Evaluation of swallowing dysfunction in cases of locally advanced squamous cell carcinoma oral cavity pre and post treatment

Poonam Raj, Devendra Kumar Gupta, Sameer Samuel, Sanajeet Kumar Singh


Background: Oral cancer is one of the leading causes of dysphagia worldwide and is extremely common in Indian males. Swallowing dysfunction occurs due to the disease itself, its predisposing factors like tobacco chewing or smoking and the treatment undertaken which includes surgery of the primary as well as neck dissection and the adjuvant radiotherapy or chemoradiotherapy. This study was aimed to evaluate swallowing dysfunction in patients of locally advanced squamous cell carcinoma of the oral cavity prior to treatment and post-surgery and adjuvant therapy.

Methods: 30 consecutive patients of advanced oral cavity squamous cell carcinoma planned for definitive treatment at a tertiary care center were randomly selected and included in the study. Evaluation of swallowing function was carried out using a dysphagia score and FEES (functional endoscopic evaluation of swallowing) initially during work-up for surgery, then three to four weeks post-surgery and finally six to eight weeks post adjuvant therapy.

Results: Results of the study revealed that swallowing dysfunctions was observed in all the timelines of the study. Smoking, larger resection and advanced tumour stage were strong risk factors for postoperative aspiration and dysphagia complications in oral cancer patients. Multi-modality treatment also increased the incidence of post treatment dysphagia.

Conclusions: Subjective and objective assessment of swallowing dysfunctions have to be considered as important tools to assess dysphagia pre and post treatment in oral cancer patients to detect swallowing dysfunction especially silent aspiration to institute early intervention in terms of swallow therapy.


Oral cancers, Swallowing dysfunction, Dysphagia score, FEES

Full Text:



Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet. 2005;365:1927-33.

Manoharan N, Tyagi BB, Raina V. Cancer incidences in rural Delhi-2004-05. Asian Pac J Cancer Prev. 2010;11:73-7.

Khandekar SP, Bagdey PS, Tiwari RR. Oral cancer and some epidemiological factors: A hospital based study. Indian J Community Med. 2006;31:157-9.

Kumar S, Heller RF, Pandey U, Tewari V, Bala N, Oanh KT, et al. Delay in presentation of oral cancer: A multifactor analytical study. Natl Med J India. 2001;14:13-7.

Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, et al. Swallowing dysfunction-preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemo-therapy: a critical review. Int J Radiat Oncol Biol Phys. 2003;57(5):1219-30.

Borggreven PA, Verdonck-de Leeuw I, Langendijk JA, Doornaert P, Koster MN, de Bree R, et al. Speech outcome after surgical treatment for oral and oropharyngeal cancer: a longitudinal assessment of patients reconstructed by a microvascular flap. Head Neck. 2005;27:785-93.

Andry G, Hamoir M, Leemans CR. The evolving role of surgery in the management of head and neck tumors. Curr Opin Oncol 2005;17:241-8.

Manikantan K, Khode S, Sayed SI, Roe J, Nutting CM, Rhys-Evans P, et al. Dysphagia in head and neck cancer. Cancer Treat Rev. 2009;35(8):724-32.

Dirix P, Nuyts S, Vander Poorten V, Delaere P, Van den Bogaert W. The influence of xerostomia after radiotherapy on quality of life: results of a questionnaire in head and neck cancer. Support Care Cancer. 2008;16:171-9.

Salama JK, Stenson KM, List MA, Mell LK, MaccrackenE, Cohen EE, et al. Characteristics associated with swallowing changes after concurrent chemotherapy and radiotherapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2008;134(10):1060-5.

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL, et al. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8.

Neubauer PD, Rademaker AW, Leder SB. The Yale Pharyngeal Residue Severity Rating Scale: An Anatomically Defined and Image-Based Tool. Dysphagia. 2015;30(5):521.

Dirix P, Nuyts S, Van den Bogaert W. Radiation induced xerostomia in patients with head and neck cancer. Cancer. 2006;107:2525-34.

Son YR, Choi KH, Kim TG. Dysphagia in Tongue Cancer Patients. Ann Rehabil Med. 2015;39(2):210-7.

Pauloski, Rademaker AW, Logemann JA, Stein D, Beery Q, Newman L, et al. Pre-treatment swallowing function in patients with head and neck cancer. Head Neck. 2000;22(5):474-82.

Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae and rehabilitation. Semin Radiat Oncol. 2009;19(1):35-42.

Brizel DM. Radiotherapy and concurrent chemotherapy for the treatment of locally advanced head and neck squamous cell carcinoma. Semin Radiat Oncol. 1998;8(4):237-46.

Manikantan K, Khode S, Sayed SI, Roe J, Nutting CM, Rhys-Evans P, et al. Dysphagia in head and neck cancer. Cancer Treat Rev. 2009;35(8):724-32.

Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As, CJ et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected, and can they be spared by IMRT?. Int J Radiat Oncol Biol Phys. 2004;60(5):1425-39.

Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterol. 1999;116:455-78.

Mathers-Schmidt BA, Kurlinski M. Dysphagia evaluation practices: Inconsistencies in clinical assessment and instrumental examination decision-making. Dysphagia. 2003;18:114-25.

Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15:383-8.

Stenson KM, MacCracken E, List M, Haraf DJ, Brockstein B, Weichselbaum R, et al. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg. 2000;126:371-7.

Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, et al. Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck. 2002;24:555-65.

Rogus-Pulia NM, Pierce MC, Mittal BB, Zecker SG, Logemann JA. Changes in swallowing physiology and patient perception of swallowing function following chemoradiation for head and neck cancer. Dysphagia. 2014;29(2):223-33.