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Eloubeidi MA, Morgan DE, Carroll WR, Johnson LF. Successful closure of pharyngo-cutaneous and phayryngo-tracheal fistulas using removable hypopharyngeal stent after laryngectomy for laryngeal carcinoma. Saudi J Gastroenterol 2012; 18:62-7. [PMID: 22249096 PMCID: PMC3271698 DOI: 10.4103/1319-3767.91730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Placement of removable stents to close pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy has not been reported before. This case presents the feasibility of removable esophageal stent in closing pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy for laryngeal cancer. Consecutive patients who underwent placement of removable esophageal stent for closing pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy for laryngeal cancer. Three patients underwent successful stent placement in the hypopharynx. The stents were well tolerated. Patient one had the stent for 14 months, leading to complete healing of the fistula. Removal was successful. The second patient was palliated but died 8 weeks after stent placement. The third patient has successful palliation of his tracheo-esophageal fistula and the stent is being exchanged every 3-4 months to palliate his fistula. Closure of pharyngo-cutaneous and tracheo-esophageal fistulas is feasible with esophageal removable stents. These stents provide alternative options when dealing with these challenging problems.
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Affiliation(s)
- Mohamad A. Eloubeidi
- Department of Gastroenterology and Hepatology, Head and Neck Surgery, the University of Alabama in Birmingham, Birmingham Alabama,Address for correspondence: Prof. Mohamad A. Eloubeidi, Professor of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh 110 72020, Beirut, Lebanon. E-mail:
| | - Desiree E. Morgan
- Department of Radiology, Head and Neck Surgery, the University of Alabama in Birmingham, Birmingham Alabama
| | - William R. Carroll
- Division of Otolaryngology, Head and Neck Surgery, the University of Alabama in Birmingham, Birmingham Alabama
| | - Lawrence F. Johnson
- Department of Gastroenterology and Hepatology, Head and Neck Surgery, the University of Alabama in Birmingham, Birmingham Alabama
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Jung SJ, Kim DY, Joo SY. Rick factors associated with aspiration in patients with head and neck cancer. Ann Rehabil Med 2011; 35:781-90. [PMID: 22506206 PMCID: PMC3309370 DOI: 10.5535/arm.2011.35.6.781] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/05/2011] [Indexed: 11/06/2022] Open
Abstract
Objective To determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC). Method Risk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included. Results Aspiration occurred in 50.2% of patients. A univariate analysis revealed that advanced age, increased duration from disease onset to VFSS, higher tumor stage, increased lymph node stage, increased American Joint Committee on Cancer (AJCC) stage, operation history, chemotherapy history, and radiotherapy history were significantly associated with aspiration (p<0.05). Among them, advanced age, increase AJCC stage, operation history, and chemotherapy history were significantly associated with aspiration in the multivariate analysis (p<0.05). Delayed swallowing reflex and reduced elevation of the larynx were significantly associated with aspiration in the multivariate analysis (p<0.05). Conclusion The major risk factors associated with aspiration in patients with HNC were advanced age, higher AJCC stage, operation history, and chemotherapy history. A VFSS to evaluate aspiration is needed in patients with NHC who have these risk factors. Delayed swallowing reflex and reduced elevation of the larynx were major abnormal findings associated with aspiration. Dysphagia rehabilitation should focus on these results.
