Multidisciplinary Cancer Investigation
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Volume 5, Issue 2 (Multidisciplinary Cancer Investigation – April 2021)
Multidiscip Cancer Investig 2021, 5(2): 1-8 |
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Cristalli G, Di Maio P, Vallati G, D'Amico R, Vidiri A, Mercante G, et al . Improving the Swallowing in Total Glossectomy With Laryngeal Preservation. Multidiscip Cancer Investig 2021; 5 (2) :1-8
URL: http://mcijournal.com/article-1-291-en.html
URL: http://mcijournal.com/article-1-291-en.html
Giovanni Cristalli 
1, Pasquale Di Maio2 , Giulio Vallati3 , Ronel D'Amico3 , Antonello Vidiri3 , Giuseppe Mercante4 , Fabio Ferreli5 , Francesca Boscolo Nata6 , Fabiola Giudici7 , Raul Pellini8 , Oreste Iocca4 , Giuseppe Spriano4
1, Pasquale Di Maio2 , Giulio Vallati3 , Ronel D'Amico3 , Antonello Vidiri3 , Giuseppe Mercante4 , Fabio Ferreli5 , Francesca Boscolo Nata6 , Fabiola Giudici7 , Raul Pellini8 , Oreste Iocca4 , Giuseppe Spriano4
1- ENT Department, United Hospitals Padua South Mother Teresa of Calcutta, Monselice, Italy & Department of Otolaryngology Head and Neck Surgery, Regina Elena Na- tional Cancer Institute, Roma, Italy , giovanni.cristalli@gmail.com
2- Department of Otolaryngology Head and Neck Surgery, Civil Hospital, San- remo, Italy
3- Department of Radiology, Regina Elena National Cancer Institute, Roma, Italy
4- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy & Department of Biomedical Sciences, Humanitas University, Milan, Italy
5- Department of Biomedical Sciences, Humanitas University, Milan, Italy
6- ENT Department, United Hospitals Padua South Mother Teresa of Calcutta, Monselice, Italy
7- Unit of Biostatistics, Epidemiology and Public Health, Department of Car- diac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
8- Department of Otolaryngology Head and Neck Surgery, Regina Elena Na- tional Cancer Institute, Roma, Italy
2- Department of Otolaryngology Head and Neck Surgery, Civil Hospital, San- remo, Italy
3- Department of Radiology, Regina Elena National Cancer Institute, Roma, Italy
4- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy & Department of Biomedical Sciences, Humanitas University, Milan, Italy
5- Department of Biomedical Sciences, Humanitas University, Milan, Italy
6- ENT Department, United Hospitals Padua South Mother Teresa of Calcutta, Monselice, Italy
7- Unit of Biostatistics, Epidemiology and Public Health, Department of Car- diac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
8- Department of Otolaryngology Head and Neck Surgery, Regina Elena Na- tional Cancer Institute, Roma, Italy
Abstract: (2622 Views)
Introduction: This study aims to evaluate the parameters that might have an impact on swallowing performance after a total glossectomy with laryngeal preservation (TGLP).
Methods: Among 39 patients who underwent surgery with curative intent for squamous cell carcinoma of the tongue, our retrospective analysis focused on 18 patients treated by TGLP and flap reconstruction. The flap was positioned using three points of suspension: mandible (anteriorly), remaining suspensor muscles (cranially), and hyoid bone (inferiorly). Videofluoroscopic swallowing studies were performed after surgery, and the movements of the hyoid bone on the horizontal and vertical plane were measured on a frame-by-frame basis, and the velopharyngeal contact was recorded. Swallowing was studied at consecutive time-intervals using the Gugging Swallowing Screen (GUSS), and patients were categorized into three groups according to their swallowing ability (good, intermediate, and bad). The relationship between categorical and continuous variables and the swallowing ability were investigated using the chi-squared or Fischer exact test and Mann-Whitney test or t-student test respectively.
Results: Swallowing ability at 6-8 months was good in 13 patients and intermediate or bad in five patients. Swallowing improved in 1 and 3 patients at 12 and 18 months, respectively. The hyoid bone movement in the y-axis and extension of surgery to the tonsil were statistically associated with swallowing (P=0.002 and P=0.04, respectively). Velopharyngeal contact was obtained in the entire cohort.
Conclusions: Flap suspension using three points of attachment, could allow the restoration of an active hyoid movement and the velopharyngeal closure, thereby achieving valid swallowing.
Methods: Among 39 patients who underwent surgery with curative intent for squamous cell carcinoma of the tongue, our retrospective analysis focused on 18 patients treated by TGLP and flap reconstruction. The flap was positioned using three points of suspension: mandible (anteriorly), remaining suspensor muscles (cranially), and hyoid bone (inferiorly). Videofluoroscopic swallowing studies were performed after surgery, and the movements of the hyoid bone on the horizontal and vertical plane were measured on a frame-by-frame basis, and the velopharyngeal contact was recorded. Swallowing was studied at consecutive time-intervals using the Gugging Swallowing Screen (GUSS), and patients were categorized into three groups according to their swallowing ability (good, intermediate, and bad). The relationship between categorical and continuous variables and the swallowing ability were investigated using the chi-squared or Fischer exact test and Mann-Whitney test or t-student test respectively.
Results: Swallowing ability at 6-8 months was good in 13 patients and intermediate or bad in five patients. Swallowing improved in 1 and 3 patients at 12 and 18 months, respectively. The hyoid bone movement in the y-axis and extension of surgery to the tonsil were statistically associated with swallowing (P=0.002 and P=0.04, respectively). Velopharyngeal contact was obtained in the entire cohort.
Conclusions: Flap suspension using three points of attachment, could allow the restoration of an active hyoid movement and the velopharyngeal closure, thereby achieving valid swallowing.
Keywords: Tongue Neoplasms, Reconstructive Surgical Procedures, Surgical Flap, Deglutition, Fluoroscopy
Select article type: Original/Research Article |
Subject:
Health Services, Quality of Life and Outcomes
Received: 2020/08/8 | Accepted: 2020/12/20 | ePublished: 2021/01/26
Received: 2020/08/8 | Accepted: 2020/12/20 | ePublished: 2021/01/26
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