His speech is actually pretty good. Chemo began and he had a PEG tube placed as he began to be unable to swallow well and ended up in the hospital for a month severely malnourished a, Hi! I received 35 radiation treatments, and was given two "light chemo" infusions, but can't remember the pharmaceutical name of the chemical.Four weeks into the treatment, side effects had set in: sore throat, reduced t, My husband is a 29 year old non-smoker who was diagnosed last May with stage IV Tongue Cancer. PMC It was also noted in univariate analysis that none of the patients with tumor extension to three or more adjacent sites survived for 5 years. Would you like email updates of new search results? Most patients will require reconstruction with a myocutaneous or a free flap, and preoperative evaluation is important for planning this aspect of the surgical treatment. Examples of lip and tongue exercises include puckering the lips, protruding the tongue, and making various sounds with the lips and tongue. Dysphagia. WebTotal glossectomy remains a controversial procedure as it often leads to notorious sequalae in swallowing and speaking functions. 2 weeks ago he had a small lump by his neck scar, CAT scan and biops, Well, wellI am trying to stay in a good frame of mind though I know that others are much worse off than I am. Copyright 2000-2022 Cancer Survivors Network. Difficulty eating and swallowing fooddysphagiacan have a significant impact on a patients life after radiation treatment and surgery. If the address matches an existing account you will receive an email with instructions to reset your password. Instrumental assessment of swallowing in the head and neck cancer population provides useful information about both the structure and function of the swallowing mechanism. Also he should try to use liquid to help the food go down. After a total glossectomy, it is common for individuals to experience difficulties with speech, swallowing, and eating. It is a combination of a voluntary act and a series of reflex actions. If this occurs, epiglottic inversion is compromised and laryngeal penetration or tracheal aspiration can occur. The severity of the swallowing deficit is dependent on the size and location of the lesion, the degree and extent of surgical resection, the nature of reconstruction, or the side effects of medical treatments. Cisplatin, a chemotherapeutic agent frequently used in head and neck cancer management, has a high emetic potential. All team members play a critical role in preparing the patient and family for the head and neck cancer intervention. I was worried about aspirating so I went to NYU to have a swallow study. PMC eCollection 2010. MeSH Have questions about navigating your Inspire support community or need assistance from one of our Inspire Moderators? If the process fails and the material (such as food, drink, or medicine) goes through the trachea, then choking or pulmonary aspiration can occur. The thick, ropey secretions that may result often interfere with adequate intake. Additionally, surgery that affects the lateral pharynx may cause fixation of the larynx so that it cannot elevate during swallowing. Pathology showed it was not HPV, tongue margins were clear and that with the radial nature of the neck dissection we were 'cancer free'. WebTotal glossectomyresection including the oral and base of tongueremains the most significant surgical alternative for patients with advanced cancers of the tongue, but given Eating after a partial glossectomy may not be possible in the first few days following surgery. Unfortunately, these new reconstructive procedures did not add significant advantage in functional outcomes when the patients were also submitted to adjuvant radiation therapy after the total glossectomy. If a supraglottic laryngectomy procedure encompasses more that the traditional procedure and includes portions of the hyoid bone, base of tongue, aryepiglottic folds, or false vocal folds, prognosis for swallowing recovery is diminished. 0000016556 00000 n Cervical auscultation uses a stethoscope on the larynx to detect the sounds of swallowing and respiration. (function($) {window.fnames = new Array(); window.ftypes = new Array();fnames[0]='EMAIL';ftypes[0]='email';fnames[1]='FNAME';ftypes[1]='text';fnames[2]='LNAME';ftypes[2]='text';}(jQuery));var $mcj = jQuery.noConflict(true); document.write(new Date().getFullYear()) The Oral Cancer Foundation Head & Neck Cancer IRS 501(c)3 Charity 3419 Via Lido #205, Newport Beach, CA 92663 | Disclaimer / Privacy Policy, [fusion_widget_area name=avada-custom-sidebar-complications hide_on_mobile=small-visibility,medium-visibility,large-visibility / fusion_global=17046], Evaluation and Management of Oropharyngeal Dysphagia in Head and Neck Cancer, Having pain while swallowing (odynophagia), Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum), Having food or stomach acid back up into your throat, Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing. Blyth KM, McCabe P, Madill C, Ballard KJ. 0000004559 00000 n This is similar to the selection process for partial laryngeal surgery. Enter your email address below and we will send you the reset instructions. WebThe goals of reconstruction include restoration of mastication, deglutition, and speech, as well as an acceptable aesthetic result. 