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PubMed2002

[Swallowing function after near-total laryngectomy, cricohyoidoepiglottopexy (CHEP), and cricohyoidopexy (CHP)].

We studied postoperative swallowing in 4 patients undergoing CHEP and 1 undergoing CHP. Swallowing was obtained by intense swallowing rehabilitation since only 1/4 of the larynx remained after near-total laryngectomy. Our swallowing rehabilitation program is detailed in this paper. The improvement of swallowing is classified into 3 stages. In stage I, volus directly intrudes into the trachea. In stage II, volus stagnates between laryngeal inlet and tracheal stoma. In stage III, volus directly flows through the esophageal inlet. Stage III indicates that rehabilitation is almost completed. Stage I is shortest at 2 to 14 days and Stage II longest at 7 to 80 days. The MTF (Method, Time, Food) score described by Fujimoto et al was used to analyze swallowing. Three cases following CHEP showed high scores shortly after the introduction of rehabilitation and reached the maximum score at discharge (15 points = normal swallowing). At present, these 3 patients are satisfied with swallowing and enjoy a good quality of life. In 2 other cases (1 CHEP and 1 CHP), both had a wide laryngeal inlet and still have some difficulty with liquids. Further modification of the surgical technique is needed especially for CHP.

Aged↗
PubMed2003

[Evaluation of pharyngeal swallowing elicited by fluid infusion using videoendoscopy in dysphagia patients].

The purpose of this study was to investigate the clinical value of assessing pharyngeal swallowing elicited by fluid infusion. Videoendoscopic examinations were performed in 126 patients with dysphagia, after injecting a fluid infusion into the pharyngeal cavity. Blue dye fluid was instilled into the unilateral vallecula through a catheter that was inserted into the biopsy channel of an endoscope. Pharyngeal swallowing elicited by the fluid infusion was classified according to 5 grades: grade 1, normal pharyngeal swallowing; grade IIa, laryngeal penetration before the triggering of pharyngeal swallowing; grade IIb, pharyngeal residue after swallowing; grade IIa + b; and grade III, no the pharyngeal swallowing. The recovery rates for oral intake using several approaches for dysphagia were 98% in grade I patients and 75% in grade IIb patients. However, the oral intake of food was more difficult in grade IIa, grade IIa + b and grade III patients. These results suggest that the classification of dysphagia based on the triggering and output situation of pharyngeal swallowing may be a useful guideline for demonstrating impaired oral food intake. We conclude that videoendoscopic examination using a fluid infusion is a valuable method for evaluating pharyngeal swallowing minus the influence of bolus transport from oral cavity to the pharynx.

Aged↗
PubMed2006

[Effects of one-way speaking valve placement on swallowing physiology for tracheostomized patients: impact on laryngeal clearance].

Tracheostomy placement affects swallowing function, increasing the risk of aspiration. Recent studies suggest that because of increased risk of swallowing disturbance associated with tracheostomy, one-way speaking valve placement may help to reduce aspiration in tracheostomized patients. We hypothesize that airflow exhaled through the laryngeal cavity using the one-way speaking valve may improve the clearance of residual bolus from the upper airway, thus preventing bolus penetration and aspiration. We studied the effects of one way speaking valve placement on laryngeal clearance and swallowing physiology. Videoendoscopic and videofluoroscopic swallowing were examined in 16 patients with the tracheostomy, and swallowing was compared with and without the one-way speaking valve in place. Valve Valve placement significantly improved laryngeal clearance and the incidence of penetration during swallowing. placement did not, however, significantly affect pharyngeal bolus residue, laryngeal elevation, pharyngeal delay or aspiration. Factors associated with the resumption of oral feedings were sufficient laryngeal elevation during swallow and the prevention of laryngeal penetration and aspiration. We concluded that one-way speaking valve placement improves laryngeal clearance and prevents laryngeal penetration, resulting in better oropharyngeal swallowing physiology and oral feeding.

Adult↗
PubMed1999

The quality of swallowing for patients with operable esophageal carcinoma: a randomized trial comparing surgery with radiotherapy.

