One of the major issues in patients who undergo reconstructive surgery after ablation of oral malignanttumors is the decline in the quality of life due to disorders of deglutition. Rehabilitation in such patients should beperformed on the basis of the functional assessment of deglutition. Methods are available for the assessment ofdeglutition; however, there is no standardized quantitative system for evaluating the oral stage of deglutition. Indeglutition, tongue movement, which transports food into the pharynx, is important, and dysfunction of the oralstage causes food to remain in the mouth as well as early transport into the pharynx.
Several methods for assessing oral function with the use of food samples have been developed. In the presentstudy, our goals were to choose the best food property for assessing the oral function of patients with deglutitiondisorders due to dysfunction of tongue mobility after ablation of tumors of the tongue, mouth floor, and lower gingivafollowed by reconstruction, and to prepare a standardized method for assessing oral function.
Food properties were assessed by sensory evaluation, which was a subjective assessment. First, we establishedsix criteria defining oral sensation on transport of food from the mouth to the pharynx. Thirty volunteers who hadnormal oral function ate 13 standardized foods. The volunteers assessed the properties of each standardized foodaccording to the six criteria, scored from-2 to 2. Then, we analyzed the data by principal components analysis.The results showed that two factors were associated with eating difficulty in the oral stage of deglutition; onefactor was plotted on the X-axis, and the second factor was plotted on the Y-axis to construct food-property maps.Thus, the food properties were visualized, and the food samples were divided into four groups.
Twenty patients who had undergone partial glossectomy to total glossectomy, ate one food from each of thefour groups on the map, and we assessed the amount of food remaining in the mouth. In the test, a banana fromGroup I, jelly from Group II, meat flakes from Group M, and protein puree from Group IV were used.
The Group IV foods showed the broadest dispersion in the amount of food remaining in the mouth. In contrast, Group II foods showed the narrowest distribution in the amount of food remaining. Group I, II, and IV foodsdid not cause misdeglutition; however, Group IlI foods caused aspiration in 3 of the 20 patients.
Our results suggest that Group IV foods may be able to distinguish slight differences in the ability to swallowamong patients who have undergone ablation of tongue tumors.
In conclusion, swallowing tests using Group IV foods such as protein puree can be used to assess the site and amount of food remaining in the mouth, and thereby provide indices of the recovery of the oral stage of deglutition.
