Patterns of Swallowing After Supraglottic Laryngectomy

Authors

  • John M. Schweinfurth MD,

    Corresponding author
    1. Division of Otolaryngology, Albany Medical College, Albany, New York
    • John M. Schweinfurth, MD, Hershey Medical Center, Department of Otolaryngology, MC H091, P.O. Box 850, 500 University Drive, Hershey, PA 17033-0850, U.S.A.
    Search for more papers by this author
  • Steven M. Silver MD

    1. Division of Otolaryngology, Albany Medical College, Albany, New York
    Search for more papers by this author

  • Presented at the Meeting of the Eastern Section of the American Laryngological, Rhinological and Otological Society, Inc., Providence, Rhode Island, January 29, 1999.

Abstract

Objective To understand the anatomical and physiological basis for early recovery of swallowing function after supraglottic laryngectomy.

Study Design Retrospective review.

Methods The records of nine patients who had undergone supraglottic laryngectomy at the Stratton Veteran's Administration Hospital (Albany, NY) between 1994 and 1998 were reviewed. Videofluoroscopic swallowing studies were obtained on all patients as early as was safely possible and were reviewed by a multidisciplinary team of physicians, nurses, and speech pathologists with regard to anatomical and functional differences between successful and unsuccessful recovery of swallowing function.

Results Five of nine patients resumed regular diets including thin liquids within 1 year of surgery; three patients remained dependent on enteral support. Swallowing success was most closely associated with short oropharyngeal transit time and an anterosuperior position of the larynx. Laryngeal positioning, tongue base mobility, and placement and coordination of the bolus for maximum swallowing efficiency can be improved with time and speech therapy.

Conclusions Factors that placed patients at significantly higher risk for aspiration included low laryngeal position and delayed oropharyngeal transit time. Tight lingual-laryngeal closure did not completely prevent aspiration. At the time of the initial surgical procedure it may be important to position the laryngeal remnant as far superior and anterior under the tongue base as possible.

Ancillary