BACKGROUND: Surgery is considered the standard treatment for operable esophageal carcinoma, although there is no compelling evidence that surgery can achieve better results than radiotherapy. There has previously been no direct randomized comparison of these two modalities with survival or disease specific outcome end points. METHODS: Ninety-nine patients with operable squamous cell carcinoma of the esophagus were randomly allocated to surgery or radiotherapy after stratification for tumor length (< or = or >5 cm). Those randomized to surgery underwent transthoracic esophagectomy with limited lymphadenectomy, whereas those in the radiotherapy arm received 50 gray in 28 fractions followed by a 15-gray boost to the primary tumor. Disease specific outcome was assessed for 4 subgroups: 1) disease specific symptoms, 2) physical symptoms, 3) ability to work, and 4) social/family interaction and global perception of disease specific outcome. The questionnaire was given prior to treatment and posttreatment at 3-month intervals for 1 year. Death was a secondary end point. RESULTS: There was an overall improvement in the quality of swallowing in both treatment arms after treatment and with the passage of time. The swallowing status was better in the surgery arm than in the radiotherapy arm at 6 months after treatment (P = 0.03, Fisher's exact test). Logistic regression analysis showed randomization arm (P = 0.035), time since treatment (P = 0.003), and pretreatment swallowing status to be significant determinants of posttreatment swallowing status. Surgery was twice as likely to result in improvement in swallowing than radiotherapy after correction for time and pretreatment swallowing status. Overall survival was better in the surgery arm than in the radiotherapy arm (P = 0.002, log rank test) (OR = 2.74 with 95% confidence intervals 1.51-4.98; P < 0.009, Cox proportional hazards model). CONCLUSIONS: Both surgery and radiotherapy can improve the quality of swallowing significantly for patients with operable esophageal carcinoma. Surgery is marginally superior to radiotherapy in improving the quality of swallowing. In this trial, survival in the surgery arm was significantly better than in the radiotherapy arm, although the small number of patients is a limitation.

Carcinoma, Squamous Cell↗
PubMed2000

Evaluation and treatment of swallowing impairments.

Swallowing disorders are common, especially in the elderly, and may cause dehydration, weight loss, aspiration pneumonia and airway obstruction. These disorders may affect the oral preparatory, oral propulsive, pharyngeal and/or esophageal phases of swallowing. Impaired swallowing, or dysphagia, may occur because of a wide variety of structural or functional conditions, including stroke, cancer, neurologic disease and gastroesophageal reflux disease. A thorough history and a careful physical examination are important in the diagnosis and treatment of swallowing disorders. The physical examination should include the neck, mouth, oropharynx and larynx, and a neurologic examination should also be performed. Supplemental studies are usually required. A videofluorographic swallowing study is particularly useful for identifying the pathophysiology of a swallowing disorder and for empirically testing therapeutic and compensatory techniques. Manometry and endoscopy may also be necessary. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitative measures, which may include dietary modification and training in specific swallowing techniques. Surgery is rarely indicated. In patients with severe disorders, it may be necessary to bypass the oral cavity and pharynx entirely and provide enteral or parenteral nutrition.

Age Distribution↗
PubMedDate not supplied

[Swallowing disorders in Parkinson's disease].

Impairment of swallowing is a common symptom in advanced stage of Parkinson's disease and severe defect of this function may cause aspiration pneumonia, problems with food intake and cachexy. The aim of this study was to assess the reflex and oral, pharyngeal, oesophageal phase of swallowing. Eleven patients with Parkinson's disease and 9 healthy subjects were investigated by electromyography (EMG) and oesophageal scintigraphy. The study demonstrates delayed triggering of swallowing reflex (543 +/- 84 ms in patients with PD vs. 230 +/- 66 ms in controls, p < 0.05) and prolongation of laryngeal movement (1880 +/- 140 ms vs. 1349 +/- 154 ms, p < 0.05). The prolongation of the oesophageal phase of swallowing with predilection to retention of water in lower one/third part of esophagus (12.45 +/- 2.45 s vs. 6.45 +/- 1.18 s, p < 0.001) was observed. The dysphagia limit, that is the maximum amount of water swallowed at once, was also evaluated (all normal subjects are able to swallow 20 ml water or more at once). In the studied patients with Parkinson's disease it was 4.5 +/- 0.86 ml. These results evidently and objectively indicate the presence of swallowing disorders in Parkinson's disease. Dysphagia was observed in all studied patients, although only 8 of them complained about it. In other 3 cases the impairment of swallowing was subclinical and it was connected with prolongation of oesophageal phase.

Aged↗
PubMed2002

Digital cineradiographic swallow study: our experience.

