Tongue Cancer Surgery Research Articles

Swallowing Rehabilitation Affects Period of Hospitalization after Surgery for Tongue Cancer.

Functional rehabilitation has been reported to improve swallowing. The effect of the presence or absence of such rehabilitation has yet to be compared in oral cancer patients, however. The purpose of this study was to investigate its effect on correlations between the period of hospitalization and the period of tube feeding (from the day of surgery to termination of tube feeding) and period of oral nutrition (from termination of tube feeding to discharge). Body weight was also measured on admission and discharge and the difference calculated. A correlation was observed between period of hospitalization and period of tube feeding in the rehabilitation group, and with the periods of tube feeding and oral nutrition in the non-rehabilitation group. In the rehabilitation group, the period of tube feeding appeared to affect period of hospitalization. On the other hand, termination of tube feeding did not tend to affect period of hospitalization. These results suggest that both periods were factors affecting period of hospitalization in the non-rehabilitation group. Not performing swallowing rehabilitation, therefore, resulted in the period of oral nutrition affecting the period of hospitalization. This suggests that it is essential that nutrients be ingested in moderation after termination of tube feeding, when they are only taken orally. Moreover, these results also indicate that rehabilitation is important in improving quality of life after discharge.

Successful tongue cancer surgery under general anesthesia in a 99-year-old patient in Okinawa, Japan: A case report and review of the literature.

As advances in the medical field have resulted in increased life expectancy, performing surgery under general anesthesia in elderly patients has become an important issue. A 99-year-old Okinawan female was admitted to the hospital presenting with pain in the tongue. Following physical examination, a clinical diagnosis of early stage tongue cancer (T2N0Mx) was confirmed. Early stage tongue cancer is particularly easy to access for surgical resection. By contrast, later stages of tongue cancer are associated with pain, dysphagia and throat obstruction. The patient and their family agreed to surgery due to the worsening pain associated with the tumor and gave informed consent for surgery. Following consultation with a cardiologist and an anesthesiologist, the tongue tumor was surgically resected under general anesthesia. Subsequent to surgery, the patient experienced pain relief and was discharged from the hospital on day 14 post-surgery. The patient was able to maintain the same quality of life, and lived for 5 years and 2 months longer without evidence of disease, surviving to the age of 104 years old. The present case demonstrates that surgery under general anesthesia may be appropriate in patients of an advanced age, with a treatment plan that should ideally be based on careful assessment of the wishes of the patient and their family, medical risks, and benefits and economic costs of alternative treatments, in addition to consideration of the patient's culture.

Ultrasound visual feedback in articulation therapy following partial glossectomy

Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy.A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change.Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy.Learning outcomes: Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study.

Dynamics of Swallowing Tablets during the Recovery Period following Surgery for Tongue Cancer

1.1. Objective: Medicinal tablets are sometimes difficult to swallow, even for healthy individuals. Accordingly, it is likely more difficult for patients to swallow tablets after oral surgery for tongue tumors. In this study, we aimed to investigate the dynamics of swallowing tablets in the recovery period following surgery for tongue tumors. 1.2. Methods: Two experiments were conducted (Experiment 1 and Experiment 2). In Experiment 1, 20 tongue cancer patients swallowed simulated tablets and underwent videofluoroscopic (VF) examination of swallowing before and after surgery. The ability or inability to pass the tablet to the esophagus and the number of swallowing attempts required to ingest the tablet were evaluated. In Experiment 2, 48 similar subjects swallowed thickened barium and simulated tablets and underwent VF examination of swallowing after surgery. The ability or inability to pass the tablet to the esophagus, the number of swallows required to ingest the tablet, the tablet position after the initial and the final swallowing reflexes, and the oral transit time and pharyngeal transit time for swallowing the thickened barium solution and simulated tablets were evaluated. 1.3. Results: After subtotal glossectomy, more subjects were unable to pass the tablet to the esophagus after surgery rather than before surgery. However, after surgery, patients needed more numbers of swallowing reflex attempts in order to successfully swallow tablets. Also, the tablets remained not only in the mouth, but also in the epiglottic vallecula and pyriform sinus. In the patients who could pass the tablet, the oral transit time of the thickened barium solution was shorter than in the patients who could not. 1.4. Conclusion: In cases of subtotal glossectomy, tablet intake should be avoided, particularly in the recovery phase, and VF or endoscopic evaluation of swallowing should be performed when tablets are prescribed. After tongue cancer surgery, patients should be recommended to make multiple swallowing attempts when swallowing tablets.

