Biomechanics of the tongue during swallowing after total laryngectomy: an integrative review.

Abstract

PURPOSE\nTo synthesize the state of scientific knowledge about biomechanics of the tongue during swallowing after total laryngectomy.\n\n\nRESEARCH STRATEGY\nThe PICO question and combinations of descriptors and single terms were formulated in the PubMed/Medline, EMBASE, LILACS, and SciELO databases.\n\n\nSELECTION CRITERIA\nArticles in Portuguese, English, or Spanish were included, without time limit, with results on the biomechanics of the tongue during swallowing and total laryngectomy, and studies on randomized or non-randomized clinical trials, cohort, case control, cross-sectional, case series, and case studies.\n\n\nDATA ANALYSIS\nyear, country, population, objective, study design, assessment methods, main outcomes, and methodological quality were analyzed.\n\n\nRESULTS\nThere were four studies in the United States, one in Australia, and one in Brazil, all published between 1986 and 2014. In all studies, the biomechanics of the tongue was the secondary outcome. Most articles had low methodological quality, small samples, predominance of the male gender, and a prevalent cross-sectional design. The assessment instruments were fluoroscopy, manometry, accelerometer or a device to capture tongue pressure. Main results indicated a higher propulsion force of the tongue base to overcome the high resistance of the neopharynx to the bolus flow, reduced contact and pressure between the base of the tongue and the posterior pharyngeal wall, residues in the tongue base after swallowing, increased pressure, and reduced resistance of the oral tongue.\n\n\nCONCLUSION\nThere are indications of compensatory tongue movements during swallowing after total laryngectomy; however, the scientific evidence is insufficient.