Rehabilitation protocol of dysphagia after subtotal reconstructive laryngectomy

Dysphagia is a constant complication of subtotal reconstructive laryngectomy, due to modifications in the anatomy and in sensitivity of the larynx and pharynx. The reduced sphincteric activity of the larynx can enhance aspiration with a higher risk of pneumonia. In our opinion, the presence of the tracheotomy tube in the first weeks after surgery interferes with proper mobility of the laryngo-tracheal axis during swallowing, as it anchors the trachea to the skin. We have conducted swallowing rehabilitation, without the tracheotomy tube, ready to aspirate eventual saliva or food debris dropping into the trachea. This protocol has been applied in 33 patients undergoing subtotal reconstructive laryngectomy and better patient compliance and swallowing performance were observed. The period to recover complete autonomous oral intake is less than one month and none of these patients showed signs or symptoms of aspiration pneumonia during hospitalisation or follow-up. This rehabilitation protocol is, therefore, a valid and effective alternative to other well-known procedures.