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Affiliation(s)
- Soo Jin Jung
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
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Pearson WG, Langmore SE, Zumwalt AC. Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid. Dysphagia 2011; 26:345-51. [PMID: 21069388 PMCID: PMC3154991 DOI: 10.1007/s00455-010-9315-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/22/2010] [Indexed: 01/19/2023]
Abstract
Superior and anterior hyoid movements are important events in pharyngeal deglutition. This cross-sectional study uses a cadaver model to document the structural properties of the muscles underlying these movements in an effort to understand how their morphology influences function. Measurements to determine physiological cross-sectional areas (PCSAs) of swallowing muscles were taken from hemisected head and neck formalin-fixed cadaver specimens (n = 13). Coordinates of muscle attachment sites and PCSAs were used to calculate î and ĵ unit force vectors, where î and ĵ represent anterior-posterior and superior-inferior directions, respectively. The suprahyoid muscle subsamples were grouped for analysis as follows: digastric (DG), geniohyoid (GH), mylohyoid (MH), and stylohyoid (SH). The ANOVA with Tukey HSD post hoc analysis of unit force vectors showed the following results: GH (-0.44 ± 0.15 cm(2)) >MH (-0.02 ± 0.21 cm(2)), DG (-0.05 ± 0.11 cm(2)), SH (0.14 ± 0.04 cm(2)), with negative values representing the anterior direction (p < 0.01); and MH (0.91 ± 0.28 cm(2)) >DG (0.29 ± 0.14 cm(2)), SH (0.22 ± 0.08 cm(2)), GH (12 ± 0.08 cm(2)), with positive values representing the superior direction (p < 0.01). The morphology of the suprahyoid muscles suggests that based on structural properties, the geniohyoid has the most potential to displace the hyoid in the anterior direction and the mylohyoid has the most potential to displace the hyoid in the superior direction. These data in complement with physiological findings may provide greater insight into these movements for those developing novel treatments for dysphagia.
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Affiliation(s)
- William G Pearson
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 715 Albany Street L-1004, Boston, MA 02118, USA.
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Shune SE, Karnell LH, Karnell MP, Van Daele DJ, Funk GF. Association between severity of dysphagia and survival in patients with head and neck cancer. Head Neck 2011; 34:776-84. [PMID: 22127835 DOI: 10.1002/hed.21819] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 03/09/2011] [Accepted: 04/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined risk factors for dysphagia, a common and serious condition in patients with head and neck cancer, and the association between severity of dysphagia and survival. METHODS Chart reviews were performed on patients diagnosed with head and neck cancer between January 2001 and April 2003, who had dysphagia diagnoses or swallowing evaluations. Regression analyses determined factors associated with dysphagia and the association between observed survival and severity of dysphagia. RESULTS Almost 50% of the 407 patients had dysphagia. Risk factors included advanced stage, older age, female sex, and hypopharyngeal tumors. The most severe dysphagia ([L.] nil per os or "nothing by mouth" status), which was associated with lower survival rates, was the strongest independent predictor of survival. CONCLUSIONS Swallowing problems should be considered when determining appropriate cancer-directed treatment and posttreatment care. Because of dysphagia's high incidence rate and association with survival, a speech-language pathologist should be involved to ensure routine diagnostic and therapeutic swallowing interventions.
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Affiliation(s)
- Samantha E Shune
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
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Zu Y, Yang Z, Perlman AL. Hyoid displacement in post-treatment cancer patients: preliminary findings. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2011; 54:813-820. [PMID: 21106700 DOI: 10.1044/1092-4388(2010/10-0077)] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Dysphagia after head and neck cancer treatment is a health care issue; in some cases, the cause of death is not cancer but, rather, the passage of food or liquid into the lungs. Hyoid displacement is known to be important to safe swallowing function. The purpose of this study was to evaluate hyoid displacement after cancer treatment. METHOD Hyoid displacement was measured in healthy persons with normal swallowing function, head and neck cancer patients postradiation only, and head and neck cancer patients postsurgery only. Three bolus conditions (5 ml and 10 ml liquid and 5 ml paste) were examined. The influence of 2 different measurement algorithms on the extent of hyoid movement was also explored. RESULTS Radiation-therapy patients in this study had greater hyoid displacement than did surgery patients. Bolus viscosity and measurement method significantly influenced displacement results, whereas bolus volume did not. However, more multiple swallows occurred with 10 ml liquid; this may account for the apparent insignificance of bolus volume. CONCLUSIONS These findings can be used to assist head and neck cancer treatment planning and counseling. Because hyoid measurement methods influence research conclusions, this aspect of design should be considered when interpreting research findings.
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Affiliation(s)
- Yihe Zu
- University of Illinois at Urbana-Champaign, USA.
