Enhanced Laryngeal Suspension: A Preliminary Experience

Abstract

Objective: Describe and evaluate the effectiveness of enhanced laryngeal suspension on dyspagia and aspiration secondary to skull base surgery and lower cranial nerve injuries. Method: Prospective study in a tertiary ENT unit between 2007 and 2010 of patients who underwent enhanced laryngeal suspension. Demographics, pathology, and cranial nerve injuries were documented. Nutrition, oral intake, and aspiration risk grade (G 0-3) were compared pre- and postoperatively. All patients had videofloroscopy evaluation, and aspiration-penetration scale changes were documented. Results: Enhanced laryngeal suspension involves removal of the thyroid cartilage above the vocal folds and suture suspension to the hyoid bone. It can be combined with a medialization thyroplasty and botox to cricopharyngeus if indicated. To date we performed this procedure on 9 patients. At first presentation, 77% (n = 7) were nil by mouth. Today, only 22% (n = 2) remains NBM. Gastrostomy tube dependance dropped from 77% (n = 7) to 44% (n = 4), and of those only 2 are on total enteral feed. Aspiration risk improved through the follow-up period (from 66% grade 3 down to 11%). Conclusion: Enhanced laryngeal suspension is an important tool in the multimodality approach to management of dyspagia and aspiration caused by skull base surgery and lower cranial nerve injuries. This is a preliminary study with a small sample, and results must be interpreted with this in mind.