Quantitative Videofluoroscopic Analysis of Postoperative Swallowing Outcomes in Patients with Oral and Oropharyngeal Cancer

TL;DR

This study uses videofluoroscopic analysis to assess swallowing outcomes in cancer patients post-surgery and identifies factors that predict swallowing difficulties.

Contribution

The study introduces quantitative biomechanical indices to analyze swallowing outcomes and identifies specific predictors like adjuvant therapy and muscle defects.

Findings

Thin liquids are most likely to cause aspiration, while thick liquids are safest.

Adjuvant therapy and male sex are linked to prolonged pharyngeal transit time.

Suprahyoid muscle defects predict reduced laryngeal elevation during swallowing.

Abstract

Postoperative dysphagia significantly affects the quality of life of patients with oral and oropharyngeal cancer. We aimed to objectively analyze swallowing function in these patients using quantitative biomechanical indices from Videofluoroscopic swallowing studies (VFSS) as well as to identify independent predictors of key swallowing outcomes.

We included 60 patients with postoperative oral and oropharyngeal cancers. VFSS were performed at 3 months (for patients without adjuvant therapy) or 6–7 months (for patients with adjuvant therapy) to assess swallowing safety (Penetration-Aspiration Scale); post-swallowing pharyngeal residue; and biomechanical functions, including pharyngeal transit time (PTT), laryngeal vestibule closure duration, pharyngoesophageal segment opening duration/dimension, and laryngeal elevation. Generalized linear models (GLMs) were used to identify independent predictors.

The cohort was predominantly male (78.3%); further, 58.4% of the patients received adjuvant therapy. Thin liquids had the highest penetration and aspiration rates, whereas extremely thick liquids had the lowest rates. The GLM identified sex, adjuvant treatment, and suprahyoid muscle defects as independent predictors of different VFSS parameters. Specifically, adjuvant therapy and sex were associated with a prolonged PTT, while suprahyoid muscle defects were significant predictors of reduced laryngeal elevation.

Swallowing impairment remains prevalent after surgery for oral and oropharyngeal cancers. VFSS analysis could highlight specific biomechanical deficits; further, we identified predictors of key swallowing outcomes, including sex, adjuvant treatment, and suprahyoid defects.

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