Critical Factors in the Oral Control Needed for Chewing and Swallowing.

Normal oropharyngeal swallowing is a complex set of neuromotor behaviors containing three phases: 1) Oral preparation to break food down to a swallowable consistency; 2) Oral phase which propels food from the mouth; 3) Pharyngeal phase creates pressure to push food into the esophagus, and includes valve functions which prevent food from entering the nose or airway and allow food into the esophagus. Systematic changes in normal oropharyngeal swallow are based on volume, viscosity, and taste of the food swallowed as well as age. Patients with oropharyngeal swallowing difficulties (dysphagia) react differently to these systematic variables in food characteristics.

Comparison of swallowing function after intensity-modulated radiation therapy and conventional radiotherapy for head and neck cancer.

Background: Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared posttreatment swallow function in 7 pairs of patients with head and neck cancer treated with either IMRT or conventional radiotherapy (RT).

Methods: Patients were matched on tumor characteristics.

Effect of induction chemotherapy on swallow physiology and saliva production in patients with head and neck cancer: a pilot study.

Background: No objective data are available to assess the potential damage induction chemotherapy alone contributes to swallowing physiology and salivary production in patients with locally and regionally confined head and neck cancer.

Methods: Thirteen patients with head and neck cancer were evaluated preinduction and postinduction chemotherapy. Assessment included: (1) percentage of nutrition taken orally and food consistencies in diet; (2) videofluorographic swallow evaluation; (3) whole mouth saliva collection; (4) quality-of-life questionnaire; and (5) pain and oral mucositis scores.

Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer.

Background: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients.

Methods: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects.

Manofluorography in the evaluation of oropharyngeal dysphagia.

Manofluorography, that is, the concurrent use of manometry and videofluorography for the evaluation of pharyngeal dysphagia, has not been widely used clinically, partially because of various limitations of conventional manometry. Technological advancements in recent years have led to substantial improvements in manometric devises, which can now overcome many of the shortcomings of standard manometry. In parallel with this, studies examining the utility of high-resolution manometry for the evaluation of pharyngeal disorders of swallowing have begun to emerge.

Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer.

Background: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing.

Methods: Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment.

A computational tool for the efficient analysis of dose-volume histograms from radiation therapy treatment plans.

A Histogram Analysis in Radiation Therapy (HART) program was primarily developed to increase the efficiency and accuracy of dose-volume histogram (DVH) analysis of large quantities of patient data in radiation therapy research. The program was written in MATLAB to analyze patient plans exported from the treatment planning system (Pinnacle 3 ) in the American Association of Physicists in Medicine/Radiation Therapy Oncology Group (AAPM/RTOG) format. HART-computed DVH data was validated against manually extracted data from the planning system for five head and neck cancer patients treated with the intensity-modulated radiation therapy (IMRT) technique.

Relationship between manometric and videofluoroscopic measures of swallow function in healthy adults and patients treated for head and neck cancer with various modalities.

Pharyngeal manometry complements the modified barium swallow with videofluoroscopy (VFS) in diagnosing pressure-related causes of dysphagia. When manometric analysis is not feasible, it would be ideal if pressure information about the swallow could be inferred accurately from the VFS evaluation. Swallowing function was examined using VFS and concurrent manometry in 18 subjects (11 head and neck patients treated with various modalities and 7 healthy adults).

Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy.

Background: Current research demonstrates that swallow function is impaired after treatment with organ-sparing chemoradiotherapy. Few studies, however, have related observed swallowing disorders with the patient's oral intake and diet in a large cohort of patients.

Methods: Swallowing function was examined using the modified barium swallow (MBS) procedure in 170 patients treated with radiotherapy with or without chemotherapy for cancer of the head and neck at 5 evaluation points: pretreatment and at 1, 3, 6, and 12 months posttreatment.

Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer.

Background: Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function.

Methods: Swallowing was examined with the modified barium swallow procedure in 144 patients surgically treated for oral or oropharyngeal cancer 3 months after healing. Univariate and multivariate correlations were used to examine the relationship between swallowing function and treatment.

Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients.

Background: Treatment decisions in head and neck cancer (HNC) might involve consideration of uncertain tradeoffs of one late effect against another or increasing toxicity or residual impairment for increased chance of survival. Understanding how patients prioritize potential outcomes, as well as whether these preferences are similar to those of nonpatients, is important to informed decision making and treatment planning.

Methods: Two hundred forty-seven newly diagnosed HNC patients from nine institutions and 131 nonpatients rank ordered a set of 12 potential treatment outcomes (eg, cure; being able to swallow; normal voice) from highest (1) to lowest (12).

Swallow function and perception of dysphagia in patients with head and neck cancer.

Background: The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy +/- chemotherapy has not been well documented in the literature.

Methods: Swallowing function in 132 patients with various lesions was evaluated using videofluoroscopy and analyzed by patient complaint of dysphagia grouping.

Results: Patients with complaints of dysphagia demonstrated significantly worse swallow function as indicated by lower oropharyngeal swallow efficiency (OPSE), longer transit times, larger residues, and more swallows with aspiration.