2010 Volume 14 Issue 3 Pages 279-287
[Introduction] As a treatment method against dysphagia due to organic defect after resection of lingual malignant tumor, palatal augmentation prosthesis (PAP) has been reported in a lot of clinical cases. However, we recently experienced 3 cases of dysphagia after resection of lingual malignant tumor, against which PAP failed but lingual augmentation prosthesis (LAP) applied in the mandible succeeded to improve the symptom as reported hereinafter.
[Case report] Case 1: Sixty-nine-year-old man treated with total resection of lingual movable region, left sided neck dissection and lingual reconstruction with pectoralis major flap. The oral examination revealed that the region of tongue except for lingual root was completely reconstructed with skin flap with no mobility. The videofluorography (VF) showed no pulmonary aspiration but almost all test meal ingested was retained on the oral floor. When LAP in which the reconstructed tongue is covered by a floor to ensure the flow route of food ingested was applied, the retained food on the oral floor was wholly diminished, successfully resulted in the improvement of disturbed swallowing.
Case 2: Sixty-four-year-old man treated with subtotal resection of the tongue, bilateral upper neck dissection and lingual reconstruction with pectoralis major flap. VF revealed weakened contact of tongue with hard palate at swallowing and failed delivery of the ingested food into the pharynx with the subsequently retained contents on the oral floor. In order to reduce the space created by the organic defect of tongue involved, PAP and LAP were applied to the maxilla and mandible respectively with the improved retention of food on the oral floor after swallowing.
Case 3: Seventy-two-year-old man treated with subtotal resection of the tongue, bilateral neck dissection and lingual reconstruction with pectoralis major flap. VF revealed difficulty in swallowing solid food due to decreased lingual mobility, suggesting a possibility of the disturbed preparation stage for swallowing. In order to prevent a potential dropping of the chewed food onto the lingual side, LAP in which the lingual side of left mandibular molar is supplemented with resin was applied with the resultant easy swallowing of solid food and the improved dysphagia during the preparation stage.
[Conclusion] In patients with a relatively extended region of lingual defect or limited movement, the symptoms of which may often fail to be improved by PAP alone, it was suggested that the application of LAP can be served as an effective therapeutic measure as indicated by the 3 cases mentioned above.
