Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Impacts to swallowing associated with the mandibular lingual release approach (MLRA) in the context of oral/oropharyngeal cancer: A scoping review (1342)

Nicola Hardingham 1 2 , Elizabeth Ward 2 3 , Nicola Clayton 2 4 5 , Richard Gallagher 6 7
  1. Speech Pathology, St Vincent's Hospital, Sydney, NSW, Australia
  2. School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
  3. Centre for Functioning and Health Research, Queensland Health, Buranda , QLD, Australia
  4. Speech Pathology Department, Concord Repatriation General Hospital, Sydney , NSW, Autralia
  5. Faculty of Health Sciences, University of Sydney, Sydney, NSW , Australia
  6. Otolaryngology, St Vincent’s Hospital, Sydney, NSW, Australia
  7. Notre Dam University, Sydney, NSW, Australia

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.

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