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Objectives: This study aimed to summarize the state of current literature and evaluate evidence for timing, methods, and effects of early intervention in patients after free flap reconstruction. Methods: A comprehensive search was conducted in nine databases. The methodological quality of literature was assessed according to the JBI Critical Appraisal Tools. Results: Eight studies were finally included. Most studies started the intervention within 1 to 2 weeks after surgery with multiple swallowing training measures. The results of meta‐analysis showed that swallowing intervention could improve swallowing function (SMD = −1.03, 95%CI [−1.37, −0.69], Z = 5.95, p < 0.01) and the quality of life (SMD = 1.52, 95%CI [0.97, 2.07], Z = 5.43, p < 0.01). Conclusion: Early swallowing intervention can improve patients' swallowing function and short‐term quality of life. We can only summarize the basic consensus of the studies on early swallowing intervention, and rigorous trials are needed in the future. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the outcomes of motor‐innervated free flaps in hemi‐tongue reconstruction by assessing the tongue mobility through midsagittal images from cine‐magnetic resonance imaging. Methods: In this retrospective study, 47 patients who underwent tongue reconstruction following hemi‐glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no‐motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. Results: Overall, the motor group showed improved functional swallowing scale compared with the no‐motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no‐motor group showed increased laryngeal elevation for compensatory movement. Conclusion: The tongue reconstruction with motor‐innervated free flaps may facilitate swallowing capacity in patients with a hemi‐tongue defect combined with tongue base resection. [ABSTRACT FROM AUTHOR]

Background: Vertical closure of the pharynx after laryngectomy can result in an outpouch of the anterior wall of the neopharynx below the tongue base, called a pseudo‐diverticulum. The prolapsed mucosa that separates the rest of the neopharynx from the pseudo‐diverticulum is termed a pseudo‐epiglottis. Methods: Prospective study of patients with pseudo‐epiglottis. M. D. Anderson Dysphagia Inventory (MDADI) scores were used to assess swallowing outcomes pre‐ and post‐pseudo‐epiglottis division, including minimally clinically important difference (MCID) assessment. Results: Of 16 patients with a pseudo‐epiglottis, 12 had dysphagia (75%). Symptomatic patients had significantly worse global MDADI and subscale scores. After division, the mean composite MDADI increased from 48.3 to 64.7 (p = 0.035), including a high MCID (16.4) with a similar improvement in the global question rating findings (31.1 vs. 60, p = 0.021). The MCID was significant for all MDADI subscales. Conclusions: Pseudo‐epiglottis formation is associated with significantly worse global and subscale MDADI scores. A clinically‐ and statistically‐significant improvement in the MDADI scores was found following surgical division. [ABSTRACT FROM AUTHOR]

Background: The 100 ml water swallow test (WST) is a validated swallow assessment used in head and neck cancer (HNC). We aimed to determine the level of agreement when completing the 100 ml WST via clinician‐graded video‐testing or patient self‐testing compared to standard face‐to‐face assessment (FTF). Methods: Convenience sampling from four UK centers. Inclusion criteria: patients with HNC treated with any modality prior to, or within 5 years of treatment. Participants were recruited to complete the 100 ml WST by video‐testing or self‐testing and compared with FTF. Results: Sixty‐three patients were recruited; 1 was unable to perform the task; 30 in video‐testing; and 32 in self‐testing. There was no difference in swallow capacity (p = 0.424) and volume (p = 0.363) for the video‐testing or the self‐testing swallow capacity (p = 0.777) and volume (p = 0.445). Conclusions: This study demonstrates that video‐testing and self‐testing are reliable methods of completing the 100 ml WST for this sample of patients with HNC. [ABSTRACT FROM AUTHOR]

