Investigation of postoperative xerostomia and contributory factors in patients with oral cancer

doi:10.19439/j.sjos.2026.01.015

Abstract

Abstract: PURPOSE: To analyze the current status of postoperative xerostomia in patients with oral cancer and the contributory factors. METHODS: A total of 140 patients undergoing oral cancer surgery in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from March 2022 to November 2022 were selected as the study objects. The Numberical Rating Scale(NRS) and Unstimulated Saliva Flow Rate(USFR) were used to assess the degree of oral dryness. Thirst level was assessed using the Thirst Distress Scale(TDS). The quality of life and psychological status of patients were evaluated by Quality of Life Questionnaire-the Head and Neck Cancer Module (QLQ-H&N35) and Self-rating Anxiety Scale. The influence factors of NRS and USFR were analyzed by univariate and multifactorial regression. RESULTS: The results of multifactorial analysis showed that in terms of dry mouth severity, patients more than 60 years old had higher NRS scores than those less than 60 years old(β=-0.133, P<0.001). Bilateral removal of submandibular gland had higher NRS score than those with unresected/unilateral submandibular gland removal(β=-0.139, P=0.002). Patients with tracheotomy had higher NRS score than those without tracheotomy(β=-0.104, P=0.007). The higher NRS scores for postoperative abstinence from drinking for five days or more(β=-0.099,P=0.002), higher NRS scores for open-mouth breathing(β=-0.103,P=0.006). Higher postoperative QLQ-H&N35(β=0.007,P<0.001) and TDS(β=0.112,P<0.001) scores were associated with more severe oral dryness. USFR was lower in females compared to males(β=0.009, P=0.045), patients with a history of alcohol consumption(β=-0.018, P=0.002), patients treated with preoperative chemotherapy(β=0.015, P=0.006), patients with more than 11h of preoperative abstinence from drinking(β=0.02, P=0.001), and tracheotomized patients(β=-0.011, P=0.048). Patients with lower preoperative USFR had lower postoperative USFR(β=0.105, P<0.001), patients with higher TDS scores had a lower USFR(β=-0.006, P<0.001). CONCLUSIONS: Gender, age, submandibular gland removal, parotid duct ligation, tracheotomy, length of postoperative abstinence from drinking, open-mouth breathing, postoperative quality of life, and thirst affected patients' oral dryness and salivation. Healthcare professionals should recognize early and provide a basis for developing care measures to reduce oral dryness.

Key words: Oral cancer, Postoperative xerostomia, Influencing factors, Longitudinal research

CLC Number:

R739.8

Guo Xingtong, Hou Lili. Investigation of postoperative xerostomia and contributory factors in patients with oral cancer[J]. Shanghai Journal of Stomatology, 2026, 35(1): 88-94.