PURPOSE: Swallowing disorders can be secondary to different types of diseases in which, at least initially, patients succeed in establishing voluntary or involuntary compensatory mechanisms that enable them to maintain a sufficient nutritional state. When the compensatory mechanisms become insufficient massive food aspiration into the airways can occur and suffocation may prove to be the main pathology. It has been calculated that in the USA about 8,000-10,000 people die each year due to suffocation. The dynamic radiological examination of swallowing is considered important not only for diagnosis, but also for planning a rehabilitation therapy and type of nutrition for the patient and for verifying the results of the therapy. The aim of this study is to analyse the results of our experience in the use of the digital cineradiography system to evaluate patients with normal and pathological swallowing. MATERIALS AND METHODS: We reviewed the digital cineradiography of 220 patients that at no time had undergone surgery and presented no organic pharyngeal or oesophageal disease (excluding hiatus hernia). All the exams followed a standard protocol that included the dynamic evaluation of the larynx, soft palate, pharynx, and gastro-oesophageal junction with a cineradiographic sequence of 12 frames/second with a 512x1024 matrix. There was also an archive of the film in a post-processing console. The patients received single photograms (printed on laserfilm), videotape recordings or CD-ROM of the dynamic exam. RESULTS: 137 (62%) of the patients did not present swallowing alterations although only 7 patients had a negative examination. In 35 cases hiatus hernia was appreciable while in 69 cases the hernia was associated with gastro-oesophageal reflux. In 23 cases aspecific functional disorders of the oesophagus were demonstrated and in 3 cases achalasia. The remaining 83 patients (38%) (37 males and 46 females, average age 57.02 yrs) presented alterations of the oral and/or pharyngeal stages of swallowing: reduction in soft-palate motility (2 cases), unilateral paralysis of the vocal chords (1 case), incontinence of the bolus during the oral stage (8 cases), lingual movement anomalies (4 cases), subepiglottic penetration (62 cases), asymmetric epiglottic tilt, aspiration of the contrast medium in the airway (17 cases), reduction of laryngeal and hyoid bone movement (9 cases), bolus retained in the valleculae and pyriform sinus (13 cases), cricopharyngeal spasm (6 cases), pharyngeal paralysis (1 case); hiatus hernia was also evident in 20 cases and gastro-oesophageal reflux was associated in 13 of them. Overall, 36% of the cases presented an isolated form while 64% of the cases presented a complex dysfunction with several simultaneous alterations. DISCUSSION AND CONCLUSIONS: The videofluorographic swallow study is an important step in the diagnostic evaluation of a dysphagic patient not only as regards the analysis of the main alteration and its capacity to confirm the presence or absence of contrast medium aspiration in the airway, but also because it provides important information on rehabilitation and nutritional orientation (oral/no oral), as well as on the results of the therapy. The recent diffusion of the digital X-ray equipment has made possible its use for the study of the organic and functional diseases of the upper alimentary tract. Currently a standard protocol for the study of swallowing with digital fluorography is not available. The technique we applied, already verified in a significant number of dysphagic patients, has allowed us to distinguish patients with normal swallowing from those with disorders of the oral and pharyngeal stage, and thus to identify disturbance and establish an appropriate rehabilitation treatment.

Adolescent↗
PubMed2003

[The relationship between normal swallowing functions, food ingestion and the lifestyle of users in a day service center].

OBJECTIVES: The physical and mental condition of elderly people changes every day and we hypothesized that this influences food intake and swallowing functions. The present study was undertaken to clarify relationships between daily living conditions and swallowing function. METHODS: The subjects were users (105 males and 219 females) of 6 day-service centers. We performed a survey of IADL (Instrumental Activities of Daily Living), mobility, eating and swallowing behavior, and general health. In addition, we used RSST (Repetitive Saliva Swallowing Test) as a screen for functional dysphasia. RESULTS: Women who had normal food ingestion and swallowing functions were capable of doing shopping, housework and taking care of money independently. Males and females who were capable of moving around from place to place had normal food ingestion and swallowing functions. With regard to daily eating habits and health condition, males and females who had normal food ingestion and swallowing functions were able to consume ordinary food, able to eat without any help, and often laugh. CONCLUSION: It was concluded that a normal swallowing condition in the elderly is related to laughing often, being independent in daily life, moving around and eating ordinary meals without any help.

Activities of Daily Living↗
PubMed2004

Digital cineradiographic study of swallowing in infants with neurologic disease. Our experience.

