The efficacy of a lingual augmentation

prosthesis for swallowing after a

glossectomy: A clinical report
Kentaro Okuno, DDS, PhD,a Kanji Nohara, DDS, PhD,b
Nobukazu Tanaka, DDS, PhD,c Yasuhiro Sasao, DDS, PhD,d and
Takayoshi Sakai, DDS, PhDe
Osaka University Dental Hospital, Osaka, Japan; Shitennoji
Yawaragien Hospital Home, Osaka, Japan; Center for Oral Functional
Disorders, Sasao Dental Clinic, Yamaguchi, Japan; Osaka University
Graduate School of Dentistry, Osaka, Japan
The excision of malignant tongue tumors often produces tongue defects that can cause dysphagia. A palatal augmentation prosthesis
is frequently used to treat such dysphagia. This report describes a patient who received a palatal augmentation prosthesis after a
glossectomy for malignant cancer of the tongue; however, no improvement was noted in swallowing function. A lingual augmentation
prosthesis was then applied to the mandible, which resulted in improved swallowing function. (J Prosthet Dent 2014;111:342-345)
After the resection of a malignant
tongue tumor, the preparatory and oral
stages of swallowing are disordered by the
presence of tongue defects.1,2 Many reports have described attaching a palatal
augmentation prosthesis (PAP) to the
maxilla to aid contact between the tongue
and palate3,4 for the treatment of
dysphagia due to surgically induced
tongue defects. However, for patients for
whom the resected region is large and the
tongues range of movement is markedly
restricted, the application of a PAP cannot
improve the swallowing function sufciently.4 This report describes a patient
who received a PAP after a glossectomy for
malignant cancer of the tongue but who
demonstrated no improvement in swallowing function. A lingual augmentation
prosthesis (LAP) was then attached to the
mandible to assist swallowing, which
resulted in improved swallowing function.

CLINICAL REPORT
A 64-year-old man underwent tongue resection for tongue cancer. The

patient did not have a relevant medical

or family history. After surgery, his chief
complaints were speech and swallowing
difculties. In April 2003, under a diagnosis of squamous cell carcinoma
(T2N0M0) of the left side of the tongue,
the patient underwent a subtotal glossectomy (resection range: the bilateral
genioglossus muscles and left hyoglossus muscle), bilateral upper neck
dissection, tongue reconstructive surgery
with a free anterolateral thigh ap that
connected to the superior thyroid artery
and internal jugular vein, laryngeal suspension, and tracheotomy. This patient
had received preoperative therapy,
which consisted of uorouracil, vitamin A, and radiation of 40 Gy (FAR).
Subsequently, the patient received instruction in swallowing (range of motion
exercises of the tongue, thermal-tactile
stimulation, supraglottic swallow,
Mendelsohn maneuver), his tracheal
cannula was removed, and he was discharged after demonstrating that he was
able to ingest food paste orally. In
October 2003, the patient visited the

department because of excessively long

meal times and speech difculties.
Within the mouth, the right side of the
tongue remained intact, and a ap had
been used to reconstruct the region from
the left to central area of the tongue.
During rest, a gap, which ranged from
the anterior to the left side of the oral
oor was observed between the ap and
the alveolar ridge (Fig. 1).
A PAP was produced to improve the
patients speech disorder, and an improvement in the articulation of speech
was noted after its insertion. With the
PAP, speech intelligibility scores increased from 50% correct to 65% correct,
and contact between the anterior region
of the tongue and the palate was facilitated. Food transportation by the tongue
also improved, and the time between the
entry of food and the initiation of the
swallowing reex was shortened. As a
result, the time that the patient required
to consume meals decreased markedly,
from 2 hours to 1 hour. However, residual food was always present after swallowing, and a gap appeared between the

Instructor, Division of Oral and Facial Disorders, Osaka University Dental Hospital.
Assistant Professor, Division of Oral and Facial Disorders, Osaka University Dental Hospital.
c
Chief, Division of Dentistry, Shitennoji Yawaragien Hospital Home.
d
Director, Center for Oral Functional Disorders, Sasao Dental Clinic.
e
Professor, Division of Functional Oral Neuroscience, Osaka University Graduate School of Dentistry.
b

The Journal of Prosthetic Dentistry

Okuno et al

April 2014

343

1 Intraoral ndings. Right side of tongue was intact; region

between left and central areas of tongue was subjected to ap
reconstruction. Gap was observed between ap and alveolar
ridge.

the tongue and the hard palate, and the

LAP had lled the gap in the anterior
area of the oral cavity, the patient was
able to transport entire boluses to his
pharynx during swallowing (Fig. 5). The
amount of residual food left on the oral
oor after swallowing was markedly less.
No laryngeal penetration or aspiration
was observed. With the PAP with LAP,
the speech intelligibility scores increased
from 50% correct to 73% correct. The
patients swallowing function was assessed by a dentist, and his speech was
assessed by a speech pathologist. After
9 years and after the loss of teeth and the
involution of a ap, the prosthesis had to
be modied. The patient has not experienced any complications and has
retained his swallowing function.

DISCUSSION

2 Lingual augmentation prosthesis.

ap used for the tongue reconstruction
and the alveolar ridge during the functioning of the tongue. Because it was
impossible to ll the gap with a PAP, an
LAP was applied to decrease the size of
the gap.
The retention clasps of the LAP
were attached to the mandibular premolar region, and an acrylic resin (Pour
Resin; Shofu Inc) plate was placed on
the lingual side of the alveolar ridge
to compensate for the gap. A lightpolymerized denture lining material
(Mild Reberon LC; GC Corp) was added
in the region of the LAP that corresponded to the tongue defect. Then, a
functional impression of the tongue was
made during swallowing and was used to
rene the morphology of the appliance
(Figs. 2, 3A, 3B).

