Fatores associados à indicação de via alternativa de alimentação após câncer de língua: uma revisão sistemática / Factors associated with the indication of alternative feeding following tongue cancer: a systematic review / Factores asociados a la indicacíon de via alternativa de nutrición después del cáncer de lengua: una revisión sistemática

Introdução: O câncer de cavidade oral constitui lesões da superfície da mucosa oral, e, devido às sequelas da doença e de seu tratamento, frequentemente ocorrem quadros de disfagia. Quando a alimentação por via oral se torna impossibilitada, é fundamental a indicação de vias alternativas de alimentação. Objetivo: verificar a ocorrência e os fatores associados ao uso de via alternativa de alimentação após câncer de língua. Método: A busca foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE e BIREME sem restrição de idioma e localização, no período de 2010 a 2021. Para complementar e evitar viés de risco foi realizada uma busca por literatura cinza no Google Scholar. Critérios de Seleção: A revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foram incluídos na pesquisa estudos que obtiveram pontuação ≥ a 6 pontos segundo o protocolo para pontuação qualitativa proposto por Pithon. Resultados: Os estudos mostram que a maioria dos indivíduos com câncer oral desenvolvem uma perda significativa de peso, necessitando de intervenção. O estágio geral da doença é um preditor significativo de perda de peso crítica em pacientes em tratamento. Conclusão: A indicação de via alternativa de alimentação após câncer de língua foi de 19,3% a 68,2%, e os fatores associados a essa indicação de VAA foram o estágio geral, cirurgia associada à terapia adjuvante, má adesão ao tratamento multidisciplinar, presença de complicações e baixa sobrevida. (AU)

Introduction: Oral cavity cancer constitutes lesions on the surface of the oral mucosa and, due to the consequences of the disease and its treatment, dysphagia often occurs. When oral feeding becomes impossible, it is essential to indicate alternative feeding routes. Objective: to verify the occurrence and factors associated with the use of an alternative feeding route after tongue cancer. Method: The search was conducted by two independent researchers in the Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE and BIREME databases without language and location restrictions, from 2010 to 2021. To complement and to avoid risk bias, a search for gray literature on Google Scholar was performed. Selection Criteria: The systematic review was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies that scored ≥ 6 points according to the protocol for qualitative scoring proposed by Pithon. Results: Studies show that most individuals with oral cancer develop significant weight loss, requiring intervention. The overall stage of the disease is a significant predictor of critical weight loss in patients undergoing treatment. Conclusion: The indication of an alternative feeding route after tongue cancer was 19.3% to 68.2%, and the factors associated with this indication of AAV were the general stage, surgery associated with adjuvant therapy, poor adherence to multidisciplinary treatment, presence of complications and poor survival. (AU)

Introducción: El cáncer de cavidad oral constituye lesiones en la superficie de la mucosa oral y, debido a las consecuencias de la enfermedad y su tratamiento, es frecuente que se presente disfagia. Cuando la alimentación oral se hace imposible, es imprescindible la indicación de vías alternativas de alimentación. Objetivo: verificar la ocurrencia y los factores asociados al uso de una vía alternativa de alimentación después del cáncer de lengua. Método: La búsqueda fue realizada por dos investigadores independientes en las bases de datos Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE y BIREME, sin restricciones de idioma y ubicación, de 2010 a 2021. Para complementar y Evitar riesgo de sesgo, se realizó una búsqueda de literatura gris en Google Scholar. Criterios de selección: La revisión sistemática se llevó a cabo de acuerdo con las recomendaciones de Elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Los estudios que puntuaron ≥ 6 puntos según el protocolo de puntuación cualitativa propuesto por Pithon et al. (2015). Resultados: Los estudios muestran que la mayoría de las personas con cáncer oral desarrollan una pérdida de peso significativa, lo que requiere intervención. El estadio general de la enfermedad es un predictor significativo de pérdida de peso crítica en pacientes que reciben tratamiento. Conclusión: La indicación de vía alternativa de alimentación tras cáncer de lengua varió del 19,3% al 68,2%, y los factores asociados a esta indicación de AAV fueron el estadio general, cirugía asociada a terapia adyuvante, mala adherencia al tratamiento multidisciplinario, presencia de complicaciones y baja supervivencia. (AU)

Speech disorders in patients with Tongue squamous cell carcinoma: A longitudinal observational study based on a questionnaire and acoustic analysis.

