Krappen S, Remmert S, Gehrking E, Zwaan M
Klinik für Hals-, Nasen-Ohrenheilkunde der Medizinischen Universität zu Lübeck.
Laryngorhinootologie. 1997 Apr;76(4):229-34. doi: 10.1055/s-2007-997417.
Reestablishing good swallowing function after resection and reconstruction of head and neck tumors is very important for our patients' well-being. Today many different surgical concepts for reconstruction after tumor surgery are in common use. It is necessary to establish a good diagnostic procedure for postoperative assessment of the swallowing function. High-speed cineradiography at a minimum of 50 frames per second is well established for evaluating swallowing problems in head and neck patients.
Thirty-six patients divided into three groups were examined using high speed cineradiography after surgical treatment of pharyngeal and oral cavity cancer. Group 1 (n = 12) included patients with a subtotal or total tongue resection and reconstruction with infrahyoid myofascial flap and jejunal flap; Group II (n = 8), patients with total resection of the oropharynx soft palate and velum and reconstruction with a free radial forearm flap; Group III (n = 15), patients with total laryngopharyngektomy and reconstruction with jejunal flap and siphon and with or without repair of the digastric muscle.
Group I: All patients with tongue reconstruction were able to swallow normally from the oral cavity into the pharynx. All patients had normal bolus propulsion because of a good tongue volume and tongue motility. There was only one case of aspiration after total glossectomy with the larynx left in place. All patients could swallow with the head and neck in a normal position. Group II: All patients with reconstruction of the soft palate and velum were able to initiate proper bolus propulsion without nasal regurgitation or rhinolalia aperta. Only one patients suffered from chronic aspiration after hemiresection of the oropharynx and hypopharynx. Group III: All patients with pharynx reconstruction had no problems with bolus transfer through the reconstructed pharynx. Aspiration into the reconstructed pharynx was a major problem for those patients without repair of the digastric muscle (5/8 = 63%). Better results were observed in the patients who underwent repair of the digastric muscle. There was only one case (13%) of aspiration.
By using high-speed cineradiography it is possible to make a detailed description of the swallowing function after extensive surgical treatment of pharyngeal and oral cavity cancer. We think that high-speed cineradiography is a very sensitive diagnostic procedure capable of detecting all functional aspects of swallowing. High-speed cineradiography should be one of the standard diagnostic studies performed surgery of the oral cavity and pharynx.
对头颈部肿瘤进行切除和重建后，恢复良好的吞咽功能对患者的健康非常重要。如今，肿瘤手术后重建的许多不同手术理念都在普遍使用。有必要建立一种良好的诊断程序，用于术后吞咽功能评估。每秒至少50帧的高速电影摄影术在评估头颈部患者的吞咽问题方面已得到广泛应用。
36例患者分为三组，在接受口腔和口咽癌手术治疗后，使用高速电影摄影术进行检查。第一组（n = 12）包括行次全或全舌切除并用舌骨下肌筋膜瓣和空肠瓣重建的患者；第二组（n = 8），行口咽软腭和腭帆全切除并用游离桡侧前臂皮瓣重建的患者；第三组（n = 15），行全喉咽切除术并用空肠瓣和虹吸管重建且有或无二腹肌修复的患者。
第一组：所有舌重建患者都能从口腔正常吞咽至咽部。由于舌体积和舌运动良好，所有患者的食团推进正常。全舌切除且保留喉部的患者中仅有1例发生误吸。所有患者在头颈部处于正常位置时都能吞咽。第二组：所有软腭和腭帆重建患者都能启动适当的食团推进，无鼻反流或开放性鼻音。口咽和下咽半切除术后仅有1例患者发生慢性误吸。第三组：所有咽重建患者在通过重建的咽部进行食团转移方面均无问题。对于未修复二腹肌的患者，误吸至重建咽部是一个主要问题（5/8 = 63%）。接受二腹肌修复的患者效果更好。仅有1例（13%）发生误吸。
通过使用高速电影摄影术，可以对口咽和口腔癌广泛手术治疗后的吞咽功能进行详细描述。我们认为高速电影摄影术是一种非常敏感的诊断程序，能够检测吞咽的所有功能方面。高速电影摄影术应成为口腔和咽部手术的标准诊断研究之一。
