PubMed Health⌕ Search

Biomedical subjects

J A Logemann

Publications and source records attributed to J A Logemann.

139 records · Page 8Linked to original sources
PubMedDate not supplied

T stage and functional outcome in oral and oropharyngeal cancer patients.

BACKGROUND: The locus and extent of resection and the type of reconstruction used in surgery are important joint determinants of functional outcome in oral and oropharyngeal cancer patients. However, prediction of functional outcome from broader factors such as clinical T stage and approximate locus of resection is important for the preoperative period when the extent of resection and the exact surgical reconstruction to be used may not be decided and preoperative counseling about potential functional outcomes is needed. METHODS: Oropharyngeal swallow efficiency (OPSE) and conversational speech understandability (CU) were measured preoperatively and 3 months posthealing in 68 patients. Analysis of variance (ANOVA) was used to determine whether clinical T stage and planned surgical locus were significantly related to these two functional measures, and discriminant analysis was used on the data obtained at 3 months to determine how well CU and liquid OPSE jointly relate to the T stages. RESULTS: In patients with a planned oral tongue locus of resection, significant differences were found at 3 months posthealing on both CU and liquid OPSE between stages T1 -T2 and T3 and between T1-T2 and T4. In patients with a planned oropharynx locus of resection, significant differences were found only on CU at 3 months. These occurred between T1-T2 and T4 and between T3 and T4. Discriminant analysis classified into the correct T stages 70% of T1-T2 and 75% of T4 stage patients, but only 28% of T3 stage patients. However, the T3-stage patients who were misclassified as T4 had significantly larger mean percent of oral tongue resected than those T3 stage patients who were misclassified as T1-T2. CONCLUSIONS: These results are useful for the preoperative counseling of patients with clinical T stages 1-2 and 4. The relationship between T stage and postsurgical function found here is stronger than reported by previous authors, but is still very general.

Adult↗
PubMedDate not supplied

Recovery of postoperative swallowing in patients undergoing partial laryngectomy.

This study assessed the achievement of postoperative swallowing in patients undergoing partial laryngectomy surgery. Oropharyngeal swallow efficiency was used to predict time to achievement of outcome. Fifty-five patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a videofluoroscopic evaluation enabled the measurement of swallowing efficiency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial curves. Patients with hemilaryngectomies achieved swallowing rehabilitation sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did patients undergoing supraglottic laryngectomies with tongue base resection (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. Higher early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, functional swallowing and eating may be achieved within 3 months of surgery while for other types, significant impairment remains up to 9 months postoperatively Early radiographic assessments of swallowing function are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved oral intake before radiotherapy is started.

Cineradiography↗
PubMedDate not supplied

Effects of maneuvers on swallowing function in a dysphagic oral cancer patient.

This study examined the effects of three swallow maneuvers: (1) the supraglottic swallow (voluntary closure of the vocal folds prior to the swallow); (2) the super-supraglottic swallow (airway closure at the level of the arytenoid to base of epiglottis); and (3) the Mendelsohn maneuver (voluntary prolongation of laryngeal elevation and cricopharyngeal opening during swallow) on swallow functioning in a 47-year-old patient who underwent right composite resection for a squamous cell carcinoma of the right retromolar trigone. All maneuvers were employed during the same videofluorographic (VFG) swallow study conducted 6 months after the patient's surgery. Biomechanical analysis of 3-mL swallows defined the extent and timing of tongue base retraction to the posterior pharyngeal wall, laryngeal elevation, laryngeal closure and cricopharyngeal opening during swallows with and without maneuvers. Airway closure duration was prolonged during supraglottic and super-supraglottic swallows, but aspiration was not eliminated. Use of the Mendelsohn maneuver improved coordination and timing of pharyngeal swallow events, including timing of posterior movement of the tongue base to the pharyngeal wall in relation to airway closure and cricopharyngeal opening, with elimination of aspiration. The Mendelsohn maneuver compensated for anatomic and physiologic changes in the oropharyngeal swallow and enabled reinstatement of safe oral intake in this surgically treated head and neck cancer patient who was previously unable to take nutrition orally.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Swallow recovery in an oral cancer patient following surgery, radiotherapy, and hyperthermia.

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.

Brachytherapy↗
PubMedDate not supplied

Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up.

BACKGROUND: The purpose of this study was to determine whether the speech and swallowing function of surgically treated oral cancer patients improves between 1 month and 1 year after surgery. METHODS: Speech and swallowing performances were assessed for 28 men and 10 women preoperatively and at 1, 3, 6, and 12 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 therapy sessions, as well as the amount and duration of radiotherapy. RESULTS: Statistical analyses revealed that the speech and swallowing function of surgically treated oral and oropharyngeal cancer patients did not improve progressively between 1 and 12 months postsurgery; the level of functioning that these patients demonstrated at the 1- and 3-month posthealing evaluations was characteristic of their status at 1 year after surgery. CONCLUSION: The lack of improvement between 1 and 12 months postsurgery may be related to the relatively small amount of therapy that these patients received during that period. Several outcome variables worsened significantly at the 6-month evaluation; the reversal of function at the 6-month evaluation point could be the effect of postoperative radiotherapy, because irradiated and nonirradiated patients differed in their pattern of recovery on oropharyngeal swallow efficiency and several speech variables.

Analysis of Variance↗
PubMedDate not supplied

Timing of glottic closure during normal swallow.