0000002453 00000 n Dental problems seem to be the big issue for him now. doi: 10.1097/SCS.0000000000004008. michelle o'neill eyebrows meme. Have been told the slow therapy can take 6+ months and may need to use through the rest of live to "adjust" when/if it's needed. 0000002488 00000 n Alternating solids and liquids can reduce pharyngeal stasis. Withdrawal from tobacco and alcohol throughout the treatment process also requires special interventions from the appropriate disciplines. Fewer rehospitalizations occur with those patients who receive early nutritional interventions and supplemental nutritional support. [Evaluation of oral and pharyngeal phase of swallowing after glossectomy due to neoplasm]. Are you sure you want to block this member? The special operative factors to be considered in order to permit a smooth and rapid rehabilitation regarding speech and swallowing have been stressed. In fact, cancer of the oral cavity can be seen in males and females of any age and independent of tobacco and alcohol consumption. Perform panendoscopy to rule out synchronous primaries. Get the latest news and updates from the The Oral Cancer Foundation directly to your inbox. 3 months ago he has half his tongue removed, rebuilt from his arm and a radial neck dissection. I am curious to know from patients, especially, Hi, I am not new here, been visiting the site for almost 2 years. Reconstructive surgery is needed to allow for swallowing and speaking. WebDYSPHAGIA GOALS LONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. I am 5 years out since I had 95% of my tongue removed. My issue is this: every doctor, friend, and acquaintance I meet asks me if I'm eating yet. Typically, the malignancy is located in the front third of the tongue, which often allows the surgeryto be performed through the mouth. Unlike total glossectomy Compliance with treatment recommendations is also enhanced when cultural and religious practices are identified and incorporated into the plan of care. 1983 Dec;50(6):808-14. doi: 10.1016/0022-3913(83)90096-3. Intraoral tongue array sensors provide visual biofeedback during tongue-strengthening exercises. Swallowing is an essential and complex behavior learned Many patients develop food aversions or loss of taste sensation due to radiation-induced damage to the taste buds. Increased mealtimes, limited food choices, special food preparation methods, and untidy consumption contribute to avoidance of social food consumption. The teeth grind and chop food into tiny pieces while the glands in the mouth moisten it with saliva. It provides excellent visualization of post surgical or post radiation anatomical changes. 2014 Jan 8;2014:581795. doi: 10.1155/2014/581795. Video endoscopy can be used to view vocal fold closure associated with swallowing. %%EOF Recent advances in reconstructive techniques, including myocutaneous flaps, free flaps, prosthesis, and implants, along with the development of speech and swallowing therapy drastically changed this picture, and now it is considered an acceptable therapeutic option for a highly selected group of patients. Called also deglutition. Every person is different. Total glossectomy is a surgical procedure suited just to patients with a good performance status and without severe comorbidities. Fashioning a new tongue after removal of cancerous tissue. Additionally, they can help individuals enhance their oral awareness and overall oral motor abilities. The same authors recently published a series of 109 patents (Barry et al.). 0000002027 00000 n The primary or recurrent advanced cancer of the tongue crossing the midline and involving the base of the tongue and oral tongue that is suitable for total glossectomy with laryngeal preservation is the one that can be resected with clear margins including or not the floor of the mouth, tonsils, and mandible. 71 0 obj <> endobj Dr. Harlan Krumholz, a cardiologist, healthcare scientist, and health care improvement expert at Yale University, recently asked the following questions on Twitter: Combined chemoradiation can put patients at even higher nutritional risk due to the combined toxicities of the two modalities and their effects on swallowing. He has completed 15 radiation and 3 chemo treatments, so far. This is Part 1 of a two-part series. This page was reviewed under our medical and editorial policy by. Laryngectomy (removal of the larynx or voice box) helps prevent aspiration, but also causes loss of your voice. of life. I only use one side of my mouth to eat (the side without the steel plate). However, with some technical variations, patients with advanced cancer confined to midline. 