Okuno et al

Videouorography with approximately

10 mL of a 2-fold dilution of 60 w/v%
liquid barium (BARITOP 120; Kaigen
Pharma Co) was used to evaluate the
swallowing function without the PAP
with LAP. Although the back of the
tongue was in contact with the soft palate because the anterior of the tongue
could not be raised sufciently, wide
gaps developed between the reconstructed tongue, oral oor, and hard
palate, which made it impossible for the
patient to transport all of the liquid at
once (Fig. 4). As a result, a marked
amount of residual liquid was present on
the oral oor after swallowing. No
laryngeal penetration or aspiration was
observed.
After PAP with LAP insertion, because the PAP had lled the gap between

Although devices such as tongue

replacement prosthesis,5 mandibular
prosthesis,6 and food guides7 to assist in
speech and swallowing have been reported, the number of studies is limited,
and the production methods, morphology, and indications for use of these
devices vary. In the present report, the
LAP was dened as a mandibular prosthesis that assists the tongue to overcome
the disabling effects of oral defects. An
LAP was delivered to a patient who
experienced food transportation problems and the collection of bolus residue
on the oral oor after swallowing, typical
symptoms of dysphagia after tongue
resection for malignant tongue cancer.
As a result, the swallowing function improved. A PAP is a treatment prosthesis
that is used to enhance the function of
the remaining tongue and improve
dysphagia by aiding contact between the
tongue and palate. Many reports describe how dysphagia was improved by
the insertion of a PAP.3 In these patients,
the residual tongue retained its mobility.
In this patient, the mobility of the
tongue in the superoinferior direction was
restricted, and contact between the
tongue and the palate was impossible.
The insertion of a PAP enabled contact
between the tongue and the palate, and
the patient was able to transport most

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Volume 111 Issue 4

3 Intraoral ndings after lingual augmentation prosthesis (LAP) insertion. LAP was produced to compensate for excavated
region of left oral oor. Morphology of LAP used to compensate for excavation of left oral oor. LAP was placed on lingual
side of mandibular dentition. A, At rest. B, At tongue protrusion.

4 Videouorography ndings. Wide gaps observed between

reconstructed tongue, oral oor, and hard palate during
swallowing.

of each bolus into the pharynx. However,

although a PAP can facilitate superoinferior tongue movements, it has little effect on tongue movement in the
anterior direction. In this patient, therefore, even though a PAP had been inserted, residual food was observed in the left
anterior area of the oral oor after swallowing. After the insertion of a PAP with
an LAP to ll the gap between the ap
used for the tongue reconstruction
and the alveolar ridge, anterior tongue
movement improved, and the amount of
residual food that remained after swallowing was reduced. Not only the insertion of the PAP but also the application of
an LAP to aid the anterior movement of
the tongue is appropriate for patients in
whom tongue mobility in the anterior direction is restricted and contact
with the lingual surfaces of the maxillomandibular anterior teeth is difcult.
The surgeon and the prosthodontist must
cooperate well to address the swallowing and speech disorders.

SUMMARY

5 Videouorography ndings after palatal augmentation

prosthesis with lingual augmentation prosthesis insertion.
Gaps had decreased, which resulted in improvement in bolus
transportation into pharynx.

The Journal of Prosthetic Dentistry

The ndings described in this report

suggest that both a PAP and an LAP
should be used in patients with dysphagia
after malignant tongue tumor resection in
which a large part of the tongue has been
resected and the range of movement of the
tongue is markedly restricted. Instruction
in swallowing and the application of

Okuno et al

April 2014

345

a PAP alone cannot achieve sufcient

improvement as during swallowing a
functionally signicant gap develops between the tongue and the mandible.

REFERENCES
1. Pauloski BR, Logemann JA, Rademaker AW,
McConnel FM, Heiser MA, Cardinale S, et al.
Speech and swallowing function after anterior
tongue and oor of mouth resection with
distal ap reconstruction. J Speech Hear Res
1993;36:267-76.
2. Furia CL, Carrara-de Angelis E, Martins NM,
Barros AP, Carneiro B, Kowalski LP. Video
uoroscopic evaluation after glossectomy. Arch
Otolaryngol Head Neck Surg 2000;126:
378-83.

3. Martins NM, Barros AP, Carneiro B,

Kowalski LP, Marunick M, Tselios N. The efcacy of palatal augmentation prostheses for
speech and swallowing in patients
undergoing glossectomy: a review of the literature. J Prosthet Dent 2004;91:67-74.
4. Weber RS, Ohlms L, Bowman J, Jacob R,
Goepfert H. Functional results after total or
near total glossectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg
1991;117:512-5.
5. Aramany MA, Downs JA, Beery QC, Aslan Y.
Prosthodontic rehabilitation for glossectomy
patients. J Prosthet Dent 1982;48:78-81.
6. Leonard RJ, Gillis R. Differential effects of
speech prostheses in glossectomized patients.
J Prosthet Dent 1990;64:701-8.
7. Lauciello FR, Vergo T, Schaaf NG,
Zimmerman R. Prosthodontic and speech

rehabilitation after partial and complete glossectomy. J Prosthet Dent 1980;43:204-11.

Corresponding author:
Dr Kentaro Okuno
Osaka University Dental Hospital
Division For Oral-Facial Disorders
1-8, Yamadaoka
Suita-city, Osaka 5650871
JAPAN
E-mail: k-okuno@dent.osaka-u.ac.jp
Copyright 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.

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Okuno et al