Postoperative Assessment of Speech and Swallowing Functions in Oral Tongue Cancer

Kim, Jae Won; Choi, Eun Chang; Cha, In Ho; Kim, Young Ho; Kim, Young Mo; Shin, Joong Wook; Kim, Sung Huhn; Kim, Tae Youn

Abstract

BACKGROUND AND OBJECTIVES
Sometimes the oral cavity functions such as swallowing and articulation may be seriously disabled after surgery despite excellent reconstruction. So, the preservation of the functions and oncologic resection of cancer in the treatment of oral tongue cancer are challenging problems for head and neck surgeon. We evaluated speech and swallowing functions in postoperative stage in the patients with oral tongue cancer to help predict the postoperative status of speech and swallowing according to the size of defect and the reconstruction methods. SUBJECTS AND METHOD: In 10 oral tongue cancer patients who had been treated by surgery as initial management, we performed speech function tests (speech intelligibility score, articulation score, predominant class of errors, diadochokinetic test, and tongue mobility test) and swallowing function tests (modified barium swallow (MBS) test, deglutition test, and swallowing ability score) and reviewed operation findings. RESULTS: In the primary repair group, the speech and swallowing function test was nearly normal, except mild mis-articulation of the lingua alveolars. In the free flap group, the speech function was intelligible despite impaired tongue mobility and mis-articulation of the lingua alveolars, the lingua palatals and the lingua velars. Impaired lateral tongue movement, marked stasis in oral cavity, delayed swallowing reflex on the MBS test resulted in decreased pharyngeal peristalsis, stasis in vallecula, incomplete laryngeal closure and elevation and aspiration. Swallowing ability was also impaired. In less over-reconstructed group (less than 200%) according to tongue defect and reconstruction volume ratio, much earlier oral diet start, seal-up and more excellent speech and swallowing function were observed because adynamic portion was relatively small. We observed that the postoperative speech and swallowing functions were not affected in the group with less than 3 cm of the tongue defect and the reconstruction with primary closure. The lingua alveolars were mainly affected on postoperative speech evaluation in primary closure and free flap group irrespective of defect volume. Speech and swallowing functions in less over-reconstructed group were superior to those in over-reconstructed group. CONCLUSION: We suggest that the results of this study can aid in counseling patients and predicting the postoperative status of speech and swallowing function according to the size of primary defect and the reconstruction methods. To better predict the postoperative functional status, we need to carry out functional evaluations and comparative assessment of the preoperative and postoperative status.