BACKGROUND: The purpose of this study was to determine the temporal characteristics and patterns of glottic closure during normal swallow using concurrent videofluoroscopy and videoendoscopy. METHODS: Three swallows each of four bolus types were examined in eight healthy volunteers with the endoscope in two positions: at the level of the uvula and at the laryngeal vestibule. Data analysis compared: (1) temporal relationships between laryngeal behaviors and oropharyngeal swallow events and (2) airway conditions at the time of key oropharyngeal events. RESULTS: Although arytenoid adduction and subsequent arytenoid contact occurred as one of the initial events during swallow, the timing of these events was highly variable. On the other hand, true vocal cord (TVC) closure occurred mainly after the onset of laryngeal elevation, and it was affected by bolus volume. CONCLUSIONS: In normal swallow, arytenoid closure did not always mean complete TVC closure, and complete TVC closure might be accomplished during the process of laryngeal elevation and arytenoid tilting.

Analysis of Variance↗
PubMedDate not supplied

Examination of swallowing after total laryngectomy using manofluorography.

Investigation of postlaryngectomy dysphagia is usually limited to the standard barium swallow. Manofluorography (mano, manometry; fluoro, videofluoroscopy; graphy, picture) is a new technique that permits analysis of simultaneous manometry and videofluoroscopy of deglutition. Manofluorography provides more detailed analysis of the swallowing dynamics during the pharyngeal stage of deglutition than either barium studies or manometry used alone. This study uses manofluorography to examine swallowing in two patient groups, total laryngectomees and total laryngectomees with tongue impairment, to analyze the role of various anatomic components in the swallowing process. Pharyngeal transit times were prolonged in both patient groups studied, with the tongue impairment group exhibiting the longest times. The postlaryngectomy pharynx offered greater resistance to bolus flow. The laryngectomy patients compensated by using increased lingual propulsion, whereas the patients with tongue impairment and total laryngectomy could not. This emphasizes the importance of the tongue in bolus propulsion in the pharynx. Other postoperative changes in swallowing are discussed.

Deglutition Disorders↗
PubMedDate not supplied

Manofluorography of deglutition after supraglottic laryngectomy.

Manofluorography (mano: manometry, fluoro: videofluoroscopy, graphy: picture) provides a simultaneous display of manometry and fluoroscopy on one video screen. This study uses manofluorography to analyze the swallowing patterns of nine patients who had undergone supraglottic laryngectomy. The results show that during swallowing the pharyngeal mechanism for preventing aspiration depends upon three processes: (1) tight lingual-laryngeal contact, (2) coordination of the swallowing reflex, and (3) tongue base and pharyngeal constrictor clearing of the hypopharynx and laryngeal inlet. Anterior suspension of the larynx under the tongue base serves to improve lingual-laryngeal contact. This close contact during deglutition protects the airway from the bolus and also opens the postcricoid region, aiding bolus passage into the esophagus. Impairment of the swallowing reflex, which can cause severe aspiration before the swallowing reflex is triggered, can be rehabilitated by swallowing therapy. Minor aspiration is commonly caused by impaired clearing of the superior hypopharynx after supraglottic laryngectomy.

Deglutition Disorders↗
PubMedDate not supplied

Normal swallowing physiology as viewed by videofluoroscopy and videoendoscopy.

This study examines normal oropharyngeal swallow physiology in 8 young adult males with concurrent videofluoroscopy and videoendoscopy. Twelve swallows were examined for each subject, 3 swallows each of 1 and 5 ml of thin liquid at each of two endoscopic positions: (1) the tip of the endoscope just at or below the tip of the uvula (high position), and (2) the tip of the endoscope just below the tip of the epiglottis (low position). Results indicate that if the clinician is interested in laryngeal events occurring before and after swallow, videoendoscopy with the endoscope in the low position is the procedure of choice. To evaluate pharyngeal anatomy and/or the presence of food in the pharynx before or after swallow, either endoscopy with the endoscope in the high position or videofluoroscopy can be used. However, if the clinician is interested in pharyngeal physiology during swallow, videofluoroscopy is a better diagnostic procedure.

Adult↗
PubMedDate not supplied

Behavioral management for oropharyngeal dysphagia.

Behavioral management of oropharyngeal swallowing disorders includes the introduction of compensatory strategies and direct therapy techniques. Compensatory strategies include postural changes, sensory enhancements, changing feeding strategies, diet changes and intraoral prosthetics. Therapy procedures include exercise programs and swallowing maneuvers. This article describes the various behavioral therapy procedures and presents their physiologic rationales and advantages and disadvantages and suggests ways to measure their effectiveness.

Behavior Therapy↗
PubMedDate not supplied

The potential future of dysphagia: population-specific diagnosis and treatment.

Care of patients with dysphagia includes screening, diagnosis, treatment and management. This article examines the increasing evidence that to be most effective each of these aspects of patient care must be tailored to the patient's medical diagnosis, specific swallowing disorders and stage of recovery or degeneration. The need to define the optimal window of intervention for each patient type is also discussed. Future research needs are emphasized.

Deglutition Disorders↗
PubMedDate not supplied

Aspiration in head and neck surgical patients.

Aspiration, the entry of material into the airway below the true vocal folds, has been reported in various types of postsurgical head and neck patients. This study was designed to examine radiographically a group of 30 head and neck surgical patients with postoperative swallowing difficulties and to identify the relationship between the physiologic causes of aspiration in each patient and the surgical procedure. The modified barium swallow technique is needed to identify the nature of aspiration in these patients. Aspiration before, during, and after the swallow was caused by a variety of problems including reduced tongue control, delayed triggering of the swallowing reflex, reduced glottic closure, reduced laryngeal elevation, and reduced pharyngeal peristalsis. Eight patients exhibited two causes of aspiration. No one food consistency caused greater aspiration in all patients. The best and worst food consistencies varied with the cause of aspiration.

Adult↗