Vergara José, Andreollo Nelson Adami, Starmer Heather M, Miles Anna, Baraçal-Prado Ana Cristina Colavite, Junqueira Aline Aparecida, Tincani Alfio José
Department of Surgery, Head and Neck Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, 13083-887, SP, Brazil.
Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil.
Dysphagia. 2025 Apr;40(2):431-442. doi: 10.1007/s00455-024-10745-8. Epub 2024 Aug 17.
The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.
远距离食管切除术后（超过5个月）口咽吞咽困难的相关因素仍不清楚。本研究旨在评估远距离次全食管切除术后患者对吞咽困难的感知、最大前向等长压力（MAIP）、最大后向等长压力（MPIP）、舌吞咽压力（LSP）以及吞咽口腔期和咽期的放射学生理成分。使用进食评估工具（EAT-10）评估患者对吞咽困难的感知。使用爱荷华口腔功能仪器测量MAIP、MPIP和LSP。采用视频荧光吞咽造影术，通过改良钡剂吞咽障碍量表（MBSImP）和渗透-误吸量表（PAS）评估吞咽的生理成分。本研究纳入了10例患者（男性占53.2%；平均年龄54.5±18.0岁）。术后平均时间为30个月（范围为5.0 - 72个月）。7例患者的EAT-10评分升高（>3）。所有患者在至少三个MBSImP成分上表现出口咽吞咽障碍（范围为3 - 12），2例患者有误吸（PAS 8）。比较喉提升和会厌运动正常与受损的患者时，MAIP值存在显著差异（p<0.001）。会厌运动正常与受损以及PAS评分正常与升高的患者之间，MPIP值存在显著差异（p<0.001）。远距离次全食管切除术后存在舌压力降低和吞咽生理变化。我们的结果表明，舌力量下降可能是与不安全吞咽相关的因素之一。舌压力评估具有诊断价值，应纳入该人群的综合评估中。
