Predicting Swallowing Outcomes from Objective Videofluoroscopic Timing and Displacement Measures in Head and Neck Cancer Patients

Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT

BACKGROUND

Upper oesophageal sphincter (UES) serves as an important anatomical and functional landmark during swallowing. However, the precise UES location before and during swallowing has not been well established.

OBJECTIVE

This study aimed to determine upper oesophageal sphincter (UES) location and displacement during swallowing accounting for sex, age, and height in healthy adults using 320-row area detector computed tomography (320-ADCT).

METHODS

Ninety-four healthy adults (43 males; 22-90 years) underwent 320-ADCT scanning while swallowing one trial of 10 mL honey thick barium. UES location at bolus hold and at maximum displacement and vertical displacement during swallowing were identified using the coordinates and the section classification of vertebrae (VERT scale). The differences and correlations of UES location and distance in terms of sex, age, and height were analysed using Mann-Whitney U test and Spearman's correlation coefficient.

RESULTS

UES locations at bolus hold and at maximum displacement were significantly lower and UES vertical displacement was significantly larger in males than in females (p < .001). UES location at bolus hold became lower with increasing age (r = -.312, p = .002), but the negative correlation was low at maximum displacement (r = -.230, p = .026), resulting in larger vertical distance with ageing. UES locations showed high negative correlation at bolus hold with height (r = -.715, p < .001), and showed moderate negative correlation at maximum displacement with height (r = -.555, p < .001), although this effect was unclear when analysed by sex.

CONCLUSION

Males showed lower UES location and larger displacement than females. The impact of age was evident with lower location before swallowing and larger displacement during swallowing. Differences observed by sex were not completely explained by using the VERT scale to adjust for height.

Discrepancy between subjective and objective postoperative oral dysfunction assessment after oral cancer treatment: A single-center cross-sectional study

OBJECTIVES

It has been reported that in many cancer types, the evaluation of complications and side effects of treatment differs between subjective and objective evaluations. The purpose of this study is to verify whether the evaluation of postoperative oral dysfunction following oral cancer treatment was consistent subjective and objective evaluations.

MATERIALS AND METHODS

This cross-sectional study collected background data and evaluated the oral function (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function and eating assessment tool [EAT-10]) of 75 patients from September 2019 to December 2021. The postoperative oral dysfunction-10 (POD-10) was used for the subjective assessment of dysfunction in oral cancer patients. Also, Matsuda-Kanno classification was used for the objective assessment. The kappa coefficient between POD-10 and oral dysfunction was calculated for the degree of agreement. The relationship between oral function measurements and POD-10 was examined by multiple regression analysis.

RESULTS

The patients' median age was 72.0 (25-75 percentile: 64.0-78.0) and 69.3% were male. The kappa coefficients indicating the degree of agreement with POD-10 were 0.41 (P < 0.01) for occlusal force, 0.27 (P = 0.01) for masticatory function, and 0.59 (P < 0.01) for EAT-10. Multiple regression analysis showed a significant association of occlusal force (β = -0.33, P = 0.03) and EAT-10 (β = 0.80, P < 0.01) with POD-10.

CONCLUSIONS

For postoperative oral dysfunction type III (occlusal type), the evaluations of subjective and objective evaluations tended to be consistent. However, for type I (transport type) and II (oral hygiene type), these evaluations may be prone to overestimation or underestimation by either the medical professional or the patient.

The Relationships Between Radiation Dosage and Long-term Swallowing Kinematics and Timing in Nasopharyngeal Carcinoma Survivors

This study aimed to investigate the relationship between intensity-modulated radiation therapy (IMRT) dosimetry and swallowing kinematic and timing measures. Thirteen kinematic and timing measures of swallowing from videofluoroscopic analysis were used as outcome measures to reflect swallowing function. IMRT dosimetry was accessed for thirteen swallowing-related structures. A cohort of 44 nasopharyngeal carcinoma (NPC) survivors at least 3 years post-IMRT were recruited. The cohort had a mean age of 53.2 ± 11.9 years, 77.3% of whom were male. There was an average of 68.24 ± 14.15 months since end of IMRT; 41 (93.2%) had undergone concurrent chemotherapy. For displacement measures, female sex and higher doses to the cricopharyngeus, glottic larynx, and base of tongue were associated with reduced hyolaryngeal excursion and pharyngeal constriction, and more residue. For timing measures, higher dose to the genioglossus was associated with reduced processing time at all stages of the swallow. The inferior pharyngeal constrictor emerged with a distinctly different pattern of association with mean radiation dosage compared to other structures. Greater changes to swallowing kinematics and timing were observed for pudding thick consistency than thin liquid. Increasing radiation dosage to swallowing-related structures is associated with reduced swallowing kinematics. However, not all structures are affected the same way, therefore organ sparing during treatment planning for IMRT needs to consider function rather than focusing on select muscles. Dose-response relationships should be investigated with a comprehensive set of swallowing structures to capture the holistic process of swallowing.