Abstract
ABSTRACTObjective:To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction.Methods:This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location.Results:The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration.Conclusion:Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.
Highlights
Supracricoid laryngectomy (SCPL) is a horizontal partial surgical procedure indicated for T2 to T4 tumors of the glottic and supraglottic region
This procedure main advantage is the preservation of laryngeal functions: laryngeal voice, swallowing and breathing, with absence of permanent stoma.[1-3]. The technique consists of removing the lower end of the epiglottis, thyroid cartilage, laryngeal ventricles, vocal folds, ventricular bands, paraglottic space, and preepiglottic space.[2]. When neoglottis formation is possible, one or both cricoarytenoid units, the epiglottis and the cricoid, remain
The larynx is located at the intersection between the upper airway and digestive tract and acts as a sphincter during swallowing to prevent aspiration.[6]. After SCPL with CHEP, the patient present dysphagia due to partial loss of this protective mechanism because of the 70% resection of the organ with removal of essential structures, such as vocal folds and vestibular folds
Summary
Supracricoid laryngectomy (SCPL) is a horizontal partial surgical procedure indicated for T2 to T4 tumors of the glottic and supraglottic region This procedure main advantage is the preservation of laryngeal functions: laryngeal voice, swallowing and breathing, with absence of permanent stoma.[1-3]. The surgical reconstruction occurs, among variations, by means of the cricohioidoepiglotopexy (CHEP) in which a pexy (suture) is made between the cricoid cartilage, the epiglottis, and the hyoid bone. This reconstruction raises the laryngeal complex to the level of the hyoid bone, leading to a structural rearrangement in the pharyngeal recesses and modification of the swallowing process.[3-5]. Their presence, in addition to significantly impairment to quality of life, generates food adaptations and discomfort during feeding, and they may favor aspiration.[5,6,8]
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