Rehabilitation der Schluckfunktion bei Patienten mit Pharynxkarzinomen*

Abstract

Surgical treatment of pharyngeal carcinoma implies different reconstructive procedures. Despite primary healing, in some cases cicatricial shrinkage occurs, resulting in dysphagia. Of 113 patients with carcinoma of the oro- and hypopharynx in the last 4 years, 35 patients were studied in a specific follow-up examination. Deglutition was evaluated via subjective responses to a questionnaire. Reproducible information was gained by videofluoroscopy and manometry of the pharyngo-esophageal segment. To assess deglutition, an arbitrary number scale was established with 7 for excellent and 1 for poor deglutition. After local tumour excision, partial and total pharyngectomy, pharyngolaryngectomy and additional myocutaneous grafting, the deglutition index ranged from 5.8 to 4.5 showing more striking differences in the time required for eating. Manometric analysis showed pressure peaks 10 times lower (3.5 hPa) than in normal subjects with prolongation of each swallow. Videofluoroscopy reveals even slight motility disturbances after ablative pharyngeal surgery. Typical findings are presented. The swallowing function after pharyngeal tumour operations requires the reconstruction of both the horizontal (oral) and vertical (pharyngeal) phase of deglutition. Since the base of the tongue seems to be the major driving force in bolus movement, it is not the extension of resection but the availability of remaining contractile tissue in the neopharynx, especially in the base of the tongue region, that determines the postoperative rehabilitation of deglutition.