DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy

Abstract Introduction Supracricoid laryngectomy (SCL CHEP) removes ~ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p<0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.

Residue localization and risk for aspiration in partial laryngectomy: the relevance of assertive therapeutic strategies and resources

ABSTRACT Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.

Supracricoid laryngectomy: the impact of senescence on swallowing safety / Laringectomia supracricóidea: o impacto da senescência na segurança da deglutição

ABSTRACT: Objective: To investigate the association between aging and the functional aspects of swallowing (laryngeal penetration and laryngotracheal aspiration) in individuals who underwent supracricoid laryngectomy in the late period and without complaints. Methods: A total of 70 patients, 56 (80%) aged >60 years and 14 (20%) <60 years, under outpatient follow-up, after cancer treatment and with no complaints of swallowing, performed functional evaluation using the swallowing videofluoroscopy. Image classification was performed using the penetration-aspiration scale developed by Rosenbek. The χ2 test and logistic regression were applied to associate the age categories to the outcomes (penetration and aspiration). Results: Patients aged over 60 years had a higher prevalence of penetration (24.29%) and aspiration (48.57%) than patients aged under 60 years. In this sample, aspiration was associated with age. Patients aged over 60 years were more likely to present penetration (27% more) during swallowing than patients under 60 years. Patients aged over 60 years had an approximately four-fold greater probability of laryngotracheal aspiration than patients aged under 60 years. Conclusion: In patients without complaints of swallowing in the late postoperative period of supracricoid laryngectomy, there is a greater probability of laryngotracheal aspiration in elderly aged over 60 years than in individuals under 60 years.

RESUMO Objetivo: Investigar a associação entre o envelhecimento e os aspectos funcionais da deglutição (penetração laríngea e aspiração laringotraqueal) em indivíduos submetidos à laringectomia supracricóidea no período tardio e sem queixas. Métodos: Setenta pacientes, sendo 56 (80%) >60 anos e 14 (20%) <60 anos, em acompanhamento ambulatorial, após tratamento oncológico e sem queixas de deglutição, realizaram avaliação funcional por meio da videofluoroscopia da deglutição. A classificação das imagens foi realizada por meio da escala de penetração-aspiração desenvolvida por Rosenbek. O teste do χ2 e a regressão logística foram aplicados para associação das categorias de idade aos desfechos (penetração e aspiração). Resultados: Os pacientes com idade acima de 60 anos apresentaram maior prevalência de penetração (24,29%) e aspiração (48,57%) do que aqueles com idade inferior a 60 anos. Nesta amostra, a aspiração se mostrou associada à idade. Pacientes acima de 60 anos tiveram chance 27% maior de penetração durante a deglutição do que os com menos de 60 anos. Pacientes acima de 60 anos tiveram chance aproximadamente quatro vezes maior de aspiração laringotraqueal do que pacientes com menos de 60 anos. Conclusão: Em pacientes sem queixas de deglutição no pós-operatório tardio de laringectomia supracricóidea, há maior chance de aspiração laringotraqueal em idosos acima de 60 anos do que em indivíduos abaixo de 60 anos.

Symptoms and factors associated with symptom clusters among older adults with oral and oropharyngeal cancers at diagnosis / Sintomas e fatores associados a clusters de sintomas entre idosos com câncer de cavidade oral e orofaringe no momento do diagnóstico

OBJECTIVE: Describe differences in pretreatment symptoms and the composition of symptom clusters in older patients with oral and oropharyngeal cancer. METHODS: In this cross-sectional study, quality of life (QoL) assessments for cancer patients (EORCT QLQ-C30 and QLQ-H & N35) were applied to 161 cases of oral and oropharyngeal cancer at the time of enrollment in an outpatient clinic. They were used to evaluate QoL-related symptoms reported by patients, according to their occurrence. To identify symptom clusters, an exploratory factor analysis (EFA) was performed, and the relationships between these clusters and independent variables were assessed with linear regression models. RESULTS: The most prevalent symptoms were pain (52%), worry (48%), and weight loss (44%). Five factors were extracted from the EFA, of which 3 were noteworthy. The dysphagia cluster was common to both cancer sites, although more frequent in oropharyngeal cancer patients, and included symptoms such as difficulty swallowing, pain, and weight loss. The psychological cluster included symptoms related to feeling worried, nervous, and depressed. The asthenia cluster, in addition to being age-related, may represent the advanced stage or progression of the disease. CONCLUSION: The dysphagia cluster loaded the most symptoms and was common to both cancers. In addition to pain (one of the main symptoms of the dysphagia cluster), psychological symptoms were also important in both groups of patients. Adequate and early control of these symptom clusters at diagnosis could favor better management of symptoms during treatment.

