Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI

ABSTRACT Objective Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Material and Methods Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks “a souk” and “a geese” were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. Results The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. Conclusion The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.

Tratamiento de la disfagia y la disglosia tras glosectomía total y reconstrucción con colgajo libre fasciocutáneo anterolateral de muslo: a propósito de un caso / Treatment of dysphagia and dysglossia after total glossectomy and reconstruction with anterolateral thigh fasciocutaneous free flap: a case report

La cirugía oncológica en lesiones extensas de carcinoma lingual obliga a realizar resecciones amplias que precisan reconstrucción con colgajo libre periférico. Los colgajos libres permiten un aspecto físico más semejante al normal, pero debido a la especialización de la lengua, no es fácil restituir su funcionalidad. Ello compromete la dinámica deglutoria en la fase oral y de transporte, además de la comunicación hablada. La terapia logopédica convencional precisa una media de 3-12 meses. Presentamos el caso clínico de un varón de 64 años con carcinoma epidermoide lingual estadio IVA (T4aN0M0) al que se le practicó glosectomía total con mandibulectomía marginal sinfisaria, reconstrucción con colgajo fasciocutáneo libre perforante anterolateral del muslo y vaciamiento ganglionar funcional bilateral. Precisó traqueostomía y sonda nasogástrica para alimentación. Valoramos al octavo día posquirúrgico e iniciamos rehabilitación por disfagia orofaríngea mecánica y disglosia precozmente a pie de cama. Los objetivos fueron: favorecer el sello labial, tragar saliva, manejo de secreciones, decanulación, coordinación neumofónica, inteligibilidad, deglución segura y eficaz, prevenir complicaciones y mejorar la calidad de vida. El paciente era capaz de comunicarse con su entorno directo en la sesión quinta y realizar una ingesta oral con dieta blanda y líquidos espesados en la octava sesión, siendo retirada la sonda nasogástrica y derivado a domicilio el día 20 del postoperatorio. Se concluye que la rehabilitación precoz e individualizada dentro de un equipo multidisciplinar es indispensable para restituir la deglución y el habla, mejorando la calidad de vida del paciente. Además, esta modalidad de actuación reduce los costes sociosanitarios (AU)

Oncological surgery in extensive lingual carcinoma lesions requires wide resection and reconstruction with a peripheral free flap. Free flaps can provide a fairly normal physical appearance but, due to the specialization of the tongue, it is not easy to restore its functionality. This compromises the dynamics of swallowing in the oral and transport phase and spoken communication. Conventional speech-language therapy requires an average of 3-12 months. We present the case of a 64-year-old man with lingual epidermoid carcinoma stage IVA (T4aN0M0) who underwent total glossectomy with marginal mandibulectomy of the symphysis, reconstruction with an anterolateral thigh fasciocutaneous free flap, and bilateral functional lymphadenectomy. The patient required tracheostomy and a nasogastric catheter for feeding. We evaluated the patient on the eighth postsurgical day and initiated rehabilitation of mechanical oropharyngeal dysphagia and dysglossia at the bedside. The objectives were to encourage labial seal, swallowing of saliva, handling of secretions, decannulation, breathing and speaking coordination, speech intelligibility, and safe and effective swallowing and to prevent complications and improve quality of life. The patient was able to communicate with his direct surrounding in the fifth session and was able to make an oral ingestion with a soft diet and thickened liquids in the eighth session. The nasogastric catheter was removed and the patient was sent home on the 20th postoperative day. We conclude that early and individualized speech-language therapy within a multidisciplinary team is indispensable to restore swallowing and speech, improving the patient's quality of life. In addition, this kind of intervention reduces social and healthcare costs (AU)

A inteligibilidade de fala nas glossectomias: resultados após a realbilitaçäo fonoaudiológica / The speech intelligibility in glossectomies: result post speech and voice rehabilitation

O tratamento primário do câncer de cavidade oral consta de cirurgia e/ou radioterapia manifestando sequelas de fala e de deglutiçäo em graus variados. O comprometimento da inteligibilidade de fala geralmente está à extensäo da remoçäo da língua, à localizaçäo e aspecto do retalho e à habilidade de movimentaçäo da porçäo remanescente. A proposta deste traalho é avaliar a inteligibilidade de fala após as glossectomias parciais e totais no início e término da reabilitaçäo fonoaudiológica. Foram avaliados 10 pacientes glossectomizados - 6 parciais e 4 totais - após a cirurgia, e destes, 4 pacientes - 2 parciais e 2 totais - foram avaliados pré e pós-terapia. Os pacientes foram submetidos a uma gravaçäo de um protocolo constando de 14 emissöes vogal/consoante/vogal. As emissöes foram editadas aleatoriamente e analisadas por 61 estudantes de Fonoaudiologia. Nas glossectomias parciais, na fase pré-terapia observou-se uma variaçäo entre 15,71 (por cento) e 66,33 (por cento) de emissöes inteligíveis e nas totais entre 25,64 (por cento) e 35,83 (por cento). No término de 2 meses de terapia observou-se uma porcentagem de melhora de 12,17(por cento) e 6,01(por cento) nos dois casos de glossectomias parciais avaliados e de 10,78(por cento) e 22,08(por cento) nos casos de glossectomias totais, sendo que o melhor resultado foi o de uma criança de 10 anos. O trabalho demonstra a efetividade da intervençäo fonoaudiológica na melhora da inteligibilidade de fala de pacientes glossectomizados