• Archives of Plastic Surgery
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• v.40 no.4
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• pp.425-432
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• 2013

Background Recently, the number of thyroid surgery cases has been increasing; consequently, the number of patients who visit plastic surgery departments with a chief complaint of swallowing deformity has also increased. We performed a scar correction technique on post-thyroidectomy swallowing deformity via platysma flap with Z-plasty and obtained satisfactory aesthetic and functional outcomes. Methods The authors performed operations upon 18 patients who presented a definitive retraction on the swallowing mechanism as an objective sign of swallowing deformity, or throat or neck discomfort on swallowing mechanism such as sensation of throat traction as a subjective sign after thyoridectomy from January 2009 till June 2012. The scar tissue that adhered to the subcutaneous tissue layer was completely excised. A platysma flap as mobile interference was applied to remove the continuity of the scar adhesion, and additionally, Z-plasty for prevention of midline platysma banding was performed. Results The follow-up results of the 18 patients indicated that the definitive retraction on the swallowing mechanism was completely removed. Throat or neck discomfort on the swallowing mechanism such as sensation of throat traction also was alleviated in all 18 patients. When preoperative and postoperative Vancouver scar scales were compared to each other, the scale had decreased significantly after surgery (P<0.05). Conclusions Our simple surgical method involved the formation of a platysma flap with Z-plasty as mobile interference for the correction of post-thyroidectomy swallowing deformity. This method resulted in aesthetically and functionally satisfying outcomes.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.30.1-30.8
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• 2019

Background: Advancements in the field of microvascular surgery and the widespread adoption of microvascular surgical techniques have made the use of osteocutaneous fibula free flaps the standard of care in the surgical management of segmental mandibular defects. Although the literature possesses abundant evidence to support the effectiveness of fibula free flaps as a reconstructive method, there are relatively few studies reporting on outcomes as objectively measured by videofluoroscopic swallowing studies (VFSS). The purpose of this study is to explore the potential correlation between early postoperative VFSS and the long-term swallowing outcomes in patients who underwent mandibular reconstruction with fibula free flaps. Methods: We performed a retrospective chart review of 36 patients who underwent mandibular reconstruction with osteocutaneous fibular free flaps between 2009 and 2012. Demographics, clinical variables, VFSS data, and diet information were retrieved. Penetration and aspiration findings on VFSS, long-term oral feeding ability, and the need for gastrostomy tube were statistical endpoints correlated with postoperative clinical outcomes. Results: Thirty-six patients were reviewed (15 females and 21 males) with a mean age of 54 years (7-81). Seventeen cases were treated for malignancy. The size of the bony defect ranged from 3 to 15 cm (mean = 9 cm). The cutaneous paddle, a surrogate for soft tissue defect, ranged from 10 to 125 ㎠ (mean = 52 ㎠). A gastrostomy tube was present in patients preoperatively (n = 8), and postoperatively (n = 14). Seventeen patients had neoadjuvant exposure to radiation. Postoperative VFSS showed penetration in 13 cases (36%) and aspiration in seven (19%). Overall, 29 patients (80.6%) achieved unrestricted diet, and this was statistically correlated with age (p = 0.037), radiation therapy (p = 0.002), and preoperative gastrostomy tube (p = 0.03). The presence of penetration or aspiration on VFSS was a strong predictor for long-term unrestricted oral diet (p < 0.001). Conclusion: Early postoperative VFSS is an excellent predictor for long-term swallowing outcomes in patients undergoing mandibular reconstruction with osteocutaneous fibula free flaps.

• The Journal of the Korea institute of electronic communication sciences
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• v.11 no.9
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• pp.909-916
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• 2016

The purpose of this study is to investigate the effect of swallowing training of high viscosity bolus for swallow function of stroke patients with dysphagia. This study subjects, acute stroke 18 patients, which were recruited to receive treatment in inpatient at general hospital, located in Kyunggido. Subjects were randomly allocated in experimental group and control group. Experimental group performed swallowing training of high viscosity bolus, while control group conducted Traditional dysphagia therapy. Both groups received treatment 30 minutes a day five times a week for four weeks. The assessment was conducted FDS(: Functional Dysphagia Scale), PAS(: Penetration Aspiration Scale), ASHA NOMS(: American Speech-language-hearing Association National Outcomes Measurements System Swallowing Scale) to compare swallow function for both group. Both groups showed significant improvements after intervention in all measures(p<.05). Change score between the two groups showed a significant improvement on experimental group than control group in FDS(p<.05). Swallowing training of high viscosity bolus could have a positive impact on swallow function for acute stroke patients with dysphagia.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.4
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• pp.75-83
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• 2022

