Quantitative Video fluoroscopic Analysis of Postoperative Swallowing Outcomes in Patients with Oral and Oropharyngeal Cancer

Articles in Press

Document Type : Original

Authors

1 Department of Otolaryngology - Head and neck surgery, University Medical Center Ho Chi Minh City Department of Otolaryngology - Head and neck surgery, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City Vietnam.

2 Department of Radiology, University Medical Center Ho Chi Minh City Vietnam. Department of Radiology, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City Vietnam.

3 Department of Radiology, University Medical Center Ho Chi Minh City Vietnam.

4 Department of Otolaryngology - Head and neck surgery, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City Vietnam.

10.22038/ijorl.2025.90978.4039

Abstract

Introduction:
Postoperative dysphagia significantly affects the quality of life of patients with oral and oropharyngeal cancer. We aimed to objectively analyze swallowing function in these patients using quantitative biomechanical indices from videofluoroscopic swallowing studies (VFSS) as well as to identify independent predictors of key swallowing outcomes.
Materials and Methods:
We included 60 patients with postoperative oral and oropharyngeal cancers. VFSS were performed at 3 months (for patients without adjuvant therapy) or 6–7 months (for patients with adjuvant therapy) to assess swallowing safety (Penetration-Aspiration Scale); post-swallowing pharyngeal residue; and biomechanical functions, including pharyngeal transit time (PTT), laryngeal vestibule closure duration, pharyngoesophageal segment opening duration/dimension, and laryngeal elevation. Generalized linear models (GLMs) were used to identify independent predictors.
Results:
The cohort was predominantly male (78.3%); further, 58.4% of the patients received adjuvant therapy. Thin liquids had the highest penetration and aspiration rates, whereas extremely thick liquids had the lowest rates. The GLM identified sex, adjuvant treatment, and suprahyoid muscle defects as independent predictors of different VFSS parameters. Specifically, adjuvant therapy and sex were associated with a prolonged PTT, while suprahyoid muscle defects were significant predictors of reduced laryngeal elevation.
Conclusion:
Swallowing impairment remains prevalent after surgery for oral and oropharyngeal cancers. VFSS analysis could highlight specific biomechanical deficits; further, we identified predictors of key swallowing outcomes, including sex, adjuvant treatment, and suprahyoid defects.