OBJETIVO: Descrever diferenças nos sintomas pré-tratamento e na composição de clusters de sintomas em pacientes idosos com câncer oral e orofaríngeo. METODOLOGIA: Neste estudo seccional, avaliações de qualidade de vida (QV) para pacientes com câncer (EORCT QLQ-C30 e QLQ-H & N35) foram aplicadas a 161 casos incidentes de câncer oral e orofaríngeo no momento da inscrição no ambulatório. Essas avaliações foram utilizadas para analisar os sintomas relatados pelos pacientes quanto à QV, de acordo com a ocorrência. Para identificar agrupamentos de sintomas, uma análise fatorial exploratória (AFE) foi realizada, e a relação entre esses agrupamentos de sintomas e variáveis independentes foi avaliada com modelos de regressão linear. RESULTADOS: Os sintomas mais prevalentes foram dor (52%), preocupação (48%) e perda de peso (44%). Cinco fatores foram extraídos do AFE, três dignos de nota. Embora mais relatado por pacientes orofaríngeos, o agrupamento de disfagia foi comum a ambos os locais de câncer e incluiu sintomas como dificuldade para engolir, dor e perda de peso. O agrupamento psicológico incluiu sintomas relacionados a sentir-se preocupado, nervoso e deprimido. O agrupamento da astenia, além de relacionado à idade, pode representar o estágio avançado ou progressão da doença. CONCLUSÕES: O cluster de disfagia carregou a maioria dos sintomas e foi comum a ambos os tipos de câncer. Além da dor, que era um dos principais sintomas desse cluster, os sintomas psicológicos também foram importantes em ambos os grupos de pacientes. O controle adequado e precoce desses grupos de sintomas no diagnóstico pode favorecer o melhor manejo dos sintomas durante o tratamento.

Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy / Deglutição, voz e qualidade de vida de pacientes submetidos à laringectomia supratraqueal alargada

ABSTRACT Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.

RESUMO Objetivo Descrever os resultados funcionais e de qualidade de vida após a laringectomia supratraqueal alargada. Métodos No período de setembro de 2009 a janeiro de 2018, 11 indivíduos do sexo masculino foram submetidos à laringectomia supratraqueal alargada. As habilidades de deglutição foram avaliadas por meio da videofluoroscopia e da escala clínica Functional Communication Measures . As vozes foram classificadas por análise perceptivo-auditiva da Consensus Auditory-Perceptual Evaluation of Voice . Todos os voluntários preencheram um questionário de autoavaliação para voz e deglutição. Resultados A aspiração foi encontrada em quatro pacientes, e todos apresentaram estase em diferentes estruturas. Todos os sujeitos deste estudo apresentavam alimentação e hidratação exclusivas por via oral. Na avaliação da qualidade de vida na deglutição, os pacientes demonstraram médias >80 em todas as áreas (83,47 média dos escores). O grau geral e a presença de rugosidade foram os maiores escores médios na avaliação perceptivo-auditiva da voz (37,81 e 49,36 consecutivamente). A média de 33,36 (±22,56) demonstrou pouco impacto na qualidade de vida sob a perspectiva dos aspectos vocais. Conclusão Após a laringectomia supratraqueal, a deglutição foi suficientemente restaurada, e a qualidade de vida foi satisfatória. A voz apresenta qualidade gravemente comprometida com comunicação oral preservada, demonstrando baixo impacto nas atividades da vida diária. Todos os indivíduos que mantiveram duas unidades cricoaritenóideas apresentaram melhores resultados funcionais na deglutição e na voz.

Evaluation of life quality of patients submitted to orthognathic surgery

OBJECTIVE: To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery. METHODS: A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases. RESULTS: The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control. CONCLUSION: Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.

OBJETIVO: comparar as mudanças relacionadas à autoestima e satisfação com aparência, entre o pré-operatório e o pós-operatório, de pacientes submetidos à cirurgia ortognática, e avaliar a qualidade de vida e mudanças psicossociais desses pacientes seis meses após a cirurgia. MÉTODOS: estudo qualitativo, de caráter observacional do tipo longitudinal, com amostra de 15 pacientes que apresentavam deformidades dentofaciais e que foram submetidos à cirurgia ortognática. Foram aplicados um questionário e dois formulários, em duas fases: uma pré-cirúrgica e outra pós-cirúrgica. RESULTADOS: os resultados mostraram que 13,3% dos pacientes obtiveram melhora em relação à autoestima e, principalmente, em relação à satisfação com a aparência. Foi também constatada melhoria nas relações sociais, profissionais e familiares. Em relação à avaliação da qualidade de vida segundo o questionário da Organização Mundial da Saúde, observou-se que a média mais baixa correspondeu ao domínio meio ambiente. CONCLUSÕES: a cirurgia ortognática traz consigo uma carga emocional elevada, que deve ser considerada antes e após o ato cirúrgico, pois o estado psicológico do paciente repercute em fatores favoráveis ou desfavoráveis durante a sua recuperação, influenciando de diferentes formas na qualidade de vida, autoestima e satisfação com a aparência.