Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy

Abstract

Dysphagi a can be a consequence of total laryngectomy even in the absence of symptoms and it could indeed directly or indirectly compromise quality of life. Aim: To evaluate the characteristics of swallowing after total laryngectomy and pharyngolaryngectomy with pharyngeal T closure, correlating them with the Quality of Life in Swallowing Disorders questionnaire. Methods: A prospective evaluation was performed in 28 patients; fifteen undergoing total laryngectomy and thirteen undergoing total pharyngolaryngectomy. Swallowing was evaluated through videofluoroscopy regarding the preparatory, oral and pharyngeal phases of swallowing, and the quality of life related to swallowing questionnaire was employed to measure quality of life. Results: Anatomical and functional changes were observed under videofluoroscopic evaluation. Dysphagia was diagnosed in 18 patients (64.3%), being mild in 66.6% and moderate/severe in 33.3%. The questionnaire indicated good quality of life in almost all scales. Complaints of dysphagia were associated to the burden (p=0.036) and mental health scale (p=0.031). The questionnaire indicated impact on the mental health scale for patients with severe dysphagia (p=0.012). Conclusions: High incidence of dysphagia was observed in some quality of life assessments, especially of mild degree.

Qualidade de vida em deglutição em idosos saudáveis

“…When we compared the values obtained by the healthy elderly to other populations, in completely dysphagic individuals (in different levels and different foundation pathologies), we observed great differences, being that the proven dysphagia, generally, result in very inferior mean scores (20,27) .…”

“…Another study, about quality of life related to swallowing in cancer patients (27) , found scores between 63 and 88 points in the 11 domains. The worst medians were obtained in the domains burden (63 pints), communication (63 points), mental health (65 points), social function (65 points) and frequency of symptoms (63 points).…”

Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa

“…16 It includes complete disease clearance and organ preservation determined by tumor extension, the amount of tissue remaining and the later plan for reconstruction. 17 Surgery for piriform fossa malignancies include removal of the total larynx and the part of the pharyngeal wall on which the tumor invaded onto and clearance of the draining interjugular lymph node levels. 17 Aspiration causing swallowing problems are not seen after total laryngectomy as airway and pharyngoesophagus are physically separated.…”

“…17 Surgery for piriform fossa malignancies include removal of the total larynx and the part of the pharyngeal wall on which the tumor invaded onto and clearance of the draining interjugular lymph node levels. 17 Aspiration causing swallowing problems are not seen after total laryngectomy as airway and pharyngoesophagus are physically separated. 18 The greatest difficulty with deglutition is in propulsion of the bolus through the oral cavity and pharyngoesophageal segment where the cleft in the palate in our case formed a technical contraindication for the surgical procedure.…”

“…19,20 So the oral preparatory phase dysfunction interfere in the performance of the subsequent phase by changes in swallowing biomechanical events causing stasis in the mouth and hypopharynx. 17 Strictures along the pharyngoesophagus narrows the food channel and can cause collection of food in the pharyngoesophagus above the stricture. 19,20 This is common when more of the pharyngeal mucosa are excised and primary closure done without attempts at reconstruction.…”