術前治療と手術による口腔癌治療に伴う舌および唾液腺障害について

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Speech intelligibility, salivary gland functions and gustation were examined in 74 patients who received chemo/radiotherapy and surgical excision of oral squarnous carcinoma. The results are surnmarized as follows. 1. Among 52 patients who received glossoectorny, mild, moderate and severe impairment of single sound speech was found in 6, 5 and 2 cases, respectively. Sentence-reading tests revealed more restrictive impairment of speech intelligibility as class 11.(slightly difficult in understanding the spoken content) in 11 cases, class jll (understandable only when the speech content is already known) in 4 cases and class If impairment (hardly understandable) in one case. 2. Speech impairment rarely resulted when the resection was limited to 1/3 of the tongue, and the impairment was greater in cases who received a glossoectorny over that limit. Speech intelligibility was related to tongue mobilit, and conservation of the tongue tip appeared important. 3. Decrease in salivary flow rate (SFR) irreversibly occurred after treatment. SFR in the chemotherapy group decreased to 87% of the original value, and SFR in the cherno/radiotherapy group finally decreased to about 50% of the original. Viscosity increased grandually showing a reverse relation vi di SFR. Secretory IgA in saliva decreased during treatments, but an increase of s-IgA occurred 3 months after treatments. 4. 99mTc uptake of the parotid and subrnandibular glands dec lined. Isotope activity in the submandibular glands decreased to about 70% of the initial value. Isotope elimination rate (IER) of the glands also decreased from an initial 26% to about 10% at one year after 60Co therapy. These results show that scintigraphy and SFR are useful for evaluation of salivary gland damage due to cancer therapies. 5. Original taste thresholds in T1 and T2 cases did not significantly differ from healthy person values, but taste thresholds, especially for sugar were originally high in T3 and T4. Elevation of taste thresholds with chemotherapy was slight, but the chemo/radiotherapy group showed lemarkable threshold elevation. Recovery, to almost original levels, however, took place within a year. It was concluded from these results that taste impairment is temporary, while damage to the salivary glands is perrnanent, and that speech' impairment depends on excised tongue volume. Aggressive induction therapy made conservative surgery possible. Therefore, mini-mizing adverse effects to the salivary glands and tongue is essential for oral cancer treatments.
社団法人日本口腔外科学会の論文

著者

冨田幸伸
高知医科大学医学部歯科口腔外科学教室

術前治療と手術による口腔癌治療に伴う舌および唾液腺障害について

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