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Rifai M, Hassouna MS, Abdel Fattah AEF, Badran H. Experience with supracricoid laryngectomy variants. Head Neck 2010; 33:1177-83. [PMID: 21755561 DOI: 10.1002/hed.21593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 02/05/2010] [Accepted: 07/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the outcomes after supracricoid laryngectomy (SCL) as an alternative to total laryngectomy (TL) for treatment of laryngeal cancer. METHODS This retrospective study involved 333 patients who underwent 4 types of SCL for squamous cell carcinoma of the larynx in an Egyptian hospital between May 1984 and May 2007. Both functional outcomes and oncological outcomes were evaluated. RESULTS Surgical margins were free from tumor invasion. The overall 5-year survival rate was 74%. Three hundred nine patients (92.8%) were decannulated, whereas 8 patients had permanent stenosis, 6 patients underwent TL, and 10 patients died. Only 7 patients (2.1%) had persistent aspiration; 6 of these patients underwent TL, whereas 1 patient died of pneumonia. The voice intelligibility score ranged from 70% to 100%, with a mean score of 89%. The score was highest when both arytenoids were preserved (mean, 95%). Ten patients died of complications directly related to the surgery. CONCLUSION Supracricoid laryngectomy is effective for managing laryngeal cancer. Modification of the technique to permit resection of both arytenoids is possible in select patients.
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Affiliation(s)
- Mohamed Rifai
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Manikantan K, Khode S, Sayed SI, Roe J, Nutting CM, Rhys-Evans P, Harrington KJ, Kazi R. Dysphagia in head and neck cancer. Cancer Treat Rev 2009; 35:724-32. [DOI: 10.1016/j.ctrv.2009.08.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 07/14/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Nguyen NP, Frank C, Moltz CC, Millar C, Smith HJ, Dutta S, Alfieri A, Lee H, Vos P, Karlsson U, Nguyen LM, Sallah S. Aspiration Risk and Postoperative Radiation for Head and Neck Cancer. Cancer Invest 2009; 27:47-51. [DOI: 10.1080/07357900802146162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsujimura T, Kondo M, Kitagawa J, Tsuboi Y, Saito K, Tohara H, Ueda K, Sessle BJ, Iwata K. Involvement of ERK phosphorylation in brainstem neurons in modulation of swallowing reflex in rats. J Physiol 2009; 587:805-17. [PMID: 19124539 DOI: 10.1113/jphysiol.2008.165324] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In order to evaluate the neuronal mechanisms underlying functional abnormalities of swallowing in orofacial pain patients, this study investigated the effects of noxious orofacial stimulation on the swallowing reflex, phosphorylated extracellular signal-regulated kinase (pERK) and gamma-aminobutyric acid (GABA) immunohistochemical features in brainstem neurons, and also analysed the effects of brainstem lesioning and of microinjection of GABA receptor agonist or antagonist into the nucleus tractus solitarii (NTS) on the swallowing reflex in anaesthetized rats. The swallowing reflex elicited by topical administration of distilled water to the pharyngolaryngeal region was inhibited after capsaicin injection into the facial (whisker pad) skin or lingual muscle. The capsaicin-induced inhibitory effect on the swallowing reflex was itself depressed after the intrathecal administration of MAPK kinase (MEK) inhibitor. No change in the capsaicin-induced inhibitory effect was observed after trigeminal spinal subnucleus caudalis lesioning, but the inhibitory effect was diminished by paratrigeminal nucleus (Pa5) lesioning. Many pERK-like immunoreactive neurons in the NTS showed GABA immunoreactivity. The local microinjection of the GABA(A) receptor agonist muscimol into the NTS produced a significant reduction in swallowing reflex, and the capsaicin-induced depression of the swallowing reflex was abolished by microinjection of the GABA(A) receptor antagonist bicuculline into the NTS. The present findings suggest that facial skin-NTS, lingual muscle-NTS and lingual muscle-Pa5-NTS pathways are involved in the modulation of swallowing reflex by facial and lingual pain, respectively, and that the activation of GABAergic NTS neurons is involved in the inhibition of the swallowing reflex following noxious stimulation of facial and intraoral structures.
