Management of Swallow Function in a Patient with an Orocutaneous Fistula
Speech and swallowing outcomes following treatment of large-volume oral cavity tumors can have varying effects on speech and swallow function. Anticipation of these deficits and appropriate treatment planning can minimize loss of function due to disuse atrophy and facilitate safe resumption of oral diet. The literature also supports the role of preoperative counseling to reduce overall cost and length of stay as well as improve functional outcomes. Rehabilitative plans may need to be adjusted depending on the presence and duration of postoperative edema, flap dehiscence, and/or fistula formation and acute radiation toxicities, all of which contribute to complex rehabilitation.
TL was a 65-year-old woman with pT4aN0M0 squamous cell carcinoma of the right alveolar ridge for which she underwent prophylactic gastrostomy tube placement and dental extractions in anticipation of adjuvant radiotherapy following composite mandibulectomy with fibular free flap and bilateral modified radical neck dissections. Five weeks following surgical resection, she received a total of 60 Gy at 2 Gy/fraction to the oral cavity and neck. Intensity-modulated radiotherapy (IMRT) was used instead of conventional radiotherapy to decrease the dose to normal tissues and, specifically, to decrease radiation exposure to the spinal cord, salivary glands, and brachial plexus.