Purpose: Conduct a scoping review to synthesise available evidence regarding the mandibular lingual release approach (MLRA) and post-operative swallowing impacts for oral cavity and/or oropharyngeal squamous cell carcinoma (OC/OPSCC). A better understanding of swallowing impacts post-MLRA is needed to inform speech pathology (SP) clinical pathways and guide dysphagia interventions for this population.
Background: OC/OPSCC and its subsequent surgical and non-surgical management can affect swallowing at all stages of the cancer journey. The MLRA is a rare open-access approach used for surgical resection of large or inaccessible OC/OPSCC. Currently, little is known about the relationship between the MLRA and post-operative swallowing. A synthesis of existing evidence is needed to inform future research and guide clinical practice for these patients.
Methods: A systematic search of 5 databases from 1950-July 2020 was conducted with 8 studies meeting study inclusion criteria. Data extraction included study purpose, design, outcome measures (OCM), participants characteristics and findings. Quality assessment was conducted using the ASHA level of evidence tool.
Results: Quality assessment rating was low for all studies. Only half-reported data from swallow related OCMs, and these were limited to measures from a patient-reported questionnaire (n=3) and a non-validated clinician scale (n=1). Dysphagia was a recognized consequence, however the absence of specificity in the data prevented calculations of incidence or severity. Three author groups commented on the potential for post-op dysfunction due to disruption of the floor of mouth musculature, however assessment of swallowing biomechanics was not conducted. There was no clear data on time to resolution.
Conclusions: The available evidence is biased towards reporting surgical outcomes, with only limited and low-quality data available for swallowing complications post-MLRA. For appropriate clinical pathways to be developed, further systematic studies are required investigating the biomechanics of dysphagia post-MLRA including its nature and pattern of recovery.