Background: The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration‐related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well‐studied. Method: Patient‐ and clinician‐reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. Results: Ninety‐three participants who received radiotherapy for HNC were included in the analysis (n = 49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n = 44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. Conclusion: Radiation dose to DARS is associated with post‐treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV)‐driven head/neck squamous cell carcinomas (HNSCC) prevalence varies globally. We evaluated HPV DNA and p16INK4a in formalin fixed paraffin embedded (FFPE) HNSCC from Argentina, Brazil, Colombia, and Peru. Methods: HPV was genotyped by PCR‐hybridization. All HPV DNA positive and some HPV DNA negative cases underwent p16INK4a immunohistochemistry. Results: HPV DNA was detected in 32.8%, 11.1%, and 17.8% of oropharyngeal (OPC), oral cavity (OCC) and laryngeal (LC) cancers, respectively. OPC HPV prevalence was higher in Colombia (94.7%), and Argentina (42.6%) compared to Brazil (10.6%) and Peru (0.0%). HPV‐16 was the most detected. Other HPVs were found in LC. Higher rates of p16INK4a positivity were observed among HPV positive OPC/OCC cases compared to LC cases. Conclusions: Our results support a role for HPV‐16 in a subset of HNSCC, corroborate the heterogeneity observed in samples from different countries, and contribute additional etiological and biomarkers information in tumors of significant impact worldwide. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to explore the 10‐year plus outcomes of Intensity Modulated Radiotherapy with concomitant chemotherapy (CRT) combined with preventive swallowing rehabilitation (CRT+) for head and neck cancer (HNC). Methods: Subjective and objective swallowing, trismus, and speech related outcomes were assessed at 10‐year plus after CRT+. Outcomes were compared to previously published 6‐year results of the same cohort. Results: Fourteen of the 22 patients at 6‐year follow‐up were evaluable. Although objective swallowing‐related outcomes showed no deterioration (eg, no feeding tube dependency and no pneumonia), swallowing‐related quality of life slightly deteriorated over time. No patients had or perceived trismus. Voice and speech questionnaires showed little problems in daily life. Overall quality of life (QOL) was good. Conclusions: After CRT with preventive rehabilitation exercises for advanced HNC, swallowing, trismus, and speech related outcomes moderately deteriorated from 6 to 10 years, with an on average good overall QOL after. [ABSTRACT FROM AUTHOR]

Background: Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed "sensory dysphagia" and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia. Methods and Results: Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune‐mediated neuronopathy, and nerve damage from prior traumatic intubation. Conclusions: Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to report the risk of pharyngoesophageal stricture after treatment for head and neck cancer. Methods Human studies on radiation therapy with or without chemotherapy for head and neck cancer published in peer-reviewed journals with assessment of pharyngoesophageal stricture with barium swallow or endoscopy were included. Results A total of 4727 patients from 26 studies treated between 1989 and 2008 were eligible for analysis. The reported overall risk of stricture was 7.2%. The risks of pharyngoesophageal stricture in both conventional and intensity-modulated radiation therapy (IMRT) studies were 5.7% and 16.7%, respectively ( p < .001). Use of concurrent ( p < .001) and taxane ( p = .01) chemotherapy was associated with the IMRT technique. Prospective studies reported a 3.3-fold increased risk of stricture compared with that of retrospective studies (odds ratio: 3.3; 95% confidence interval: 2.3-4.8; p < .001). Conclusions Pharyngoesophageal stricture after IMRT and chemotherapy treatment for head and neck cancer is not uncommon. Videofluoroscopic swallow study should be performed prospectively to evaluate swallowing function. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background The purpose of this investigation was to present 5-years of quality-of-life (QOL) results of a multicenter randomized phase III trial, assessing intra-arterial (IA) versus standard intravenous (IV) chemoradiation for inoperable stage IV head and neck cancer. Methods Evaluation of 71 patients through European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC QLQ-C30) and Head and Neck Module (QLQ-H&N35), and trial-specific questionnaires. Treatment consisted of standard radiotherapy with 4 weekly IA or 3 weekly IV cisplatin infusions. Results No significant differences in treatment-related QOL problems between 1 and 5 years posttreatment were observed, except for 'dry mouth' (gradually improving; p = .004). Survivors have lower fatigue levels ( p = .04), better voice ( p = 0.3), and swallowing ( p = .03) than patients who could not complete all subsequent follow-up questionnaires. Conclusions Most treatment-related QOL issues deteriorate during treatment, improve in the first year, and then remain stable, except xerostomia, improving up to the 5-year assessment point. Survivors show more positive scores for fatigue, voice, and swallowing. QOL issues at 1 year, thus, for most already represent those after 5-year follow-up. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background Research has reported relationships between 3-dimensional (3D) radiation dose to head and neck structures and consequential swallowing/nutritional outcomes. However, this evidence is preliminary. The current study aimed to identify which reported dose constraints identified functional impairment at 6 months posttreatment. Methods Dose constraints with reported relationships to swallowing and nutrition were identified through a systematic literature review. Dose-volume histograms for 12 patients with T1-T3 oropharyngeal cancer treated with 3D conformal radiotherapy determined dosages delivered to specific structures. Doses were examined in relation to published dose constraints and the swallowing and nutritional outcomes at 6 months posttreatment. Results In all, 66% of the reported mean, maximum, and partial doses to 8 structures correctly identified swallowing and nutrition outcomes at 6 months. Conclusion The relationships observed between known dosimetric constraints and functional outcomes highlight the potential for dosimetric data to assist in prognosis and treatment. Systematic research is required to refine dosimetric parameters and the impact on functional outcomes. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]