Functional analysis after supracricoid partial laryngectomy with cricohyoidoepiglottopexy

To assess prospectively speech and swallowing function in a series of 17 patients after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

Retrospective study.

From 1983 to 1996, 69 patients at Department of Otolaryngology-Head and Neck Surgery, CHUV (Lausanne, Switzerland) underwent a supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Seventeen of them (25%) could be contacted and accepted participation in a functional evaluation that included a questionnaire to document their present nutritional status and diet. A formal voice evaluation was also performed, which included psychoacoustic evaluation of vocal qualities, fundamental frequency parameters, phonation intensity range, phonatory quotient (vital capacity divided by maximum phonation time), and a laryngeal video laryngoscopy performed with a rigid endoscope.

Median postoperative follow-up was 66 months (range, 12-152 mo). Nine of 17 patients (53%) recovered a normal diet with no increased incidence of aspirations. Seven of 17 had minor limitations such as no peanuts, dry bread, or rice. Two of 17 patients were restricted to pureed food. Assessment of voice showed a clearly decreased mean fundamental frequency at 70.1 Hz (normal range, 121-211 Hz) and a narrowed frequency range of phonation with a mean value of 8.8 semitones (normal value, 27). Forty-two percent of the patients went back to their normal professional life after the operation. Among the 10 who did not, 3 (16%) retired and 7 actually had to give up their profession, because of the modification of their voice or general asthenia and age close to retirement.

Restoration of laryngeal function after supracricoid partial laryngectomy with cricohyoidoepiglottopexy is satisfactory. Although most of the patients seem to recover normal swallowing function, severe voice alterations appear to be inevitable.