Role of videofluorography in assessing functional abnormalities in patients of head and neck cancer treated with chemoradiotherapy

Aim: The major toxicity following treatment for head neck cancer is swallowing dysfunction which can be easily assessed by videofluorography (VFG), allowing documentation of the site and extent of abnormality thereby facilitating directed management. Methods: Between October 2003 and January 2007, 56 patients with locally advanced head and neck cancer were treated by an accelerated radiotherapy schedule with concurrent weekly cisplatin chemotherapy. Three months following treatment, these patients were locally disease free clinically, but complained of varying degrees of dysphagia and were subjected to a VFG evaluation. Results: This group comprised 52 men and four women with a median age of 56 years. The primary site distribution was: oral cavity (9), oropharynx (22), larynx (19), hypopharynx (5) and unknown primary (1). Swallowing function abnormalities in the form of structural displacement and temporal delays were documented and recorded as weakness of the tongue musculature (n = 6), palatal kink (n = 8), premature leak into the oropharynx (n = 20), impaired hyoid elevation (n = 23), impaired epiglottic tilt (n = 26), unilateral pharyngeal wall impairment (n = 16), residuum in vallecula or pyriform fossa (n = 30), aspiration in trachea (n = 29) and loss of nasopharyngeal seal (n = 7). Multiple abnormalities of different sub-sites were seen in each patient. Conclusion: VFG can document dysmotility disorders of upper aero-digestive tract like dysfunction of the base of tongue, larynx and pharyngeal musculature leading to stasis of the bolus and vallecular residuum, epiglottis dysmotility resulting in silent aspirations, and inadequate nasopharyngeal seal leading to nasal regurgitation. A clinical correlation alongwith quantification of VFG findings is required.