【論文摘要】The Approach of Early Intervention in Postoperation of Oral Cancer by Physical Therapy in Chi Mei Medical Center, Liouying

【論文摘要】奇美醫療財團法人柳營奇美醫院口腔癌術後早期物理治療介入模式

羅政安(Zheng-An Luo) ； 李建和(Jen-Ho Le) ； 蔣維凡(Wei-Fan Chiang) ； 林任芬(Jen-Fen Lin)

《物理治療》 44卷2期 (2019/06) Pp. 113-114

https://doi.org/10.6215/FJPT.201906.P10

摘要

Background and Purpose: The occurrence of oral cancer in our hospital is within the top 5. Oral cancer most commonly occurs on the lip, gingiva, buccal mucosa, tongue, the floor of the mouth, or palate. In our hospital, stage III, IVA and IVB of the oral cancer staging were found in most cases. These patients usually underwent the excision of the involved area and lymph nodes around the neck, and might be have to receive the flap surgery for reconstruction, if necessary. They also might need to receive a period of radiotherapy, chemotherapy or both of them after surgery. After interventions in the oral cancer, most patients may have uncomfortable symptoms around the neck or the shoulder, and some limitations on their daily living activities, such as eating, speaking or going back to work. This study would reveal how physical therapy could be applied on these patients in the future. Methods: This study included 34 patients, undergoing wide excision of the oral tumor and neck dissection with or without flap reconstruction in our hospital. The physical therapist provided the education on gentle range of motion (ROM) exercise of the neck and upper extremities, and cardiopulmonary exercise at least 3 times within 1 to 2 weeks after surgery. And we would arrange routine rehabilitation program, such as massage and stretch for the stiff tissue, if necessary after 2 weeks. All patients were received evaluation of the distance of mouth opening (mm), function-related tests (FRT) for bilateral shoulders, and the difficulty in the oral activities, such as bite, drinking water, and cleaning within 7 d and 90 d after surgery, respectively. Results: The ages of all the patients were from 32 to 61 years old. Within 1 week after surgery, they could open their mouth less than 20 mm in average. But after 3 months, they could open their mouth to nearly 25 mm in average. The results of FRT showed mild limitations in the shoulder of the surgery side within 7 d after surgery, but improved slightly after 3 months without significant effect. We also found that some patients had more limitations in the shoulder of the surgery site on 1 week than 3 months after surgery, especially the patient with reconstruction by pectoralis major myocutaneous flap. There were significant improvements in all three of the oral activities from 1 week to 3 months after surgery (p ＜ 0.05). Conclusion: The patients of the oral cancer, undergoing surgery intervention in the involved site, mostly had some limitations on both oral activities and the functions of the shoulder near the involved site. It is important that the early rehabilitation program should be selected to fit for different complications of the surgery, radiotherapy or chemotherapy appropriately. Clinical Relevance: Our results revealed the important way to help the design of the early approach of the rehabilitation program for the patient of the oral caner after medical intervention in Taiwan in the future.