Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study.

Nicole Pizzorni,Micol Castellari,Giovanni Succo,Erika Crosetti,Antonio Schindler,Marco Fantini

doi:10.3390/cancers11040549

Abstract

Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure (p = 0.021). Inefficient swallowers presented a longer pharyngeal transit time (p = 0.008), a reduced pharyngoesophageal segment opening lateral (p = 0.008), and a worse tongue base retraction (p = 0.018 with solids and p = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL.

Highlights

Open partial horizontal laryngectomies (OPHLs) are conservative surgical techniques aimed to the treatment of laryngeal carcinomas in early-intermediated T stage [1]
Swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction
Among the OPHLs, OPHL type II is characterized by the resection of the entire thyroid cartilage, with the inferior limit represented by the upper edge of the cricoid ring

Summary

Introduction

Open partial horizontal laryngectomies (OPHLs) are conservative surgical techniques aimed to the treatment of laryngeal carcinomas in early-intermediated T stage [1]. Among the OPHLs, OPHL type II is characterized by the resection of the entire thyroid cartilage, with the inferior limit represented by the upper edge of the cricoid ring. Cancers 2019, 11, 549 horizontally from above, and the pre-epiglottic space and epiglottic cartilage are transected so that the suprahyoid part of the epiglottis is spared. On both sides, the inferior constrictor muscles are incised, the piriform sinuses dissected, the inferior horns of thyroid cartilage cut and the ventricular and vocal folds divided down to the lower limit of resection in the subglottic region. The cricoid is pulled up to the level of the hyoid bone to achieve the laryngeal reconstruction by a cricohyoidoepiglottopexy

Methods

Discussion

Conclusion