Dysphagia Recovery Following Surgical Resection of Oral and Oropharyngeal Cancer via the Mandibular Lingual Release Approach

Aims: Dysphagia is a common consequence of oral/oropharyngeal squamous cell carcinoma (OC/OPSCC) and its treatments. Preliminary evidence indicates that severe dysphagia may follow OC/OPSCC resection via the mandibular lingual release approach (MLRA), but further research is required. This prospective case series documents dysphagia presentation and outcomes up to 12-months post-treatment for OC/OPSCC involving the MLRA. Material and Methods: Five consecutive patients with advanced OC/OPSCC (T3, N+) were planned for multi- modal treatment, including surgery via MLRA. Data was collected at five endpoints: baseline (pre-treatment), acute and 6-weeks post-operative, then 6 and 12-months post-treatment. Clinical and fluoroscopic swallowing assessments included the functional oral intake scale (FOIS), penetration-aspiration scale (PAS); dynamic imaging grade of swallowing toxicity (DIGEST), MBS impairment profile (MBSImp) and MD Anderson dysphagia inventory (MDADI). Results: Pre-surgery mild-moderate impairment in swallowing efficiency was observed (FOIS moderate=3, mild=2). In the acute post-operative stage, all cases showed severely impaired swallowing efficiency and safety (FOIS severe=5; DIGEST life-threatening=4). Minimal improvements were observed at six-weeks (n=4), with persistent static impairments in swallowing efficiency and safety at six-months (FOIS severe=4; DIGEST moderate=4). At 12-months, the surviving cases (n=3), remained gastrostomy dependent (FOIS severe=3; DIGEST severe=1, moderate=2). MBSImp revealed significant deficits in oral and pharyngeal swallowing, while MDADI scores indicated severe early impacts followed by ongoing moderate effectors on swallowing-related quality of life. Conclusion: Dysphagia is a severe and persistent complication of OC/OPSCC treated with a MLRA, significantly impacting quality of life. Comprehensive dysphagia management is essential from diagnosis through to survivorship for these patients.