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Affiliation(s)
- Takanori Tsujimura
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan
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The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer. Oral Oncol 2008; 45:665-8. [PMID: 19095492 DOI: 10.1016/j.oraloncology.2008.10.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to evaluate the effect of neuromuscular electrical stimulation (NMES) in patients suffering from dysphagia following treatment for head and neck cancer. In a prospective, double blinded, randomized case control study between January 2006 and December 2007, 14 patients were randomized to 30min of NMES and 30min of traditional swallowing training for 5 days per week for 2 weeks (experimental group), and 12 patients were randomized to sham stimulation plus traditional swallowing training (control group). Effects were assessed using the clinical dysphagia scale (CDS), the functional dysphagia scale (FDS), the American speech-language-hearing association national outcome measurement system (ASHA NOMS) and the M.D. Anderson dysphagia inventory (MADI). Pretreatment evaluation showed no significant differences between the two groups for all parameters. Average changes of FDS score were 11.4+/-8.1 for the experimental group and 3.3+/-14.0 for the control group (P=0.039). CDS, ASHA NOMS and MADI showed some difference with treatment, but the changes were not significant (P>0.05). NMES combined with traditional swallowing training is superior to traditional swallowing training alone in patients suffering from dysphagia following treatment for head and neck cancer.
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Motility Differences in Free Colon and Free Jejunum Flaps for Reconstruction of the Cervical Esophagus. Plast Reconstr Surg 2008; 122:1410-1416. [DOI: 10.1097/prs.0b013e31818820f4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ahlawat SK, Al-Kawas FH. Endoscopic management of upper esophageal strictures after treatment of head and neck malignancy. Gastrointest Endosc 2008; 68:19-24. [PMID: 18355822 DOI: 10.1016/j.gie.2007.11.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 11/14/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Dysphagia, usually due to proximal esophageal strictures, is a debilitating complication of therapy (surgery, radiotherapy, or chemotherapy) for head and neck malignancy. Scant attention has been given in the literature to the endoscopic management of these proximal esophageal strictures. OBJECTIVE Our purpose was to assess the technical and functional outcomes of endoscopic management of proximal esophageal strictures after therapy for head and neck cancers. DESIGN Retrospective case series. SETTING Academic medical center. PATIENTS Consecutive patients undergoing endoscopy and dilation of proximal esophageal strictures caused by chemoradiation or surgery for head and neck malignancy. MAIN OUTCOME MEASUREMENT Technical and functional success after endoscopic dilation. RESULTS Twenty-four patients were included. The mean age of patients was 70.4 years (range 42 to 82 years). The primary tumor site was larynx in 10 patients, oropharynx or hypopharynx in 4 patients, upper esophagus in 4 patients, and other sites in the remainder. Technical success (a luminal diameter of 42F or greater) was achieved in 80% of patients. Adequate dysphagia relief was achieved in 84% of patients whose esophageal stricture was dilated at least up to 42F. The average follow-up was 22 months (range 1-96 months). Repeat dilation was needed in 58% of patients. No complications or death occurred during the study period. LIMITATIONS Retrospective design and highly selected patient population. Dysphagia assessment in conjuction with a speech pathologist was not performed in all patients. Results may not be applicable to other settings. CONCLUSION In this case series, proximal esophageal strictures after treatment of head and neck malignancy were amenable to antegrade endoscopic dilation; however, no patient in our study had complete lumen obstruction. Repeat dilations are often needed and are effective in achieving and maintaining adequate dysphagia relief.
