The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia

Kamp, Martine F. van der; Rinkel, Rico N. P. M.; Eerenstein, Simone E. J.

doi:10.1007/s00405-016-4424-4

Cited by 19 publications

(44 citation statements)

References 17 publications

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“…45 According to some authors, swallowing function was not affected by the diameter of the neopharynx after primary closure with a pharyngeal remnant width ranging from 3 to 8 cm. 26 A pseudodiverticulum was more frequently seen after vertical closure compared to T-shaped neopharyngeal closure. 17,45 The frequency of pseudodiverticulum formation seemed to be dependent on the type of pharyngeal closure.…”

Section: Instrumental Swallowing Assessmentmentioning

confidence: 91%

“…[45][46][47][48][49][50][51][52][53][54][55][56] None of the 44 articles met all critical appraisal criteria (Table 3). Seventeen articles fulfilled all criteria for external validity, 13,17,22,[26][27][28]30,32,35,36,[38][39][40]44,46,49,50 and six studies did not fulfill any of these criteria. 14,19,33,34,42,45 Two of the included articles fulfilled all criteria for internal validity, 18,48 representing a low risk of bias.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…15,36,40,44,49,53 Translation of the results to best clinical decision making is not possible in 18 studies because the methodology and results were not described in sufficient detail to warrant doing so. 14,16,19,20,26,27,30,33,34,40,46,47,[51][52][53][54][55][56] Information on the number of raters and how exams were evaluated was missing in almost all studies. Only in five studies were the raters blinded 15,18,26,48,49 and only in three studies was information given on interobserver or intraobserver reliability.…”

Section: Methodological Commentsmentioning

confidence: 99%

“…16,19 The reported frequency of the main structural disorders of the neopharynx with or without pharyngeal reconstruction was as follows: 15% to 19% stricture formation 24,32 ; 42% to 60% pseudodiverticulum formation 35,45,54,55 ; 4% to 18% fistulas 16,17,19,24,31,33,45 ; 7% to 13% tumor recurrence 16,45 ; and 22% to 36% prominent cricopharyngeal muscle. 26 Radiographic signs of disturbed bolus transport through the jejunal interposition graft were commonly observed after total pharyngolaryngectomy, 25,48 whereas Krappen et al 14 observed no problems with bolus transport after pharynx reconstruction with a tubed jejunal interposition graft with siphon. 26 A pseudodiverticulum was more frequently seen after vertical closure compared to T-shaped neopharyngeal closure.…”

Section: Instrumental Swallowing Assessmentmentioning

confidence: 99%

“…(Continues) assessed by cineradiography, 14 VFSS, 25,26 perfusion manometry, 34 videomanometry, 35 or MDADI, 41 was reported after mucosa-and-muscle pharyngeal primary closure (eg, Tshaped, Y-shaped, or vertical closure) compared to only mucosa primary closure, 35 after T-shaped pharyngeal closure compared to vertical closure or circumferential closure, 26,41 after horizontal pharyngeal closure compared to vertical closure, 41 after ALT flap compared to jejunal graft interposition, 25 and after insertion of a jejunum siphon with repair of the digastric muscle versus insertion without repair of the digastric muscle. (Continues) assessed by cineradiography, 14 VFSS, 25,26 perfusion manometry, 34 videomanometry, 35 or MDADI, 41 was reported after mucosa-and-muscle pharyngeal primary closure (eg, Tshaped, Y-shaped, or vertical closure) compared to only mucosa primary closure, 35 after T-shaped pharyngeal closure compared to vertical closure or circumferential closure, 26,41 after horizontal pharyngeal closure compared to vertical closure, 41 after ALT flap compared to jejunal graft interposition, 25 and after insertion of a jejunum siphon with repair of the digastric muscle versus insertion without repair of the digastric muscle.…”

Section: Instrumental Swallowing Assessmentmentioning

confidence: 99%

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Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

et al. 2018

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Background This systematic review qualitatively summarizes the current literature on diagnosis and treatment of oropharyngeal dysphagia (OD) after total laryngectomy (TLE). Methods Electronic databases PubMed, Embase, and the Cochrane Library were used. Two independent reviewers carried out the literature search and assessed the methodological quality of the included studies using a critical appraisal tool. Results Forty‐four articles met the inclusion criteria. Of these, 35 studies were on diagnosis, four on therapy, and five on both diagnosis and treatment of OD following TLE. Study aims, swallowing‐assessment methods, and main findings of the included studies were summarized and presented. Conclusions The reviewers found heterogeneous outcomes and serious methodological limitations, which prevented us from pooling data to identify trends that would assist in designing best clinical practice protocols for OD following TLE. Further research should focus on several remaining gaps in our knowledge on diagnosis and treatment interventions for OD following TLE.

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Section: Instrumental Swallowing Assessmentmentioning

confidence: 91%

Section: Methodological Qualitymentioning

confidence: 99%

Section: Methodological Commentsmentioning

confidence: 99%

Section: Instrumental Swallowing Assessmentmentioning

confidence: 99%

Section: Instrumental Swallowing Assessmentmentioning

confidence: 99%

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Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

et al. 2018

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

et al. 2023

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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.

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Health‐Related Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy

et al. 2021

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Objectives/Hypothesis The aims were to determine health‐related quality of life (HRQoL), including voice problems, dysphagia, depression, and anxiety after total laryngectomy (TL), and investigate the associations between HRQoL and the late effects. Study Design Cross‐sectional study. Methods 172 participants having received a TL 1.6 to 18.1 years ago for laryngeal/hypopharyngeal cancer filled in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, Core and Head and Neck module (EORTC QLQ‐C30, EORTC QLQ‐H&N35), Voice‐Related Quality of Life questionnaire (V‐RQOL), M.D. Anderson Dysphagia Inventory (MDADI), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Results Participants scored worse than normative reference populations on all scales/items of the EORTC questionnaires, except one, and almost half of the scales/items showed a clinically relevant difference. Moderate/severe dysphagia was present in 46%, moderate/severe voice problems in 57%, depression in 16%, and anxiety in 20%. Decreasing age, increasing numbers of comorbidities, increasing voice problems, increasing dysphagia, and increasing depression symptoms, were associated with a lowered EORTC QLQ‐C30 summary score. Conclusion A substantial proportion of participants experienced clinically significant late effects and increasing levels of these were associated with a lowered HRQoL. Level of Evidence 3 Laryngoscope, 132:980–988, 2022

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The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia

Cited by 19 publications

References 17 publications

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

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

Health‐Related Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy

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