頭頸部癌患者における嚥下機能について
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概要
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Head and neck cancer patients often exhibit swallowing disturbance after treatment, which is a major cause of morbidity and reduced quality of life. Thus, the posttreatment swallowing function should be appropriately evaluated in head and neck cancer patients. We first of all present herein the results of postsurgical swallowing function using a combination of videofluorography (VF) and manometry in 14 patients with head and neck cancer, consisting of 8 oral cavity cancer patients, 4 oropharyngeal cancer patients, and 2 hypopharyngeal cancer patients. Oropharyngeal swallowing pressure after partial resection of the mandible without reconstruction of the bony segment defect decreased compared with the normal control. VF and manometric examination revealed that partial resection of the mandible without reconstruction of the bony segment defect had a negative effect upon swallowing function. The oropharyngeal swallowing pressure markedly decreased in patients with oropharyngeal cancer after surgery, and no significant differences were observed in the hypopharyngeal swallowing pressure between oropharyngeal cancer patients and normal control. The tongue base should be reconstructed to compensate for decreased oropharyngeal swallowing pressure. Although hypopharyngeal cancer patients who underwent partial resection of the hypopharynx showed a marked decrease in their hypopharyngeal swallowing pressure, they could take food orally 6 months after treatment. Partial pharyngectomy with preservation of the larynx is a good procedure for selected patients. In addition, we discuss swallowing function after concurrent chemoradiotherapy (CCRT). Although swallowing disturbance was observed in about 40% of the patients treated with CCRT, dysphagia in these patients was minimal and could be managed with rehabilitation and dietary intake modification. Existing disease, such as cerebral infarction and respiratory dysfunction, tended to result in posttreatment swallowing disturbance after CCRT. Swallowing function after larynx-preserving reconstruction in elderly patients is also reviewed. Microsurgical reconstruction of pharyngeal and oral defects was thought to be a safe procedure even in patients over 80 years of age with performance status 0 or 1.