Zuydam A C, Rogers S N, Brown J S, Vaughan E D, Magennis P
Speech and Language Therapy Department, University Hospital Aintree, Liverpool, UK.
Br J Oral Maxillofac Surg. 2000 Oct;38(5):513-8. doi: 10.1054/bjom.2000.0482.
The resection of even relatively small tumours that involve the base of tongue can lead to problems with swallowing. Free tissue transfer has improved the functional results and reduced the complications of head and neck surgery. The outcome after ablative operations depends on the site and extent of the resection, and in cases where the tongue base is involved, swallowing can be severely impaired. Aspiration in a patient with swallowing difficulties is of particular concern, however, there is a range of techniques that can be introduced during videofluoroscopy to reduce or eliminate aspiration. It is during the rehabilitation phase that procedures and techniques to improve swallowing and prevent aspiration should be incorporated. The efficacy of adaptive manoeuvres needs further evaluation, and in this study we aim to assess the effectiveness of compensatory procedures and therapy techniques (chin tuck and supraglottic swallow) in eliminating aspiration. We report on a study of the swallow function of 13 patients following surgical resection of the oropharynx including the base of tongue. Postoperative assessment by videofluoroscopy was carried out at 2 weeks, 1 month, 3 months, and 6 months according to a standard protocol. Subjects were analysed in two groups depending on the degree of resection of the tongue base resection (less than 1/4,1/4 or more).Patients' swallowing disorders were related to the extent of the resection and the consistency of the bolus. Those with involvement of a quarter of the tongue base or more generally had greater impairment, and radiotherapy tended to exacerbate these problems. Compensatory procedures and therapy techniques were effective in 50% of patients who aspirated, and tended to be more effective between the one month and 6 month follow-up in patients with smaller resections.
即使是切除相对较小但累及舌根的肿瘤也可能导致吞咽问题。游离组织移植改善了功能结果并减少了头颈外科手术的并发症。切除术后的结果取决于切除的部位和范围，在舌根受累的情况下，吞咽功能可能会严重受损。吞咽困难患者的误吸尤其令人担忧，然而，在视频透视检查过程中可以采用一系列技术来减少或消除误吸。改善吞咽和预防误吸的程序和技术应在康复阶段实施。适应性动作的疗效需要进一步评估，在本研究中，我们旨在评估代偿性程序和治疗技术（收下巴和声门上吞咽）在消除误吸方面的有效性。我们报告了一项对13例接受包括舌根在内的口咽手术切除患者吞咽功能的研究。根据标准方案，在术后2周、1个月、3个月和6个月通过视频透视检查进行评估。根据舌根切除程度（小于1/4、1/4或更多）将受试者分为两组进行分析。患者的吞咽障碍与切除范围和食团的黏稠度有关。舌根受累四分之一或更多的患者通常有更严重的损害，放疗往往会加剧这些问题。代偿性程序和治疗技术在50%的误吸患者中有效，并且在切除范围较小的患者中，在1个月至6个月的随访期间往往更有效。
