2005 Volume 9 Issue 1 Pages 76-82
Purpose：The purpose of this study was to examine the compatibility of palatal augmentation prosthesis (PAP) by investigating the prognosis of PAP which was prepared in our hospital in an attempt to promote the recovery of swallowing function in patients with dysphagia after surgical intervention for mandibular/tongue cancers．
Subjects and methods： Five patients (Case Nos.① to ⑤；all males；age at operation：25-63；average age： 50.6 yrs) who had submitted to PAP settlement after subtotal or total lingual resection due to mandibular/tongue cancers during the period from June 2003 to April 2004 (11 months) in the Department of Oral surgery，Okayama University were enrolled in this study．The evaluation of swallowing function before and after PAP settlement was performed by means of lingual mobility test，modified water drinking test and food ingestion test in addition to the swallowing videofluorography and ultrasonic diagnosis．The assessment of PAP compatibility was mainly based on the superior mobility of the tongue and disabilities during oral and pharyngeal stages．The clinical course after settlement of PAP prepared by using the palatographs thus obtained was examined by referring to the patient's medical record．
Results： In Case Nos.①，② and ⑤，their tongues showed almost no superior or anterior movement with the resultant low scoring points．Case No.④ had a relatively high scoring point，the result of which could be explained in relation to the size of skin flap in part．The examination performed before PAP settlement revealed some disabilities during preparatory/lingual stages in all cases as well as those during pharyngeal stage in all except for Case No.③．The time elapsed after operation to PAP settlement was 8642 days in Case No.① and 2107 days in Case No.②．In Case Nos.③ to ⑤，the corresponding time ranged from 38 to 56 days． After PAP settlement，the improved ingestive and swallowing functions were evident during preparatory/lingual stage for food mass transportation in Case Nos.③ to ⑤． Especially in Case Nos.④ and ⑤，disability during pharyngeal stage was also improved． In Case Nos.① and ②， however，a sense of incongruity still remained at the time of swallowing which finally resulted in PAP incompatibility，though some improvement was observed during preparatory/lingual stage． In Case Nos.③ to ⑤ with an established PAP compatibility， PAP subsequently became unnecessary and thus removed owing to the completely improved swallowing function in Case No.③．On the other hand，PAP is now used under a continued adjustment in Case No.④ and no adjustment in Case No.⑤．
Discussion：
1) In 3 cases in which PAP was applicable in a relatively early stage after operation，PAP compatibility could be obtained though the extent of lingual resection varied case by case．In the remaining cases in which PAP was applied at a more prolonged time after operation，however，a trend of PAP incompatibility was observed especially in those with more extended range of resection，suggesting that the outcome would be better when PAP is applied as early as possible after operation．
2) Although the examination of lingual mobility employed as a clinical criterion for PAP application was useful in part，it seemed necessary to establish more detailed criteria for its validation．