PURPOSE: This study was conducted to find out the effects of neurocognitive rehabilitation therapy on the swallowing function and quality of life of stroke patients. METHODS: Thirty patients were selected and randomly allocated into an experimental and a control group. Patients in the experimental group received 15 minutes of neurocognitive rehabilitation treatment combined with 15 minutes of traditional treatment. For the control group, patients received 30 minutes of traditional dysphasia treatment. The experiments were conducted for 30 minutes a day, five times a week, for four weeks. New VFSS and SWAL-QOL were administrated to evaluate the outcomes. RESULTS: Swallowing functions were significantly improved in the experimental group and the control group (p < .05), but there was no statistically significant difference in pre- and post-interventional swallowing between the groups (p > .05). The quality of life was also significantly improved (p < .05) for both groups, but there was a statistically significant difference between the two groups (p > .05). Third, a correlational analysis between swallowing function and quality of life revealed a moderate correlation between New VFSS and SWAL-QOL (p < .05). CONCLUSION: The results of this study suggest that swallowing therapy through neurocognitive rehabilitation treatment program could be helpful for improving swallowing function and quality of life in stroke patients. Although there was no statistically significant changes from traditional rehabilitation therapy, training in recognizing the senses in the oral cavity and external environment through neurocognitive rehabilitation therapy can be applied as one of the treatment options.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.255-260
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• 2008

Purpose: Tongue cancer is the most common malignant tumor of the oral cavity and the ultimate goal in treatment of the cancer is not only complete excision and meticulous closure of the wound, but also, reconstruction of a demensional and functional tongue. Our study focuses on various factors, such as defect size, extent of tumor, age, application of mandibulectomy or radiotherapy, and their influences on postoperative speech and swallowing function. Methods: Our study was based on 59 patients who underwent tongue cancer operation and reconstruction of the tongue. Speech and swallowing were evaluated according to categories documented by Sultan and Teichgraeber. Patients were classified into 3 groups as partial glossectomy, hemiglossectomy and total glossectomy groups for evaluation. The average age of the patients were 51, and the mean follow-up period was 4 years 2 months. Results: The partial glossectomy group showed statistically relevant results for speech articulation and swallowing abilities compared to the total glossectomy group. In cases of defects involving the mouth floor, the group showed decreased results compared to the group without mouth floor involvement. Increased age showed decreased postoperative results with statistical significance, while mandibulectomy and radiotherapy revealed no statistically significant data. Analysis according to TNM staging resulted in decreased functional result with advanced staging without statistical significance. Conclusion: To summarize the factors influencing the functional outcome in tongue reconstruction, younger patients and early stage cancer with minimal surgical extent revealed more satisfying results while mandibulectomy and radiation did not have influence on our analysis. Addition of various influencing factors and studies with longer follow up periods on our patient groups may provide effective data for more satisfying functional outcomes in the future.

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.139-151
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• 2022

Reconstructive surgery in the management of head and neck cancer has evolved to include structure-specific approaches in which organ-specific treatment algorithms help optimize outcomes. Tongue cancer management and reconstruction are surgical challenges for which well-executed reconstructive plans should be completed promptly to avoid delaying any subsequently planned oncologic treatment. Crucial considerations in tongue cancer resection are the significant functional morbidity associated with surgical defects, particularly in terms of speech and swallowing, and the consequent negative impact on patients' quality of life. With the evolution of microsurgical techniques and the development of the perforator flap concept, flap options can be tailored to the characteristics of various tongue defects. This has allowed the implementation of pliable flaps that can help restore tongue mobility and yield subsequent functional outcomes. Using an evolutional framework, we present this series of reviews related to tongue reconstruction. The first part of the review summarizes flap options and flap-related factors, such as volume and tissue characteristics. Related functional aspects are also presented, including tongue mobility, speech, and swallowing, as well as ways to evaluate and optimize these outcomes.

