Long-Term Results of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy as Treatment for Life-Threatening Aspiration

Abstract

In most of our patients, life-threatening aspiration was successfully treated by UES myotomy and laryngeal suspension with restoration of oral intake.

Feasibility and potential value of lipofilling in post‐treatment oropharyngeal dysfunction

“…However, despite the fact that a clear volume increase can be accomplished, the lipofilling injections nevertheless did not improve function in all of our patients. Currently, it is well acknowledged that dysphagia post‐surgery and/or chemoradiotherapy is multifactorial in its physiological basis, which indicates that other factors such as fibrosis, reduced hyolaryngeal elevation, pharyngeal constrictor activity, and/or insufficient sphincter opening may also be an important factor besides volume loss . This might explain why improving just one element was not sufficient to make significant gains for some cases, though it was for others.…”

“…Often, due to insufficient contact between the base of tongue and posterior pharyngeal wall, the food bolus is swallowed less powerfully, leading to stagnation of food (residue), with a high risk of aspiration of the residue. A combination of decreased tongue strength, deficient/reduced hyolaryngeal elevation, lack of pharyngeal constrictor activity, lack of oropharyngeal seal, or insufficient opening of the esophageal inlet may also play a role in aspiration . Long‐term and even lifelong feeding tube dependency is sometimes unavoidable, and quality of life in these patients is often seriously impaired …”

Long-Term Results of External Upper Esophageal Sphincter Myotomy for Oropharyngeal Dysphagia

“…If the result of UES myotomy is not successful because of insufficient pharyngeal propelling combined with insufficient laryngeal elevation, additional laryngeal suspension can be considered [15]. …”

“…In our study we observed none of these complications. Dauer[15] reports one pharyngocutaneous fistula in eight patients treated with an external myotomy. Larger studies have not reported this complication[3, 7].…”

Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

“…Profound OPD is typically a consequence of a combination of reduced lingual and pharyngeal contraction pressure and limited or absent laryngohyoid elevation . CPM alone is frequently insufficient to prevent aspiration, because the UES opening is an active mechanical event dependent on elevation of the larynx off of the cervical spine rather than simply a consequence of cricopharyngeus muscle relaxation . The laryngohyoid complex can be elevated surgically to mechanically open the UES .…”