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Affiliation(s)
- Sushil K Ahlawat
- Division of Gastroenterology and Hepatology, University of Medicine and Dentistry New Jersey-New Jersey Medical School, Newark, New Jersey, USA
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Rifai M. Extended supracricoid laryngectomy with excision of both arytenoids: the modified reconstructive laryngectomy. Acta Otolaryngol 2007; 127:642-50. [PMID: 17503235 DOI: 10.1080/00016480601001940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSION Modified reconstructive laryngectomy (MRL) with excision of both arytenoid cartilages will expand the range of indications for conservative surgery in the management of cancer of the larynx. OBJECTIVE The present work describes a modification of the standard reconstructive laryngectomy procedure, in order to address problems related to aspiration, and to improve functional results. PATIENTS AND METHODS The study was conducted in Cairo University Hospital. MRL was performed on 14 patients who were scheduled for total laryngectomy. This technique allows for preservation of the superior laryngeal nerves, by fashioning folds of the pharyngeal mucosa to replace the arytenoids. This is followed by reconstruction of the airway through elevation and attachment of the remaining tracheal rings and/or cricoid to the hyoid bone and epiglottis. RESULTS MRL was successful in all of the 14 patients included in this preliminary study. All of the patients maintained comprehensible speech, and only one required a speaking type of tracheotomy tube.
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Affiliation(s)
- Mohamed Rifai
- Head and Neck Surgery, Kasr El Aini Hospital, Medical School, Cairo University, Cairo, Egypt.
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Conio M, Blanchi S, Filiberti R, Repici A, Barbieri M, Bilardi C, Siersema PD. A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures. Gastrointest Endosc 2007; 65:714-20. [PMID: 17383472 DOI: 10.1016/j.gie.2007.02.050] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The management of patients with refractory hypopharyngeal strictures after surgery in combination with radiation therapy is disappointing, and nutrition through feeding tubes is often required. OBJECTIVE To evaluate the efficacy and safety of a modified self-expanding Niti-S metal stent in the treatment of hypopharyngeal strictures after combined therapy for laryngeal cancer. DESIGN Case series. SETTING A general hospital and a university hospital. PATIENTS Seven consecutive patients were included. One of them did not have laryngectomy. INTERVENTIONS All patients received a modified Niti-S stent. MAIN OUTCOME MEASUREMENTS Improvement of dysphagia, avoiding periodic bougienage, and enteral nutrition through feeding tubes. RESULTS After placement of the first stent, dysphagia improved in all patients. Six of 7 patients developed stent migration and/or granulomatous tissue ingrowth or overgrowth. Additional stents were placed in all patients after a median of 3 months after the previous stent placement. One patient developed an esophagorespiratory fistula caused by a Polyflex stent. Two patients died of causes unrelated to the stent. The remaining 5 patients remained alive and asymptomatic after a median follow-up of 10 months. LIMITATIONS Periodic stent exchange. Stent placement did not resolve the stricture definitively. We had a limited number of patients and have no long-term outcome data yet. CONCLUSIONS The use of this modified Niti-S stent avoids both enteral nutrition through feeding tubes and the need for periodic bougienage in patients with difficult-to-treat benign hypopharyngeal strictures.
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Affiliation(s)
- Massimo Conio
- Department of Gastroenterology, General Hospital, Sanremo, Italy
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Impact of swallowing therapy on aspiration rate following treatment for locally advanced head and neck cancer. Oral Oncol 2006; 43:352-7. [PMID: 16931114 DOI: 10.1016/j.oraloncology.2006.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 04/07/2006] [Accepted: 04/11/2006] [Indexed: 10/24/2022]
Abstract
This study examines the efficacy of swallowing therapy in cancer-free patients who developed aspiration following treatment for locally advanced head and neck cancer. The records of 41 patients who underwent swallowing therapy for aspiration were reviewed. All patients were cancer free at a median follow-up of 25 months (6-150 months). Their treatment were respectively chemoradiation (24), and postoperative radiation (17). All patients had two or more modified barium swallow (MBS). Dysphagia severity was graded from 1 to 7. Dysphagia grade was compared before and following swallowing therapy. Before swallowing therapy, there were 16 grade 5 (trace aspiration), and 25 grade 6-7 (severe aspiration). In the chemoradiation group, there were nine grade 5, five grade 6, and 10 grade 7. Corresponding numbers for the postoperative group were: seven grade 5, seven grade 6, and three grade 7. Following swallowing therapy, there were six grade 3, seven grade 4, 10 grade 5, six grade 6, and 12 grade 7. In the chemoradiation group, there were four grade 3, three grade 4, four grade 5, five grade 6, and eight grade 7. In the postoperative group, there were two grade 3, four grade 4, six grade 5, one grade 6, and four grade 7. Overall, 13 patients (32%) had improvement of their dysphagia severity. Seven of them were in the chemoradiation group (29%), and six (35%) were in the postoperative group. Among 25 patients who presented with grade 6-7 aspiration, only nine (36%) improved to grade 5 or less. Four of them (27%) were in the chemoradiation group, and five (29%) were in the postoperative group. Swallowing therapy is effective to improve dysphagia severity and reduce the need for tube feedings. However, a significant number of patients still suffered from chronic severe aspiration. New strategies must be devised to improve their outcome.
