Vox-Implants Injection after Partial Laryngectomy

Abstract

Objective To illustrate a surgical technique for swallowing rehabilitation of patients after partial laryngectomy and to evaluate quality of life after treatment. Methods A longitudinal prospective study. 11 patients with persistent swallowing impairment after partial laryngectomy were included in the study. Swallowing disorders were diagnosed with videofluoroscopy and FEES (fiberoptic endoscopic evaluation of swallowing), and were quantified by 2 scales (a dysphagia score and a modified Penetration-Aspiration scale). A self-evaluation questionnaire about quality of life after polydimethylsiloxane (PDMS) injection was submitted to each patient (EORTC-QLQ 30). After identification of site of inhalation of bolus, PDMS was injected into the neoglottis to fill the neoglottic gap in order to obtain a better continence of the neolarynx. Aerodynamics and acoustic analysis were assessed before and after treatment. Results Average follow-up was 25 months (range 5–39). All patients showed an improvement both in the dysphagia score and in the modified Penetration-Aspiration scale. Average improvement was 2.6 points in the dysphagia score (p=0.0042) and 2.1 in the modified Penetration-Aspiration scale (p=0.0043). MPT showed an average improvement of 5 sec (p=0,037). The quality of life assessment showed a subjective improvement in each patient. Conclusions PDMS injection can be a useful technique in surgical rehabilitation of swallowing in patients who underwent partial laryngectomy. FEES is a very important tool in identifying anatomical alterations that can cause incorrect passage of bolus in the airways during deglutition. Filling these regions with PDMS can avoid passage of food into the airways, thus improving deglutition and voice and by consequence, patients’ quality of life.