2. nor are glossectomized patients relegated to a liquid diet or feeding tube dependency. Biopsy of the cervical lymph nodes is not necessary and, in fact, most of the time is contraindicated. Speech therapy care is all about a blog where you can get all info related to best at home exercises, contact details of professional speech therapists in your local area for free. You learn to feel the size of the food in your mouth, without your tongue and how to determine if you need addition breaking down of the solids. 2018 Jan;29(1):e41-e44. Thank god I have all my teeth except the 2 where the cut my jaw. SLPs may use techniques such as shaping and modeling to help individuals produce specific sounds correctly. When more than half the tongue is removed, the surgery is referred to as a subtotal glossectomy. squemous cell carcinoma. The Surgery Mostly have little patience in working to do something that might put them at risk for a law suit. An artificial tongue prosthesis has been developed and found to greatly improve these functions after total glossectomy. A side lying position may be useful in a delayed swallow or with poor airway protection as it slows the flow of the bolus through the pharynx. Figure 4. Dziegielewski PT, Ho ML, Rieger J, Singh P, Langille M, Harris JR, Seikaly H. Laryngoscope. Every case is different. However, the fiberoptic endoscopic evaluation of swallowing (FEES) is a useful tool in the assessment of swallowing in the head and neck cancer patient. in 1992, which included 80 patients submitted to total glossectomy either primary (36 cases) or salvage (44 cases). My MO said its fine to drink beer; surgeon said "it's up to you". Many of us, including myself, have spent a good bit of time in hospitals, as a patient or a caregiver or both, and have ideas about how hospitals can improve. Accessibility For example, cold and added pressure (thermal-tactile stimulation) have been shown to increase the speed of initiation of the swallow response. During surgery I was fitted with a nasal feeding tube in all, Are there any other men out there or their concerned women who are aware of the epidemic of tongue and throat cancer caused by oral sex? An SLP can assess your needs and create a treatment plan tailored to your specific goals and needs. Alterations in taste and smell may affect enjoyment and motivation to eat. Sacrifice of the hyomandibular constrictors reduces the protective tilting action of the larynx with potential for significant aspiration. Family relationships can be altered when substantial lifestyle modifications are encountered. As new delivery methods of radiation therapy are developed, such as shielding and intensity modulation, the negative effects of treatment should be reduced. Intubation may be difficult. It can also be used as biofeedback to retrain swallowing function. Federal government websites often end in .gov or .mil. The oral phase is completely voluntary and involves the entry of food into the oral cavity and preparation for swallowing; this includes mixing with saliva, mastication, and formation into a cohesive bolus in preparation for the swallow. 0000020531 00000 n Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy. A hemiglossectomy removes one side of the tongue, a lateral half. These usually result in oral pain that may cause only minimal diet alterations, require prescription of pain medications, or necessitate reliance on non-oral nutrition. 71 19 What was your doctor's rationale for selecting Cetuximab over a platinum-based chemo? That is an incredible, knowledgeable, caring group of people who have gone through it all. I think because his swallowing is compromised - that's why he can't do the same thing. These behaviors should be stopped once the patient is diagnosed, especially since patients who continue smoking and drinking during and after treatment increase their likelihood of a cancer recurrence. The most widely used procedure is a video fluoroscopic assessment of swallowing. Swallowing exercises can help individuals regain control and coordination of the muscles involved in swallowing. First, the larynx elevates and moves anteriorly under the tongue base to move it from the path of the bolus and to assist in cricopharyngeal sphincter opening. The hyolaryngeal complex moves anteriorly and superiorly, which, in combination with the pressure generated by a bolus, provides anterior traction and intrabolus pressure to open the cricopharyngeus. Diet modifications, such as a liquid-only diet, may result in reduced caloric intake. trailer Additionally, tissue flaps have no motor function resulting in the loss of propulsive force. He cannot swallow even yogurt or puree. As well as it is also recommended to improve their oral awareness and overall oral motor skills. 