PURPOSE: The study is aimed at proposing the use of digital cineradiography in the evaluation of swallowing disorders in children affected by severe neurological or developmental disability, in order to correctly identify these conditions and provide therapeutic approaches that could solve their feeding problem, improve their nutritional conditions and decrease the risk of infections. MATERIALS AND METHODS: In the period between March 2001 and July 2003, 12 children (8 males and 4 females), aged between 9 months and 13 years, (average 6.2 years), affected by severe neurological or psychomotor disorders were evaluated with digital cineradiography. This investigation was requested for recurrent pulmonary infections and/or dysphagia with weight loss. All the examinations were performed with radio-controlled equipment provided with a digital C arm. RESULTS: Using the above mentioned technique, in all 12 patients, it was possible to differentiate those with disorders of the oral and/or pharyngeal swallowing phase (9/12) from those without swallowing dysfunction (3/12). In 9/9 patients passage of contrast medium into the upper airways was observed during swallowing: in 2 of them this was limited to the laryngeal vestibule (sub-epiglottic penetration), while in 7/9 cases aspiration of contrast medium into the trachea (5/9) or into the right bronchus (1/9) or into both bronchi (1/9) was recorded. In one patient the aspiration decreased in the sequences acquired with hyperflexion of the head. In 3/9 patients we recorded the transition of contrast medium into the nasopharynx during swallowing caused by incomplete closing of the oropharyngeal isthmus by the soft palate. In 3/9 patients there was incomplete clearing of the pharynx with contrast medium deposition in glosso-epiglottic vallecules and in the pyriform sinuses; only in one case did this stagnation result in post-swallowing aspiration. More than one disorder was found in 5/9 patients, and one only in 4/9. CONCLUSIONS: On the basis of our preliminary data it is possible to conclude that the dynamic swallowing study with digital technique allows a clear-cut evaluation of the swallowing process with minimum discomfort for the patient. On the other hand, the technique exposes to the risk of ionizing radiation; however, in consideration of the important clinical and therapeutic implications and in agreement with the literature, we believe that the importance of the information provided by the technique outweighs the risks linked to radiations.

Adolescent↗
PubMed1989

[Videofluoroscopic studies of the swallowing process in children with cerebral palsy].

The swallowing problems of cerebral palsied children are clinically evaluated by means of subjective criteria. Little research has been done to analyse these problems objectively and scientifically. The aim of this study was to analyse the swallowing patterns of cerebral palsied children in two age groups by means of videofluorography. Ten cerebral palsied children between the ages of four and thirteen years were selected as subjects. During the investigation they were asked to swallow a liquid and certain aspects of the oral preparatory, oral and pharyngeal phases of swallowing were analysed. The results of the study indicated that swallowing problems do occur in cerebral palsied children, mainly during the oral phase, and in some cases take on the form of inadequate contact between the tongue and palate and poor control of the bolus. The group of younger children had more swallowing problems than the older group. In the former group the type of cerebral palsy did not seem to play any role in the swallowing problems which occurred while in the older group there were indications that the type of cerebral palsy could possibly play a role. The results of the study indicate that videofluorography can be implemented effectively to scientifically evaluate the swallowing problems of cerebral palsied children.

Adolescent↗
PubMed1988

Swallowing physiology and pathophysiology.

Many disturbances in oropharyngeal physiology can result in aspiration. Poor tongue movement in chewing or in the oral swallow can cause food to fall into the pharynx and into the open airway before swallowing. A delay in triggering the pharyngeal swallow can result in food falling into the airway during the delay when the airway is open. Reduced peristalsis in the pharynx, whether unilateral or bilateral, will cause residue in the pharynx after the swallow that can fall or be inhaled into the airway. Reduced laryngeal elevation causes food to catch at the top of the airway. This residual food is then easily aspirated during the inhalation after the swallow. Reduced laryngeal closure may result in food penetrating the larynx during the pharyngeal swallow. Cricopharyngeal dysfunction can result in material remaining in the pyriform sinus, with aspiration of material into the airway after the swallow. Aspiration may also occur because food returns or is refluxed from the stomach or esophagus back into the pharynx. Each of these causes of aspiration can occur in a variety of patients, including those with neurologic impairment or structural damage. Each of these causes of aspiration has a different treatment. Thus, accurate and in-depth evaluation of swallowing anatomy and physiology in the oral-pharyngeal region as well as in the esophagus is necessary in successful re-establishment of oral nutrition in the dysphagic patient. Currently, such thorough evaluation requires radiographic graphic techniques, that is, videofluoroscopy and often manometry as well.

Deglutition↗
PubMed1985

Swallowing disorders in persons with cerebrovascular accident.

