颈椎纤维化作为吞咽困难的预测因子。
Cervical Fibrosis as a Predictor of Dysphagia.
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A.
出版信息
Laryngoscope. 2021 Mar;131(3):548-552. doi: 10.1002/lary.28880. Epub 2020 Jul 6.
OBJECTIVE
Radiotherapy of head and neck cancer (HNCA) causes dysfunction through radiation-induced fibrosis (RIF). We hypothesize that the degree of cervical fibrosis is associated with swallowing dysfunction. This study evaluated the association between cervical fibrosis and swallowing dysfunction in patients after radiation therapy for HNCA.
STUDY DESIGN
Cross sectional study.
METHODOLOGY
A convenience sample of patients with dysphagia who were at least 1 year post radiation therapy for HNCA underwent simultaneous cervical ultrasound (US) and video-fluroscopic swallow study (VFSS). US determinants of fibrosis were measurements of sternocleidomastoid fascia (SCMF) thickness bilaterally at the level of the cricoid. Primary and secondary outcome variables on VFSS were pharyngeal constriction ratio, a validated measure of pharyngeal contractility, and penetration aspiration scale (PAS). A qualitative assessment of lateral neck rotation was performed as a functional measure of neck fibrosis.
RESULTS
Simultaneous cervical US and VFSS examinations were performed on 18 patients with a history of radiotherapy for HNCA and on eight controls. The mean (±SD) age of the entire cohort (N = 26) was 66 (±10) years. Individuals with a history of radiation had significantly thinner mean SCMF (0.26 [±0.04 mm]) compared to controls (0.48 [±0.06 mm]; P < .05). Individuals with thinner SCMF were more likely to have moderate to severe restriction in lateral neck rotation, a higher PCR, and a higher PAS (P < .05).
CONCLUSION
Thinner sternocleidomastoid fascia on ultrasound in patients having undergone radiotherapy for head and neck cancer was associated with reduced lateral neck movement, poorer pharyngeal constriction and greater penetration/aspiration scale. The data suggest that cervical fibrosis is associated with swallowing dysfunction in head and neck cancer survivors and support the notion that, "As the neck goes, so does the swallow."
LEVEL OF EVIDENCE
- Laryngoscope, 131:548-552, 2021.
目的
头颈部癌症（HNCA）的放射治疗会导致放射性纤维化（RIF）引起的功能障碍。我们假设颈椎纤维化的程度与吞咽功能障碍有关。本研究评估了 HNCA 放射治疗后患者颈椎纤维化与吞咽功能障碍之间的关系。
研究设计
横断面研究。
方法
对至少在 HNCA 放射治疗后 1 年出现吞咽困难的患者进行便利抽样，同时进行颈椎超声（US）和视频荧光吞咽研究（VFSS）。US 纤维化的确定指标是环状软骨水平双侧胸锁乳突肌筋膜（SCMF）的厚度测量。VFSS 的主要和次要结果变量是咽缩肌比值，这是一种经过验证的咽收缩性测量方法，以及渗透抽吸量表（PAS）。对侧颈部旋转的定性评估作为颈部纤维化的功能测量。
结果
对 18 例接受过 HNCA 放射治疗的患者和 8 例对照者进行了同时的颈椎 US 和 VFSS 检查。整个队列（N=26）的平均（±SD）年龄为 66（±10）岁。有放疗史的个体的平均 SCMF 明显较薄（0.26 [±0.04 mm]），而对照组为 0.48 [±0.06 mm]；P <.05）。SCMF 较薄的个体更有可能出现中度至重度的侧颈旋转受限、较高的 PCR 和较高的 PAS（P <.05）。
结论
在接受头颈部癌症放射治疗的患者中，超声检查的胸锁乳突肌筋膜较薄与侧颈运动减少、咽缩力降低和渗透/抽吸量表增大有关。数据表明，颈椎纤维化与头颈部癌症幸存者的吞咽功能障碍有关，并支持“颈部如何，吞咽如何”的观点。
证据水平
3。喉镜，131：548-552，2021。
Zotero 插件