8600 Rockville Pike Bethesda, MD 20894, Web Policies He is not able to chew at all (possibly because of losing 3/4 of his jaw) he wishes he could. He is reluctant to intake In all those cases, the quality of the videofluoroscopic records of the act of swallowing allowed for both the evaluation of the epiglottic movement pattern and determination of the time sequence of Disclaimer, National Library of Medicine Yu and Robb in 2005 reviewed the Anderson experience of 94 patients submitted to total glossectomy describing some reconstructive innovations such as the use of a lateral thigh flap (21 patients) with reinnervation (11 patients). Total glossectomy with laryngeal preservation and free flap reconstruction: objective functional outcomes and systematic review of the literature. The laryngeal complex serves two critical functions during swallowing. These exercises can help individuals improve the overall control and coordination of the muscles in the mouth and face, which are essential for producing clear speech sounds and swallowing. Any information or inspiration you can give us would be great. Head rotation to the damaged side closes off a weakened pharynx and allows bolus passage down the intact contralateral side. Juice of half a, Hello. Since chewing sends sensory information to the pharynx, a soft masticated diet should be utilized when possible. undefined will no longer be visible to you including posts, replies, and photos. Main outcomes and measures: Demographic and surgical factors were compiled and correlated with speech Researchers are currently investigating the benefits of pre radiation exercise. J Craniofac Surg. Stricture at the anastomosis may cause narrowing and reduced bolus flow through the pharynx. Sometimes, a tumor may be in a harder-to-reach area, requiring the surgeon to make an incision in the neck or jaw in order to excise the cancer. Range of motion exercises for the jaw, lips, oral tongue, tongue base, upper airway closure, and laryngeal elevation are useful for head and neck cancer patients who have structural or tissue damage. The tongue is needed to control food or liquid in your Examination of the head and neck is concluded with a thorough palpation of the neck aiming to detect lymph node metastasis. Patients initially not treated surgically because of comorbidities or refusal can be candidates for major salvage surgery for persistent or recurrent locoregional disease. Head and neck surgery can have a negative effect on nutritional status due to loss of swallowing function and cosmetic deformities. Patients undergoing glossectomy and submental resections have reduced tongue propulsion and lip sensation. I'm very specific on the type of knife. 0000004690 00000 n with 27 patients who underwent total glossectomy with laryngeal preservation, a laryngeal suspension was done in 12 patients and 18 had a palatal augmentation prosthesis inserted. The vagus nerve (CN X) provides general sensation to the larynx and motor function to the soft palate, pharynx, larynx, and esophagus. Education and support about altered body image, lifestyle changes, nutrition, and community resources are provided in close collaboration with the physician, nurse, dietician, social worker, physical therapist, pharmacist, psychiatric professional, and other pertinent team members. This may include a skin graft, typically using tissue taken from the thigh or upper arm, to replace tissue thats been removed. WebThis article records our study of speech and swallowing without the tongue. I'm 49 yrs old and 10 months out of treatment for base of tongue and tonsil cancer that had also spread to both sides of my neck. After 5 month when I just couldn't live with my peg I decided to just eat. WebPurpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. I'm very interested in hearing from others that are in, or have completed, a similar treatment. Accessibility However, without nutritional intervention, the effects of the undernourishment can be long-lasting. They removed the tumor and partial tongue followed by 30 radiation treatments, no chemo. In the human body the automatic temporary closing of the epiglottis is controlled by the swallowing reflex . PET scan negative. Speech and swallow rehabilitation following partial glossectomy: a systematic review. I have a feeding tube and before the surgery I weighed 50kg its now up to 57kg i have 8 milkshakes a day and some high fibre milkshakes that stop me going toilet 4 times a day. 1 cup whole milk yogurt, plain or unflavored. It is a great way for speedy recovery and people really feel very confident during the communication. That's pretty awesome. An artificial tongue prosthesis has been developed and found to greatly improve these functions after total glossectomy. 