术前吞咽训练对口腔癌术后吞咽发病率的影响:随机对照试验

IF 0.8 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Journal of Maxillofacial & Oral Surgery Pub Date : 2024-10-01 Epub Date: 2024-09-03 DOI:10.1007/s12663-024-02324-z
Subbiah Shanmugam, R R Pravenkumar
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引用次数: 0

摘要

背景和目的:口腔癌手术和相关的整形手术会造成吞咽功能的机械和神经损伤。尽管进行了术后康复,但吞咽功能障碍仍是一个令人担忧的问题。本研究旨在探讨通过术前吞咽运动进行术前康复训练对接受复合切除术和舌分隔切除术患者的潜在益处,从而改善吞咽效果,提高术后生活质量:研究中的 60 名患者被随机分为运动组和对照组,每组 30 人。研究对象包括接受复合切除术或舌分隔切除术的口腔鳞状细胞癌患者,不包括出现严重三趾骨畸形的患者。运动组患者在术前至少一周内严格遵守一套六项主动运动的指导。术前吞咽运动包括以证据为基础的针对吞咽肌肉群的运动。术后吞咽康复训练与对照组相同。手术 6 个月后对患者进行评估。对结果进行了主观和客观评估。客观评估采用重复唾液吞咽试验(RSST)、水吞咽试验(WST)和食物吞咽试验(FST)等廉价、新颖的临床方法,并使用吞咽困难严重程度量表(1-7)进行分级:根据主观评估得出的平均口腔摄入量表(1-口腔固体、2-口腔半固体/易咀嚼食物、3-仅口腔液体和 4-非口腔、依赖口胃管的食物)在运动组明显较低,而对照组的 OIS 分数明显较高。运动组中 DSS 评分为 5、6 和 7 分的患者人数较多。对照组中 DSS 评分为 3 分和 4 分的患者人数较多。考虑到辐射、伤口发病率和舌头切除术等混杂因素,两组之间的差异具有统计学意义:结论:术前吞咽练习对术后吞咽能力有积极影响。这是首个评估 PSE 对口腔癌术后患者影响的随机试验。我们的训练方案需要标准化,吞咽困难的临床客观评估方法也需要进一步验证。不过,使用 PSE 进行术前康复训练有可能改善口腔癌患者的生活质量。
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Impact of Prehabilitation With Preoperative Swallowing Exercises on Postoperative Swallowing Morbidity in Oral Cavity Cancer: Randomized Controlled Trial.

Background and objective: Oral cancer surgery and the associated reconstructive procedures cause mechanical and neurological impairment of swallowing. Despite postoperative rehabilitation, functional impairment of swallowing remains a concern. This study is to investigate the potential benefits of prehabilitation with preoperative swallowing exercises to patients undergoing composite resections and compartmental tongue resections so that it results in better swallowing outcomes and improved quality of life after surgery.

Materials and methods: Sixty patients included in the study were randomized into an exercise and control group of 30 each. Patients with squamous cell carcinoma of the oral cavity undergoing composite resection or compartmental tongue resections were included, and patients with severe trismus at presentation were excluded. Patients in the exercise group were instructed on a set of six active exercises to be followed strictly for a period of at least 1 week before surgery. Preoperative swallowing exercises comprised of evidence-based exercises targeting the muscle groups involved in swallowing. Postoperative swallowing rehabilitation was the same as that of the control group. Patients were assessed after 6 months of surgery. Outcomes were assessed both subjectively and objectively. Objective assessment was done by inexpensive, novel clinical methods of repetitive saliva swallow test (RSST), water swallow test (WST) and food swallow test (FST) to and graded using dysphagia severity scale (1-7).

Results: Average oral intake scale (1-Oral solids, 2-Oral semisolids/easy to chew foods, 3-Oral liquids only and 4-Non-oral, orogastric tube dependent) assessed subjectively was significantly lower in exercise arm, and the control arm had a significantly higher OIS score. Exercise arm had higher number of patients in DSS scores of 5, 6 and 7. The control arm had a higher number of patients in DSS scores of 3 and 4. The differences between the two groups were found to be statistically significant taking into consideration the confounding factors of radiation, wound morbidity and tongue resections.

Conclusion: Preoperative swallowing exercises have shown a positive impact on postoperative swallowing ability. This is the first randomized trial to assess the effect of PSE in postoperative oral cancer patients. Our exercise protocol needs standardization, and clinical objective method of dysphagia assessment requires further validation. However, prehabilitation with PSE has the potential to improve the quality of life in oral cancer patients.

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来源期刊
Journal of Maxillofacial & Oral Surgery
Journal of Maxillofacial & Oral Surgery DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
1.90
自引率
0.00%
发文量
138
期刊介绍: This journal offers comprehensive coverage of new techniques, important developments and innovative ideas in Oral and Maxillofacial Surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments, diagnostic equipment’s and modern therapeutic drugs and devices. Journal of Oral and Maxillofacial Surgery is recommended for first or priority subscription by the Dental Section of the Medical Library Association. Specific topics covered recently have included: ? distraction osteogenesis ? synthetic bone substitutes ? fibroblast growth factors ? fetal wound healing ? skull base surgery ? computer-assisted surgery ? vascularized bone grafts Benefits to authorsWe also provide many author benefits, such as free PDFs, a liberal copyright policy, special discounts on Elsevier publications and much more. Please click here for more information on our author services.
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