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Biomedical subjects

F M McConnel

Publications and source records attributed to F M McConnel.

At least 19 recordsLinked to original sources
PubMed1999

Factors related to dropout in a study of head and neck cancer patients after surgery.

The extent and nature of dropout was assessed in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing function in patients with head and neck cancer. Of 150 patients who were enrolled to be followed up with speech and swallow assessments for 1 year after surgery, 113 (75%) dropped out and 37 (25%) returned to complete the study at the final 12-month evaluation point. In general, those completing the study had a smaller resection than the patients who dropped out before the 12-month evaluation. Fifty percent of the dropout was accounted for by medical reasons, 23% by administrative reasons, and 27% by patient-specific reasons (i.e., reasons known only to the patient). Analysis of the dropout categories revealed that higher cancer stage, larger volume of resection, and having a flap surgical closure versus a primary closure or skin graft increased a patient's chance of dropping out. A larger volume of resection was also related to an increased chance of being a patient-specific dropout. Patients who reported no or low alcohol usage had a greater chance of completing follow-up than being a patient-specific dropout.

Adult↗
PubMed1999

Relating speech and swallow function to dropout in a longitudinal study of head and neck cancer.

The relation between functional outcome and dropout from a 12-month follow-up period was examined in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing in patients with head and neck cancer. In a group of 150 patients recruited to a surgical study in the Cancer Control Science Program in Head and Neck Cancer Rehabilitation, dropout from all causes and dropout from specific causes (medical, patient, and administrative specific) were assessed in relation to longitudinal speech and swallow function. In univariate analysis, better speech articulation was associated with decreased risk of dropout from all causes and from medical-specific causes. Better swallow performance was associated with decreased risk of medical-specific dropout. Multivariate analysis revealed the following: (1) only articulation function was associated with dropout from all causes; (2) the association of speech articulation function with medical dropout was diminished after adjusting for advanced age and surgical resection variables; (3) the association of speech articulation function became significant for patient-specific dropout after adjusting for advanced age and surgical resection variables and indicated that better function decreased the risk of this type of dropout; and (4) swallowing function was not related to dropout. Patients treated for oral or oropharyngeal cancer who have poorer speech outcomes are more likely to drop out from a longitudinal study. Basing study results on only patients who complete a longitudinal study will understate the level of dysfunction experienced.

Adult↗
PubMed1998

Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing.

BACKGROUND: The preservation of speech and swallowing function is the primary goal when reconstructing soft tissue defects in the oral cavity or oropharynx. The type of reconstructive procedure used should be based on outcome data examining speech and swallowing function; yet, there is a paucity of such information. OBJECTIVES: To present the results of a multi-institutional prospective study of speech and swallowing function before and after soft tissue reconstruction of the oral cavity and oropharynx, and to compare 3 methods of reconstruction with respect to speech and swallowing function: primary closure, distal myocutaneous flap, and microvascular free flap. DESIGN: Prospective case-comparison study. SETTING: Four leading head and neck cancer institutions. PATIENTS: The patients were selected from a database of 284 patients treated at the different institutions. The patients were matched for the location of the oral cavity or oropharyngeal defect and the percentage of oral tongue and tongue base resection. Those patients who had previous speech and swallowing deficits and patients in whom postoperative fistulas or wound infections developed were excluded from the study. METHODS: The patients underwent speech and swallowing evaluation preoperatively and 3 months after healing. This evaluation included videofluoroscopic studies of swallowing and tests of speech intelligibility and sentence articulation. Videofluoroscopy provided measures of swallowing efficiency and bolus movement. Liquid and paste consistencies were used in evaluating swallowing function. MAIN OUTCOME MEASURE: The functional results of the reconstruction. RESULTS: Patients who had primary closure were more efficient at swallowing liquids, had less pharyngeal residue, a longer oral transit time with paste, and higher conversational intelligibility than patients who underwent reconstruction with a distal flap. Compared with patients who underwent reconstruction with a free flap, those who had primary closure had more efficient swallowing of liquids, less pharyngeal residue, and shorter pharyngeal delay times with paste. No difference in the speech and swallowing function existed between patients treated with distal myocutaneous flaps and those treated with microvascular free flaps. CONCLUSION: Contrary to the current theory of oral and oropharyngeal reconstruction, we found that the use of primary closure resulted in equal or better function than the use of flap reconstruction in patients with a comparable locus of resection and percentage of oral tongue and tongue base resection.

Deglutition↗
PubMed1998

Proposed catheter standards for pharyngeal manofluorography (videomanometry)

With the recent introduction of commercially available pharyngeal manofluorography systems, catheter design should be standardized. Catheters of different designs can produce different data because of their design characteristics. A standard catheter design should make results between investigators comparable and facilitate acceptable normal values. The authors' combined laboratory experience with many catheter designs was reviewed and the literature consulted. For pharyngeal manofluorography, the proposed standard catheter should be 2 x 4 mm in diameter, ovoid, and 100 cm long. The catheter should be marked in centimeters with an anterior and posterior orientation. There should be a slightly malleable, 3- to 4-cm length without sensors beyond the most distal sensor. Solid state transducer sensors should be three or four in number and placed in the pharyngoesophageal segment, midhypopharynx, and tongue base (esophagus for fourth sensor). Sensor spacing should be 3 cm, except 2 cm between the midhypopharynx and tongue base. Unidirectional, in-line, posteriorly oriented sensors with the option of a single circumferential sensor in the cricopharyngeus are currently preferred over circumferential sensors because of their small diameter (patient comfort).