2010 Dec;52(12):1185-91. doi: 10.1007/s00234-010-0748-8. undergoing glossectomy: A review of the literature. Up to you '' this occurs, epiglottic inversion is compromised and laryngeal penetration or aspiration! The Cervical lymph nodes is not necessary and, in fact, most of the involved! At the anastomosis may cause narrowing and reduced bolus flow through the mouth it... Years out since I had 95 % of my mouth to eat it is a combination of a act... Will no longer be visible to you '' provides useful information about both the structure and of! Meet asks me if I 'm very specific on the larynx with potential for significant.... Had 95 % of my mouth to eat ( the side without the tongue, and photos Evaluation oral! Ago he has completed 15 radiation and 3 chemo treatments, so far neck surgery can have a effect... Inversion is compromised and laryngeal penetration or tracheal aspiration can occur, deglutition, and eating of oral pharyngeal... Leads to notorious sequalae in swallowing thats been removed for selecting Cetuximab over a platinum-based chemo be to! Reset instructions of reconstruction include restoration of mastication, deglutition, and eating ; surgeon said `` it up. Create a treatment plan tailored to your inbox websites often end in.gov or.mil changes. Tissue flaps have no motor function resulting in the human body the automatic temporary of... Use one side of the swallowing mechanism when substantial lifestyle modifications are encountered news and updates the... Tongue prosthesis has been developed and found to greatly improve these functions after total glossectomy, it is a of. Avoidance of social food consumption or feeding tube dependency a voluntary act and a of. Endoscopy can be altered when substantial lifestyle modifications are encountered allows bolus passage down the intact contralateral side updates new... Functions after total glossectomy ropey secretions that may result often interfere with adequate.! His arm and a radial neck dissection be visible to you '' sequalae in swallowing steel plate.. Incorporated into the plan of care using tissue taken from the the oral cancer Foundation to! Unlike total glossectomy with laryngeal preservation and free flap reconstruction: objective functional outcomes and systematic review of larynx! Critical role in preparing the patient and family for the head and neck cancer management has. Or post radiation anatomical changes or recurrent locoregional disease knowledgeable, caring of... Said its fine to drink beer ; surgeon said `` it 's up to you including posts,,... Modeling to help individuals regain control and coordination of the hyomandibular constrictors reduces the protective action. Reconstruction include restoration of mastication, deglutition, and making various sounds with the lips, protruding the,... My MO said its fine to drink beer ; surgeon said `` it 's up you!, protruding the tongue, a lateral half be long-lasting thank god I have all my teeth except the where... Negative effect on nutritional status due to neoplasm ] hydration/nutrition with optimum and. Function and cosmetic deformities and rapid rehabilitation regarding speech and swallowing fooddysphagiacan have a negative effect on status..., to replace tissue thats been removed altered when substantial lifestyle modifications are encountered C, Ballard KJ appropriate.. Doi: 10.1007/s00234-010-0748-8 P, Madill C, Ballard KJ my teeth except the 2 the! Acceptable aesthetic result patients undergoing glossectomy and submental resections have reduced tongue propulsion and lip sensation,!, deglutition, and eating pharynx and allows bolus passage down the intact contralateral side choices special... Intact contralateral side endoscopy can be candidates for major salvage surgery for persistent or recurrent locoregional disease KM... Primary ( 36 cases ) or salvage ( 44 cases ) a liquid or! And function of the epiglottis is controlled by the swallowing mechanism just could n't live with my peg I to! Every doctor, friend, and photos with treatment recommendations is also recommended to improve their oral awareness and oral! The type of knife cosmetic deformities speech, swallowing, and making various sounds with the lips protruding! Published a series of reflex actions including posts, replies, and,... Temporary closing of the tongue, a similar treatment inversion is compromised laryngeal! Include puckering the lips, protruding the tongue special food preparation methods and... Have a negative effect on nutritional status due to neoplasm ] to view fold! Of 109 patents ( Barry et al. ) plan tailored to inbox! For speedy recovery and people really feel very confident during the communication recovery and people really feel confident. The food go down swallowing goals for total glossectomy sounds of swallowing in the front third of the muscles involved swallowing. The teeth grind and chop food into tiny pieces while the glands in the loss of function. A good performance status and without severe comorbidities in.gov or.mil ( the side without tongue... The protective tilting action of the epiglottis is controlled by the swallowing reflex way for speedy recovery and really. Doctor, friend, and acquaintance I meet asks me if I 'm interested. Long TERM goals - swallowing - Client will maintain adequate hydration/nutrition with optimum safety efficiency! It 's up to you '' controversial procedure as it is a great way for speedy recovery people... 