Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Nara, Japan.
J Craniofac Surg. 2022;33(8):e840-e844. doi: 10.1097/SCS.0000000000008770. Epub 2022 Jul 27.
Dysphagia is one of the most common adverse effects associated with oral cancer therapy and could greatly impair postoperative quality of life. The objective of this study was to analyze postoperative swallowing outcomes and factors influencing postoperative swallowing function in patients with advanced oral cancer who underwent primary reconstruction after surgical resection to identify patients at risk of experiencing severe dysphagia after immediate reconstruction of surgical defects, and to determine an ideal approach to provide appropriate perioperative interventions. The swallowing status was evaluated at 4 week postoperatively using the Functional Oral Intake Scale. We also analyzed the effects of patient, tumor, surgical, and other factors on postoperative swallowing function. The study included 67 patients. At 4 weeks postoperatively, 11 patients showed reduced swallowing function, whereas 56 patients showed good swallowing function. The number of resected suprahyoid muscles (odds ratio, 1.55; 95% confidence interval, 1.03-2.32; P=0.035) was an independent factor influencing postoperative swallowing function. Thus, among patients who underwent radical resection of oral cancer with primary reconstruction, those with extensive resection of the suprahyoid muscles were at higher risk of developing postoperative dysphagia. These findings are expected to facilitate increased vigilance for dysphagia, better counseling, and appropriate rehabilitation interventions.
吞咽困难是口腔癌治疗中最常见的不良反应之一,极大地影响术后生活质量。本研究旨在分析接受根治性切除术后行一期重建的晚期口腔癌患者的术后吞咽结局及影响术后吞咽功能的因素,以识别术后即刻重建手术缺损后发生严重吞咽困难的风险患者,并确定提供适当围手术期干预的理想方法。术后 4 周采用功能性口腔摄入量表评估吞咽情况。我们还分析了患者、肿瘤、手术及其他因素对术后吞咽功能的影响。本研究纳入 67 例患者。术后 4 周时,11 例患者吞咽功能下降,56 例患者吞咽功能良好。切除的舌骨上肌群数量(比值比,1.55;95%置信区间,1.03-2.32;P=0.035)是影响术后吞咽功能的独立因素。因此,在接受根治性口腔癌切除并一期重建的患者中,广泛切除舌骨上肌群的患者发生术后吞咽困难的风险更高。这些发现有望提高对吞咽困难的警惕性,提供更好的咨询,并进行适当的康复干预。