Exploratory Study on Guide Wire-Guided Tongue Resection under Ultrasonography for Adequate Safe Margins in Tongue Cancer Surgery

Exploratory Study on Guide Wire-Guided Tongue Resection under Ultrasonography for Adequate Safe Margins in Tongue Cancer Surgery

A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation.

This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted. An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging. Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients. Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.

Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review protocol

Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review protocol

Dysphagia in Tongue Cancer Patients

ObjectiveTo identify risk factors for dysphagia in tongue cancer patients. Dysphagia is a common complication of surgery, radiotherapy, and chemotherapy in tongue cancer patients. Previous studies have attempted to identify risk factors for dysphagia in patients with head and neck cancer, but no studies have focused specifically on tongue cancer patients.MethodsThis study was conducted on 133 patients who were diagnosed with tongue cancer and who underwent a videofluoroscopy swallowing study (VFSS) between January 2007 and June 2012 at the Asan Medical Center. Data collected from the VFSS were analyzed retrospectively. Patients with aspiration were identified.ResultsPatients showed a higher incidence of inadequate tongue control, inadequate chewing, delayed oral transit time, aspiration or penetration, vallecular pouch and pyriform residue, and inadequate laryngeal elevation after surgery. Moreover, male gender, extensive tumor resection, a higher node stage, and more extensive lymph node dissection were major risk factors for aspiration in tongue cancer patients.ConclusionTongue cancer patients have difficulties in the pharyngeal phase as well as the oral phase of swallowing. These difficulties can worsen after tongue cancer surgery. Gender, the extent of tumor resection, and lymph node metastasis affect swallowing in tongue cancer patients. Physicians should take these risk factors into account when administering swallowing therapy to tongue cancer patients.

舌癌に対する再建術後の体重減少に関する検討

広範切除を行った舌癌術後の長期的な体重減少のリスク因子を解析する目的で，当科で原発巣切除と遊離皮弁を用いた再建手術を行った98例を対象として後ろ向きに研究を行った。体重減少のリスク因子と考えられる年齢，BMI（Body Mass Index），T病期，舌切除範囲（半切除，亜全摘，全摘），頸部郭清術の範囲，術後放射線療法（PORT）に関し，術後1年の体重減少率10%以上となる高度体重減少との相関を比較検討した。単変量解析では舌切除範囲（p＝0.01），両側頸部郭清術（p＝0.03），PORT（p＝0.0008）において有意な相関を認めた。多変量解析ではPORT（p＝0.003）が有意なリスク因子であった。舌癌に対する広範切除術後は舌切除範囲やPORTといったリスク因子と体重推移に留意し，高度の体重減少を生じる前に積極的な栄養介入を行う必要がある。

Internal three dimensional tongue motion during “s” and “sh” from tagged magnetic resonance imaging; control and glossectomy motion

This study aims to ascertain the effects of tongue cancer surgery (glossectomy) on tongue motion during the speech sounds “s” and “sh.” Subjects were one control and three glossectomies. The first patient had surgery closed with sutures. The second had sutures plus radiation, which produces fibrosis and stiffness. The third was closed with an external free flap, and is of particular interest since he has no direct motor control of the flap. Cine and tagged-MRI data were recorded in axial, coronal and sagittal orientations at 26 fps. 3D tissue point motion was tracked at every time-frame in the word. 3D displacement fields were calculated at each time-frame to show tissue motion during speech. A previous pilot study showed differences in “s” production [Pedersen et al., JASA (2013)]. Specifically, subjects differed in internal tongue motion pattern, and the flap patient had unusual genioglossus lengthening patterns. The “s” requires a midline tongue groove, which is challenging for the patients. This study continues that effort by adding the motion of “sh,” because “sh” does not require a midline groove and may be easier for the patients to pronounce. We also add more muscles, to determine how they interact to produce successful motion. [This study was supported by NIH R01CA133015.]

