Videofluoroscopy of the swallowing act after partial supraglottic laryngectomy by CO2 laser

Abstract

The evaluation of functional deglutition in patients after partial supraglottic laryngectomy by CO 2 laser was performed by videoflouroscopy of the swallowing act. We studied 20 patients in PA and LL projections, and the swallowing act, at 25 frames per s, was captured on videotape. Aspiration was found in six patients, four of whom had manifest clinical symptoms of aspiration. Four patients had post-deglutitive, one intra-deglutitive and one both intra-and post-deglutitive aspiration. Other swallowing disturbances or structural deformities were not detected. Dynamic radiological studies of swallowing, such as videoflouroscopy of the swallowing act, can provide valuable information regarding functional results after surgical procedures in the upper aerodigestive tract. Our encouraging results prove the validity of partial supraglottic laryngectomy by CO 2 laser as a method of treatment for carcinoma of the larynx.

Voice, swallowing and quality of life in patients after transoral laser surgery for supraglottic carcinoma

“…To our knowledge, our study is the first to prospectively examine both functional and oncological outcomes of laser surgery. Our findings strongly support the results of previous retrospective studies [7][8][9][10][11][12][13][14][15][16][17][18]32].…”

“…The main postoperative problem resulting from deglutition was aspiration. The reduced incidence of aspiration following laser surgery thus constitutes a functional advantage over conventional supraglottic laryngectomy [7,[11][12][13][14]. The incidence of aspiration pneumonia has been found to be lower after laser surgery (11.5%) than after conventional laryngectomy (40%) [7].…”

“…Transoral laser surgery [6] has several advantages over conventional supraglottic laryngectomy, including faster recovery of swallowing function, lower incidences of aspiration pneumonia and pharyngocutaneous fistulae, avoidance of tracheostomy and shorter hospital stay [7][8][9][10][11][12][13][14][15][16][17][18]. Although laser surgery has shown better functional outcomes without compromising oncological outcomes, partial or complete resection of supraglottic structures may cause postoperative voice or swallowing problems.…”

“…Studies assessing functional outcomes of transoral laser surgery have measured outcomes at different times after surgery [7,[11][12][13][14]16]. Little is known, however, about functional outcomes relative to extent of laser resection or about the health-related quality of life (QOL) of these patients.…”

Functional outcomes after different types of transoral supraglottic laryngectomy

“…Comparing VEES and VFS outcomes, the former seems to underestimate the true incidence of tracheal aspiration (with a higher number of false negatives), although it allows obtaining more anatomic and functional information than VFS. 8,20 In contrast, VFS shows only two-dimensional dynamic images and gives little insight into anatomic details, but allows the unique possibility of detecting even minor aspiration throughout each phase of deglutition. Therefore, at present, the combination of VEES and VFS provides the most comprehensive evaluation of swallowing.…”