BACKGROUND: Speech disorders are common dysfunctions in patients with tongue squamous cell carcinoma (TSCC) that can diminish their quality of life. There are few studies with multidimensional and longitudinal assessments of speech function in TSCC patients. METHODS: This longitudinal observational study was conducted at the Hospital of Stomatology, Sun Yat-sen University, China, from January 2018 to March 2021. A cohort of 92 patients (53 males, age range: 24-77 years) diagnosed with TSCC participated in this study. Speech function was assessed from preoperatively to one year postoperatively using the Speech Handicap Index questionnaire and acoustic parameters. The risk factors for postoperative speech disorder were analyzed by a linear mixed-effects model. A t test or Mann‒Whitney U test was applied to analyze the differences in acoustic parameters under the influence of risk factors to determine the pathophysiological mechanisms of speech disorders in patients with TSCC. RESULTS: The incidence of preoperative speech disorders was 58.7%, which increased up to 91.4% after surgery. Higher T stage (P＜0.001) and larger range of tongue resection (P = 0.002) were risk factors for postoperative speech disorders. Among the acoustic parameters, F2/i/decreased remarkably with higher T stage (P = 0.021) and larger range of tongue resection (P = 0.009), indicating restricted tongue movement in the anterior-posterior direction. The acoustic parameters analysis during the follow-up period showed that F1 and F2 were not significantly different of the patients with subtotal or total glossectomy over time. CONCLUSIONS: Speech disorders in TSCC patients is common and persistent. Less residual tongue volume led to worse speech-related QoL, indicating that surgically restoring the length of the tongue and strengthening tongue extension postoperatively may be important.

A Novel Risk Model for Predicting Dysphagia after Tongue Reconstruction: A Retrospective Multicenter Study in Japan.

BACKGROUND: There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction. METHODS: This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence. RESULTS: Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15. CONCLUSION: The authors' risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

A Comparison Study of Outcomes and Complications Between Marginal Mandibulectomy With or Without Additional Mandibulotomy in Tongue Cancers.

BACKGROUND: Marginal mandibulectomy with or without additional mandibulotomy could represent the alternatives to avoid segmental mandibulectomy in carefully selected tongue cancers. AIM AND OBJECTIVES: This study investigated a subgroup of tongue cancers with suspected involvement to the alveolar bone because of the shallow and deformed mouth floor. We aimed to compare the functional outcomes, postoperative complications, and disease control efficacy between the 2 different marginal mandibulectomy approaches, with or without additional mandibulotomy. MATERIALS AND METHODS: A retrospective study of 29 marginal mandibulectomies and 26 combined mandibulotomies for tongue cancer wide excisions and flap reconstruction at Chang Gung Memorial Hospital Linkou Branch during 2014 to 2019 was performed. RESULTS: The combined mandibulotomy group had more advanced T-status ( P < 0.001) and greater tumor diameters ( P < 0.001) but not increased preexisting trismus, bone invasions, or positive margins. The additional mandibulotomy increased flap necrosis ( P = 0.044), late infections ( P = 0.004), and tongue movement limitations ( P = 0.044) but not osteoradionecrosis. Osteoradionecrosis was unrelated to the resected mandibular length or the mandibulotomy sites. Feeding tube dependence was greater in the combined group at discharge ( P = 0.014), but no long-term differences were noted. Kaplan-Meier overall survival ( P = 0.052) and disease-free survival ( P = 0.670) were both comparable between the 2 groups. CONCLUSIONS: The combined procedure of mandibulotomy and marginal mandibulectomy in large tongue cancers without bone invasions is associated with increased soft tissue-related complications but not bone-related complications. However, comparable disease control, survival, and long-term tube feeding outcomes were noted.

Perioperative Management of a Patient With Tongue Cancer Who Developed Pneumomediastinum Following Tracheostomy Performed to Secure the Airway.

Prior to a scheduled operation for a 45-year-old male patient with tongue cancer, a tracheotomy performed under intravenous sedation to prevent asphyxia due to extensive bleeding resulted in pneumomediastinum and subcutaneous emphysema. The planned operations were postponed until reduction of the pneumomediastinum was confirmed. During operation, airway pressure was kept low to prevent tension pneumomediastinum along with a sufficient depth of anesthesia, controlled analgesia, and continuous administration of muscle relaxants. Postoperatively, sedation was used to avoid stress and complications with the vascular anastomosis site. In this case, air leakage into the soft tissues was one of the possible causes of the event associated with increased airway pressure. Although the incidence of such complications is relatively low, caution should be exercised after tracheostomy.

