Changes of swallowing function in 40 patients with tongue squamous cell carcinoma after simultaneous reconstruction: a longitudinal study

doi:10.19438/j.cjoms.2021.01.003

Abstract

Abstract: PURPOSE: To investigate the changes of swallowing function in 40 patients with tongue squamous cell carcinoma undergoing radical resection and simultaneous repair and reconstruction 1 year after operation, to find the best swallowing rehabilitation opportunity for patients, and to provide targeted swallowing function guidance for patients. METHODS: The swallowing function of 40 cases of tongue squamous cell carcinoma undergoing simultaneous reconstructive surgery before (S0), 7 days to 10 days (S1), 3 months (S2), 6 months (S3), and 12 months (S4) after surgery were tested by the special evaluation method of swallowing function such as water swallowing test (WST) and the functional oral intake scale (FOIS). The data were analyzed using GraphPad Prism 5.0 software packages. RESULTS: Postoperative deglutition and feeding function were poor, especially in stage S1, which decreased significantly, and in stage S2 and S3, which accumulated gradually. Except for some patients, stage S4 patients returned to the preoperative state. WST results showed that there wasn't significant difference in swallowing function between stage S3, S4 patients and stage S0 patients (P>0.05). FOIS results showed that there was no significant difference in feeding function between S4 stage patients and S0 stage patients (P>0.05). The recovery of the feeding function was 6 months later than that of the swallowing function. The recovery of swallowing and feeding ability of patients with T4 tumor was worse than that of patients with T2 and T3 in stage S4, and the difference was statistically significant(P<0.05). The recovery of feeding ability in stage S4 patients was better in patients without tongue root deficiency than those with tongue root deficiency, and the difference was statistically significant(P<0.05). Postoperatively, patients without radiotherapy or chemotherapy had a better recovery of feeding function in S4 than those with radiotherapy or chemotherapy, and the difference was statistically significant(P<0.05). CONCLUSIONS: Some patients had mild dysphagia before operation, and 3 to 6 months after operation is the best time for patients to recover their swallowing function. It is important to strengthen health education and swallowing rehabilitation training of T4 patients and patients with loss of tongue, radiotherapy, and chemotherapy.

Key words: Tongue squamous cell carcinoma, Flap, Operation, Swallow

CLC Number:

R739.8

HE Xing-fang, LIN Yan-tong, WANG Shuai, YE Jing-jing, LIU Jie, HUANG Qiu-yu. Changes of swallowing function in 40 patients with tongue squamous cell carcinoma after simultaneous reconstruction: a longitudinal study[J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(1): 12-17.

References

[1] 尹倩. 口腔癌的病因与治疗研究进展[J]. 肿瘤研究与临床, 2014, 26(8): 573-576.
[2] Engel H, Huang JJ, Lin C, et al.A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes[J]. Plast Reconstr Surg, 2010, 126(6): 1967-1977.
[3] Ji YB,Cho YH,Song CM,et al.Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method[J]. Eur Arch Otorhinolaryngol, 2017, 274(10): 3751-3756.
[4] 窦祖林. 吞咽障碍评估与治疗[M].北京:人民卫生出版社, 2017:65-95.
[5] Maurer J, Hipp M, Schafer C, et al.Dysphagia: Impact on quality of life after radio (chemo)therapy of head and neck cancer[J]. Strahlenther Onkol, 2011, 187(11): 744-749.
[6] 廖贵清,卢涣滋.口腔癌相关吞咽障碍评估方法[J].口腔疾病防治,2018, 26(6): 341-346.
[7] 吴洪芸,杨悦.口腔领面部肿瘤患者吞咽困难评估量表的应用现状及功能训练的研究进展[J].中华现代护理杂志,2019, 25(14): 1842-1845.
[8] 鲍光辉,刘静,裴赛敏,等.术后重建修复对口腔肿瘤切除患者生活质量影响研究[J].中国现代医学杂志,2015,25(3):66-70.
[9] 陈昌连,梁秀凤.舌癌术后患者与吞咽功能相关的远期生命质量调查分析[J]. 中国实用护理杂志,2015, 31(28): 2161-2164.
[10] Hey C, Lange BP, Eberle S, et al.Water swallow screening test for patients after surgery for head and neck cancer: early identification of dysphagia, aspiration and limitations of oral intake[J]. Anticancer Res, 2013, 33(9): 4017-4021.
[11] 朱亚芳,张晓梅,张钦缔,等.中文版经口摄食功能评估量表在摄食_吞咽障碍脑卒中患者中的信效度检验[J]. 实用医学杂志, 2017, 33(22): 3826-3829.
[12] Ahn-Jarvis JH, Piancino MG.Chapter 14: impact of oral health on diet/nutrition[J]. Monogr Oral Sci , 2020, 28: 134-147.
[13] 张春谊,刘蕊,赵凡,等.围术期肠内营养支持对舌癌患者营养状况及生存质量的影响[D].现代肿瘤医学,2019, 27(5): 766-770.
[14] Brockbank S, Miller N, Owen S, et al.Pretreatment information on dysphagia: exploring the views of head and neck cancer patients[J]. J Pain Symptom Manage, 2015, 49(1): 89-97.
[15] Eisbruch A, Schwartz M,Rasch C,et al.Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer:
Which anatomic structures are affected and can they be spared by IMRT?[J]. Int J Radiat Oncol Biol Phys, 2004, 60(5): 1425-1439.
[16] Guillen-Sola A, Soler NB, Marco E, et al.Effects of prophylactic swallowing exercises on dysphagia and quality of life in patients with head and neck cancer receiving (chemo) radiotherapy: the Redyor study, a protocol for a randomized clinical trial[J]. Trials, 2019, 20(1): 503-510.