Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry

Abstract

Introduction Understanding of swallowing pressures after total laryngectomy (TL) and what constitutes a “functional” swallow are limited. Mobile structures are altered or removed after TL, with consequent effects on pressure profiles. High-resolution manometry (HRM) can characterize these pressures. Methods Six TL subjects without dysphagia and six controls underwent pharyngeal HRM. Timing and pressure variables for the velopharynx, mesopharynx, and upper esophageal sphincter (UES) were compared. Changes in variables due to bolus volume were evaluated in TL subjects. Results TL subjects had increased duration of velopharyngeal pressure (p=0.012). Maximum mesopharyngeal pressure was lower versus controls (p=0.003). Maximal and total pre-opening (p=0.002; p=0.002) and post-closure (p=0.001; p=0.002) UES pressures were lower. Maximum mesopharyngeal pressure (p=0.032) decreased with increasing bolus volume. Conclusions Increased velopharyngeal pressure duration and total swallow duration reflect separation of the pharynx into distinct conduits for air and food, thus ensuring successful bolus passage without the need for respiration. Decreased UES pressure highlights the effects of disrupting the cricopharyngeal and rostral esophageal muscle fibers from their attachments to the larynx and performing a cricopharyngeal myotomy. Additional studies including subjects with dysphagia could further characterize the functional TL swallow and identify aspects susceptible to dysfunction.

The applicability of high resolution manometry in total laryngectomy

“…Another study evaluated six total laryngectomy patients without dysphagia and six control patients, all of them underwent HRM. A decrease in UES pressure was seen in total laryngectomy patients, and the low pressure was due to possible changes in muscle connections at the UES level, especially cricopharyngeal interruption (10) .…”

Fisiología del esfínter velofaríngeo durante la deglución. Revisión sistemática de literatura

“…A nivel velofaríngeo, los resultados evidenciaron que los sujetos TL comparados con los controles, exhibieron una mayor duración de la presión velofaríngea (p = 0,012) y una tasa de aumento de la presión velofaríngea más lenta (p = 0,005); mientras que no hubo diferencias en la presión velofaríngea máxima (p = 0,821) y la presión total generada en la velofaringe (p = 0,163). La presión velofaríngea y la duración total de la deglución reflejan la separación de la faringe en conductos distintos para el aire y los alimentos, lo que garantiza el paso exitoso del bolo sin la necesidad de respiración 29 .…”

Effects of Aspiration Prevention Surgery on the Dynamics of the Pharynx and Upper Esophageal Sphincter

“…Total laryngectomy for laryngeal cancer reportedly has an effect on postoperative pharyngeal pressure and UES dynamics and induces reduced UES pressure, 8 , 13 , 14 prolonged UES relaxation duration, 13 and increased velopharyngeal pressure duration. 8 Cricopharyngeal myotomy can also affect the postoperative swallowing dynamics and result in reduced UES resting pressure 15 , 16 and improved UES relaxation duration during swallowing. 17 , 18 Some studies have reported that no significant change in pharyngeal pressure was observed as a result of cricopharyngeal myotomy for patients with neuromuscular diseases, 15 , 16 , 19 whereas other studies have reported statistically significant increases in peak pharyngeal pressure.…”