To identify risk factors for dysphagia in tongue cancer patients. Dysphagia is a common complication of surgery, radiotherapy, and chemotherapy in tongue cancer patients. Previous studies have attempted to identify risk factors for dysphagia in patients with head and neck cancer, but no studies have focused specifically on tongue cancer patients.
This study was conducted on 133 patients who were diagnosed with tongue cancer and who underwent a videofluoroscopy swallowing study (VFSS) between January 2007 and June 2012 at the Asan Medical Center. Data collected from the VFSS were analyzed retrospectively. Patients with aspiration were identified.
Patients showed a higher incidence of inadequate tongue control, inadequate chewing, delayed oral transit time, aspiration or penetration, vallecular pouch and pyriform residue, and inadequate laryngeal elevation after surgery. Moreover, male gender, extensive tumor resection, a higher node stage, and more extensive lymph node dissection were major risk factors for aspiration in tongue cancer patients.
Tongue cancer patients have difficulties in the pharyngeal phase as well as the oral phase of swallowing. These difficulties can worsen after tongue cancer surgery. Gender, the extent of tumor resection, and lymph node metastasis affect swallowing in tongue cancer patients. Physicians should take these risk factors into account when administering swallowing therapy to tongue cancer patients.
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To determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC).
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.
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).
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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Objective: This study was designed to examine swallowing function of 16 head and neck surgical patients who had postoperative swallowing difficulties and to identify the relationship between the physiologic causes of aspiration and the surgical procedure in each patient.
Method: Group A was five patients who had partial pharyngolaryngectomy due to hypopharyngeal cancer, Group B was nine patients who had wide excision due to oral cavity cancer, and Group C was two patients who had supraglottic horizontal laryngectomy due to supraglottic laryngeal cancer. Their swallowing function was evaluated with videofluoroscopic swallowing study (VFSS).
Results: Aspiration occurred in 40% of patients with partial pharyngolaryngectomy, 44% of patients with wide excision, and 100% of patients with supraglottic horizontal laryngectomy. Group A showed swallowing difficulty because of reduced laryngeal closure and reduced pharyngeal peristalsis. Group B showed swallowing difficulty because of reduced pharyngeal peristalsis, reduced laryngeal function, and impaired tongue control. Group C showed swallowing difficulty for impaired tongue control, reduced laryngeal function, reduced pharyngeal peristalsis, and late swallowing reflex. Most of the patients who had had head and neck cancer surgery can regain normal swallowing function after adequate swallowing rehabilitation.
Conclusion: Each group of head and neck surgical patients had different cause of swallowing difficulty. The knowledge of the determinant component of swallowing pathophysiology is important for successful swallowing rehabilitation.
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