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Deterioration of intraoral recognition of shapes after treatment of oral and pharyngeal cancer.
Umeå University, Faculty of Medicine, Department of Odontology.
Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
2000 (English)In: Otolaryngology and head and neck surgery, ISSN 0194-5998, E-ISSN 1097-6817, Vol. 122, no 4, 584-589 p.Article in journal (Refereed) Published
Abstract [en]

Thirty patients with diagnosed malignant tumors of the oral cavity or pharynx were tested in regards to intraoral shape recognition at 4 test occasions: before all treatment, after radiotherapy, 6 months after surgery, and 1 year after surgery. They were compared within groups as well as with a group of healthy reference individuals of the same age who underwent the same test procedure at a 2-month interval. The tumor itself did not influence the capability of shape recognition. The reference individuals demonstrated significantly better results on the second test occasion, which is known as a learning effect. Learning improvement was not seen in the patients whose second test occasions were after radiotherapy, implying an impediment amounting to the magnitude of the learning effect. At 6 months after surgery the patients' capabilities of shape recognition had deteriorated significantly with no difference between the oral cancer group and the pharyngeal cancer group. No spontaneous rehabilitation had taken place 1 year after surgery. The presence or absence of surgical lingual nerve damage did not influence the results. The nonoperated side does not compensate for the operated one. It is plausible that decreased oral sensory acuity in recognizing the shape of the bolus contributes to postoperative swallowing problems.

Place, publisher, year, edition, pages
2000. Vol. 122, no 4, 584-589 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-3953DOI: 10.1016/S0194-5998(00)70108-2PubMedID: 10740185OAI: diva2:142872
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2015-11-13Bibliographically approved
In thesis
1. Impairment of intra-oral sensation, discrimination ability, and swallowing function following radiotherapy and surgery for oral and pharyngeal cancer
Open this publication in new window or tab >>Impairment of intra-oral sensation, discrimination ability, and swallowing function following radiotherapy and surgery for oral and pharyngeal cancer
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Oral and pharyngeal cancer is commonly treated with a combination of radiotherapy and surgery. It is a clinical knowledge that patients often experience severe swallowing disorders following treatment. Since surgical sequelae are instantaneous and obvious, little attention has been paid to other concurrent effects of the treatment. To shed light on this subject, the aim of this thesis was twofold (i) to make a retrospective inventory of the sequelae following treatment and (ii) to perform a prospective, inceptive examination at diagnosis, and to follow-up after radiotherapy, six months and 12 months after surgery.

The files of ninety-nine patients revealed that following treatment one-third had to use gastric fistulas and more than nine of ten patients had restricted swallowing capacity. Every second patient could only swallow puréed or liquid food.

Adequate intra-oral sensation and discrimination ability is essential for bolus preparation and bolus control, for appropriate elicitation of the swallowing reflex and, hence, for the oral phase of swallowing. At the inceptive examination, the prospective part of the study demonstrated intra-oral discrimination ability in patients was equal to that in healthy controls but was impaired six months after treatment and there was no significant improvement after 12 months. It had been expected that the patient’s healthy, non-tumor side would compensate but it did not. An explanation was found when it was revealed that radiotherapy induced a delayed decline in intra-oral sensation. Sensory decline was not demonstrated within a month after radiotherapy but was manifest six months later. Since the radiotherapy field includes the neck, because of the risk for metastasis, it is highly plausible that pharyngeal sensation declines in a manner corresponding to that found intra-orally when the healthy side is irradiated. In accord with this presumption, pharyngeal swallowing function deteriorated in patents with oral tumors. Cineradiographic evaluation of oral and pharyngeal swallowing function disclosed a significant association between the degree of swallowing dysfunction and the degree of sensory decline and with the degree of impairment of shape recognition.

Conclusions: Delayed intra-oral sensory decline, found to be induced by radiotherapy, can be expected to appear in the entire radiation field, including the oral cavity and the pharynx, with adverse effect on swallowing. Testing intra-oral sensation close to the last radiotherapy session is not advisable, because sensory decline does not develop immediately after radiotherapy but manifests after six months. Spontaneous sensory rehabilitation cannot be expected after six months. The significant association between degree of swallowing dysfunction and degree of intra-oral sensory decline and impaired discrimination ability must be considered in the quest for functional rehabilitation of patients treated for oral or pharyngeal cancer.

112 p.
Umeå University odontological dissertations, ISSN 0345-7532 ; 85
Medical sciences, Oral cancer, pharyngeal cancer, radiotherapy, surgery, intra-oral sensation, sensibility, swallowing, intra-oral discrimination, deglutition disorders, dysphagia, function, dysfunction, radiography, cineradiography, follow-up, MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Research subject
Diagnostic Radiology
urn:nbn:se:umu:diva-266 (URN)91-7305-651-0 (ISBN)
Public defence
2004-06-02, 260, 3A, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2010-02-24Bibliographically approved

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Isberg, Annika
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