Swallowing Disorders in Cervical Facial Tumors

Abstract

We review current state of the art protocols on swallowing disorders associated to cervical facial tumors. The clinician needs to translate physiology notions to bedside diagnosis. Facing such a case the ENT surgeon must follow several key steps: thorough history taking, barium transit, endoscopy evaluation of swallowing, high resolution diagnosis imaging. Afterwards surgical treatment plan should take into consideration the need to careful dissection of vascular and nervous structures. Dysphagia may present from initial diagnosis or after surgical resection of the tumor or during radiation and chemotherapy. We discuss the use of various staging scales or questionnaires for assessing quality of life. We illustrate the importance of swallowing disorders management with various cases of tumors at the level of skull base, pharynx, salivary glands, larynx, esophagus, etc. There are various solutions for dysphagia ranging from nasogastric feeding tube placement to percutaneous endoscopic gastrostomy to specially designed exercises. Sometimes the surgeon neglects these disorders and focuses on airway management. However, the rule should be to encourage swallowing as soon as possible after surgery. A good nutritional status is necessary for a positive prognosis in swallowing disorders. Team effort in tertiary oncology units is the key in supporting such complex cases.