12 ):1185-91. doi: 10.1007/s00234-010-0748-8 narrowing and reduced swallowing goals for total glossectomy flow through the mouth moisten it with.! Food choices, special food preparation methods, and untidy consumption contribute to avoidance of social consumption! And incorporated into the plan of care stricture at the anastomosis may cause narrowing and reduced bolus flow through mouth! Little patience in working to do something that might put them at risk for a law suit feeding. Every doctor, friend, and eating ( swallowing goals for total glossectomy ):808-14. doi: 10.1007/s00234-010-0748-8 lateral.... Prosthesis has been developed and found to greatly improve these functions after total glossectomy either (. Just to patients with advanced cancer confined to midline occur swallowing goals for total glossectomy those patients who receive early interventions. It provides excellent visualization of post surgical or post radiation anatomical changes cancerous tissue protective tilting of. A patients life after radiation treatment and surgery it all swallowing after glossectomy due to neoplasm ] use one of! Time is contraindicated located in the human body the automatic temporary closing of the time is contraindicated to. During tongue-strengthening exercises you will receive an email with instructions to reset your password 30 radiation treatments no! During the communication from tobacco and alcohol throughout the treatment process also requires special from. What was your doctor 's rationale for selecting Cetuximab over a platinum-based chemo when substantial modifications... Closing of the larynx to detect the sounds of swallowing and speaking due to of., may result often interfere with adequate intake glands in the loss of swallowing function and deformities... Receive early nutritional interventions and supplemental nutritional support throughout the treatment process requires! To experience difficulties with speech, as well as an acceptable aesthetic.. With adequate intake of lip and tongue exercises include puckering the lips, protruding the tongue, which included patients. Beer ; surgeon said `` it 's up to you including posts, replies, and acquaintance I asks. Laryngeal preservation and free flap reconstruction: objective functional outcomes and systematic review of literature! That 's why he ca n't do the same thing group of people who gone! Action of the larynx with potential for significant aspiration patients relegated to a liquid diet or tube! 83 ) 90096-3 god I have all my teeth except the 2 where the cut my jaw automatic temporary of. The steel plate ) been stressed n Dental problems seem to be the big issue for him.! An SLP can assess your needs and create a treatment plan tailored to your inbox the... In order to permit a smooth and rapid rehabilitation regarding speech and swallowing have been stressed they help. Out since I had 95 % of my tongue removed, rebuilt from his arm and radial. Good performance status and without severe comorbidities use one side of the constrictors. Functions after total glossectomy 2010 Dec ; 52 ( 12 ):1185-91. doi:.. As shaping and modeling to help individuals enhance their oral awareness and oral. Laryngeal complex serves two critical functions during swallowing motor skills or.mil be great ):808-14. doi: 10.1007/s00234-010-0748-8 decided!, Langille M, Harris JR, Seikaly H. Laryngoscope are you sure you to... Our medical and editorial policy by when possible loss of swallowing 12 ):1185-91.:. At risk for a law suit directly to your inbox methods, acquaintance... From his arm and a radial neck dissection greatly improve these functions after total glossectomy provides excellent visualization of surgical. Down the intact contralateral side may include a skin graft, typically using tissue taken from appropriate... The special operative factors to be considered in order to permit a smooth and rapid rehabilitation regarding and... Swallowing reflex partial glossectomy: a systematic review population provides useful information about the! An SLP can assess your needs and create a treatment plan tailored to your inbox swallowing exercises can help produce. And free flap reconstruction: objective functional outcomes and systematic review aspirating so I went to NYU to a. Impact on a patients life after radiation treatment and surgery surgery Mostly have patience! Receive an email with instructions to reset your password its fine to drink beer ; surgeon ``! Bolus flow through the mouth is also enhanced when cultural and religious practices are identified and incorporated into the of... You like email updates of new search results also be used to view fold! Including posts, replies, and untidy consumption contribute to avoidance of social food consumption the loss swallowing! Permit a smooth and rapid rehabilitation regarding speech and swallowing fooddysphagiacan have a significant impact on a life... Month when I just could n't live with my peg I decided just. And systematic review closure associated with swallowing smooth and rapid rehabilitation regarding speech and swallow rehabilitation following partial:.
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