Effects of Different General Anaesthetic Techniques on Immune Responses in Patients Undergoing Surgery for Tongue Cancer

The aim of this study was to investigate the effects of different general anaesthesia techniques on immune responses in patients undergoing surgery for tongue cancer. Sixty American Society of Anesthesiologists physical status 1 or 2 patients undergoing elective reconstructive surgery for tongue cancer were randomised to three groups. Group 1 received propofol induction and maintenance (TIVA), group 2 received propofol induction and sevoflurane maintenance (MIXED) and group 3 received sevoflurane induction and maintenance (SEVO). All patients received an infusion of remifentanil. Blood samples were obtained at eight time-points: 30 minutes before induction (T0); one hour (T1), three hours (T2) and five hours (T3) after induction; at the end of the operation (T4); and 24 hours (T5), 48 hours (T6) and 72 hours (T7) after operation. The T lymphocyte subsets (including CD3(+) cells, CD3(+)CD4(+) cells and CD3(+)CD8(+)cells) and CD4(+)/CD8(+) ratio, natural killer cells and B lymphocytes were analysed by flow cytometry. All immunological indicators except CD3(+)CD8(+) cells were significantly decreased in all groups at T1~T5 compared to T0 (P <0.05). The percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios were significantly lower in the MIXED groups and SEVO groups but not the TIVA group at T6 as compared with T0 (P <0.05). There were minor but statistically significant differences in the percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios between the SEVO group and the TIVA group at T2approxT6 (P <0.05). These findings suggest that propofol has slightly less effect on cellular immune responses than sevoflurane.

Expression of the cancer stem cell markers CD44v6 and ABCG2 in tongue cancer: Effect of neoadjuvant chemotherapy on local recurrence

The efficacy of neoadjuvant chemotherapy (NAC) is controversial, and no report supports NAC with a high evidence level. Recently, we showed that a deep surgical margin was resected very close to the tumor site in many NAC-treated oral squamous cell carcinoma patients, suggesting that NAC may lead to local recurrence and poor outcomes. The purpose of this study was to evaluate the effect of NAC on tumor local recurrence using cancer stem cell marker immunohistochemistry. We retrospectively analyzed 89 patients who underwent radical surgery for tongue cancer, and examined the effect of NAC on tumor local recurrence. Cancer stem cell marker (CD44v6 and ABCG2) expression was detected by immunohistochemistry. In our study, the local recurrence rate was 12.4%. CD44v6 and ABCG2 expression was significantly associated with regional lymph node metastasis, pattern of invasion, depth of invasion, perineural invasion and local recurrence, respectively. Tumor local recurrence was a significant independent predictive factor of the 5-year disease specific survival. CD44v6 or ABCG2 positivity in NAC-treated patients was significantly associated with tumor local recurrence. It was suggested that local recurrence in NAC-treated cases is associated with cancer stem-like cells. We propose that NAC leads to the selection and/or residue of more aggressive cancer stem-like cells.

Severe Pulmonary Suppuration with Infection-Induced Systemic Inflammatory Response Syndrome following Tongue Cancer Surgery in a Patient Undergoing Tocilizumab Therapy for Rheumatoid Arthritis.

A 65-year-old woman with rheumatoid arthritis treated by tocilizumab (TCZ) presented with tongue squamous cell carcinoma. While surgery was performed without any complications the aspiration pneumonia rapidly worsened by postoperative day 2 and severe pulmonary suppuration in the right lung field with infection-induced systemic inflammatory response syndrome (SIRS) was diagnosed. Antibiotic and respirator treatment improved her condition. The anti-inflammatory effect of TCZ may mask the symptoms and signs of severe infection with SIRS.

