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Pharyngeal swallowing dysfunction following treatment for oral and pharyngeal cancer: Association with diminished intraoral sensation and discrimination ability
Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
2008 (English)In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 30, no 10, 1344-1351 p.Article in journal (Refereed) Published
Abstract [en]

Background.

Swallowing disorders following treatment for oral and pharyngeal cancer are mainly considered a surgical sequel. The recent finding that radiotherapy-induced decline in intraoral sensory abilities established an incentive to elucidate any association between the degree of sensory decline and the degree of swallowing dysfunction.

Methods.

Oral and pharyngeal swallowing was cineradiographically examined in 15 patients with oral or pharyngeal cancer before and after treatment. The patients were also tested for intraoral sensation, shape recognition, and hole size identification.

Results.

Swallowing function deteriorated in 67% of the patients 6 months posttreatment, with no significant improvement after 12 months. The degree of swallowing dysfunction was statistically significantly associated with the degree of diminished intraoral sensation and shape recognition.

Conclusion.

In the quest for rehabilitation after treatment for oral and pharyngeal cancer, the impact of impaired intraoral sensation and discrimination ability on swallowing function should be taken into consideration

Place, publisher, year, edition, pages
2008. Vol. 30, no 10, 1344-1351 p.
Keyword [en]
cineradiography, deglutition disorders, oropharyngeal cancer treatment, radiotherapy, surgery
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-10648DOI: 10.1002/hed.20881PubMedID: 18720519OAI: oai:DiVA.org:umu-10648DiVA: diva2:150319
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-12-14Bibliographically 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.

Publisher
112 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 85
Keyword
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
Identifiers
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)
Opponent
Supervisors
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2010-02-24Bibliographically approved

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