References

[1] Ren ZH, Hu CY, He HR, et al.Global and regional burdens of oral cancer from 1990 to 2017: results from the global burden of disease study[J]. Cancer Commun (Lond), 2020, 40(2-3): 81-92.
[2] Kaidar-Person O, Gil Z, Billan S.Precision medicine in head and neck cancer[J]. Drug Resist Updat, 2018, 40: 13-16.
[3] Mortazavi H, Baharvand M, Movahhedian A, et al.Xerostomia due to systemic disease: a review of 20 conditions and mechanisms[J]. Ann Med Health Sci Res, 2014, 4(4): 503-510.
[4] Ge N, Peng X, Zhang L, et al.Partial sialoadenectomy for the treatment of benign tumours in the submandibular gland[J]. Int J Oral Maxillofac Surg, 2016, 45(6): 750-755.
[5] Arai SR, Butzlaff A, Stotts NA, et al.Quench the thirst: lessons from clinical thirst trials[J]. Biol Res Nurs, 2014, 16(4): 456-466.
[6] 于江丽, 张黎明. 不同饮水时间对全麻腰椎手术禁食患者口腔舒适度的影响[J]. 现代临床护理, 2012, 11(4): 48-50.
[7] 任慧玲. 禁食禁饮继发胃肠道术后患者口干不适体验及其现况研究[D]. 武汉:华中科技大学, 2016.
[8] Jaguar GC, Lima EN, Kowalski LP, et al.Impact of submandibular gland excision on salivary gland function in head and neck cancer patients[J]. Oral Oncol, 2010, 46(5): 349-354.
[9] Obika LFO, Okpere SO, Ozoene JO, et al.The role of oropharnygeal receptors in thirst perception after dehydration and rehydration[J]. Niger J Physiol Sci, 2014, 29(1): 37-42.
[10] Villa A, Polimeni A, Strohmenger L, et al.Dental patients' self-reports of xerostomia and associated risk factors[J]. J Am Dent Assoc, 2011, 142(7): 811-816.
[11] Pedersen AM, Bardow A, Jensen SB, et al.Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion[J]. Oral Dis, 2002, 8(3): 117-129.
[12] Miletich I.Introduction to salivary glands: structure, function and embryonic development[J]. Front Oral Biol, 2010, 14: 1-20.
[13] 任慧玲, 黄素芳. 禁食禁饮期胃肠道术后患者继发口腔干燥不适体验的质性研究[J]. 中国实用护理杂志, 2016, 32(11): 830-833.
[14] Serrano C, Fariña MP, Pérez C, et al.Translation and validation of a Spanish version of the xerostomia inventory[J]. Gerodontology, 2016, 33(4): 506-512.
[15] 尤文璇, 张琦. 国内外口渴程度评估工具的研究进展[J].护理研究, 2020, 34(1): 123-126.
[16] Waldréus N, Jaarsma T, van der Wal MH, et al. Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure[J]. Eur J Cardiovasc Nurs, 2018, 17(3): 226-234.
[17] Jensen K, Bonde Jensen A, Grau C.A cross sectional quality of life study of 116 recurrence free head and neck cancer patients. the first use of EORTC H&N35 in Danish[J]. Acta Oncol, 2006, 45(1): 28-37.
[18] 段泉泉, 胜利. 焦虑及抑郁自评量表的临床效度[J]. 中国心理卫生杂志, 2012, 26(9): 676-679.
[19] Murphy JI, Weaver NE, Hendricks AE. Accessible analysis of longitudinal data with linear mixed effects models[J]. Dis Model Mech, 2022, 15(5): dmm048025.
[20] Assy Z, Jager DHJ, Mashhour E, et al.Regional differences in perceived oral dryness as determined with a newly developed questionnaire, the Regional Oral Dryness Inventory[J]. Clin Oral Investig, 2020, 24(11): 4051-4060.
[21] Kessler AT, Bhatt AA.Review of the major and minor salivary glands, part 1: anatomy, infectious, and inflammatory processes[J]. J Clin Imaging Sci, 2018, 8: 47-44.
[22] Porter SR, Scully C, Hegarty AM.An update of the etiology and management of xerostomia[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004, 97(1): 28-46.
[23] 邓菲, 吕珊, 易春燕, 等. 中文版口渴痛苦量表在维持性腹膜透析患者中的信度及效度分析[J]. 中国中西医结合肾病杂志, 2022, 23(9): 768-771.
[24] Fan WF, Zhang Q, Luo LH, et al.Study on the clinical significance and related factors of thirst and xerostomia in maintenance hemodialysis patients[J]. Kidney Blood Press Res, 2013, 37(4-5): 464-474.
[25] Atif S, Syed SA, Sherazi UR, et al.Determining the relationship among stress, xerostomia, salivary flow rate, and the quality of life of undergraduate dental students[J]. J Taibah Univ Med Sci, 2021, 16(1): 9-15.
[26] Bulthuis MS, Jan Jager DH, Brand HS.Relationship among perceived stress, xerostomia, and salivary flow rate in patients visiting a saliva clinic[J]. Clin Oral Investig, 2018, 22(9): 3121-3127.
