Management of swallowing in supraglottic and extended supraglottic laryngectomy patients

Abstract

Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in-home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non-compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery.

Morphological reconstruction of the neoepiglottis after hyo‐sub‐glosso‐epiglottectomy (anteriorly extended supraglottic laryngectomy)

“…6 Compared to these dismal results, our morphological reconstruction worked well, and all three patients demonstrated quite favorable functional results. All three cases began oral intake during POD 17 to 20 and could resume their preoperative diet, including case 2 who had previously undergone total esophagectomy (Table I).…”

Epiglottis Reconstruction with Auricular Free Flap for Rehabilitation of Dysphagia: A Case Study

“…Aspiration of liquid and food is a well-known complication of supraglottic laryngectomy [7,8]. Swallowing rehabilitation with a speech and language therapist is necessary in the postoperative period [7].…”

“…Swallowing rehabilitation with a speech and language therapist is necessary in the postoperative period [7].…”

Swallowing function in patients with vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma

“…Various airway protection maneuvers were trialed with varying textures and consistencies to develop a therapeutic swallowing and exercise program. Therapy included the Mendelsohn maneuver, effortful swallowing technique, and the supraglottic swallow maneuver . Patients were sent home once they could achieve normal oral alimentation.…”

“…Therapy included the Mendelsohn maneuver, effortful swallowing technique, and the supraglottic swallow maneuver. 9 Patients were sent home once they could achieve normal oral alimentation. A gastrostomy tube was placed when a patient was unable to demonstrate the ability to maintain adequate hydration and nutrition through oral means alone for at least 4 weeks and for so long as there was any concern about swallowing safety.…”