Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry

Area of Science:

• Otolaryngology
• Swallowing Physiology
• Surgical Outcomes

Background:

• Swallowing pressures after total laryngectomy (TL) are not well understood.
• TL alters pharyngeal structures, impacting pressure profiles.
• High-resolution manometry (HRM) can assess these pressure changes.

Purpose of the Study:

• To compare pharyngeal swallowing pressures between TL subjects and controls using HRM.
• To evaluate the effect of bolus volume on swallowing pressures in TL subjects.

Main Methods:

• Pharyngeal HRM was performed on 6 TL subjects and 6 controls.
• Key timing and pressure variables of the velopharynx, mesopharynx, and UES were analyzed.
• Swallowing pressures were assessed with varying bolus volumes in TL subjects.

Main Results:

• TL subjects exhibited increased velopharyngeal pressure duration.
• Mesopharyngeal pressure was lower in TL subjects compared to controls.
• UES pressures (pre-opening and post-closure) were significantly reduced in TL subjects.
• Mesopharyngeal pressure decreased with larger bolus volumes in TL patients.

Conclusions:

• Longer velopharyngeal pressure duration suggests successful bolus transit due to separate air/food pathways post-TL.
• Reduced UES pressures reflect anatomical changes from larynx removal and cricopharyngeal myotomy.
• Further research with dysphagic TL patients is needed to fully characterize functional swallowing.