79 5 M0), 3 months after treatment (M3), and 6 months after treatment (M6). Patients that did not perform both objective and subjective measures at one time point were excluded. A comparison between objective and subjective data was based on assumptions regarding best fit of subjective data to objective data. Mixing Ability Test The MAT consists of two layers of wax, with the colors red and blue (Plasticine modelling wax, non-toxic DIN EN-71, art. nos. crimson 52801 and blue 52809, Stockmar, Kalten Kirchen, Germany).24 The total thickness is 3 mm, with a diameter of 30 mm. The outcome variable ranges between 5-30, where a lower score implies a better mixed tablet and better masticatory performance. A subject was asked to chew on this tablet 20 times in order to mix the two colors. The tablet is then flattened, pressed to a thickness of 2 mm, and scanned on both sides using a high-quality scanner (Epson® V750, Long Beach, CA, USA). The scanned images are then processed using Adobe Photoshop CS3 extended (Adobe, San Jose, CA, USA). The histograms of both sides of the flattened and scanned wax tablet are added to obtain red and blue intensity distributions. The spread of the color intensities is measured.24 In previous research, this test has proven to be highly reliable in patients with HNC (ICC = 0.886).15 100 mL Water Swallow test During the WST, a subject was asked to drink 100 mL of water as quickly as is comfortably possible. The time to swallow this 100 mL (in seconds) and the number of swallows were counted, both by the subject and the researcher. Timing started when the water touched the bottom lip, and stopped when the larynx came to rest after the last swallow.25 Persons failed the test when they coughed or choked post swallow, had a wet voice quality post swallow, or were unable to drink the whole 100 mL.17 When a person was unable to drink the 100 mL, the residual water was measured and noted. In previous research, this test has proven to be highly reliable in patients with HNC (ICC=0.923 for number of swallows, and ICC=0.893 for duration).26 Saliva collection Salivary flow was collected simultaneously from the floor of mouth (mainly submandibular gland) using a pipette, and from the left and right parotid gland using Lashley cups, as first described in 1981.18 The cups were placed over the orifice of the Stenson’s duct. Stimulation of the glands was achieved by applying one drop of citric acid to the mobile part of the tongue every minute, and collection was carried out for 10 minutes. The volume of saliva was measured as collected in tubes by weight, assuming the density of saliva 1 g/ml. The
RkJQdWJsaXNoZXIy MjY0ODMw