Tubed Supraglottic Laryngeal Closure to Treat Chronic Aspiration After Radiotherapy for Head and Neck Cancer

Abstract

Objectives/Hypothesis: To evaluate the long-term swallowing outcomes after surgical treatment for chronic aspiration in patients treated with radiotherapy for head and neck cancer. Study Design: This was a retrospective study. Methods: The data of patients who underwent radiotherapy for head and neck cancer and who subsequently required a laryngectomy or a tubed supraglottic laryngeal closure (TSLC) for recurrent aspiration pneumonia between 2004 and 2017 were retrieved from a tertiary referral hospital dysphagia clinic. The Functional Oral Intake Scale (FOIS) and the Swallowing Performance and Status Scale (SPSS) were used to assess swallowing function. Results: Of the 17 patients who required surgery for chronic aspiration secondary to radiotherapy for head and neck cancer, two underwent a laryngectomy and 15 a TSLC. During a mean follow-up of 77 months, the FOIS and SPSS scores significantly improved at 12, 24, and 36 months after laryngectomy and TSLC relative to the baseline (P < .05). Both patients who underwent laryngectomy and 11 of the 15 (73.3%) who underwent a TSLC resumed oral feeding. Both laryngectomy patients had episodes of recurrent aspiration pneumonia after surgery due to leakage through the tracheoesophageal puncture or prosthesis, whereas none of the TSLC patients had these episodes. Conclusion: A tubed supraglottic laryngeal closure, which is a reversible procedure that preserves the larynx and allows for natural phonation, should be considered an alternative to laryngectomy for the control of chronic aspiration.

Perceptual Voice and Speech Analysis after Supraglottic Laryngeal Closure for Chronic Aspiration in Head and Neck Cancer

“…One TSLC patient who had a good postoperative voice and swallowing function suffered from social anxiety related to the tracheostomy tube. The patient was eventually decannulated after undergoing an adequate transoral carbon dioxide laser reopening of the tubed supraglottis 14 . This demonstrated that a TSLC is a reversible procedure that preserves the larynx and allows for natural phonation and that can be considered an alternative to a laryngectomy for the control of chronic aspiration, especially for those patients who are reluctant to lose their larynx.…”

“…We have previously reported on the efficacy of a TSLC to control chronic aspiration in post‐irradiated NPC patients 14 . Of the 17 patients in that series who required surgery for chronic aspiration secondary to radiotherapy for head and neck cancer, two underwent a laryngectomy and 15 a TSLC.…”

“…Sequential diagrams of a tubed supraglottic laryngeal closure with placement of a tibial periosteal graft 14 . A, Preoperative appearance of the supraglottis with circumferential rim incision of the supraglottic mucosa (dotted line).…”

Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency

“…Although numerous studies have examined APS, [9][10][11][12][13][14][15][16][17]23 they have investigated a single surgical technique or a specific disease, which is inadequate for determining the benefits and risks of APS. Here, we included 100 patients, which is, to our knowledge, the largest sample size reported in APS-related publications to date.…”

Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition

“…Tubed supraglottic closure has been recently described, with encouraging results. 633 Laryngeal voice in the presence of a tracheostomy can be achieved whilst minimising the aspiration risk by reducing the supraglottic aperture.…”