Biomechanics of the tongue during swallowing after total laryngectomy: an integrative review
Biomecânica da língua durante a deglutição após laringectomia total: revisão integrativa
Larissa Mendonça dos Anjos; Thiago Emerson dos Santos Ferreira; Leandro Pernambuco
Abstract
Purpose: To synthesize the state of scientific knowledge about biomechanics of the tongue during swallowing after total laryngectomy. Research strategy: The PICO question and combinations of descriptors and single terms were formulated in the PubMed/Medline, EMBASE, LILACS, and SciELO databases. Selection criteria: Articles 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. Data analysis: year, country, population, objective, study design, assessment methods, main outcomes, and methodological quality were analyzed. Results: There 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. Conclusion: There are indications of compensatory tongue movements during swallowing after total laryngectomy; however, the scientific evidence is insufficient.
Keywords
Resumo
Objetivo: Sintetizar o estado do conhecimento científico sobre biomecânica da língua durante a deglutição após laringectomia total. Estratégia de pesquisa: Formulou-se a questão PICO e combinações de descritores e termos livres para busca nas bases de dados PubMed/Medline, EMBASE, LILACS e SciELO. Critérios de seleção: incluíram-se artigos nos idiomas português, inglês ou espanhol; sem limite de tempo; com resultados sobre a biomecânica da língua durante a deglutição em laringectomizados totais; e estudos do tipo ensaio clínico randomizado ou não randomizado, coorte, caso controle, transversal, série de casos e estudos de caso. Análise dos dados: analisou-se ano, país, população, objetivo, delineamento do estudo, instrumentos de avaliação, principais desfechos e qualidade metodológica. Resultados: Foram incluídos quatro estudos realizados nos Estados Unidos, um na Austrália e um no Brasil, publicados entre 1986 e 2014. Em todos os estudos incluídos a biomecânica da língua foi um desfecho secundário. A maioria dos artigos teve baixa qualidade metodológica, com amostras pequenas, predomínio do sexo masculino e desenho transversal prevalente. Os instrumentos de avaliação foram videofluoroscopia, manometria, acelerômetro ou dispositivo para captar pressão de língua. Resultados principais indicaram mais força de propulsão da base de língua para superar a alta resistência da neofaringe ao fluxo do bolo alimentar; redução do contato e pressão entre base de língua e parede posterior da faringe; resíduo em base de língua após deglutição; pressão aumentada e resistência reduzida da língua oral. Conclusão: Existem indícios de movimentos compensatórios de língua durante a deglutição após laringectomia total, porém, as evidências científicas são insuficientes.
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Referências
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Submetido em:
12/04/2020
Aceito em:
12/10/2020
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