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Ding R, Logemann JA. Swallow physiology in patients with trach cuff inflated or deflated: A retrospective study. Head Neck 2005; 27:809-13. [PMID: 16086414 DOI: 10.1002/hed.20248] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past research has suggested that medical diagnosis and trach cuff conditions may contribute to swallow physiology changes in patients with tracheostomy. This study attempts to investigate the differences in swallow physiology between patients with trach cuff-inflated and trach cuff-deflated conditions with respect to four medical diagnostic categories: neuromuscular disorder, head and neck cancer, respiratory diseases, and general medical diagnosis. METHODS Retrospective database analysis of videofluoroscopic study results in 623 patients with tracheostomies with trach cuff-inflated or cuff-deflated conditions. Swallow disorders were examined for each patient. RESULTS The frequencies of reduced laryngeal elevation and silent aspiration were found to be significantly higher in the cuff-inflated condition than the cuff-deflated condition. Significant swallow physiology changes were also found to be significantly different among various medical diagnostic categories. CONCLUSIONS It is important to evaluate changes in swallow physiology under both the trach cuff-inflated and cuff-deflated conditions to fully assess swallow function.
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Affiliation(s)
- Ruiying Ding
- University of Wisconsin-Whitewater, Department of Communicative Disorders, 1022 Roseman Building, Whitewater, Wisconsin 53190, USA.
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Abstract
CONTEXT Swallowing is a continuous dynamic process, characterized by complex stages, that involves structures of the oral cavity, pharynx, larynx and esophagus. It can be divided into three phases: oral, pharyngeal and esophageal. Dysphagia is characterized by difficulty with, or the inability to swallow food of normal consistencies. OBJECTIVE To investigate the presence of swallowing difficulties and modifications made to the consistency of the food consumed in cases of total and partial laryngectomy, with or without subsequent radiotherapy, among patients who had not been diagnosed as having dysphagia. TYPE OF STUDY Descriptive study. SETTING Voice Clinic of São Paulo Hospital, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil. METHOD 36 laryngectomy patients: 25 total and 11 frontolateral cases, were studied. A survey consisting of a 23-item questionnaire was applied by a single professional. RESULTS Among those interviewed, 44% reported having modified the consistency of the food consumed (56% of the total and 20% of the partial frontolateral laryngectomy cases). It was not possible to investigate the influence of radiotherapy on the groups in this study, because the partial frontolateral laryngectomy cases were not exposed to radiotherapy. There was a higher incidence of complaints of swallowing difficulties in total laryngectomy cases (p < 0.027) than in partial frontolateral cases. However, there was no relationship between the surgery and weight loss. We also noted the patients' other problems regarding the eating process, as well as the compensation that they made for such problems. DISCUSSION Research has shown an association between laryngectomy and swallowing difficulties, although there have been no reports of associated changes in eating habits among laryngectomized patients. CONCLUSIONS This study showed that difficulty in swallowing is not rare in total and frontolateral laryngectomy cases. Such patients, even those who did not complain of dysphagia, also had minor difficulties while eating, and had to make some adaptations to their meals.
