Reconstruction technique following total laryngectomy affects swallowing outcomes

Abstract

Objectives How reconstruction affects function following total laryngectomy is unclear. This study seeks to determine whether reconstruction method is associated with differences in swallowing outcomes. Methods Retrospective review of reconstruction technique in patients undergoing TL was compared by pharyngeal transit time (PTT), patient‐reported dysphagia (EAT‐10), and diet‐tolerated (FOIS). Results Ninety‐five patients met inclusion criteria, with 40 patients (42.1%) undergoing primary closure and 55 patients (57.9%) undergoing tissue transfer. There was no difference in EAT‐10 scores between the groups (P = .09). There was a significantly higher proportion of patients achieving oral diet (FOIS >3) with primary closure (P = .003). Patients undergoing PMC vs free flap had similar rates of g‐tube dependency. Primary closure had the shortest PTT (1.89 seconds) compared to free flap (3.47‐4.65 seconds) or PMC (5.1 seconds; P = .035). Conclusions When primary closure is achievable, these results suggest improved swallowing outcomes with better tolerance of oral diet and shorter pharyngeal transit times. Level of evidence IV

Free Flap microvascular pharyngeal closure results in improved dysphagia-specific quality of life following total laryngectomy

“…This reached significance in the MDADI functional subscale while approaching significance in all other subscales as well as the composite score. To the best of our knowledge, only one other study has compared dysphagiarelated outcomes by pharyngeal closure technique using a validated dysphagia index [10]. Harris et al used the EAT-10 questionnaire and in contrast to the present study, they found no significant difference in EAT-10 scores between PC, PMMF and FF pharyngeal closure [10].…”

“…To the best of our knowledge, only one other study has compared dysphagiarelated outcomes by pharyngeal closure technique using a validated dysphagia index [10]. Harris et al used the EAT-10 questionnaire and in contrast to the present study, they found no significant difference in EAT-10 scores between PC, PMMF and FF pharyngeal closure [10]. Other previous studies have compared patients by self-reported dysphagia or alternative measures of dysphagia such as diet consistency, feeding tube dependence or need for oesophageal dilation.…”

“…Over one-third of patients cite dysphagia as the most significant issue affecting their day to day life following TL [9]. Rates of dysphagia appear similar between patients who undergo primary TL and salvage TL [4,10]. Causes of dysphagia following TL include a diverticulum, a pseudoepiglottis, cricopharyngeal dysfunction and strictures; factors that can be impacted by the pharyngeal closure technique [8].…”

Total Laryngectomy: A Review of Surgical Techniques

“…Hui et al demonstrated that the narrowest width of the pharyngeal remnant (about 1.5 cm relaxed or 2.5 cm stretched) is sufficient both for primary closure and for restoration of swallowing function [53]. While these values are the theoretical lower limits of pharyngeal width that can be used in neopharyngeal reconstruction without significant stenosis, a larger neopharyngeal diameter does not correlate with better swallowing outcomes [53,54].…”

Common mental disorders and patient-reported swallowing disorders following total laryngectomy

“…Total laryngectomy (TL) corresponds to the entire removal of the larynx 1 , and although this implies in a definitive dissociation between the digestive and respiratory tracts, postoperative anatomical impairments can affect oropharyngeal swallowing because the elevation of the larynx is eliminated and the propulsion of the tongue base is decreased, leading to a rupture of the constricting musculature of the pharynx, an increase in pharyngeal transit time, the presence of pharyngeal residues and a decrease in esophageal peristalsis [2][3][4][5] . Other pathophysiological aspects can also compromise swallowing after TL such as pseudodiverticulum, fistualization, stenosis, fibrosis, prosthesis leakage and gastroesophageal reflux 6 , in addition to sensory and motor impairment of the laryngeal nerves that innervate the pharynx 7 .…”