Keywords

Main Subjects

References

  1. Kraaijenga S, van der Molen L, van den Brekel M, Hilgers F. Current assessment and treatment strategies of dysphagia in head and neck cancer patients: A systematic review of the 2012/13 literature. Curr Opin Support Palliat Care. 2014; 8(2): 152–63.
  2. Schindler A, Mozzanica F, Barbiera F. Dysphagia evaluation and treatment after head and neck surgery and/or chemoradiotherapy of head and neck malignancy. In: Dziewas R, Warnecke T, editors. Dysphagia: Diagnosis and treatment. New York: Springer; 2018. p. 649–68.
  3. Porto de Toledo I, Pantoja LLQ, Luchesi KF, Assad DX, De Luca Canto G, Guerra ENS. Deglutition disorders as a consequence of head and neck cancer therapies: A systematic review and meta-analysis. Support Care Cancer. 2019;27(10): 3681–700.
  4. Gourin CG, Johnson JT. A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck. Laryngoscope. 2009;119(11):2124–34.
  5. Frowen J, Cotton S, Corry J, Perry A. Impact of demographics, tumor characteristics, and treatment factors on swallowing after (chemo)radiotherapy for head and neck cancer. Head Neck. 2010;32(4): 513–28.
  6. Jung SJ, Kim DY, Joo SY. Risk factors associated with aspiration in patients with head and neck cancer. Ann Rehabil Med. 2011;35(6):781–90.
  7. Nakayama Y, Yamakawa N, Ueyama Y, Yagyuu T, Ueda N, Nakagawa Y, et al. Examination of suprahyoid muscle resection and other factors affecting swallowing function in patients with advanced oral cancer after surgical resection and reconstruction. J Craniofac Surg. 2022;33(8):e840–4.
  8. Duprez F, Madani I, De Potter B, Boterberg T, De Neve W. Systematic review of dose–volume correlates for structures related to late swallowing disturbances after radiotherapy for head and neck cancer. Dysphagia. 2013;28(3):337–49.
  9. Kodama N, Kumai Y, Miyamoto T, Matsubara K, Samejima Y, Orita Y. Factors affecting the swallowing dysfunction following oral cancer surgery. Ann Rehabil Med. 2021;45(5):368–78.
  10. Nguyen NP, Moltz CC, Frank C, Karlsson U, Nguyen PD, Vos P, et al. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer. Eur J Radiol. 2006; 59(3): 453–9.
  11. Lee SY, Kim BH, Park YH. Analysis of dysphagia patterns using a modified barium swallowing test following treatment of head and neck cancer. Yonsei Med J. 2015;56(5):1221–6.
  12. Borggreven PA, Verdonck-de Leeuw I, Rinkel RN, Langendijk JA, Roos JC, David EF, et al. Swallowing after major surgery of the oral cavity or oropharynx: A prospective and longitudinal assessment of patients treated by microvascular soft tissue reconstruction. Head Neck. 2007;29(7):638–47.
  13. Lam L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction: A systematic review. Oral Oncol. 2013; 49(6):507–24.
  14. Huang ZS, Chen WL, Huang ZQ, Yang ZH. Dysphagia in tongue cancer patients before and after surgery. J Oral Maxillofac Surg. 2016;74(10):2067–72.
  15. Leonard R, Kendall K. Dysphagia assessment and treatment planning: A team approach. 4th ed. San Diego: Plural Publishing; 2019.
  16. Belafsky PC, Kuhn MA. The clinician’s guide to swallowing fluoroscopy. 1st ed. New York: Springer; 2014.
  17. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration aspiration scale. Dysphagia. 1996;11(2):93–8.
  18. Steele CM, Grace-Martin K. Reflections on clinical and statistical use of the penetration-aspiration scale. Dysphagia. 2017;32(5):601–16.
  19. Robbins J, Kays S, Gangnon R, Hind J, Hewitt A, Gentry L. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150–8.
  20. Arrese LC, Schieve HJ, Graham JM, Stephens JA, Carrau RL, Plowman EK. Relationship between oral intake, patient perceived swallowing impairment, and objective videofluoroscopic measures of swallowing in patients with head and neck cancer. Head Neck. 2018;41(4):1016–23.
  21. Suarez-Cunqueiro MM, Schramm A, Schoen R, Seoane-Leston J, Otero-Cepeda XL, Bormann KH, et al. Speech and swallowing impairment after treatment for oral and oropharyngeal cancer. Arch Otolaryngol Head Neck Surg. 2008;134(12):1299–304.
  22. Starmer HM, Tippett D, Webster K, Quon H, Jones B, Hardy S, et al. Swallowing outcomes in patients with oropharyngeal cancer undergoing organ-preservation treatment. Head Neck. 2014; 36(10):1392–7.
  23. Wall LR, Ward EC, Cartmill B, Hill AJ. Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: A systematic review. Dysphagia. 2013; 28(4):481–93.
  24. Kalavrezos N, Cotrufo S, Govender R, Rogers P, Pirgousis P, Balasundram S, et al. Factors affecting swallow outcome following treatment for advanced oral and oropharyngeal malignancies. Head Neck. 2014; 36(1):47–54.
  25. Azzam P, Mroueh M, Francis M, Abou Daher A, Zeidan YH. Radiation-induced neuropathies in head and neck cancer: Prevention and treatment modalities. ecancermedicalscience. 2020;14:1133.
  26. Xiao JB, Cherukupalli A, Tran KL, Prisman E. Predictors of gastrostomy tube placement in head and neck cancer patients undergoing radiation or chemoradiotherapy: A systematic review. Head Neck. 2025;47(3):1006–17.
  27. Tei K, Maekawa K, Kitada H, Ohiro Y, Yamazaki Y, Totsuka Y. Recovery from postsurgical swallowing dysfunction in patients with oral cancer. J Oral Maxillofac Surg. 2007;65(6):1077–83.
  28. Leonard R, Kendall K, McKenzie S. UES opening and cricopharyngeal bar in nondysphagic elderly and nonelderly adults. Dysphagia. 2004; 19(3):182–91.
  29. Nguyen NP, Frank C, Moltz CC, Vos P, Millard C, Smith HJ, et al. Dysphagia severity and aspiration following postoperative radiation for locally advanced oropharyngeal cancer. Anticancer Res. 2008;28(1B):431–4.
  30. O'Connell DA, Rieger J, Harris JR, Dziegielewski P, Zalmanowitz J, Sytsanko A, et al. Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm free flap. Arch Otolaryngol Head Neck Surg. 2008;134(8):857–64.
  31. Son YR, Choi KH, Kim TG. Dysphagia in tongue cancer patients. Ann Rehabil Med. 2015;39(2): 210–7.
  32. Pauloski BR, Rademaker AW, Logemann JA, McConnel FM, Heiser MA, Cardinale S, et al. Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer. Head Neck. 2004;26(7):625–36.

 

 

Iranian Journal of Otorhinolaryngology

Articles in Press, Corrected Proof
Available Online from 25 December 2025

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