Videofluoroscopy and videoendoscopy in evaluation of swallowing function in 31 patients submitted to surgery for advanced buccopharyngeal carcinoma

Swallowing function has been evaluated by means of videofluoroscopy and videoendoscopy in 31 patients submitted to surgery for local extended bucco-pharyngeal carcinoma. Aim was to better predict functional deficits and subsequent recovery perspectives of patients as far as concerns swallowing. In 30 patients, surgery was combined with radiotherapy, pre-operative in 6 cases and post-operative in 24. Site and extension of resection were defined using Urken's classification of hard and soft tissue deficits. In 3 cases, resection included half of tongue base and was followed by direct closure of the surgical defect. In 4 cases, the entire hemitongue (hemibody and hemibase) was resected and repair was performed with a free flap. In 5 cases, the whole tongue base was resected (posterior glossectomy). In 2 of these, direct closure of the gap was performed while the other 3 received a free flap. Another 3 cases required resection of the entire mobile tongue with corresponding buccal floor. All were repaired with free flaps. In 6 cases, resection comprised half the tongue base and adjacent tonsillar fossa and was performed using a transmandibular approach (demolitive in 3 cases, reconstructive in 3). Of these patients, 3 received direct closure and 3 reconstruction with a free flap. In 4 patients, resection included the tonsillar fossa and soft palate while in 5 other patients the whole soft palate was resected in addition to the tonsillar fossa. All these 9 patients received repair with free flaps. The remaining patient underwent resection of the entire oro-hypopharyngeal posterior wall, reconstructed with a free flap. During video-endoscopy examination, both liquid and soft meal ("pudding") were given to patients. Diagnostic parameters studied were: grade of pharyngo-laryngeal sensitivity, latency in onset of pharyngeal swallowing reflux, drop of the bolus in pre-swallowing phase, grade of the pharyngeal residual, inhalation and pooling of saliva. Data collected may be usefully employed not only in predicting the type and grade of swallowing deficit related to the extension of resection and repair technique used, but could also be helpful in the choice of the most appropriate behavioural procedure of rehabilitation for the patient.