Dental health in patients with and without HPV-positive oropharyngeal and tongue cancer.

BACKGROUND: Human papilloma virus is associated with oral and oropharyngeal cancer. Our aim was to examine oral health in patients with oropharyngeal (OPSCC) and oral tongue cancer (OTSCC), expecting better oral health among OPSCC patients. MATERIAL AND METHODS: Fifty-five OPSCC patients with known HPV status and 59 OTSCC patients were randomly selected from a list of consecutive patients of the Helsinki University Hospital, Finland. Oral health was assessed from panoramic jaw radiographs. Total Dental Index (TDI) summarizing the dental health status was calculated and Finnish population study data were used for comparison. Descriptive statistics were used for analyses. RESULTS: Patients with HPV-positive OPSCC had higher periapical lesion index compared with HPV-negative OPSCC patients or with OTSCC patients. Residual roots were more common among OPSCC patients compared with OTSCC patients, because of their higher occurrence among HPV-negative OPSCC patients compared with OTSCC patients. Similarly, modified TDI score was significantly higher among OPSCC patients than among OTSCC patients, because of higher TDI score among HPV-negative OPSCC patients compared with OTSCC patients. OPSCC patients more often used a removable prosthesis than OTSCC patients. Dental health of the cancer patients was poorer when compared with the population data. CONCLUSIONS: Our study hypothesis was only partly confirmed. Periapical lesions were more prevalent among HPV-positive OPSCC patients, compared with the other groups. The number of residual roots was higher among HPV-negative subgroup. Thus, OPSCC patients had worse oral health parameters than OTSCC patients.

Recovery pattern analysis of swallowing function in patients undergoing total glossectomy and hemiglossectomy.

OBJECTIVES: To investigate the recovery process of swallowing function and ascertain swallowing pattern in patients undergoing total glossectomy (TG). MATERIALS AND METHODS: A cohort study was conducted in consecutive patients with tongue squamous cell carcinoma who received TG/hemiglossectomy (HG) from May 2017 to December 2019. Exposure factors included tongue resection range (HG and TG) and postoperative radiotherapy (PRT and non-PRT). The swallowing functions were evaluated by M.D. Anderson dysphagia inventory (MDADI), water swallow test (WST), and tongue pressure (TP) at pretreatment, 1, 4, 7, 12, 18 and 24 months postoperatively. Videofluoroscopy swallowing study (VFSS) was applied to analyze swallowing pattern of TG patients. RESULTS: A total of 67 patients were enrolled, of which 17 underwent TG and 50 underwent HG. Both MDADI and TP of the TG and PRT group were lower than those of the HG and non-PRT group. TG patients had no evident improvement in MDADI and TP after surgery. There was a higher risk of swallowing unsafety with abnormal WST outcome in TG (P < 0.001, OR = 106.52) than that in HG. VFSS analysis identified prolonged oral and pharyngeal transit time, disorganized swallowing sequence, abnormal hyoid bone movement, and frequent invalid swallows in patients with TG. A shortened OTT (<5066.50 ms) and a larger pharyngeal constriction ratio (PCR > 0.31) were associated with increased risks of penetration and aspiration. CONCLUSION: Postoperative swallowing pattern is a characteristic of severely impaired safety and efficacy in patients with TG. Impaired OTT and PCR are variables that should be examined when determining the need for rehabilitation treatment.

Quality of life in tongue cancer treated patients before and after speech therapy: a randomized clinical trial.

