Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain; Department of Surgery, University of Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncología Del Principado de Asturias (IUOPA), Universidad de Oviedo. C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain.
Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias (HUCA). C/ Carretera de Rubín, S/n, 33011, Oviedo, Asturias, Spain.
J Craniomaxillofac Surg. 2021 Oct;49(10):959-970. doi: 10.1016/j.jcms.2021.04.015. Epub 2021 May 5.
This study aimed to assess the functional swallowing outcomes in cohort of oral cancer patients treated with tumor resection and reconstruction by means of microvascular free flaps. Duration from onset to the last examination was classified into three periods: less than 12 months, from 13 to 24 months, and more than 24 months. Type of feeding, dysphagia, and laryngeal aspiration were the dependent variables, and the study was mainly focused on the data from the multivariate analysis. Fifty-one patients were included in the study. Twenty-one patients had dysphagia, 11 showed stasis in vallecula and pyriform sinuses, 9 experienced laryngeal penetration, and 8 aspirations. Surgery combined with radiochemotherapy was associated with a higher prevalence of dysphagia (p = 0.03). Frequency of dysphagia was higher in the first year after treatment and less frequent after 24 months (p = 0.003). Dysphagia was associated with laryngeal penetration (p = 0.001), and this with aspiration (p < 0.0005). In conclusion, as it seems that the method of reconstruction has a major influence on swallowing, when there are relevant alternatives in the way the reconstruction is done, always the approach should be chosen that reduces dysphagia to a minimum.
本研究旨在评估经微血管游离皮瓣肿瘤切除和重建治疗的口腔癌患者的吞咽功能结局。从发病到最后检查的时间分为三个时期:少于 12 个月、13 至 24 个月和超过 24 个月。依赖变量为喂养方式、吞咽困难和喉吸入,研究主要集中在多变量分析的数据上。研究纳入 51 例患者。21 例有吞咽困难,11 例出现会厌谷和梨状窝滞留,9 例有喉穿透,8 例有吸入。手术联合放化疗与吞咽困难的高发生率相关(p=0.03)。治疗后 1 年内吞咽困难的频率更高,24 个月后频率更低(p=0.003)。吞咽困难与喉穿透相关(p=0.001),喉穿透与吸入相关(p<0.0005)。总之,由于重建方法似乎对吞咽有重大影响,因此在重建方式有相关替代方案时,应始终选择可将吞咽困难降至最低的方法。