Swallowing outcomes following division of pseudo‐epiglottis resulting from vertical pharyngeal closure in laryngectomy

Abstract

Background: Vertical closure of the pharynx after laryngectomy can result in an outpouch of the anterior wall of the neopharynx below the tongue base, called a pseudo-diverticulum. The prolapsed mucosa that separates the rest of the neopharynx from the pseudo-diverticulum is termed a pseudo-epiglottis.Methods: Prospective study of patients with pseudo-epiglottis. M. D. Anderson Dysphagia Inventory (MDADI) scores were used to assess swallowing outcomes pre-and post-pseudo-epiglottis division, including minimally clinically important difference (MCID) assessment.Results: Of 16 patients with a pseudo-epiglottis, 12 had dysphagia (75%). Symptomatic patients had significantly worse global MDADI and subscale scores. After division, the mean composite MDADI increased from 48.3 to 64.7 (p = 0.035), including a high MCID (16.4) with a similar improvement in the global question rating findings (31.1 vs. 60, p = 0.021). The MCID was significant for all MDADI subscales. Conclusions: Pseudo-epiglottis formation is associated with significantly worse global and subscale MDADI scores. A clinically-and statisticallysignificant improvement in the MDADI scores was found following surgical division.