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SWALLOWING SKILLS AND ORAL INTAKE FOLLOWING GLOSSECTOMY ABSTRACT INTRODUCTION

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SWALLOWING SKILLS AND ORAL INTAKE FOLLOWING GLOSSECTOMY

ABSTRACT

INTRODUCTION:
Cancers of the oral cavity is rampant in Indian scenario. Surgical intervention is commonly recommended in individuals with cancers involving the tongue. Glossectomy is the removal of all or part of the tongue affected by cancer. The oral tongue receives neural control from the cortex and 12th cranial nerve (hypoglossal). The oral tongue is under voluntary control and is responsible for manipulating food in the mouth for chewing and sensing volume and viscosity. When the oral tongue has completed chewing, it will subdivide the food into a swallowable bolus depending on viscosity and sequester any remaining food in the cheek ouch. Then the oral tongue initiates the oral stage of swallow by sealing the sides of the tongue against lateral anterior alveolar ridge and sequentially squeezing the bolus backwards through the mouth by upward movement of the midline of the oral tongue. Pressure from the oral tongue propels the bolus back, sensory information is sent to the medulla to trigger the pharyngeal stage of swallow. Extent of resection directly affects swallowing function. When the tail of the bolus reaches the base of the tongue which is under medullary control via the 10th cranial nerve(vagus), the pressure generation against the food through the pharynx is the result of tongue base posterior movement to touch the inward moving posterior pharyngeal walls. Thus, the combination of oral tongue propulsion through the mouth and base of the tongue propulsion through the pharynx drives the bolus into the esophagus. The clearance of the valleculae is the result of the tongue base should make complete contact with posterior pharyngeal wall or there will be residue remaining in the valleculae after the swallow. This is true in both adults and children. When a patient has postradiation xerostomia specific effects on swallowing may include impaired mastication, prolonged oral phase time and increased oral and pharyngeal residue. When more than one phase of swallowing is involved the severity of the problem is increased. Combined resection of the soft palate and tonsillar pillars may impact bolus transport through the oral cavity and pharynx causing nasopharyngeal reflux and pharyngeal stasis.

NEED OF THE STUDY:
Review of literature revealed scanty research comparing the swallowing functional aspects involving varied extent of resection of the tongue. Hence a need was felt to explore and characterise the same.

AIM AND OBJECTIVE: The present study aimed to highlight and compare specific swallowing skills and oral intake in a group of individuals with glossectomy who have undergone varied extent and site of resection.

METHOD and MATERIALS: The present study was a prospective study and sampling was purposive. It consisted of 20 patients with glossectomy with varied site and extent of resection (6 patients with near total/ total glossectomy, 8 patients with hemiglossectomy and 6 patients with partial glossectomy). Patients with multiple tumor sites and those who had undergone radiation therapy were excluded from the study. A detailed swallowing assessment was carried out using Videofluoroscopic Swallow Study (VFSS) while oral intake was rated using Functional Oral Intake Scale (FOIS). Performance of these patients in daily life with respect to swallowing was rated using Performance Status Scale for Head and Neck Cancer (PSSHNC).

RESULTS AND DISCUSSIONS:
Results revealed that swallowing dysfunction systematically deteriorated with increased resection site. Oral preparation and oral phase was affected to some degree in all the patients. Pharyngeal phase was affected more in patients with near total/ total glossectomy. Statistical analysis revealed significant difference between groups for oral intake status, PSSHNC scores and swallowing functions (p < 0.01). Similar findings have been reported by Pauloski 2008. This was attributed to the fact that tongue is the most active organ involved not only in oral preparation and oral phase, but also in bolus regulation in the pharyngeal area.

CONCLUSION:
Extensive resection of tongue has drastic effects on swallowing functions, oral intake status and PSSHNC. These findings has implications in intervention of individuals with glossectomy.