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Affiliation(s)
- Jackeline Pillon
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
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Abstract
In head and neck cancer patients malnutrition impacts on quality of life, complications of therapy and also prognosis, in part via altered immunity. Dysphagia assessment is extremely valuable but more work is needed to optimize the rehabilitation of the incompetent swallow in this particular patient group. Proper nutritional assessment is mandatory pre-/peri-/post-treatment. The range and palatability of nutritional supplements has greatly increased over the past few years. Many of the early problems of percutaneous gastrostomy feeding have been addressed but complication rates still remain high. As accelerated radiotherapy and chemoradiation techniques become more widely advocated, nutrition is likely to become increasingly important. The authorship includes two otolaryngologists, a nutritionist and a speech and language therapist with an interest in head and neck dysphagia, thereby aiming to provide a broad perspective of these issues. However, there appears to be a lack of prospective evaluation of many aspects of dysphagia/nutrition in head and neck cancer, which needs to be addressed.
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Affiliation(s)
- E J Grobbelaar
- Department of Otolaryngology Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
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Schwarz JK, Giese W. Organ preservation in patients with squamous cancers of the head and neck. Surg Oncol Clin N Am 2004; 13:187-99. [PMID: 15062369 DOI: 10.1016/s1055-3207(03)00120-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Treatment strategies that have the potential to improve functional organ preservation in patients who have head and neck cancer are emerging. Clinical research in this field, however, has been limited by the lack of standardized, objective criteria of organ function post treatment and by lack of prospective assessment of organ function in treatment trials [56]. Advances in surgical techniques, radiation techniques, radiation protectants, and combined-modality therapies are promising, but well-planned and executed clinical trials are necessary to determine how best to apply these techniques to patient care.
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Affiliation(s)
- James K Schwarz
- Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Lindstrom DR, Conley SF, Arvedson JC, Beecher RB, Carr MH. Anterior lingual thyroglossal cyst: antenatal diagnosis, management, and long-term outcome. Int J Pediatr Otorhinolaryngol 2003; 67:1031-4. [PMID: 12907063 DOI: 10.1016/s0165-5876(03)00195-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To describe the long-term outcome of a large anterior lingual thyroglossal duct cyst, diagnosed antenatally by ultrasound that completely obstructed the oral cavity and had almost completely replaced the anterior two-thirds lingual musculature. METHODS Longitudinal observation. RESULTS Anticipated airway obstruction at birth did not occur. Complete cyst removal occurred at day 2 of life with a rim of lingual muscle observed present only on the left side. Complete and safe oral feeding was achieved by day 11 of life. Progressive muscle mass development and function with mild asymmetry was observed during sequential assessments. Vigorous speech therapy was started at age 7 months achieved 80-100% intelligible speech with minimal misarticulations at age 33 months. CONCLUSION This case demonstrates the remarkable compensatory ability of the tongue to achieve almost normal function with minimal anterior musculature that is critical to deglutition and articulation. Early speech therapy appears key to improving functional outcomes of speech. A strong central nervous system basis for suckle development is suggested by the rapid development of a safe and effective suckle and swallow soon after cyst resection and in spite of in utero tongue fixation.
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Affiliation(s)
- D Richard Lindstrom
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9000 West Wisconsin Avenue, P.O. Box 1997, Milwaukee, WI 53201, USA
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Hsiao HT, Leu YS, Chang SH, Lee JT. Swallowing function in patients who underwent hemiglossectomy: comparison of primary closure and free radial forearm flap reconstruction with videofluoroscopy. Ann Plast Surg 2003; 50:450-5. [PMID: 12792531 DOI: 10.1097/01.sap.0000044147.09310.e8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The swallowing function of patients who had undergone hemiglossectomy with either primary closure of the defect or radial forearm flap reconstruction was studied with videofluoroscopy. Patients with primary closure were unable to lift the tongue tip, had poor tongue-to-palate contact on initiating swallowing, had premature spilling of the bolus into the pharynx, had a large amount of barium stasis on the floor of the mouth, and had prolonged oral transit time. With flap reconstruction, patients easily could lift the tongue and make good contact with the entire palate. They were able to seal the posterior pharyngeal sphincter by elevation of the reconstructed tongue, approximating it to the soft palate, so that premature spilling of the bolus rarely happened. Their swallowing pattern was nearly normal. Although the reconstructed flap is nonfunctional, it provides bulk and helps the remaining tongue to complete the swallow. Compared with primary closure of the tongue defect, the authors suggest it is better to reconstruct it with a free radial forearm flap when more than 50% of the tongue is resected.