Adult↗
PubMed1998

Surgical variables affecting speech in treated patients with oral and oropharyngeal cancer.

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.

Adult↗
PubMed1994

Analysis of intrabolus forces in patients with Zenker's diverticulum.

This report presents 10 patients with Zenker's diverticulum who were evaluated with simultaneous solid-state manometry and fluoroscopy. With this method, intrabolus forces are determined. Each patient had abnormal intrabolus forces regardless of the size of the diverticulum and cricopharyngeal muscle dysfunction. In the literature, there has been conflicting manometry results when studying Zenker's diverticulum. The use of analysis of intrabolus forces increases the sensitivity of manometric evaluation. This study establishes pressure abnormality in the pharyngoesophageal segment of patients with Zenker's diverticulum. The pathogenesis of Zenker's is presented based on these findings.

Deglutition↗
PubMed1994

Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: a pilot study.

This study examined the correlation between swallow function at 3 months postoperatively and surgical variables including volume resected, flap volume, ratio of flap volume to volume resected, percentage of oral tongue, tongue base, and anterior and lateral floor of mouth resected, and whether or not the mandible was preserved in 30 surgically treated oral cancer patients. Swallows of measured amounts of liquid and paste (pudding) materials were examined videofluoroscopically. Nine measures of swallow function were completed for each swallow. A factor analysis of all swallow variables was done for liquid and for paste consistencies to determine whether one measure was statistically representative of all swallow measures. This analysis indicated that oral pharyngeal swallow efficiency (OPSE) represented all measures for both liquid and paste consistencies. Then the correlation between OPSE and surgical variables was defined. Only percentage of oral tongue and percentage of tongue base resected were significantly negatively correlated with OPSE. That is, OPSE decreased for both liquid and paste as percentage of oral tongue or percentage of tongue base resected increased. Results are discussed in terms of diet choices and surgical management.

Deglutition↗
PubMed1994

Dysphagia associated with pharyngoesophageal segment dysfunction.

This paper deals with pharyngoesophageal segment dysfunction in swallowing. The mechanisms of normal opening of the PE segment is discussed. Problems in evaluation of the PE segment are presented. Examples of various etiologies of PE segment dysfunction are discussed.

Central Nervous System Diseases↗
PubMed1994

Dysphagia secondary to head and neck cancer surgery.

This paper deals with swallowing abnormalities associated with the resection of cancers of the head and neck. The different sites of resection and the effects on swallowing as documented by modified barium swallow and manofluorography are described. Recommendations are made for the most functional types of reconstruction based upon the experience of the senior author.

Deglutition Disorders↗
PubMed1993

Speech and swallowing function after anterior tongue and floor of mouth resection with distal flap reconstruction.

The purpose of this study was to assess the postoperative functioning of oral cancer patients with resections of the anterior tongue and floor of mouth, reconstructed with distal flap closure. Speech and swallowing performance was assessed for 11 men and 5 women preoperatively and at 1 and 3 months postoperatively following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined using videofluoroscopy. Data were also collected on the number and duration of speech/swallowing treatment sessions, as well as the amount and duration of radiation therapy. Statistical analyses revealed that patients demonstrated a significant and severe impairment in speech and swallow functioning after surgery, with no recovery of function by 3 months post-healing. The degree of impairment in these patients may be related to the adynamic character of the distal flap used for reconstruction. Lack of improvement at the 3-month evaluation may be related to either the timing of postoperative radiation therapy or the low rate (44%) and amount of speech/swallowing treatment provided to these patients.

Adult↗
PubMed1993

Speech and swallow function after tonsil/base of tongue resection with primary closure.

Speech and swallowing function was examined in 11 patients who underwent surgical resection of greater than 1 cm of tongue base, tonsil, and faucial arch with mandible resected on the side of the tumor and reconstruction by primary closure. Preoperatively and 1 and 3 months post-healing, high fidelity audio recordings were made of a 6- to 7-minute conversational speech sample, the sentence version of The Fisher Logemann Test of Articulation Competence was administered, and videofluoroscopic assessment of oropharyngeal swallow was conducted. All subjects exhibited changes in speech and swallowing function postoperatively, with little improvement during the study. Patients exhibited greatest difficulty on stop and fricative consonants and bolus propulsion. Comparison with patients who received anterior tongue and floor of mouth resections and distal flap reconstruction revealed consistently better speech performance by the tonsil/base of tongue patients, although the same phonemes were affected. Swallow function was equally affected in the two groups. Results are discussed in terms of locus of surgical resection, nature of reconstruction, and need for swallowing therapy.

