Ann Rehabil Med.  2015 Apr;39(2):210-217. 10.5535/arm.2015.39.2.210.

Dysphagia in Tongue Cancer Patients

• Son YR
• Choi KH
• Kim TG

• KMID: 2273042
• DOI: http://doi.org/10.5535/arm.2015.39.2.210

Abstract

OBJECTIVE
To identify risk factors for dysphagia in tongue cancer patients. Dysphagia is a common complication of surgery, radiotherapy, and chemotherapy in tongue cancer patients. Previous studies have attempted to identify risk factors for dysphagia in patients with head and neck cancer, but no studies have focused specifically on tongue cancer patients.
METHODS
This study was conducted on 133 patients who were diagnosed with tongue cancer and who underwent a videofluoroscopy swallowing study (VFSS) between January 2007 and June 2012 at the Asan Medical Center. Data collected from the VFSS were analyzed retrospectively. Patients with aspiration were identified.
RESULTS
Patients showed a higher incidence of inadequate tongue control, inadequate chewing, delayed oral transit time, aspiration or penetration, vallecular pouch and pyriform residue, and inadequate laryngeal elevation after surgery. Moreover, male gender, extensive tumor resection, a higher node stage, and more extensive lymph node dissection were major risk factors for aspiration in tongue cancer patients.
CONCLUSION
Tongue cancer patients have difficulties in the pharyngeal phase as well as the oral phase of swallowing. These difficulties can worsen after tongue cancer surgery. Gender, the extent of tumor resection, and lymph node metastasis affect swallowing in tongue cancer patients. Physicians should take these risk factors into account when administering swallowing therapy to tongue cancer patients.

Keyword

Head and neck cancer; Tongue cancer; Dysphagia; Aspiration; Videofluoroscopic swallowing study

MeSH Terms

Chungcheongnam-do
Deglutition
Deglutition Disorders*
Drug Therapy
Head and Neck Neoplasms
Humans
Incidence
Lymph Node Excision
Lymph Nodes
Male
Mastication
Neoplasm Metastasis
Radiotherapy
Retrospective Studies
Risk Factors
Tongue
Tongue Neoplasms*

Reference

1. Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Bhamidipati PV, et al. Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol. 2006; 80:302–306. PMID: 16890314.

2. Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Nguyen PD, et al. Impact of swallowing therapy on aspiration rate following treatment for locally advanced head and neck cancer. Oral Oncol. 2007; 43:352–357. PMID: 16931114.

3. Jung SJ, Kim DY, Joo SY. Rick factors associated with aspiration in patients with head and neck cancer. Ann Rehabil Med. 2011; 35:781–790. PMID: 22506206.

4. Kotz T, Costello R, Li Y, Posner MR. Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck. 2004; 26:365–372. PMID: 15054740.

5. Namaki S, Tanaka T, Hara Y, Ohki H, Shinohara M, Yonhehara Y. Videofluorographic evaluation of dysphagia before and after modification of the flap and scar in patients with oral cancer. J Plast Surg Hand Surg. 2011; 45:136–142. PMID: 21682610.

6. Logemann JA, Pauloski BR, Rademaker AW, McConnel FM, Heiser MA, Cardinale S, et al. Speech and swallow function after tonsil/base of tongue resection with primary closure. J Speech Hear Res. 1993; 36:918–926. PMID: 8246480.

7. Pauloski BR, Logemann JA, Rademaker AW, McConnel FM, Heiser MA, Cardinale S, et al. Speech and swallowing function after anterior tongue and floor of mouth resection with distal flap reconstruction. J Speech Hear Res. 1993; 36:267–276. PMID: 8487519.

8. Han TR, Paik NJ, Park JW. The functional dysphagia scale using videofluoroscopic swallowing study in stroke patients. J Korean Acad Rehabil Med. 1999; 23:1118–1126.

9. Pannunzio TG. Aspiration of oral feedings in patients with tracheostomies. AACN Clin Issues. 1996; 7:560–569. PMID: 8970257.

10. Starmer H, Gourin C, Lua LL, Burkhead L. Pretreatment swallowing assessment in head and neck cancer patients. Laryngoscope. 2011; 121:1208–1211. PMID: 21484812.

11. Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013; 28:494–500. PMID: 23460344.

12. Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly: epidemiology, diagnosis and management. Drugs Aging. 2005; 22:115–130. PMID: 15733019.

13. Smith RV, Kotz T, Beitler JJ, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results. Arch Otolaryngol Head Neck Surg. 2000; 126:384–389. PMID: 10722013.

14. Agarwal J, Palwe V, Dutta D, Gupta T, Laskar SG, Budrukkar A, et al. Objective assessment of swallowing function after definitive concurrent (chemo)radiotherapy in patients with head and neck cancer. Dysphagia. 2011; 26:399–406. PMID: 21344191.

15. Carrara-de Angelis E, Feher O, Barros AP, Nishimoto IN, Kowalski LP. Voice and swallowing in patients enrolled in a larynx preservation trial. Arch Otolaryngol Head Neck Surg. 2003; 129:733–738. PMID: 12874074.

16. Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004; 15:383–388. PMID: 14998839.

17. Steiniger JR, Parnes SM, Gardner GM. Morbidity of combined therapy for the treatment of supraglottic carcinoma: supraglottic laryngectomy and radiotherapy. Ann Otol Rhinol Laryngol. 1997; 106:151–158. PMID: 9041821.

18. Plant RL. Anatomy and physiology of swallowing in adults and geriatrics. Otolaryngol Clin North Am. 1998; 31:477–488. PMID: 9628945.

19. Weber RS, Ohlms L, Bowman J, Jacob R, Goepfert H. Functional results after total or near total glossectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg. 1991; 117:512–515. PMID: 1902355.

20. Lango MN, Egleston B, Ende K, Feigenberg S, D'Ambrosio DJ, Cohen RB, et al. Impact of neck dissection on long-term feeding tube dependence in patients with head and neck cancer treated with primary radiation or chemoradiation. Head Neck. 2010; 32:341–347. PMID: 19693946.

21. Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The prevalence of dysphagia in primary care patients: a HamesNet Research Network study. J Am Board Fam Med. 2007; 20:144–150. PMID: 17341750.

22. Wall LR, Ward EC, Cartmill B, Hill AJ. Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: a systematic review. Dysphagia. 2013; 28:481–493. PMID: 24078216.