• 대한두경부종양학회:학술대회논문집
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• 2007.05a
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• pp.80-84
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• 2007

Background and Objectives : The radial forearm free flap is a useful reconstructive method of surgical defects after oral and oropharyngeal tumor resection. We evaluated the swallowing and speech outcomes of radial forearm free flap reconstruction for oral and oropharyngeal cancers. Materials and Methods : We retrospectively reviewed clinical data of 84 patients who underwent reconstructive surgery for oral or oropharyngeal cancer using radial forearm free flap from August 1994 to January 2007. Modified barium swallowing (MBS) was done in 100 patients and speech-language assessment was done in 23 patients by a speech-language pathologist. Results were analyzed according to the swallowing functions and the speech-language assessments. Results : According to the results of MBS which was done postoperatively, aspiration occurred in three patients and velopharyngeal insufficiency occurred in four patients who had been reconstructed with multilobed free flap due to large mucosal defects. There was one patient who exhibited severe articulation impairment out of 23 patients. However, 19 patients out of 23 patients showed excellent intelligibility in speech. Conclusion : We concluded that the radial forearm free flap technique is an excellent reconstructive method for the restoration of palatal and pharyngeal function in oral and oropharyngeal cancer patients.

• Archives of Craniofacial Surgery
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• v.23 no.5
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• pp.193-204
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• 2022

Tongue reconstruction remains a major aspect of head and neck reconstructive procedures. Surgeons planning tongue reconstruction should consider several factors to optimize the overall outcomes. Specifically, various technical aspects related to tongue reconstruction have been found to affect the outcomes. Multidisciplinary teams dedicated to oncologic, reconstructive, and rehabilitative approaches play an essential role in the reconstructive process. Moreover, operative planning addressing certain patient-related and defect-related factors is crucial for optimizing functional speech and swallowing, as well as quality of life outcomes. Furthermore, tongue reconstruction is a delicate process, in which overall functional outcomes result from proper flap selection and shaping, recipient vessel preparation and anastomosis, surgical approaches to flap insetting, and postoperative management. The second part of this review summarizes these factors in relation to tongue reconstruction.

• Journal of Korean Medicine Rehabilitation
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• v.18 no.1
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• pp.111-123
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• 2008

Objectives : The objective of this study was to investigate the outcomes of functional electrical stimulation (FES) which was applied twice a day in patients with dysphagia after stroke. Methods : Eleven patients with dysphagia after stroke were participated. The electrical stimulator with two channels was employed for forty minutes daily or forty minutes twice a day for fifteen days. Participants were divided into two groups by random method; The FES was performed twice a day for Twice-FES group (n=6), and once a day for Standard-FES group (n=5). For evaluation of dysphagia, the functional dysphagia scale by videofluoroscopic swallowing study, and swallow function scoring system by six clinical swallowing stage were assessed at pre- and post-treatment. Results : In both groups, there was a significant decrease of total functional dysphagia scales after FES treatment (p<0.05) and the results mainly affected the pharyngeal phase of deglutition. There was no significant difference between the two groups in total functional dysphagia scales, but the Twice-FES group had a decreased residue in oral cavity compared to the standard FES group. In both groups, there were significant improvements in swallow function scoring system (p<0.05). The twice-FES group had more high clinical swallowing stages. Conclusions : The results demonstrated that FES is a clinically effective intervention in treatment of stroke patients with dysphagia. Moreover, the treatment applied twice a day had relatively positive effects on the reduction of oral cavity residue and the improvement of clinical swallowing stage.

• Therapeutic Science for Rehabilitation
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• v.7 no.1
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• pp.11-26
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• 2018

Objective : This case study was to verify effects of cognitive rehabilitation and swallowing rehabilitation on Hypoxic-Ischemic Brain Injury patient by Suicidal Attempt. Methods : The subject was a 32-year old Hypoxic-ischemic brain injury patient by suicidal attempt. He received treatment once a day five times a week, for a half an hour for each session from September 8th to December 16th, 2016. Treatment were cognitive and swallowing rehabilitation. He was assessed based on Mini-Mental State Examination-Korean (MMSE-K), Korean-Modified Barthel Index (K-MBI), Computerized Neurocognitive Function Test (CNT), Videofluoroscopic Dysphagia Scale (VDS), American Speech-Language-Hearing Association National Outcomes Measurements System (ASHA-NOMS). Results : The patient's total MMSE-K score increased from 25 to 27. His K-MBI score increased from 74 to 88. His memory, attention span, and executive function (DST, VST, SWCT, WCST) by CNT scores were improved. VDS score has no changes to 34, 44.5 and 34. ASHA-NOMS score also has no change to 6, 2 and 6. Conclusion : The study showed that the application of the treatment of cognitive and swallowing in hypoxic-ischemic brain injury patient by suicidal attempt results has positive effects on cognitive functions, and swallowing function.