Gupta Devendra Kumar, Singh Sanajeet Kumar, Sabarigirish K, Roy Ravi, Chugh Rajeev, Goyal Sunil, Parikh Badal, Sukumar Reddy N
Classified Specialist (ENT & Head Neck Onco), Army Hospital (R&R), Delhi Cantt, India.
Commandant, Military Hospital Jhansi, India.
Med J Armed Forces India. 2023 Mar-Apr;79(2):181-188. doi: 10.1016/j.mjafi.2021.10.002. Epub 2021 Dec 13.
Follow-up of patients treated for head and neck cancer is an important part of the overall treatment. Oral cancers are one of the leading causes of dysphagia. Swallowing dysfunction occurs owing to the disease itself, its predisposing factors, and the treatment. This study aims to evaluate swallowing dysfunction in patients with oral cavity cancers.
This prospective study was carried out in a tertiary care hospital institution. Thirty patients with T3, T4 oral cancers were evaluated using institutional dysphagia score and fiber optic endoscopic evaluation of swallowing (FEES) (Penetration-Aspiration Scale, Yale Pharyngeal Residue Scale) before treatment, after surgery, and after adjuvant therapy.
Advanced-stage tumor, larger resections, and adjuvant therapy are risk factors for dysphagia postoperatively. Although the dysphagia score is our institutional score, the results are promising, that is, 10 % of patients having symptoms at baseline evaluation, which increased to 60% and 70% after surgery and adjuvant radiotherapy respectively. Our study findings of the Penetration Aspiration Scale are 13% aspiration rate at the baseline evaluation, which increased to 57% and 73% after surgery and after adjuvant radiotherapy, respectively, and these results are consistent with those of other report studies. The Vallecular Residual Scale showed that there was a significant association between three different timelines and demonstrated dysphagia among study subjects.
Subjective and objective assessment of swallowing dysfunction before and after the treatment of head and neck cancers is underreported and underrecognized. Most of the patients in our study had significant swallowing impairment after treatment. FEES is a very effective procedure to diagnose dysphagia and will help in incorporating better preventative and rehabilitative measures.
头颈部癌症患者的随访是整体治疗的重要组成部分。口腔癌是吞咽困难的主要原因之一。吞咽功能障碍是由疾病本身、其诱发因素及治疗导致的。本研究旨在评估口腔癌患者的吞咽功能障碍。
本前瞻性研究在一家三级医疗医院机构开展。对30例T3、T4期口腔癌患者在治疗前、手术后及辅助治疗后，使用机构吞咽困难评分和吞咽功能的纤维内镜评估（FEES）（渗透 - 误吸量表、耶鲁咽残留量表）进行评估。
晚期肿瘤、更大范围的切除及辅助治疗是术后吞咽困难的危险因素。尽管吞咽困难评分是我们机构的评分，但结果很有意义，即10%的患者在基线评估时有症状，术后和辅助放疗后分别增至60%和70%。我们关于渗透误吸量表的研究结果显示，基线评估时误吸率为13%，术后和辅助放疗后分别增至57%和73%，这些结果与其他报告研究一致。会厌谷残留量表显示，三个不同时间点之间存在显著关联，且研究对象中存在吞咽困难。
头颈部癌症治疗前后吞咽功能障碍的主观和客观评估报告不足且未得到充分认识。我们研究中的大多数患者在治疗后有明显的吞咽障碍。FEES是诊断吞咽困难的非常有效的方法，将有助于纳入更好的预防和康复措施。
