Systematization of Degrees of Complexity and Objectification of Clinical Assessment of Dysphagia of Oral and Oropharyngeal Stages of Swallowing

Abstract

Aim: Global monitoring of the incidence shows that oral and pharyngeal cancer is one of the most common cancers in the world. Treatment of such patients, regardless of its type (surgical, radiation, chemotherapy) is quite traumatic, which leads to damage to surrounding tissues, disruption of their functions and before swallowing. Objectification of the severity of functional disorders is difficult in both the first and second phases of swallowing. There is also no systematization of severity, which could be used in the clinic in such patients. The aim of the work was to select and evaluate methods for diagnosing swallowing disorders and systematization of oral and oropharyngeal dysphagia. Materials and Methods: The study included 36 patients aged 38-55 years (men) who were treated in the Department of Head and Neck Tumors „Podolsk Regional Oncology Center” with malignant tumors of the tongue, bottom of the mouth and oropharynx stage I-III. All patients had problems with chewing and swallowing. A comprehensive method of assessing the effectiveness of chewing and ultrasound examination of the act of swallowing, the presence of the pain component on the visual-analog scale (VAS) at the time of hospitalization and in the postoperative period for 10 days. Results: Clinical and ultrasound studies have shown a reduction in muscle contraction in all patients, regardless of the location of the process. Changes were observed depending on the clinical course of the disease, the prevalence of the tumor and the volume of the muscles being incised. There was a tendency that patients who could not mix and form the food bolus were also unable to take a normal sip. These manipulations were accompanied by varying intensity of pain. Based on the obtained data, groups of patients by severity and their systematization were formed. Conclusions: The systematization of oral and oropharyngeal dysphagia on the basis of objective indicators is proposed (masticatory efficiency – masticatory test, ultrasound examination). To assess the first phase of swallowing, a set of studies with three methods is recommended: 1 – chewing test; 2 – visual-analog scale of pain; 3 – ultrasound examination. To assess the second phase of swallowing – two methods: 1 – visual-analog scale of pain; 2 – ultrasound examination. The transfer of the patient from the tube feeding to the usual was carried out on the basis of the obtained objective indicators, taking into account subjective data as auxiliary.