DETECTION OF FUNCTIONAL-CHANGES IN SWALLO WING BY CINERADIOGRAPHY AFTER TREATMENT OF PHARYNGEAL AND ORAL CAVITY CANCER

Reestablishing good swallowing function after resection and reconstruc tion of head and neck tumors is very important for our patients' well- being. Today many different surgical concepts for reconstruction after tumor surgery are in common use. It is necessary to establish a good diagnostic procedure for postoperative assessment of the swallowing fu nction. High-speed cineradiography at a minimum of 50 frames per secon d is well established for evaluating swallowing problems in head and n eck patients. Methods: Thirty-six patients divided into three groups w ere examined using high speed cineradiography after surgical treatment of pharyngeal and oral cavity cancer. Group I (n = 12) included patie nts with a subtotal or total tongue resection and reconstruction with infrahyoid myofascial flap and jejunal flap; Group I (n = 12), patient s with total resection of the oropharynx soft palate and velum and rec onstruction with a free radial forearm flap; Group III (n = 16), patie nts with total laryngopharyngektomy and reconstruction with jejunal fl ap and siphon and with or without repair of the digastric muscle. Resu lts: Group I: All patients with tongue reconstruction were able to swa llow normally from the oral cavity into the pharynx. All patients had normal bolus propulsion because of a good tongue volume and tongue mot ility. There was only one case of aspiration after total glossectomy w ith the larynx left in place. All patients could swallow with the head and neck in a normal position. Group II: All patients with reconstruc tion of the soft palate and velum were able to initiate proper bolus p ropulsion without nasal regurgitation or rhinolalia aperta. Only one p atient suffered from chronic aspiration after hemiresection of the oro pharynx and hypopharynx. Group III: All patients with pharynx reconstr uction had no problems with bolus transfer through the reconstructed p harynx. Aspiration into the reconstructed pharynx was a major problem for those patients without repair of the digastric muscle (5/8 = 63%). Better results were observed in the patients who underwent repair of the digastric muscle. There was only one case (13%) of aspiration. Con clusions: By using high-speed cineradiography it is possible to make a detailed description of the swallowing function after extensive surgi cal treatment of pharyngeal and oral cavity cancer. We think that high -speed cineradiography is a very sensitive diagnostic procedure capabl e of detecting all functional aspects of swallowing. High-speed cinera diography should be one of the standard diagnostic studies performed s urgery of the oral cavity and pharynx.