All Title Author
Keywords Abstract


Management of Oropharyngeal Dysphagia in Laryngeal and Hypopharyngeal Cancer

DOI: 10.1155/2012/157630

Full-Text   Cite this paper   Add to My Lib

Abstract:

On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results. 1. Introduction Dysphagia is defined as difficulty in swallowing. It is a symptom that expresses a disorder in the transport of food and endogenous secretions (saliva) through the upper digestive tract. Oropharyngeal dysphagia (OD) is a more anatomically restricted term referred to alterations in the transfer of the bolus from the mouth to the esophagus (that means, in bolus propelling from the mouth to the pharynx, in the pharyngeal reconfiguration during the swallow, or in the opening of the upper esophageal sphincter) [1]. OD is an inescapable concern in the management of patients with laryngeal and hypopharyngeal cancer. Being as a symptom at presentation, as an adverse effect during whatever the treatment, or as sequelae compromising the quality of life of the patients, swallowing disorders have to be adequately anticipated and dealt with [2]. Swallowing is one of the vital functions that the larynx is involved in. For an outcome to be considered functional, the patient has to be able to swallow in an effective and safe manner. Actually, preserving a functional deglutition is usually the most important goal of the different function-preserving surgical techniques on the larynx and the hypopharynx, as a larynx that does not prevent aspiration cannot be preserved. Even though OD has been specifically classified in the latest versions of the

References

[1]  I. J. Cook and P. J. Kahrilas, “AGA technical review on management of oropharyngeal dysphagia,” Gastroenterology, vol. 116, no. 2, pp. 455–478, 1999.
[2]  P. García-Peris, L. Parón, C. Velasco et al., “Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life,” Clinical Nutrition, vol. 26, no. 6, pp. 710–717, 2007.
[3]  O. Ekberg, S. Hamdy, V. Woisard, A. Wuttge-Hannig, and P. Ortega, “Social and psychological burden of dysphagia: its impact on diagnosis and treatment,” Dysphagia, vol. 17, no. 2, pp. 139–146, 2002.
[4]  I. M. Lang, “Brain stem control of the phases of swallowing,” Dysphagia, vol. 24, no. 3, pp. 333–348, 2009.
[5]  C. M. Steele and A. J. Miller, “Sensory input pathways and mechanisms in swallowing: a review,” Dysphagia, vol. 25, no. 4, pp. 323–333, 2010.
[6]  S. Hamlet, J. Faull, B. Klein et al., “Mastication and swallowing in patients with postirradiation xerostomia,” International Journal of Radiation Oncology Biology Physics, vol. 37, no. 4, pp. 789–796, 1997.
[7]  M. Alicandri-Ciufelli, A. Piccinini, A. Grammatica et al., “Voice and swallowing after partial laryngectomy: factors influencing outcome,” Head & Neck. In press.
[8]  N. P. Nguyen, C. C. Moltz, C. Frank et al., “Dysphagia following chemoradiation for locally advanced head and neck cancer,” Annals of Oncology, vol. 15, no. 3, pp. 383–388, 2004.
[9]  I. Topaloglu, G. K?prücü, and M. Bal, “Analysis of swallowing function after supracricoid laryngectomy with cricohyoidopexy,” Otolaryngology, vol. 46, pp. 412–418, 2012.
[10]  J. M. Schweinfurth and S. M. Silver, “Patterns of swallowing after supraglottic laryngectomy,” Laryngoscope, vol. 110, no. 8, pp. 1266–1270, 2000.
[11]  G. Peretti, C. Piazza, A. Cattaneo, L. De Benedetto, E. Martin, and P. Nicolai, “Comparison of functional outcomes after endoscopic versus open-neck supraglottic laryngectomies,” Annals of Otology, Rhinology and Laryngology, vol. 115, no. 11, pp. 827–832, 2006.
[12]  A. Castro, I. Sanchez-Cuadrado, R. Bernaldez, A. Del Palacio, and J. Gavilan, “Laryngeal function preservation following supracricoid partial laryngectomy,” Head & Neck, vol. 34, no. 2, pp. 162–167, 2012.
[13]  E. C. Chong, W. P. Hong, C. B. Kim et al., “Changes of esophageal motility after total laryngectomy,” Otolaryngology, vol. 128, no. 5, pp. 691–699, 2003.
[14]  P. Clavé, A. Verdaguer, and V. Arreola, “Oral-pharyngeal dysphagia in the elderly,” Medicina Clinica, vol. 124, no. 19, pp. 742–748, 2005.
[15]  S. Middleton, P. McElduff, J. Ward et al., “Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial,” The Lancet, vol. 378, no. 9804, pp. 1699–1706, 2011.
[16]  P. Clavé, V. Arreola, M. Romea, L. Medina, E. Palomera, and M. Serra-Prat, “Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration,” Clinical Nutrition, vol. 27, no. 6, pp. 806–815, 2008.
[17]  A. Y. Chen, R. Frankowshi, J. Bishop-Leone et al., “The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson Dysphagia Inventory,” Archives of Otolaryngology, vol. 127, no. 7, pp. 870–876, 2001.
[18]  J. E. Terrell, D. L. Ronis, K. E. Fowler et al., “Clinical predictors of quality of life in patients with head and neck cancer,” Archives of Otolaryngology, vol. 130, no. 4, pp. 401–408, 2004.
[19]  B. Jones, B. W. Gayler, M. P. Rosen et al., Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria Dysphagia, American College of Radiology (ACR), Reston, Va, USA, 2010.
[20]  J. E. Aviv, J. H. Martin, M. S. Keen, M. Debell, and A. Blitzer, “Air pulse quantification of supraglottic and pharyngeal sensation: a new technique,” Annals of Otology, Rhinology and Laryngology, vol. 102, no. 10, pp. 777–780, 1993.
[21]  R. M. Miller and M. E. Groher, “Speech-language pathology and dysphagia: a brief historical perspective,” Dysphagia, vol. 8, no. 3, pp. 180–184, 1993.
[22]  P. Clave, J. Almirall, A. Esteve, A. Verdaguer, M. Berenger, and M. Serra-Prat, “Dysphagia. A team approach to prevent and treat complications,” in Hospital Healthcare Europe 2005/2006, S. Taylor, Ed., pp. N5–N8, Campden Publishing Ltd, London, UK, 2005.
[23]  B. Roa Pauloski, J. A. Logemann, A. W. Rademaker et al., “Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer,” Head & Neck. In press.
[24]  F. C. Holsinger, O. Laccourreye, G. S. Weinstein, E. M. Diaz Jr, and A. J. McWhorter, “Technical refinements in the supracricoid partial laryngectomy to optimize functional outcomes,” Journal of the American College of Surgeons, vol. 201, no. 5, pp. 809–820, 2005.
[25]  W. J. Goodwin Jr and P. M. Byers, “Nutritional management of the head and neck cancer patient,” Medical Clinics of North America, vol. 77, no. 3, pp. 597–610, 1993.

Full-Text

comments powered by Disqus