Abstract
PurposeTongue mobility has shown to be a clinically interesting parameter on functional results after tongue cancer treatment which can be objectified by measuring the Range Of Motion (ROM). Reliable measurements of ROM would enable us to quantify the severity of functional impairments and use these for shared decision making in treatment choices, rehabilitation of speech and swallowing disturbances after treatment.MethodNineteen healthy participants, eighteen post-chemotherapy patients and seventeen post-surgery patients were asked to perform standardized tongue maneuvers in front of a 3D camera system, which were subsequently tracked and corrected for head and jaw motion. Indicators, such as the left-right tongue range and the deflection angle with the horizontal axis were extracted from the tongue trajectory to serve as a quantitative measure for the impaired tongue mobility.ResultsThe range and deflection angle showed an excellent intra- and interrater reliability (ICC 0.9) The repeatability experiment showed an average standard deviation of 2.5 mm to 3.5 mm for every movement, except the upward movement. The post-surgery patient group showed a smaller tongue range and higher deflection angle overall than the healthy participants. Post-chemoradiation patients showed less difference in tongue ROM compared with healthy participants. Only a few patients showed asymmetrical movement after treatment, which could not always be explained by T-stage or the side of treatment alone.ConclusionWe introduced a reliable and reproducible method for measuring the ROM and to quantify for motion impairments, that was able to show differences in tongue ROM between healthy subjects and patients after chemoradiation or surgery. Future research should focus on measuring patients with oral cancer pre- and post-treatment in combination with the collection of detailed information about the individual tongue anatomy, so that the full ROM trajectory can be used to identify changes over time and to quantify functional impairment.
Highlights
Head and neck cancer is the sixth most frequently occurring cancer worldwide
Post-chemoradiation patients showed less difference in tongue Range Of Motion (ROM) compared with healthy participants
We introduced a reliable and reproducible method for measuring the ROM and to quantify for motion impairments, that was able to show differences in tongue ROM between healthy
Summary
Head and neck cancer is the sixth most frequently occurring cancer worldwide. Carcinoma of the tongue and base of the tongue account for about 20% of all head and neck cancers[1], and incidences are rising, in the oropharynx due to HPV infections [2]. Surgery is the most preferred treatment for tongue carcinomas, whereas base of tongue carcinomas are mostly treated by organ sparing radiation with or without concurrent chemotherapy[3]. In advanced cases, both treatments might seriously affect the mobility of the tongue, resulting in impaired speech, swallowing, or mastication[4,5]. The organ sparing surgical chemoradiation is usually the preferred treatment for base of the tongue tumors, but in advanced cases this modality may lead to serious functional deficits with more impact on swallowing than surgery of the mobile tongue[3,11]. It is not possible to accurately predict the functional impairments at an individual level, clinical decision making, which implements expected functional sequelae, remains mainly dependent on the personal experience of the treating physician
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