INTRODUCTION: Tongue cancer is one of the most common subtypes of head and neck cancer. The aggressive effects of treatment cause aesthetic, psychosocial and functional deficits, especially dysphagia, which affects patient quality of life. Rehabilitation, which is essential for functional maximum recovery, helps patients deal with new and altered structures and has a positive impact on quality of life. OBJECTIVE: To verify the impact of speech therapy on swallowing quality of life in tongue cancer patients after treatment. METHODS: This parallel randomized clinical trial was conducted at a public hospital in Porto Alegre, RS, Brazil. Before and after the intervention, a quality of life questionnaire (the Deglutition Handicap Index) was employed, dysphagia severity was assessed with fiberoptic endoscopic evaluation of swallowing, and the Functional Oral Intake Scale carried out. The experimental group underwent four-week sessions of speech therapy over one month, while the control group received the institution's usual follow-up. RESULTS: Thirty individuals treated for tongue cancer were divided into a study and a control group. Deglutition Handicap Index scores decreased significantly (approximately 40 points) (p < 0.001) after the intervention in the study group. There was a significant correlation between improved quality of life, reduced dysphagia severity and increased in Functional Oral Intake Scale scores (p < 0.001). CONCLUSION: After speech therapy, quality of life scores related to deglutition and dysphagia severity improved in patients treated for tongue cancer.

Locally advanced tongue squamous cell carcinoma in epidermolysis simplex bullosa patient: a therapeutic conundrum.

Epidermolysis bullosa simplex (EBS) is a debilitating condition affecting the skin and mucous membranes that is characterised by frequent ulceration and blistering on trivial trauma. In EBS, oral cavity mucosal injuries lead to a high propensity for developing squamous cell carcinomas. Locally advanced tongue carcinoma arising in this background presents a challenging therapeutic conundrum. To our knowledge, this is the first case of aggressive locally advanced tongue carcinoma that has developed sporadically in a patient with EBS and no family history. Routine screening of oral mucosal lesions will lead to early detection and timely management of this debilitating condition.

Congenital tongue base lipoblastoma causing neonatal airway compromise.

Lipoblastomas are benign tumours of immature fat cells presenting in infancy. A lipoblastoma within the airway lumen causing airway compromise is an extremely rare occurrence. We present a 6 hours of life girl who had airway compromise due to a lobulated mass at the base of the tongue. The mass was excised after emergency endotracheal intubation.

Intraoral midline mandibulotomy to improve access for transoral robotic surgery (TORS) base of tongue resection in a retrognathic and microstomic patient.

A 74-year-old man was referred to a tertiary academic otolaryngology clinic for evaluation of a left-sided neck mass with unknown primary. Nuclear imaging modalities revealed a primary cancer located at the left tongue base. Further investigation revealed the tumour to be a p16 positive squamous cell cancer with metastatic spread to cervical lymph nodes of multiple levels. The patient was found on initial investigation to have microstomia and a retrognathic mandible, which are typically considered unsuitable for robotic surgery due to difficulties obtaining adequate exposure.The patient underwent bilateral neck dissection, followed by transoral robotic-assisted left base of tongue resection. A midline intraoral mandibulotomy was performed to improve robotic access. Following tumour resection, the mandible was repaired using open reduction with internal plate fixation. Postoperative occlusion was maintained, and the patient recovered well from mandibulotomy with none of the morbidity or cosmetic defects associated with a traditional lip-split approach.

Fu's subcutaneous needling for subcutaneous adhesions and scar hyperplasia in the neck region: A case report.

RATIONALE: Lymphadenectomy for tongue cancer in the neck region is often accompanied by local impaired mobility, gland damage, difficult in swallowing, and postoperative complication and seriously affects patients life quality. We reported a case of subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy for tongue lesions accompanied by impaired neck mobility and difficult in swallowing was treated using Fu's subcutaneous needling (FSN) treatment. PATIENT CONCERNS: A 55-year-old male with tongue cancer received surgical intervention with lymphadenectomy 8 years ago was revealed a 15 cm-long curved surgical incision in the neck region and surrounded by numerous scar tissues. DIAGNOSIS: Post-operation subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy was diagnosed. INTERVENTIONS: FSN treatment was performed 2 to 3 times per week for 1 month to sway the affected tightened muscle and dissociate the superficial fascia beneath the scar resulted in a considerable improvement in neck movement. OUTCOMES: The Vancouver Scar Scale (VSS) was as follows: color (M) - 1; vascular distribution (V) - 0, thickness (H) - 2, and flexibility (P) - 4, with a total of 7 points before FSN treatment. The VSS after 1 month of FSN treatment was as follows: M1, V0, H2, and P2, with a total of 5 points. Neck mobility in different directions, i.e., stretching to the back of the neck and laterally bending the neck to the left and/or right side, was improved (P < .05). LESSONS: At present, treatment of chronic scar hyperplasia has certain side effects and limitations. FSN is safe and convenient, with minimal destruction of the superficial fascia, having evident effects of dissociating tissue adhesion under scars and compensating for deficiencies in scar hyperplasia treatment. It can provide new ideas for future treatments.

