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Background Patients treated for head and neck cancer frequently develop dysphagia. Bolus characteristics are altered during fluoroscopic swallowing studies to observe the impact on swallowing function. The purpose of this study was to determine bolus volume and consistency effects on oropharyngeal swallowing physiology and patient awareness of swallowing difficulty. Methods Twenty-one patients with head and neck cancer were assessed pre-chemoradiation and post-chemoradiation. The Modified Barium Swallow Study (MBSS) was utilized to examine swallow physiology. Each patient provided perceptual ratings of swallowing difficulty after each swallow of varying bolus types. Results Oral transit times were significantly longer with pudding boluses. There were trends for higher residue percentages as well as perceptual ratings for pudding and cookie boluses. One correlation between perceptual ratings and physiology was significant. Conclusion Patient awareness of swallowing difficulty and aspects of swallowing physiology vary with bolus consistency. Patient awareness does not correlate with observed changes in swallowing physiology. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1122–1129, 2015

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. Swallowing function was evaluated with the modified barium swallow procedure pretreatment and at 3 and 6 months postcancer treatment completion. Swallows were analyzed for bolus transit times, bolus residues, laryngeal closure (LAC) duration, cricopharyngeal opening (CPO) duration, and oropharyngeal swallow efficiency (OPSE). Data were analyzed using multifactor repeated measures analysis of variance and adjusted for baseline function. Results Main effect of radiation type was significant for all measures on at least 1 bolus type. Patients treated with IMRT demonstrated shorter bolus transit times, less oral and pharyngeal residue, longer LAC, and larger OPSE. Conclusion Patients treated with IMRT demonstrated faster, more efficient swallows, and greater airway protection. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1575–1582, 2015

Oral tongue strength and swallowing ability are reduced in patients treated with chemoradiotherapy for oral and oropharyngeal cancer.Patients with oral or oropharyngeal cancer treated with high-dose chemoradiotherapy underwent tongue strength, swallowing, and dietary assessments at pretreatment and 1, 3, 6, and 12 months posttreatment. Tongue strength was assessed using the Iowa Oral Performance Instrument (IOPI). Oral and pharyngeal residue was evaluated utilizing videofluoroscopy.Mean maximum tongue strength dropped a nonsignificant amount immediately after treatment, and then increased significantly at 6- and 12-months posttreatment completion. Analyses were adjusted for patient dropout. Tongue strength was not significantly correlated with swallow observations of percentage oral and pharyngeal residue. Ability to eat various diet consistencies was reduced after treatment but improved over time at a rate similar to changes in oral intake and type of diet.Parallel but not significant changes in oral intake, diet, and tongue strength in the first year post chemoradiation therapy need further study in a larger population.

Over the past 10 years, a number of investigators have noted significant negative effects of chemoradiation on oropharyngeal swallow. Investigators have examined oropharyngeal swallow in patients with head and neck cancer undergoing or having completed external beam irradiation to define swallowing physiology in these populations and thereby to define possible rehabilitation strategies.1–6 These most frequently noted effects have been described as delay in triggering the pharyngeal swallow, reduced laryngeal elevation, and reduced tongue base retraction.7 Xerostomia also has been well-documented in patients treated with radiotherapy with or without chemotherapy.2,8–10 Generally, investigators have studied patients who received individual chemoradiation protocols11,12 or patients with a specific site of disease.13 Few studies have examined differences in oropharyngeal swallow as a result of the site of the patient’s tumor (ie, larynx, hypopharynx, nasopharynx, oropharynx, and unknown primary tumor). Pauloski et al14,15 reported varying rates of patient-reported complaints of dysphagia across sites of disease, with patients with tumors of the oral cavity showing higher pretreatment rates of complaint, whereas patients with pharyngeal tumors showing the highest rates of complaint when posttreatment evaluations were included. Few comparisons have been made of the effects of various chemoradiation protocols on swallow. Newman et al16 compared temporal swallowing measures between intraarterial cisplatin with radiation (RADPLAT) with other protocols of systemic chemoradiation treatment and observed lower rates of aspiration with RADPLAT. This article examines differences in swallowing disorders and swallowing physiology across five sites of disease and across four chemoradiation protocols in a group of 53 patients with head and neck cancer.

Background This study investigated the status of the p53 tumor suppressor gene in patients less than 40 years of age who had squamous cell carcinoma of the tongue develop with no known risk factors. Methods Histologic sections from 21 patients were prepared from formalin-fixed, paraffin-embedded tissue and were processed for standard immunohistochemistry for detection of the p53 protein. In addition, tumors were evaluated by single-strand conformation polymorphism and by DNA sequencing to identify potential mutations in the conserved exons (5–9) of the p53 gene. Results Eighty-one percent (17 of 21) of the patients overexpressed p53 by immunohistochemical analysis. However, none of these patients demonstrated mutations in exons 5–9 of the gene. Conclusions These data suggest that the molecular mechanisms by which the young individuals with no risk factors had altered p53 function in oral squamous cell carcinoma may differ from those of the more typical population of individuals who have this malignancy develop. © 2000 John Wiley & Sons, Inc. Head Neck 22: 328–335, 2000.

Background. No study has examined the nature and extent of swallowing impairment in oral cancer patients following treatment with combined hyperthermia and interstitial radiotherapy. Few studies have examined the effects of voluntary swallow maneuvers (supersupraglottic and Mendelsohn) on pharyngeal phase swallowing in the oral cancer patient treated with surgery or radiotherapy. This study examined the effects of combined radiotherapeutic salvage treatments of hyperthermia and interstitial implantation and swallow recovery using swallow maneuvers in a surgically treated and irradiated oral cancer patient. Methods. The patient under study, a 51-year-old man, underwent radiotherapy, according to Radiation Therapy Oncology Group (RTOG) protocol #8419, consisting of a combination of interstitial irradiation and hyperthermia to the base of tongue, for a recurrent squamous cell cancer. He underwent videofluorographic (VFG) examination of his swallowing, a modified barium swallow at three time points: 2 days following radiotherapy treatment (VFG1), 4 weeks later (VFG2), and 8 months later (VFG3). Temporal and biomechanical analyses of swallows were performed at each time point. Results. Swallow maneuvers and time resulted in improved laryngeal elevation and laryngeal vestibule closure during the swallows on VFG2. Maximum upper esophageal sphincter (UES) opening width and duration were more normal. Fewer swallows were required for bolus clearance through the pharynx. Base of tongue tissue necrosis occurred as a complication of radiotherapy between VFG2 and VFG3, with resultant severe reduction in posterior movement of the tongue base, incomplete tongue base contact to the posterior pharyngeal wall, reduced laryngeal elevation, and incomplete laryngeal vestibule closure during swallowing at VFG3. UES opening became less normal and a greater number of swallows were required for bolus clearance through the pharynx. Conclusions. Combined interstitial irradiation and hyperthermia can cause oropharyngeal swallowing problems. Time and swallow therapy can improve these swallow disorders. Tongue base tissue necrosis can cause further swallow impairment, emphasizing the importance of the tongue base in normal deglutition. Further studies are needed to examine the impact of combined hyperthermia and interstitial implantation for treatment of tongue base tumors on swallow functioning in a larger group of patients. © 1994 John Wiley & Sons, Inc.