Impact of Tracheal Tube on Swallowing in Post-Operative Head and Neck Cancer Patients: Scintigraphic Analysis

Giovanni Almadori,Jacopo Galli,Gaetano Paludetti,Venanzio Valenza,Laura Tricarico,Valeria Tempesta,Tiziana Di Cesare,Maria Raffaella Marchese

doi:10.1007/s00455-020-10222-y

Abstract

Dysphagia is common in tracheostomized patients who underwent head and neck surgery for cancer treatment. The objective of this study was to evaluate, by means of oropharyngoesophageal scintigraphy (OPES), the impact of an occluded tracheal tube (TT) on swallowing in patients treated for head and neck cancer before hospital discharge, to provide further information to the benefit of out-patient care management. From October 2018 to November 2019, we enrolled 19 tracheostomized patients (6 females and 13 males; mean age 61 years) who underwent primary surgical resection of head and neck tumor and swallowing rehabilitation during hospitalization. All subjects underwent a double-standard OPES, one with occluded tracheal tube and the other without TT, with their tracheal stoma being closed directly by a plaster. For each study, we assessed and compared the following quantitative parameters: oral transit time (OTTsec), pharyngeal transit time (PTTsec), esophageal transit time (ETTsec), oral retention index (ORI%), pharyngeal retention index (PRI%), esophageal retention index (ERI%), and aspiration percentage (AP%). The mean values of OTT, PTT, ORI%, PRI%, and ERI% were abnormal during OPES both with TT and without TT and did not statistically differ between the two tests (p > 0.05). Aspiration was detected in 4 cases out of 19 (21.05%) cases during OPES with TT and in 4/19 (21.05%) cases without TT who showed a mean AP% of 11.4% and 11.5% respectively (p > 0.05). Patients with abnormal AP% (> 0%) during OPES with TT showed aspiration signs without TT. Our study showed that the mere presence of a closed tracheal tube does not impact significantly the oropharyngeal transit of bolus during swallowing. This result suggests the possibility to maintain a small-diameter occluded tracheal tube in place for the postsurgical management of head and neck cancer patients.

Highlights

Dysphagia is a dysfunction that deeply impacts patients, especially during post-surgery recovery
The median and mean values of oral (OTT), pharyngeal (PTT) transit time, and oral (ORI%), pharyngeal (PRI%), and esophageal (ERI%) retention index were abnormal during oropharyngoesophageal scintigraphy (OPES) with occluded tracheal tube and without tracheal tube
Prior researches showed that tracheostomy tubes could impair swallowing causing an increased risk of aspiration through the following mechanisms: decrease in laryngeal elevation due to an anchoring effect of the tracheal tube [2], desensitization of the larynx and loss of the protective reflex [20], and uncoordinated laryngeal closure attributable to chronic upper airway bypass [21]

Summary

Introduction

Dysphagia is a dysfunction that deeply impacts patients, especially during post-surgery recovery. It is the most common short-term and long-term sequela in subjects undergoing head and neck oncologic surgery [1]. In this regard, tracheostomy with placed tracheal tube represents a safety measure which allows better management of pulmonary secretions and access to remove aspirated material, limiting bronchopulmonary complications. Over the last twenty years, there have been conflicting results in the literature on whether the presence of a tracheal tube impacts swallowing functions [2].

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Conclusion