Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck

BACKGROUND: Swallowing dysfunction is a common side effect of chemoradiation. METHODS: Twelve patients with stage III or IV squamous cell carcinoma of the head and neck were enrolled. Videofluorographic swallowing studies were performed before initiation of chemoradiation to provide baseline swallowing function data. Postchemoradiation videofluorographic swallowing studies were performed from 1 to 14 weeks after the completion of treatment (mean, 8 weeks). RESULTS: Changes in swallowing physiology after treatment included decreased base of tongue to posterior pharyngeal wall contact (p =.0010) and reduced pharyngeal contraction (p =.0313), resulting in impaired bolus transport through the pharynx. In addition, decreased laryngeal elevation (p =.0039), decreased laryngeal vestibule closure (p =.0078), and laryngeal penetration (p =.0078) were present. Bolus volume did not have a significant effect on swallowing ability. Aspiration was observed in four patients. CONCLUSIONS: Organ preservation treatment impairs movement of structures essential for normal swallowing. Prophylactic swallowing exercises may benefit these patients.     

Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation.

OBJECTIVE: RADPLAT (concurrent selective supradose intraarterial cisplatin and external-beam irradiation) delivers extraordinarily high cisplatin concentration to head and neck structures. This study was designed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech. METHODS: Videofluorographic swallowing studies and articulation testing of 14 head and neck cancer patients treated with RADPLAT were compared with 16 treated with systemic chemoradiation 1 month after treatment. RESULTS: RADPLAT and systemic chemoradiation patients did not differ significantly on most swallow outcome measures, and there was significantly less aspiration on 1 and 3 mL liquid for RADPLAT individuals. Speech function was comparable except for RADPLAT's significantly worse /s, z/ productions. CONCLUSIONS: Increased concentration of cisplatin to the head and neck did not result in generally reduced swallowing or articulatory function.     

Physiology of swallowing

The mechanism behind normal swallowing is complex and multifactorial. Due to the close proximity of the pathways of swallowing and respiration, precise coordination between these functions is vital in order to avoid entry of material into the airway and to ensure optimal health and nutrition in general. Swallowing can be divided into three stages: oral, pharyngeal and oesophageal and although initiation of the swallow is often under voluntary control, swallowing is also triggered frequently throughout the day as a reflex action due to the presence of saliva in the oropharynx. Dysphagia is a symptom frequently encountered by clinicians and its causes are vast and varied. A thorough understanding of the physiology of swallowing remains necessary to conduct a full assessment and instigate appropriate treatment for these patients in whom dysphagia is often debilitating and may significantly affect their quality of life. We present an account of the physiology of swallowing, using clinical examples to illustrate certain aspects.     

Physiology of swallowing

The mechanism behind normal swallowing is complex and multifactorial. Due to the close proximity of the pathways of swallowing and respiration, precise coordination between these functions is vital in order to avoid entry of material into the airway and to ensure optimal health and nutrition in general. Swallowing can be divided into three stages: oral, pharyngeal and oesophageal, and although initiation of the swallow is often under voluntary control, swallowing is also triggered frequently throughout the day as a reflex action due to the presence of saliva in the oropharynx. Dysphagia is a symptom frequently encountered by clinicians and its causes are vast and varied. A thorough understanding of the physiology of swallowing remains necessary to conduct a full assessment and instigate appropriate treatment for these patients in whom dysphagia is often debilitating and may significantly affect their quality of life. We present an account of the physiology of swallowing, using clinical examples to illustrate certain aspects.