Patterns of variance in /s/ during normal and glossectomy speech

The production of speech includes considerable variability in speech gestures despite our perception of very repeatable sounds. Variability is seen in vocal tract shapes and tongue contours when different speakers produce the same sound. This study asks whether internal tongue motion patterns for a specific sound are similar across subjects, or whether they indicate multiple gestures. There are two variants of the sound /s/, which may produce two gestures or may represent a multitude of gestures. The first goal of this paper was to quantify internal tongue differences between these allophones in normal speakers. The second goal was to test how these differences are affected by subjects expected to have different speech gestures: normal controls and subjects who have had tongue cancer surgery. The study used tagged MRI to capture midsagittal tongue motion patterns and principal components analyses to identify patterns of variability that define subject groups and /s/ types. Results showed no motion differences between apical and laminal controls in either the tongue tip or whole tongue. These results did not support unique tongue behaviours for apical and laminal /s/. The apical patients, however, differed from all other speakers and were quite uniform as a group. They had no elevation and considerable downward/backward motion of the tongue tip. This was consistent with difficulty in maintaining the tip–blade region at the proper distance from the palate.

Tongue Strength as a Predictor of Functional Outcomes and Quality of Life after Tongue Cancer Surgery

Surgical resection of oral cancer can result in altered speech, swallowing, and quality of life (QOL). To date, the oral outcome variables of tongue strength, tongue and jaw range of motion, and saliva production have not been extensively assessed. This pilot study was done to assess tongue strength along with other oral outcomes and their relationship to performance status for speech, swallowing, and QOL after partial glossectomy. Our aim was to create a norm for what should be considered a normal tongue strength value in this population. We hypothesized that patients with tongue strength of 30 kPa or greater would perform better on the performance status scale and various QOL measures than do patients with tongue strength of less than 30 kPa. We used a cross-sectional design in this study. The postoperative assessment included 1) Performance Status Scale and Karnofsky Performance Status Scale; 2) oral outcome variables of tongue strength, jaw range of motion. and saliva production; and 3) patient-rated QOL ratings via Eating Assessment Tool, M. D. Anderson Dysphagia Inventory, EORTC-H&N35, and Speech Handicap Index. Patients with tongue strength of at least 30 kPa performed better on the performance status scales and various QOL measures. The cutoff score of 30 kPa for tongue strength measures revealed a trend in predicting performance on the scales and QOL measures. The oral outcome variables correlated with performance status for speech, swallowing, and QOL. We propose a norm for tongue strength in this population, based on the trend seen in this group of patients, as none previously existed. Future studies are under way that incorporate a larger sample size to further validate this norm. Future studies will also examine oral functional outcome measures in a larger population by inclu'ding other oral and oropharyngeal sites to help predict speech and swallow performance status and QOL.

OP169: A retrospective analysis of locally advanced tongue cancer treated with surgery at tertiary care centre in India

Background Locally advanced oral cancer is mainly treated by multimodality i.e. surgery followed by adjuvant therapy. Tongue cancer holds a poor prognosis despite of the advances in various treatment modalities. In the era of organ preservation, surgery for locally advanced tongue cancer is too morbid. Management of Locally advanced tongue cancer (LADTCA) surgery revolves around poor prognosis due to early recurrences and morbid surgery which require extensive reconstruction. Material and methods Retrospective study of patients with histologically proven squamous cell carcinoma of LADTCA who underwent surgery at our centre during 2008–2011 were analyzed for different histopathological parameters and recurrence patterns. Results We reviewed the charts of 874 patients. Wide excision was done in 671 patients and major glossectomy done for 203 patients. Out of these, 57 patients were included in the study after fulfilling the inclusion criteria. All underwent major glossectomy with neck dissection and reconstruction. The mean age was 47.5 yrs with majority males. Thirty percent patients were young ( Sixty percent had thickness more than 2 cm.Sixty percentage of patients had perineural invasion. Nodal positivity rate was 64% with unilateral nodal positivity in 39% and bilateral positivity in 28% patients. Perinodal extension was seen in 53% of patients. Ninety-four percent had free margins and 6% had involved margins. Median Disease free survival was 7 month. Sixty-three percent of patients had recurrence i.e. local recurrence and/or regional recurrence in 65% and distant metastasis and/or local disease in 35% patients. Perineural invasion ( p = 0.011), nodal metastasis ( p = 0.006), perinodal extension ( P = 0.031), bilateral node positivity ( p = 0.012) were significantly correlated with recurrence. Conclusion Major glossectomy achieves good palliation of symptoms and offers potential chance of cure in selected cases.