Thirty-eight CVA patients with swallowing disorders were studied videofluorographically (VFG) to determine: (1) the nature of their swallowing disorders, (2) the relationship between the site of the cerebrovascular accident and the nature of the swallowing disorder(s) exhibited and (3) the frequency and etiology of any aspiration present. The 38 CVA patients exhibited a variety of physiologic disturbances in swallowing, usually occurring in combination rather than as isolated disorders. A delayed swallowing reflex was the most frequent disorder seen in all patient groups. Reduced pharyngeal peristalsis was the next most frequent disorder, followed by reduced tongue control. Only brainstem CVA patients exhibited reduced laryngeal closure. Two patients (no right CVAs) experienced cricopharyngeal dysfunction. Few differences in nature of swallowing disorders were seen according to lesion location. Approximately one third of the patients aspirated, most frequently because of delayed triggering of the swallowing reflex. All aspiration occurred because of disorders in the pharyngeal stage of the swallow, emphasizing the importance of VFG evaluation of dysphagia in CVA patients.

Adult↗
PubMed1985

The effects of swallowing frequency and transdermal scopolamine on esophageal acid clearance.

Fourteen volunteers were studied on two occasions to assess the effect of swallowing frequency on acid clearance time. The experimental protocol consisted of two trials of infusion of 15 ml of 0.1 N HCl into the distal esophagus. One trial required swallowing every 30 s for 10 min. The other trial involved an initial rapid swallowing rate (seven swallows in the 1st min) with a gradual predetermined decline in rate. This procedure was repeated 12 h after application of a transdermal scopolamine patch. Baseline clearance times for rapid and slow swallowing were not significantly different. The anticholinergic drug significantly prolonged the clearance times for both rapid and slow swallowing. Under baseline conditions, sequential swallows (after the first three to four swallows) produced a significant rise in pH until the clearance criterion of pH 4.0 was reached. This effect was abolished with the anticholinergic drug. These results support a two-stage model of acid clearance with initial volume clearance and subsequent salivary buffering of residual intraesophageal acid.

Administration, Topical↗
PubMed1983

Wet swallows stimulate abnormal contractions in patients with oesophageal motility disorders.

The aim of this study was to determine the effect of dry and wet swallows on oesophageal contractions in patients with oesophageal motility disorders (achalasia, diffuse oesophageal spasm and "intermediate" motility disorders). Wet swallows resulted in greater amplitude of oesophageal contractions than did dry swallows, both in patients with oesophageal motility disorders and controls. In patients with oesophageal motility disorders wet swallows were also followed by a greater incidence of repetitive contractions than dry swallows. This increased incidence of abnormal contractions correlated significantly with the increase in oesophageal baseline pressure during wet swallows. The administration of pentagastrin further increased the amplitude and duration of oesophageal contractions in patients with oesophageal motility disorders, but the incidence of abnormal contractions remained unaltered. It is concluded that wet swallows compared to dry swallows pronounce the abnormality of oesophageal contractions in patients with oesophageal motility disorders.

Adult↗
PubMed1994

[Syndrome of delayed maturation of the sucking-swallowing reflex].

BACKGROUND: Neonates with neurological diseases often have difficulty in sucking or swallowing. This report describes such difficulties in a group of infants with normal development, suggesting late maturation of sucking and swallowing. POPULATION AND METHODS: Seven infants (four girls, three boys) had suffered from aspiration since their first day of life (four cases) with severe asphyxia (two cases), late repeated episodes of airway obstruction by accumulated secretions (two cases), and weak isolated sucking and swallowing (one case). The lack of sucking and swallowing or difficulty with them were the main manifestations in these newborns: the face lacked expression and the tongue movements were abnormal with, in two cases, hyper-extension of the neck. A second phase during the first months of life was marked by episodes of bradycardia and/or drowsiness. A third phase during the first years of life was characterized by repeated episodes of respiratory infections, recurrent stridor and accumulation of saliva. These manifestations required prolonged hospitalization (mean: 2.5 months), nasogastric feeding, and in two cases, surgery. The investigations during the acute phases included a cineradiographic study of swallowing, laryngoscopy, monitoring of the distal esophagus pH, a barium swallow, polygraphic recording during sleep and MR imaging of the brain stem. The difficulties in sucking or swallowing disappeared before the age of 6 months (two cases), between 6 and 12 months (one case), between 1 and 5 years (four cases) without any sequelae or speech disorders. CONCLUSION: These transient sucking or swallowing difficulties suggest late maturation of praxis. They required specialized prolonged education after careful, essentially clinical, investigation.

Deglutition Disorders↗
PubMed1994

Rehabilitation of oropharyngeal swallowing disorders.