[27] Hammond L, Chakraborty A, Thorpe C, et al.Relieving perception of thirst and xerostomia in patients with palliative and end-of-life care needs: a rapid review[J]. J Pain Symptom Manage, 2023, 66(1): e45-e68.
[28] Łysik D, Niemirowicz-Laskowska K, Bucki R, et al.Artificial saliva: challenges and future perspectives for the treatment of xerostomia[J]. Int J Mol Sci, 2019, 20(13): 3199.
[29] Johansson AK, Johansson A, Unell L, et al.A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects[J]. Eur J Oral Sci, 2009, 117(1): 13-19.
[30] Åstrøm AN, Lie SA, Ekback G, et al.Self-reported dry mouth among ageing people: a longitudinal, cross-national study[J]. Eur J Oral Sci, 2019, 127(2): 130-138.
[31] Johansson AK, Omar R, Mastrovito B, et al.Prediction of xerostomia in a 75-year-old population: a 25-year longitudinal study[J]. J Dent, 2022, 118: 104056.
[32] Han P, Suarez-Durall P, Mulligan R.Dry mouth: a critical topic for older adult patients[J]. J Prosthodont Res, 2015, 59(1): 6-19.
[33] Ikebe K, Matsuda K, Morii K, et al.Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007, 103(2): 216-222.
[34] Pow EHN, McMillan AS, Leung WK, et al. Salivary gland function and xerostomia in southern Chinese following radiotherapy for nasopharyngeal carcinoma[J]. Clin Oral Investig, 2003, 7(4): 230-234.
[35] Cunning DM, Lipke N, Wax MK.Significance of unilateral submandibular gland excision on salivary flow in noncancer patients[J]. Laryngoscope, 1998, 108(6): 812-815.
[36] Pedersen AML, Sörensen CE, Proctor GB, et al.Salivary secretion in health and disease[J]. J Oral Rehabil, 2018, 45(9): 730-746.
[37] Burghartz M, Sittel C, Fiz I, et al.Impact of benign parotid gland tumors on whole salivary flow rate[J]. Laryngorhinootologie, 2020, 99(8): 545-551.
[38] Larsen AK, Fjerbaek A, Kaasby K, et al.Eating desire and experiences of thirst, hunger, nausea and pain in tracheost-omized ICU patients, an explorative study[J]. Clin Nutr ESPEN, 2021, 46: S645.
[39] Sivasankar M, Fisher KV.Oral breathing increases Pth and vocal effort by superficial drying of vocal fold mucosa[J]. J Voice, 2002, 16(2): 172-181.
[40] Weiler RME, Fisberg M, Barroso AS, et al.A study of the influence of mouth-breathing in some parameters of unstimulated and stimulated whole saliva of adolescents[J]. Int J Pediatr Otorhinolaryngol, 2006, 70(5): 799-805.
[41] 李烨, 刘芳丽, 袁举, 等. 全麻术后患者口渴护理的最佳证据总结[J]. 中华护理教育, 2023, 20(3): 356-361.
[42] 张真真, 邱洪杰, 张翠娟, 等. 心脏体外循环术后患者口干口渴水平及影响因素研究[J]. 中国体外循环杂志, 2022, 20(1): 20-24.
[43] Martins PR, Fonseca LF, Rossetto EG, et al.Developing and validating the Perioperative Thirst Discomfort Scale[J]. Rev Esc Enferm USP, 2017, 51: e03240.
[44] Kara B.Validity and reliability of the Turkish version of the thirst distress scale in patients on hemodialysis[J]. Asian Nurs Res(Korean Soc Nurs Sci), 2013, 7(4): 212-218.
[45] Can S, Gezginci E, Yapici N.Effect of menthol lozenges after extubation on thirst, nausea, physiological parameters, and comfort in cardiovascular surgery patients: a randomized controlled trial[J]. Intensive Crit Care Nurs, 2023, 76: 103415.
[46] Lin R, Li H, Chen L, et al.Prevalence of and risk factors for thirst in the intensive care unit: an observational study[J]. J Clin Nurs, 2023, 32(3-4): 465-476.
[47] Nascimento LA, Nakaya TG, Conchon MF, et al.Prevalence, intensity and discomfort of thirst in surgical patients in the immediate post-operative period[J]. Rev SOBECC, 2019, 24(2): 85-90.
[48] Maldonado RN, Conchon MF, Birolim MM, et al.Thirst of the orthopedic surgical patient in the immediate postoperative[J]. Rev Baiana Enferm, 2020, 34: e34533.
[49] Pavani MM, Fonseca LF, Conchon MF.Thirst in surgical patients: perceptions of the nursing team in inpatient units[J]. J Nurs UFPE, 2016, 10(9): 3352-3360.