Functional evaluation protocol

Correct deglutition is the result of a precise coordination of the many structures present in the head and neck, indeed, although the deglutition sequence can be influenced and controlled by inputs from the cortical centres, it is, first and foremost, a semiautomatic mechanism . These mechanisms need correct sensory information from the muscles and mucosae of the areas involved, to generate a coordinated sequence of muscle contractions that generate the act of deglutition. Consequently, any involvement of the sensory or motor integrity of the oral cavity, pharynx or larynx can cause dysphagia. Therefore, surgery on the above areas can potentially cause dysphagia of varying severity. This calls for the need to evaluate the impact that surgery can have in terms of dysphagia and, when possible, the need to quantify it, in relation also to the patient’s quality of life. despite the increasing application of the “organ saving” concept, surgical treatment, often followed by radiotherapy, remains the treatment of choice for most cancer sites in the head and neck. radiotherapy too can cause worsening, with the appearance or exacerbation of dysphagia secondary to xerostomy or radio-treated soft tissue fibrosis. given the current increasingly careful attention of surgeons to functional aspects, surgery must always take into account the need for surgical radicality, the strategy for optimally preserving swallowing, speech and respiratory function, to optimise the patient’s quality of life. Since all patients having pharyngeal-laryngeal cancer surgery are at risk of dysphagia, it is fundamental to perform an evaluation before restoring oral feeding, also considering that according to recent studies, patients with dysphagia always tend to underestimate their condition. For this reason, the patient should undergo an initial “bedside” assessment, followed by a more detailed and thorough study able to identify any episodes of silent aspiration. This evaluation must be scheduled according to the type of procedure, local oedema, the presence of postoperative complications (such as pharyngocutaneous fistula) and the patient’s psychological conditions. The functional protocol can be broken down into the analysis of the fundamental functions of the pharyngolaryngeal organ, i.e., an evaluation of swallowing, speech and respiratory functions, which together contribute to influencing the patient’s quality of life.