SARS-CoV-2 detection in formalin-fixed paraffin-embedded tissue specimens from surgical resection of tongue squamous cell carcinoma.

In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, pathologists can be exposed to infection handling surgical specimens. Guidelines related to safety procedures in the laboratory have been released. However, there is a lack of studies performed on biopsy and surgical resection specimens. Here we report the detection of SARS-CoV-2 in formalin-fixed paraffin-embedded samples from surgical resection of tongue squamous cell carcinoma of a patient who developed COVID-19 postsurgery. RNA of SARS-CoV-2 strain was detected in the tumour and the normal submandibular gland samples using real-time PCR-based assay. No viral RNA was found in metastatic and reactive lymph nodes. We demonstrated that SARS-CoV-2 RNA can be detected in routine histopathological samples even before COVID-19 disease development. These findings may give important information on the possible sites of infection or virus reservoir, and highlight the necessity of proper handling and fixation before sample processing.

Strongyloides hyperinfection in a patient with solid malignant tumor a case report.

Strongyloides stercoralis is unique among the nematodes, in which it completes its life cycle inside a single human host by causing autoinfection in the host, and it causes hyperinfection leading to persistent and fatal disseminated infections in immunocompromised hosts. The present case report is about strongyloidiasis fatal hyperinfection in a patient with malignant tumor of the tongue on radiotherapy treatment, to highlight the need for clinical suspicion of strongyloidiasis in an immunocompromised host. As per the Centers for Disease Control and Prevention, the mortality in strongyloides hyperinfection syndrome is alarmingly high, a case fatality rate that is almost 90%. Hence, the clinicians should be well equipped to diagnose, treat, and also prevent the fatal consequences of this lethal nematode. Detailed workup for this parasitic infection is crucial, and this case report emphasizes that a simple wet mount stool microscopic examination can clinch the diagnosis.

Transoral Robotic Surgery in the Management of a Tongue Base Schwannoma.

Schwannomas are the most common benign tumors arising from the peripheral nerve sheath, and the intraoral location is very atypical, representing less than 1% of all cases. Surgical excision is the treatment of choice, and a variety of surgical approaches have been described. The authors report the first described case of tongue base schwannoma treated with transoral robotic surgery (TORS). A 47-years-old female patient complaining mild dysphagia and snoring, presented a submucosal swelling at the right side of the tongue base. MRI showed a large well-circumscribed solid mass, homogeneously isointense in T1WI and hyperintense on T2WI, with no lymph node metastasis. According to size, location and radiological characteristic of the mass a TORS approach was chosen. An extracapsular dissection was performed, and the lesion was completely removed with no intraoperative complications. The final diagnosis based on histopathological examination and IHC analysis (S-100 positive) was a schwannoma of the tongue base. The post-operative course was uneventful, and no recurrence was observed after 6 months of follow-up. This study demonstrates the feasibility of TORS in the treatment of a tongue base schwannoma. This is a valid alternative to the common transoral approach in order to avoid more invasive external approaches, and further studies are recommended in order to clarify if this approach could be proposed as the first line treatment in selected cases.

Endoscopic Transoral Resection of Tongue Base Ancient Schwannoma.

Schwannoma is a benign slow growing nerve sheath tumor that is typically encapsulated and composed of well-differentiated schwann cells. Schwannomas may take origin from different nerves such as cranial, spinal nerves, and the sympathetic chain. Approximately 25% to 45% of all occur in the head and neck only 1% of them are located in the oral cavity. However, it is quite rare to for schwannomas to form on the tongue base. Ancient schwannoma is the rarest, and also extremely rare in oropharynx. A 32-year-old female patient was admitted to our clinic with complaints of hoarseness, difficulty in swallowing, throat pain, snoring, and dyspnea. In examination, a smooth surfaced circumscribed mass, which originated from the tongue base was observed. In the magnetic resonance imaging, a 4.5 × 3 cm sized tongue base mass which narrowed the upper airway was detected. An endoscopic transoral excisional biopsy was performed. The histopathological diagnosis was determined as ancient schwannoma. The use of the endoscopic transoral approach can be suitable to protect the important anatomical structures, functions, and reduce the complications and esthetic concerns for the resection of tongue base schwannomas.