Oral cancer surgery follow-up

Oral cancer refers to malignant tumors that occur in the buccal mucosa, upper and lower gums, hard palate, tongue, and floor of mouth.

According to the 2022 edition of the "CSCO Guidelines for the Diagnosis and Treatment of Head and Neck Tumors", for the treatment of early oropharyngeal cancer (stages I and II), surgery or radiotherapy alone should be used. In addition to the resection of the primary lesion and neck lymph node dissection, most patients also need flap repair of tissue defects. The surgery is traumatic and takes a long time to recover. Due to the proliferation of scar tissue, it is easy to cause difficulty in opening the mouth and stiffness of the shoulders and neck. Radiation can easily make the oral mucosa inelastic, resulting in complications such as difficulty eating and swallowing, malnutrition, etc.

The goal of rehabilitation treatment is to help patients return to normal life as soon as possible, improve their swallowing, language or other functions, and help them return to their original jobs.

Oral cancer rehabilitation training methods: speech training, oral exercises, mouth opening training, swallowing training, shoulder and neck function training, etc.

Starting from the 2nd week after surgery

The purpose is to enable oral cancer patients to maximize the use of remaining tongue tissue, transplanted tissue and adjacent tissue to improve speech clarity.

Relatively easy, purse your lips to make a whistle sound, then open your mouth to make a whistle sound, alternately make a whistle sound, pull your upper and lower lips inward to make a whistle sound, and puff up your cheeks to make a whistle sound. Puff up your cheeks to make a gargle sound. Each of the above pronunciation exercises lasts for 1 to 2 seconds, and the cycle lasts 5-10 minutes/time, 3 times/day, until the patient feels no fatigue.

If possible, read aloud every day in an exaggerated manner to improve the rhythm, prosody and clarity of your speech.

Starting from the 2nd week after surgery

Relax your lips, close your upper and lower lips slightly, and lay your tongue flat naturally. Then chew as if there is food in your mouth, so that the cheek muscles and mandible can move, and at the same time, the molars can move up and down and left and right, so that the pain can be tolerated. Oral exercises are suitable for patients with different degrees of limited mouth opening because of their small range of motion.

Do it for 5-10 seconds each time, rest for 1 minute, repeat the practice for 15-20 minutes, and practice 3-4 times a day.

Start 2 weeks after surgery

The normal swallowing mechanism is divided into four stages: oral preparation, oral stage, pharyngeal stage, and esophageal stage. Oral cancer patients usually cannot completely seal their lips during the oral preparation stage, so they cannot chew smoothly, and the food bolus cannot be formed, maintained or sent back. There is often residual food in the side grooves, and the food bolus may fall before the pharyngeal stage is activated.

1. Breathing training : Improve breathing control ability through closed mouth breathing, abdominal breathing and strengthening glottal lock exercises, and learn to cough at will to expel food that is accidentally inhaled into the airway in time;

2. Sensory stimulation training (Rood technique) : Popsicles stimulate the sense of the tongue and pharynx, black pepper and mint are used for olfactory stimulation, etc.;

3. Tongue-brake swallowing (Masako training) : Slightly extend the tongue outward and gently bite the part of the tongue behind the tip with your teeth while swallowing to make the posterior pharyngeal wall protrude forward;

4. Isometric swallowing (Shaker training) : Lie on your back on the bed, raise your head as high as possible without leaving your shoulders, look at your toes, and repeat several times;

5. Mendelssohn technique : For patients whose larynx can be lifted, let them keep the lifted position and swallow empty for a few seconds, thereby prolonging and expanding the opening of the upper esophageal sphincter and improving the overall coordination of swallowing.

3 weeks after surgery, lasting 1-2 years

Clinically, mouth opening limitation is divided into 4 degrees: mild (2.0-2.5cm), moderate (1.0-2.0cm), severe (<1.0cm) and complete mouth opening limitation.

For those with mild mouth opening restriction, active mouth opening training should be used. Open the mouth until the temporal muscles feel slightly swollen. Keep this position for about 5-10 minutes, and rest for 1 minute. Repeat this action for 3-4 cycles, 3 times a day.

It is recommended that patients with moderate to severe symptoms use a mouth opener for training. Open the mouth as wide as possible, insert the mouth opener, and adjust the angle of the mouth opener until the patient's temporalis muscle feels a slight swelling. Maintain the training for 10-15 minutes and train 3 times a day.

Start training 3 weeks after surgery

1. Tongue extension exercise : Extend your tongue as far forward as possible, lick your lower lip with the tip of your tongue, then lick your upper lip, moving left and right towards the corners of your mouth;

2. Tongue retraction exercise : use a straw to drink, retract the tongue into the mouth and roll it up;

3. Tongue thrust movement : The tip of the tongue alternately thrusts against the inside of the upper and lower front teeth;

4. Tongue flicking : Use the tip of the tongue to press against the front of the upper teeth and flick the tongue to make a "der" sound;

5. Tongue licking and tongue rolling exercises : Move the tongue up, down, left and right in the mouth, touching various parts of the mouth with the tongue.

Practice once in the morning, noon and evening every day, and practice the five items in a cycle for 30 minutes each time.

Starting from the 3rd week after surgery

1. Smile training : Close your lips, stretch them to the sides, smile, and show as many teeth as possible.

2. Cheek suction exercise : Close your lips and pull them forward slightly, and suck your cheeks inward from the corners of your mouth until they are concave.

3. Cheek puffing exercise : take a deep breath, close your lips and puff up your cheeks, hold your breath to reach a certain pressure, blow air out, and use your lips to try your best to prevent the air from rushing out.

In the fourth week, practice moving your jaw back and forth and left and right, and at the same time practice twisting your mouth to exercise your facial muscles.

Practice once every morning and evening, hold each movement for 5 seconds, relax, and repeat 15-20 times.

Start about 1 month after surgery

Neck lymph node dissection may damage or cut the accessory nerve, resulting in shoulder and arm dysfunction after surgery.

Early shoulder and neck functional training can effectively reduce local adhesion and scar contracture after surgery and prevent functional movement disorders of the shoulder and arms.

1. Lowering and raising your head : When lowering your head, keep your lower jaw as close to the chest wall as possible, and when raising your head, tilt your head back.

2. Flex the neck left and right : Turn the neck left and right close to 90 degrees, flex the neck left and right, hold each movement for 3-5 seconds, and move the movement from small to large. Rest for 1 minute and repeat all the movements.

3. Shoulder shrug exercise : Sit freely on a chair, raise both shoulders to the ears, maintain this position for 5 minutes, then relax, and repeat 5 times.

4. Shoulder-lifting wall climbing exercise : Stand freely beside the wall, stretch out your arms, and use your fingers to climb up the wall, climbing as high as possible.

Oral cancer recurrence most commonly occurs 1-2 years after treatment. Regular oral and systemic examinations can help detect recurrences and second primary cancers early.

Generally speaking, in the first year after treatment, follow-up examinations should be conducted every 1-3 months; in the second year, follow-up examinations should be conducted every 2-4 months; in the third to fifth years, follow-up examinations should be conducted every 4-6 months; and after the fifth year, follow-up examinations should be conducted every 6-12 months.