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Affiliation(s)
- Hung-Tao Hsiao
- Department of Plastic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Wasserman T, Murry T, Johnson JT, Myers EN. Management of swallowing in supraglottic and extended supraglottic laryngectomy patients. Head Neck 2001; 23:1043-8. [PMID: 11774389 DOI: 10.1002/hed.1149] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aspiration of food and liquid following supraglottic and supracricoid laryngectomy has been documented and found to be the most frequent major postoperative complication that extends hospitalization. The advantages as well as disadvantages of discharging a patient with percutaneous endoscopic gastrostomy (PEG) placement and home therapy versus an aggressive in-hospital dysphagia management program remain controversial. The present investigation examines an aggressive in-patient postoperative dysphagia management program following decannulation. METHODS Twenty-one patients participated in a four-part dysphagia management program following decannulation: patient education, indirect therapy, swallowing evaluation, and nutrition education. RESULTS Eleven patients achieved functional swallowing goals prior to discharge with no reports of pneumonia or rehospitalization over a 3-month follow-up period. Six patients were discharged with a tracheostomy and duo tube; five of these patients were started on an oral diet the same day of decannulation. Four patients decannulated prior to discharge did not achieve functional swallowing. CONCLUSION Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in-home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non-compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery.
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Affiliation(s)
- T Wasserman
- Swallowing Disorders Center, Department of Otolaryngology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 214 EEI, Pittsburgh, Pennsylvania 15213, USA
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Monfared A, Kim D, Jaikumar S, Gorti G, Kam A. Microsurgical anatomy of the superior and recurrent laryngeal nerves. Neurosurgery 2001; 49:925-32; discussion 932-3. [PMID: 11564255 DOI: 10.1097/00006123-200110000-00026] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2001] [Accepted: 06/04/2001] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the microsurgical anatomy of the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN) with respect to anatomic landmarks, and to identify their vascular supplies. METHODS The microsurgical anatomy of the anterior neck, the course of the right and left SLN and RLN and their variations were studied in 21 cadavers. Fresh cadavers were perfused with colored silicon dye to investigate the microvasculature in detail. RESULTS SLN originates from the inferior vagal ganglion at the C2 level and descends medially toward the thyrohyoid membrane. It branches into an external and an internal branch deep to the internal carotid artery at the C3 level. The external branch, along with the cricothyroid artery, descends deep to the superior thyroid artery toward the cricothyroid muscle. Accompanied by the superior laryngeal artery, the internal branch passes deep to the loop of the superior thyroid artery and pierces the thyrohyoid membrane. Both nerves reside in the fascia covering longus colli muscles and are supplied by their accompanying arteries. The loop of RLN is found at the T1-T3 level on the right, and more caudally at the T3-T6 level on the left, entering the larynx between C5-C7 levels on both sides. RLN receives arterial supply from the esophageal and tracheal branches of the inferior thyroid artery proximally, and by the inferior laryngeal artery distally. CONCLUSION Incidental intraoperative injury to the SLN and RLN potentially could be avoided by understanding the detailed course of each nerve with respect to the surrounding anatomic landmarks and by recognizing their blood supplies.
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Affiliation(s)
- A Monfared
- School of Medicine, Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5327, USA
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Monfared A, Kim D, Jaikumar S, Gorti G, Kam A. Microsurgical Anatomy of the Superior and Recurrent Laryngeal Nerves. Neurosurgery 2001. [DOI: 10.1227/00006123-200110000-00026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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