Dysphagia evaluation and treatment after head and neck surgery and/or chemoradiotherapy of head and neck malignancy

Abstract

Tumors of the head and neck represent 3.2% of newly diagnosed cancer; both surgery and chemoradiotherapy are valid treatment options for head and neck cancer. In many head and neck cancer patients dysphagia, malnutrition, and aspiration pneumonia are found and significantly impact the quality of life. Dysphagia is related to the tumor itself or its treatment consequences. A large number of surgical procedures according to tumor site and extension, patient age, and general conditions have been developed and are reviewed in this chapter. Swallowing disorders are related to both the surgical approach (open or endoscopic) and the tissue removed; while surgery of oral and oropharyngeal cancers mainly impact the oral control, oral peristalsis, and mastication, partial laryngeal surgery interferes with airway protection mechanisms, and complete laryngeal removal may be complicated with hypopharyngeal strictures. Different chemoradiotherapy protocols are available nowadays and are here reviewed; dysphagia may arise in the first 2 years as well as many years afterwards and is mainly related to increased oropharyngeal transit time, reduced tongue and pharyngeal strength, restricted laryngeal and hyoid elevation, poor vestibule and true vocal fold closure, and possibly abnormal upper esophageal sphincter function. The primary treatment goal of dysphagia in head and neck cancer patients is to maintain functional oral feeding and prevent aspiration and thoracic complications. All patients treated for a head and neck cancer should have access to a dysphagia specialist and to an instrumental investigation in order to establish adequate treatment.