Speech and swallowing rehabilitation of post-partial mandibulectomy: a case report
Keywords:Oral cancer, Dysphagia, Speech therapy, Mandibulectomy, Quality of life
Squamous cell carcinomas of the oral cavity require multiple treatment approaches such as chemotherapy, radiotherapy, and surgical treatment. Glossectomy and mandibulectomy are the most common surgical treatment procedures for oral carcinoma with pre-, and post-surgical chemo-radiotherapy depending on the stage of cancer. The patients with glossectomy and mandibulectomy are at risk of developing a wide range of impairments in speech and swallowing functions due to surgical procedures and post chemo-radiation therapy (trismus and xerostomia). The present case report describes a 52-year-old male who had a history of oral squamous cell carcinoma and underwent wide excision of maxillar and mandibular regions who presented with severe speech and swallowing impairments. On examination of speech and swallowing functions, the patient exhibited oral dysphagia of moderate severity and poor speech intelligibility. The patient had undergone 50 speech and swallow therapy sessions over two months duration and post-therapy evaluation showed improvements in speech and swallowing functions. The patient had exhibited improvements in quality of life on various physical and functional domains post-rehabilitation. However, the improvements were limited due to the presence of trismus and hypernasality due to maxillar resection. This case report describes the importance of speech and swallowing rehabilitation to improve the post-surgical impairments in speech and swallowing functions and also the overall quality of life of patients with oral cancers.
Sharma S, Satyanarayana L, Asthana S, Shivalingesh KK, Goutham BS, Ramachandra S. Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries. J Oral Maxillofac Pathol. 2018;22(1):18.
Manju Mohan P, Friji MT, Dinesh Kumar S, Mohapatra D. Clinical evaluation of swallowing and dysphagia management in a patient with total mandibulectomy and primary reconstruction. J All India Instit Sp & Hear. 2013;32.
Bachmann AS, Höche S, Peters B, Wiltfang J, Hertrampf K. Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients. J Cranio Maxillofac Surg. 2021;49(11):1072-80.
Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M. Dysphagia bedside screening for acute-stroke patients: the gugging swallowing screen. Stroke. 2007;38:2948-52.
Kempster GB, Gerratt BR, Abbott KV, Barkmeier-Kraemer J, Hillman RE. Consensus Auditory-Perceptual Evaluation of Voice: Development of a standardized clinical protocol. Am J Sp Lang Path. 2009;18(2):124-32.
D'cruz AK, Yueh B, Das AK, McDowell JA, Chaukar DA, Ernest AW. Validation of the University of Washington quality of life questionnaires for head and neck cancer patients in India. Indian J Cancer. 2007;44(4):147.
Bjordal K, De Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. Eur J Cancer. 2000;36(14):1796-807.
Lazarus CL, Husaini H, Jacobson AS, Mojica JK, Buchbinder D, Okay D, Urken ML. Development of a new lingual range-of-motion assessment scale: normative data in surgically treated oral cancer patients. Dysphagia. 2014;29(4):489-99.
Loh SY, Mcleod RW, Elhassan HA. Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures. Euro Arch Oto-Rhino-Laryngol. 2017;274(7):2695-707.
Shu-Ching CH. Oral dysfunction in patients with head and neck cancer: a systematic review. J Nurs Res. 2019;27(6):e58.