Video fluoroscopic evaluation after glossectomy

Background: The swallowing deficits that result from oral or oropharyngeal resections vary considerably depending on the site, extension of the resect ion, and type of reconstruction. Most patients will experience some degree of dysphagia despite the reconstructive effort. Furthermore, a glossectomy is frequently associated with voice and speech difficulties. Objectives: To characterize swallowing in patients who underwent a glossect omy and to define the limits and the compensatory movements using video flu oroscopic analysis. Design and Setting: Video fluoroscopic evaluation of 15 patients who underw ent glossectomies at the Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo, Sao Paulo, Brazil. Patients: We examined 15 patients: 5 who underwent a partial glossectomy, 2 who underwent a subtotal glossectomy, and 8 who underwent a total glossect omy with laryngeal preservation and reconstruction with myocutaneous flaps (9 pectoralis major flaps and 1 latissimus dorsi flap). The 15 patients wer e enrolled in a program that included voice, speech, and swallowing rehabil itation. Results: All patients who underwent a partial glossectomy had difficulties with formation and anteroposterior propulsion of the bolus in the oral cavi ty and an increase in oral transit time, which was more evident with materi als of thicker consistencies. All patients who underwent a total or subtota l glossectomy with laryngeal preservation had an increase in oral transit t ime and stasis of food in the oral cavity, the pharynx, and the superior es ophageal sphincter. Of the 15 patients, 2 had moderate and asymptomatic asp iration. These 2 patients had swallowing compensations, such as increased b uccal, mandibular, pharyngeal, and laryngeal activity and voluntary protect ion of the larynx during swallowing. Conclusions: This study demonstrates the effectiveness of swallowing in pat ients who were enrolled in voice, speech, and swallowing rehabilitation aft er undergoing a partial or total glossectomy. An increase in oral transit t ime was detected in all patients. Only 2 of the 10 patients who underwent a total glossectomy had persistent asymptomatic aspiration.