Patients with oropharyngeal swallowing disorders can be rehabilitated through a program of radiographic assessment to define the patient's anatomic or physiologic swallowing disorder(s), followed by use of carefully selected compensatory and/or therapeutic strategies. Compensatory strategies are designed to eliminate symptoms of swallowing disorders, i.e., aspiration and inefficient swallow, and include postural changes, enhancement of sensory input, changes in food characteristics (viscosity, temperature, taste), modifications in volume and speed of food presentation, and intraoral prosthetics. Therapeutic strategies are designed to change swallow physiology and include range of motion exercises, sensory motor integration procedures and swallow maneuvers. The effects of many of these procedures can be assessed during the radiographic diagnostic procedure, once the patient's oropharyngeal anatomy and swallowing physiology have been defined. In general, swallowing assessment should be completed as soon as the patient is identified as dysphagic, and an appropriate rehabilitation plan initiated.

Deglutition↗
PubMed2000

Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results.

OBJECTIVE: To evaluate the long-term effects on swallowing function of concomitant continuous infusion hydroxyurea and hyperfractionated radiation therapy used to treat advanced head and neck carcinoma. DESIGN: A prospective evaluation of swallowing function was performed on an inception cohort by analyzing posttreatment videoflouroscopic swallow function studies using radiological descriptors for pharyngeal transport abnormalities and temporal measures of structural movements, as well as by conducting patient interviews to assess alimentation, more than 1 year after tumor treatment (range, 52-124 weeks; median, 70 weeks). SETTING: Academic tertiary care referral medical center. PATIENTS: Ten patients, aged 44 to 71 years, with stage III and IV squamous cell carcinoma of the oral cavity, oropharynx, or hypopharynx. MAIN OUTCOME MEASURE: Radiographic and temporal swallow abnormalities, as well as functional status, were documented and compared with published norms and results of earlier swallowing studies when possible. RESULTS: Pharyngeal transport dysfunction and anterior segment abnormalities, manifested by epiglottic dysmotility, vallecular residue, laryngeal penetration, or aspiration, were evident in all 10 patients. Posterior segment abnormalities, such as pharyngeal stasis, constrictor dysmotility and piriform residue were documented in 8 patients. Three patients developed late aspiration, and the majority of patients showed persistent or worsened delay in laryngeal movement compared with their earlier posttreatment evaluations. Also, 3 patients developed a hypopharyngeal stricture, and 6 patients continued to require gastrostomy tube supplementation beyond 1 year. There was no association between site of primary, duration to swallowing evaluation, and severity of dysfunction. CONCLUSION: Prolonged and debilitating functional swallowing abnormalities may occur after this aggressive concomitant chemotherapy and radiotherapy regimen.

Adult↗
PubMed2005

Submandibular gland transfer for prevention of xerostomia after radiation therapy: swallowing outcomes.

OBJECTIVE: To assess swallowing outcomes in patients with oropharyngeal carcinoma in relation to the Seikaly-Jha procedure for submandibular gland transfer (SJP). The SJP has recently been described as beneficial in the prevention of xerostomia induced by radiation therapy in patients with head and neck cancer. DESIGN: Inception cohort. SETTING: University-affiliated primary care center. PATIENTS: A phase 2 clinical trial was conducted from February 1, 1999, through February 28, 2002, to evaluate SJP in patients with head and neck cancer. During that period, a consecutive sample of 51 patients who underwent surgical resection and reconstruction with a radial forearm free flap for oropharyngeal carcinoma were referred for functional assessment of swallowing after completion of adjuvant radiation therapy. At 6 months after surgery, swallowing assessments for 24 patients were available. INTERVENTION: The cohort of 24 patients included 13 who had preservation of 1 submandibular gland (SJP group) and 11 who did not (control group). MAIN OUTCOME MEASURES: Quantitative and qualitative aspects of swallowing were obtained to determine whether patients in the SJP group performed more optimally than those in the control group. RESULTS: Baseline and stimulated salivary flow rates were significantly different between groups. Patients in the SJP group were able to move the bolus through the oral cavity and into the pharynx faster than those in the control group. In addition, patients in the SJP group swallowed less often per bolus than patients in the control group. The complete swallowing sequence was twice as long in controls. CONCLUSIONS: The SJP for submandibular gland transfer appears to be beneficial in promoting more time-efficient swallowing behaviors. This efficiency has implications for the overall well-being and nutritional status of patients with head and neck cancer.

Adult↗