P077 Swallowing Outcomes Following Supracricoid Partial Laryngectomy in the Setting of Adjuvant Therapy

Abstract

Objective: To evaluate swallowing recovery following supracricoid partial laryngectomy. Design: Retrospective review. Setting: Major comprehensive cancer center. Patients: Twenty-seven patients treated with supracricoid partial laryngectomy for primary or recurrent larynx cancer. Intervention: Functional swallowing strategies, maneuvers, and therapies based on objective modified barium swallow (MBS) study results. Main Outcome Measures: Hospital recovery (length of stay, decannulation rates, complications), swallowing outcomes (physiology, symptoms), and nutritional results (time to oral intake, tube dependency, final diet). Results: Supracricoid partial laryngectomy included 1 arytenoid cartilage in 8 of 27 patients. The mean (SD) length of hospitalization was 8 days (9.23 days [median, 6 days; range, 3-53 days]) with a mean (SD) number of weeks to decannulation of 5 (8.23 weeks [median, 1 week; range, 1-30 weeks]). One patient required permanent tracheostomy. The most common complications were pneumonia and subcutaneous emphysema (7 [26%] of 27 complications). Pneumonia occurred more often in patients who had received radiation therapy (P=.02). Twenty-two patients had MBS studies. Initially, all patients aspirated thin liquids and 55% (12 of 22) aspirated pureed consistencies owing to neoglottic incompetency. Diet modifications alone did not alleviate aspiration; 64% (14 of 22) of patients needed to use swallowing strategies. The supraglottic swallow maneuver was most effective in reducing or eliminating aspiration. Eighty-one percent (22 of 27) of patients returned to complete oral intake with mean (SD) time to feeding tube removal of 10 weeks (8.33 weeks [median, 6 weeks; range, 1-29 weeks]); 7 of these patients used swallowing strategies. Nineteen percent of patients (5 of 27) remained partially (4 of 27) or fully (1 of 27) tube dependent. Arytenoid resection did not significantly affect hospital course or swallowing outcomes. Conclusion: Supracricoid partial laryngectomy initially produces severe swallowing dysfunction but most patients return to oral intake following targeted dysphagia intervention.