2010 Fiscal Year Final Research Report
Evaluating postsurgical swallowing disturbance and function in patients with head and neck cance
| Project/Area Number |
19591988
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Otorhinolaryngology
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| Research Institution | Saitama Medical University |
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Principal Investigator |
HIGO Ryuzaburo Saitama Medical University, 医学部, 准教授 (10301110)
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| Project Period (FY) |
2007 – 2010
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| Keywords | 頭頸部癌 / 嚥下機能 / 嚥下圧測定 / 手術 / Videofluorography |
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| Research Abstract |
Objectives : Head and neck cancer patients who undergo tumor resection and reconstruction often exhibit swallowing disturbance after surgery. Swallowing disturbance is usually evaluated by videofluorography (VF) ; however, this method provides an inferior qualitative analysis. We examined the usefulness of manometry in obtaining quantitative data on swallowing function in patients after head and neck cancer resection and reconstruction, which may allow for us to lead to new reconstruction methods with recovery of swallowing function.
Methods : We investigated postsurgical swallowing function using a combination of VF and manometry in patients with head and neck cancer, who underwent tumor resection and reconstruction. Oropharyngeal swallowing pressure, hypopharyngeal swallowing pressure, and relaxation time of upper esophageal sphincer (UES) were measured at the same time as the VF examination.
Results and discussion : Partial resection of the mandible without reconstruction for the defe
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ct of the bony segment had a negative effect upon oropharyngeal swallowing pressure. Hypopharyngeal swallowing pressure was normal unless the resection area involved the hypopharynx. A combination of VF and manometry revealed that mandibular bone partial resection resulted in disturbed elevation of the larynx while pharyngeal swallowing pressure decreases in those patients who do not undergo bony segment reconstruction. The tongue, including the base of the tongue, should be set in a closed space so that pharyngeal swallowing pressure does not release. In patients with oropharyngeal cancer patients, findings from the pharyngeal stage in the VF examination were well correlated to the results of oropharyngeal swallowing pressure, but hypopharyngeal swallowing pressure and UES relaxation were not correlated to the results of the VF examination. Patients who exhibited a decrease in both oropharyngeal and hypopharyngeal swallowing pressure were still restricted to a liquid diet a year after surgery, while patients who exhibited hypopharyngeal swallowing pressure could orally ingest a soft or normal diet soon after surgery. Thus patients who maintained hypopharyngeal swallowing pressure generally were able to eat normally soon after surgery, even if the oropharyngeal swallowing pressure was disturbed. Our study, using VF and manometry together, suggested that maintenance of hypopharyngeal swallowing function in patients with oropharyngeal cancer is important in the restoration of oral food intake. In patients with hypopharyngeal cancer patiens, we examined swallowing function after partial resection of the hypopharynx. To keep function of the tongue base, which resulted in maintaining oropharyngeal swallowing pressure, is important for hypopharyngeal cancer patiens after partial resection of the hypopharynx. Less
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