Anna Rzewuska

Oral functions such as chewing, swallowing and speech can be disturbed due to a tumor proliferation that affects the tongue, and are substantially impaired after the excision of the tumor. Self-assessment of the aforementioned functions performed by the patients individually and in cooperation with the use of the functional intraoral Glasgow scale (FIGS) revealed that the functions were compromised after the excision of the tumor of higher clinic advancement in elderly patients after the excision of the anterior part of the oral cavity. Improvement of these functions after three, six and twelve months postoperative was slower in tumors with higher clinic advancement after excision with reconstruction.

Wstęp: Cechy osobowości chorych operowanych z powodu nowotworu jamy ustnej kształtują poziom lęku i depresji związanych z deformacją ciała oraz jakość życia w chorobie, a także są związane z czasem przeżycia chorych. Konieczne jest ich uwzględnianie przy planowaniu leczenia oraz rehabilitacji osób chorych. Celem pracy było poznanie związku między właściwościami osobowościowymi a przebiegiem rehabilitacji czynnościowej u chorych leczonych z powodu nowotworu jamy ustnej.Materiały i metody: W badaniu wzięło udział 100 chorych, 42 kobiety i 58 mężczyzn (55,78 ±11,68 lat) operowanych z powodu raka płaskonabłonkowego jamy ustnej. Chorzy uczestniczyli w rehabilitacji funkcji jamy ustnej. Oceniano przebieg gojenia, zniekształcenie pooperacyjne twarzy, sprawność oddychania, połykania i mowy w odniesieniu do „obrazu siebie”, „obrazu ciała” i „poziomu akceptacji choroby” wg Adjective Check List ACL-37, Body Cathexis Scale i Illness Acceptance Scale po upływie 2, 4 i 12 tyg. od zabiegu operacyj...

Excision of a part or the whole of tongue due to oral cancer disturbs swallowing and speech. Lower airways aspiration of the swallowed bolus in patients after such oral structures excision is a symptom of major swallowing disorder and may be the cause of aspiration pneumonia. Restoration of oral nutrition is possible after exclusion or reduction of aspiration threat in the patients. Video fluoroscopic evaluation of the swallowing performed at the beginning of the swallowing rehabilitation in 95 patients after a total or partial glossectomy due to oral cancer, who assessed their saliva swallowing as efficient on the day of examination, showed disturbances of all of the swallowing stages. The most common disturbances involved the oral stage: limited mobility of the oral tongue, impaired glossopalatal seal, and weak glossopharyngeal seal. The most serious among them involved pharyngeal stage of swallowing, as leakage into the larynx and aspiration. The patients used their own methods during barium suspension swallowing to facilitate the swallowing act. They used such methods as: changing the position of the head to the body, additional swallows, engaging the adjacent structures into sealing the oral fissure. We assumed that the compensatory mechanisms (CM) worked out by the patients before the swallowing examination will enable them efficient barium suspension swallowing. The CM were applied by 71 of 95 patients; 51 of the patients used more than one compensatory mechanism. Swallowing in 61 of the compensating patients was at least functional; swallowing in 10 of the compensating patients was non-efficient and caused recurrent aspiration. The results of our research negate the validity of multiple swallows (more than three) without apnea elongation because it may lead to aspiration. Aspiration was also recorded in patients with weak airways closure and immovable epiglottis, who complemented the impaired oral transport with gravitational oral transport by moving chin up during a swallow. The hypothesis that CM applied by the patients after oral cancer excision during saliva swallowing will be helpful in swallowing of the barium suspension was not proved. In 10 of all the patients recurring aspiration was found despite CM application. Determination of aspiration risk is the key to efficient swallowing rehabilitation. The assessment of CM applied spontaneously by the patients' maintenance validity is particularly important. Video fluoroscopic examination of swallowing allows to assess the aforementioned issue and is crucial for better comprehension of CM applied by the patients in creating a new swallowing pattern after oral cancer excision.