PP156: Morbidity of partial glossectomy in the patients with mobile tongue cancers

Purpose Articulation & swallowing difficulty are common functional morbidity in the patients underwent tongue cancer surgery. This study was performed to evaluate articulation & swallowing disability in the patients underwent partial glossectomy without reconstruction. And it also aimed to analysis clinical characteristics & demography in patients with the sequelae. Materials and methods We retrospectively reviewed medical charts and interviewed the patients by telephone from 1985 through 2011. One hundred ninety-six patients of 266 had early stage tongue cancer, and 132 patients underwent partial glossectomy without reconstruction. Among them, 63 patients responded the telephone interview. Results Most patients had good functional outcomes after partial glossectomy. Morbidity was affected by resection volume of tongue and follow-up period after operation rather than the stages. Additional neck dissection and postoperative radiotherapy were not be related operational morbidity in partial glossectomy patients. In most of the early stage patients, reconstruction is not necessary even resection volume over 50 cm 3 . Conclusions Early mobile tongue cancer patients generally showed good functional outcomes after partial glossectomy even without the reconstruction.

OP206: Functional outcomes after oral tongue cancer surgery: Determination of optimal reconstruction method

Purpose Postoperative functional outcomes such as speech and swallowing are affected by volume of tongue resected and reconstruction method in oral tongue cancer. The aim of this study is to evaluate postoperative function and determine the adequate reconstruction method after oral tongue cancer surgery. Material and Methods We studied 42 patients with oral tongue cancer who underwent glossectomy with primary closure or secondary intention (20 patients) and free flap reconstruction (22 patients). We compared the postoperative function depending on the volume of tongue resected and reconstruction method using six methods including tongue movement test (0–16 points), alternate articulation test (0–16 points), articulation screening test (0–6 points), simplified speech test (0–6 points), swallowing function using Functional Outcome of Swallowing Scale (0–5 points) and quality of life using EORTC QLQ–C30 and HN35 (65–266 points). Results The patients included 26 male (61.9%) and 16 female (38.1%), and mean age was 54.5 years. Of all patients, postoperative functional outcomes had inverse correlation with the volume of tongue resected. Of 22 patients who underwent partial glossectomy, patients with primary closure or secondary intention had better function in tongue movement test, articulation screening test, and simplified speech test than patients with free flap reconstruction (p = 0.04, 0.01, Conclusions Primary closure or secondary intention is appropriate reconstructive methods after partial glossectomy. However, free flap reconstruction is recommended after hemiglossectomy.

Fonoterapia em glossectomia total: estudo de caso

A cirurgia curativa do câncer de língua ocasiona sequelas que prejudicam o bom funcionamento das funções estomatognáticas. O objetivo do trabalho é descrever, por meio de estudo de caso, os achados da avaliação e a evolução da reabilitação fonoaudiológica das funções de deglutição e fala de um indivíduo de 58 anos, gênero masculino, submetido à glossectomia total em junho de 2009. Após a avaliação diagnosticou-se disfagia orofaríngea mecânica severa e alteração na articulação da fala. Na reabilitação fonoaudiológica foram utilizadas, como formas de atuação, as terapias direta e indireta. Na terapia indireta trabalhou-se controle motor oral, sensibilidade, mobilidade, motricidade, tônus e postura das estruturas adjacentes da língua resseccionada. Na terapia direta empregou-se a manobra de postura de cabeça para trás para auxiliar na ejeção de alimentos para a faringe. O paciente passou a alimentar-se exclusivamente por via oral, com a restrição de sólidos, após dez meses em tratamento. No que se refere à fala, foram utilizados exercícios de sobrearticulação, velocidade e ritmo para melhorar a sua inteligibilidade. Dessa forma, considerou-se os resultados da intervenção fonoaudiológica positivos e o paciente recebeu alta após um ano em tratamento. Conclui-se que as ressecções de língua apresentam sequelas significativas nas funções de deglutição e fala, assim sendo, é imprescindível a atuação fonoaudiológica para modificar e adaptar essas funções, além de proporcionar melhor qualidade de vida ao paciente.

A case of hysterical conversion disorder following tongue cancer surgery

A case of hysterical conversion disorder following tongue cancer surgery