Upright epiglottis prevents aspiration in patients with nasopharyngeal carcinoma post-chemoradiation

Abstract

NPC is the most widely found malignant tumor in the head and neck region in Indonesia. Chemoradiation therapy for NPC can induce swallowing disorders (dysphagia) that adversely affects a patients quality of life. This study aimed to assess the swallowing process by flexible endoscopic evaluation of swallowing in patients with nasopharyngeal carcinoma after chemoradiation. Thirty-nine patients with NPC who had chemoradiation therapy more than one month previously underwent flexible endoscopic evaluation of swallowing and were assessed for oral transport time, sensation, standing-secretion, pre-swallowing leakage, residue, penetration, aspiration, and silent aspiration. The most common structural abnormalities were an upright and swollen epiglottis (89.4%), poor oral hygiene, and velopharyngeal closure defects (56.4%). This examination also revealed a mild degree of standing secretion (38.5%) and aspiration (10.3%). No penetration was observed in 64.1% of the patients, and no silent aspiration was observed in any of the patients. A severe degree of residue (45.7%) was observed when administering oatmeal, while the residue was mild to moderate when administering gastric rice, crackers, and milk. The residue changed to a mild degree (32.3%–51.4%) in all food administrations after the watering maneuver. The highest penetration was noted after oatmeal administration (42.8%), and the highest aspiration was found after milk administration (8.6%). Standing secretion in almost all patients was caused by hyposensitivity of the hypopharynx. Persistent residue and hyposensitivity of the hypopharynx led to aspiration. The low percentage of aspiration and silent aspiration might have been caused by the upright and swollen epiglottis that prevented aspiration. Poor oral hygiene and a dry mouth led to prolonged oral transport. Therefore, most patients had hypopharyngeal abnormalities in the form of a swollen and upright epiglottis. Secretion and food residue were also detected. Drinking helps to expedite the swallowing process by facilitating oral phase transport and reducing residues.

Effects of CIK Cell Therapy Combined with Camrelizumab on the Quality of Life in Patients with Nasopharyngeal Carcinoma and Analysis of Prognostic Factors

“…The application of kareolizumab means that immunotherapy for nasopharyngeal carcinoma has entered a new era, and the progresses in molecular biology and bioengineering technology have enabled the immunotherapy methods to gradually increase. CIK is a new type of immunocompetent cell that can be used for nasopharyngeal carcinoma treatment [ 23 ]. CIK cells are the T cells obtained by cultivating human peripheral blood mononuclear cells with various cytokines and are characterized with broad tumoricidal spectrum and high efficiency in killing tumors.…”

A Large Cohort Analysis of Epiglottic Phenotypes and Pharyngeal Residue

“…Radiation to the head and neck is known to cause swallowing dysfunction, as well as anatomic changes in the epiglottis due to fibrosis and edema. [25][26][27][28][29] Cervical spine osteophytes or spinal hardware may impinge into the pharyngeal lumen and prevent epiglottic inversion. 11,30,31 Seo et al showed that maximal epiglottic angular velocity was lower in stroke patients, and that a decreased maximal epiglottic tilt angle, and decreased maximal epiglottic angular velocity were associated with increased risk of aspiration in this population.…”

Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice

“…Moreover, Tamin 30 stated that microtrauma in the tonsil basal cell epithelia due to repetitive acid and pepsin exposure serves as an entry point for the infiltration of human papillomavirus (HPV), especially subtypes 6 or 11. This results in partial suppression of the early viral gene, which stimulates the proliferation of basal cells and leads to lateral expansion and hypertrophy of the cells.…”