Analysis of Variance↗
PubMed1992

The effects of bolus flow on vertical pharyngeal pressure measurement in the pharyngoesophageal segment: clinical significance.

Measurement of pressures in the pharyngeal esophageal segment (P-E segment) is complicated by the vertical motion and by the rapidly changing pressures in the segment. The sensors move superiorly and inferiorly with respect to the P-E segment during the swallow. This study examines the validity of manofluorographic measurements taken in the P-E segment by using a catheter with sensors spaced at 1 cm intervals. Seven normal volunteers were tested. Measurements were similar using one sensor and using an average of five sensors. During the time of bolus passage, the P-E segment is open and the bolus itself equalizes pressures measured within the bolus.

Deglutition↗
PubMed1991

The effect of asymmetric pharyngoesophageal pressures on manofluorographic measurements.

The fact that pressures in the pharynx are asymmetric has raised questions about the validity of measurements made using manofluorography. Using a special manometric catheter that measures the pressures in four different directions, manofluorography was performed on seven normal volunteers and the measurements in the four directions were compared. When the bolus was not present the measurements were found to be asymmetrical. When the bolus filled the cavity, the measurements were symmetrical. Therefore, manometric measurements made in the pharynx during bolus flow are not invalidated by variations in the orientation of the catheter.

Catheterization↗
PubMed1990

A kinematic study of the oropharyngeal swallowing of a liquid.

Swallowing can become a problem for people with advanced age or laryngeal cancer, especially after surgical resection. The purpose of this study was to quantify the mechanical transport of the bolus through the throat by simultaneously comparing the instantaneous position and velocity of the bolus to the generation of pressure at different sites in the oropharyngeal cavity. Swallows of barium liquid were analyzed using Manofluorography, which simultaneously recorded pressure and barium position through a split screen display. Frame-by-frame analysis was used to describe bolus motion. The graph of head and tail movement showed an hourglass shape with an initial slow, then rapid movement of the bolus head. The peak bolus head velocity averaged 47 cm/s and the maximum acceleration was 460 cm/s2. Comparison of pressure traces with the kinematic curves revealed the relative timings of tongue movement, negative suction pressure from the pharyngoesophageal segment and the contraction wave. The magnitude of the gravity and resistance forces were estimated and relative strengths compared. The pharynx can be viewed as a dynamic conduit with changing diameters. The tongue driving force initially drove the bolus. Laryngeal elevation and the pharyngoesophageal segment developed a prebolus negative suction pressure ahead of the bolus. For vertical swallowing of the barium liquid, gravity played the dominant role in head transport. Contraction of the pharyngeal walls served to clear the tail of the bolus from the pharynx. These results aid in the understanding of the physiology of normal swallowing and provide quantitative data for the evaluation of oropharyngeal reconstruction.

Biomechanical Phenomena↗
PubMed1989

Quantitative assessment of pharyngeal bolus driving forces.

This study analyzes the differences between wet and dry swallows; a manofluorogram is used to determine forces that affect pharyngeal bolus flow. By defining bolus pressures, many of the limitations of pharyngeal manometry are surmounted. This makes manometry a more useful clinical tool. The study results indicate that only a small portion of pharyngeal-generated pressure is directly applied to the bolus. The manofluorogram demonstrates that bolus transit relies on the synergistic action of two pumps--the oropharyngeal propulsion pump and the hypopharyngeal suction pump. A technique is illustrated for quantifying the forces that affect bolus flow. Quantification of force can differentiate abnormal forces responsible for lingual, pharyngeal, and hypopharyngeal pathology in dysphagic patients. The degrees of impairment can be measured.

Adult↗
PubMed1988

Timing of major events of pharyngeal swallowing.

Normal swallowing depends on the synergistic motion of the tongue, larynx, and pharyngeal wall to develop a bolus pressure gradient for bolus transit. However, few studies have provided timing relationships for clinical evaluations. To examine the timing relationships of pharyngeal anatomic motion, pressure generation, and bolus transit in the normal swallow, this study uses a new method, manofluorography, to correlate these swallowing aspects. Thirty-one events were timed by analyzing five swallows each in 14 normal subjects. A different perspective of pharyngeal physiology is presented.

Deglutition↗
PubMed1988

Manofluorography of deglutition after total laryngopharyngectomy.

Manofluorography is a new technique for the evaluation of swallowing that provides simultaneous display of manometry and videofluoroscopy on one video screen. Data are presented from a study of deglutition in 10 patients who had prior total laryngopharyngectomy with replacement by either jejunal graft or gastric pull-up. Factors that enhance bolus passage are the presence of a widely patent graft and an intact swallowing reflex. Factors that impair bolus transit include stricture, jejunal peristalsis, impaired lingual coordination, and stenosis at the anastomotic site. The swallowing patterns of these patients serve as models of the open and closed cavity swallow and illustrate principles of manofluorographic interpretation.

Anastomosis, Surgical↗