Analysis of Swallowing Function after Supracricoid Laryngectomy with Cricohyoidopexy

Abstract Introduction Supracricoid laryngectomy (SCL CHEP) removes ∼ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p < 0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.

Download Full-text

Evaluation of swallowing function after supracricoid laryngectomy as a primary or salvage procedure

Dysphagia ◽

10.1007/s00455-015-9645-y ◽

2015 ◽

Vol 30 (6) ◽

pp. 686-694 ◽

Cited By ~ 5

Author(s):

Francesco Bussu ◽

Jacopo Galli ◽

Venanzio Valenza ◽

Lucia D’Alatri ◽

Daniele Antonio Pizzuto ◽

...

Keyword(s):

Salvage Procedure ◽

Supracricoid Laryngectomy ◽

Swallowing Function

Download Full-text

Laryngeal Reconstruction with a Sternohyoid Muscle Flap after Supracricoid Laryngectomy

Otolaryngology ◽

10.1177/0194599814549002 ◽

2014 ◽

Vol 151 (5) ◽

pp. 824-829 ◽

Cited By ~ 4

Author(s):

Yue Yu ◽

Xiao-lei Wang ◽

Zhen-gang Xu ◽

Yue-huang Wu

Keyword(s):

Disease Free Survival ◽

Muscle Flap ◽

Early Postoperative Period ◽

Cancer Center ◽

Supracricoid Laryngectomy ◽

Swallowing Function ◽

Removal Time ◽

Group A ◽

Disease Free Survival Rate ◽

Group B

Objective To compare postoperative respiratory and swallowing functions between patients who underwent classic supracricoid laryngectomy (SCL) and those who underwent SCL with laryngeal reconstruction using the sternohyoid muscle. Study Design Prospective study. Setting National cancer center. Subjects and Methods Forty-four patients who consecutively underwent SCL for laryngeal squamous cell carcinoma from December 2009 to March 2011 were included. Postoperative parameters including the mean tracheostomy decannulation time, tracheostomy decannulation rate at 6 months, mean nasogastric tube (NGT) removal time, degree of dysphagia at 3 months, and survival time after surgery were evaluated. Results Twenty-one patients underwent classic SCL (group A), and 23 underwent SCL with laryngeal reconstruction (group B). After a median follow-up period of 37 months (range, 3-44 months), group A had a significantly longer mean decannulation time (120.05 ± 109.38 days vs 33.43 ± 22.60 days, respectively; P < .01) and NGT removal time (37.30 ± 29.97 days vs 17.22 ± 10.95 days, respectively; P < .01) than group B. Swallowing function after 6 months was significantly better in group B than in group A ( P = .004). The decannulation rate after 6 months was significantly higher in group B than in group A (95.7% vs 66.7%, respectively; P = .036). The 3-year disease-free survival rate was not significantly different between group A and group B (95.2% vs 95.7%, respectively; P = .961). Conclusion Laryngeal reconstruction using a sternohyoid muscle flap seems to improve quality of life in the early postoperative period after SCL.

Download Full-text

The Effect of Arytenoid Resection on Functional Results of Cricohyoidopexy

Otolaryngology ◽

10.1016/j.otohns.2009.04.012 ◽

2009 ◽

Vol 141 (2) ◽

pp. 272-275 ◽

Cited By ~ 12

Author(s):

İmdat Yäce ◽

Sedat Çaglı ◽

Ali Bayram ◽

Fatih Karasu ◽

Işıl Satı ◽

...

Keyword(s):

Nasogastric Tube ◽

Case Series ◽

Early Postoperative Period ◽

Supracricoid Laryngectomy ◽

Swallowing Function ◽

Dysphagia Score ◽

Maximum Phonation Time ◽

Perceptual Evaluation ◽

Tube Removal ◽

Significant Difference

OBJECTIVE: The aim of this study was to evaluate the influence of arytenoid resection on voice and swallowing function in patients who undergo supracricoid laryngectomy with cricohyoidopexy. STUDY DESIGN: A case series with chart review. According to the arytenoid number, patients were divided into two groups: 11 patients with two arytenoids and 9 patients with one arytenoid. The decannulation, nasogastric tube removal, and hospitalization times were noted. Maximum phonation time, average fundamental frequency, percent jitter, percent shimmer, and noise-to-harmonic ratio were measured. Grade, roughness, breathiness, asthenicity and strain scale (for the perceptual evaluation of vocal quality), Voice Handicap Index (for self-assessment of the voice), and dysphagia score were used. RESULTS: The mean decannulation, nasogastric tube removal, and hospitalization time was 18.4, 40.2, and 32.7 days in patients with one arytenoid, whereas 8.8, 20.8, and 25.3 days in patients with two arytenoids, respectively. The differences were statistically significant. For all of the parameters that are associated with voice function and dysphagia, there was no statistically significant difference between one arytenoid and two arytenoids. CONCLUSION: Arytenoid resection may affect the swallowing function in the early postoperative period, but for voice and deglutition functions there was no difference between cricohyoidopexy with one arytenoid and two over the course of time.

Download Full-text

Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd21.3.89 ◽

2011 ◽

Vol 21 (3) ◽

pp. 89-99

Author(s):

Michael F. Vaezi

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Best Practice ◽

Clinical Care ◽

Diagnostic Testing ◽

Diagnostic Tools ◽

Swallowing Function ◽

Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

Download Full-text

Knowledge and Skills for Evaluation of Velopharyngeal Physiology for Speech

Perspectives on Speech Science and Orofacial Disorders ◽

10.1044/ssod24.2.67 ◽

2014 ◽

Vol 24 (2) ◽

pp. 67-76 ◽

Cited By ~ 2

Author(s):

Thomas Watterson ◽

Lynn Marty Grames

Keyword(s):

Visual Evaluation ◽

Swallowing Function ◽

Knowledge And Skills ◽

Speech Language Pathologist ◽

Speech Evaluation ◽

The Relationship

The American Speech-Language-Hearing Association (ASHA) has developed Knowledge and Skills (KAS) recommendations for evaluation of the larynx and swallowing function but the evaluation of velopharyngeal (VP) function has never been addressed. This article will review previous documents that have addressed general endoscopic knowledge and skills and develop a case for a new KAS that specifically addresses visualization and evaluation of the VP mechanism. The new KAS document will delineate and explain the relationship between speech evaluation and visual evaluation of VP physiology. The unique skills required of the speech-language pathologist for this kind of evaluation will be discussed.

Download Full-text