外加徒手治療對放射線治療及手術後頭頸部癌療癒者的效果：個案報告

Effect of Additional Manual Therapy for Head and Neck Cancer Survivor Status Post Radiotherapy and Surgery: A Case Report

李怡昀(Yi-Yun Li) ； 林慧芬(Huei-Fen Lin) ； 林亞蓉(Ya-Jung Lin)

《物理治療》 46卷2期 (2021/06) Pp. 73-80

https://doi.org/10.6215/FJPT.202106_46(2).0003

摘要

背景與目的：放射線治療為頭頸癌治療之一，其後遺症與生活品質下降、吞嚥困難、張口困難和頸部活動度受限相關，而針對後遺症的療效研究多以運動治療為主，外加徒手治療應能放鬆手術或放射線引起之纖維化。因此，本報告目的為探討外加徒手治療對接受手術及放射線治療後的頭頸癌療癒者在張口困難、舌下甲狀軟骨和頸關節活動度以及嗆咳頻率的效果。方法：個案為56歲男性，曾因口腔癌與鼻咽癌於2011年接受手術及放射線治療，又因口腔癌復發接受腫瘤切除及下頷骨重建手術。術後5個月後進行7週的傳統物理治療包含顳顎關節運動與肩頸肌力訓練，後3週外加徒手治療。結果：經4週傳統物理治療後，顳顎關節活動度進步8mm並達平原期。後3週外加徒手治療後，舌下甲狀軟骨和頸關節活動度改善，且嗆咳頻率降至50％。結論：本報告顯示外加徒手治療能提供放射線治療及手術後頭頸癌療癒者舌下甲狀軟骨和頸關節活動度及嗆咳頻率較佳的進步。

關鍵字

頭頸部癌 ； 徒手治療 ； 關節活動度 ； 纖維化

並列摘要

Background and Purpose: Treatments for head and neck cancer included radiotherapy, chemotherapy, and surgery. Consequences of radiotherapy were associated with decreased quality of life, dysphagia, trismus, and reduced cervical range of motion (CROM). However, limited studies investigated treatment effects for these consequences. Most of them only focused on the effects of exercise programs. Additional manual therapy may further release surgery or radiation-induced fibrotic tissue. Hence, our purpose is to investigate the effects of additional manual therapy on trismus, infrahyoid thyroid cartilage mobility, CROM, and choking frequency for head and neck cancer after surgery and radiotherapy. Methods: A 56-year-old male diagnosed with left oral cavity and nasopharyngeal cancer status post (s/p) tumor excision and radiotherapy in 2011. Due to the recurrence of oral cavity cancer in 2018, he underwent another tumor excision and mandibular reconstruction. Five months later, he received physical therapy including temporomandibular joint (TMJ) mobility exercise and strengthening exercises for neck and scapulae muscles for 7 weeks. Manual therapy was added during the last 3 weeks of the physical therapy treatments. Results: TMJ mobility improved (8mm) and leveled at the fourth week of traditional physical therapy. After additional manual therapy, CROM in all directions, infrahyoid thyroid cartilage mobility improved. The frequency of choking during eating reduced to 50%. Conclusion: Additional manual therapy could have better effects on infrahyoid thyroid cartilage mobility, CROM, and choking frequency for head and neck cancer survivor s/p radiotherapy and surgery than traditional physical therapy alone.

並列關鍵字

Head and neck cancer ； Manual therapy ； Range of motion ； Fibrosis