Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study

Area of Science:

• Otolaryngology
• Swallowing Disorders
• Surgical Outcomes

Background:

• Dysphagia is a frequent complication following open partial horizontal laryngectomy (OPHL).
• The specific physio-pathological mechanisms underlying impaired swallowing safety and efficiency post-OPHL remain incompletely understood.
• Lower airway invasion and pharyngeal residue are common concerns after this procedure.

Purpose of the Study:

• To investigate the physio-pathological mechanisms that compromise swallowing safety and efficiency in patients after OPHL.
• To identify specific videofluoroscopic parameters associated with unsafe or inefficient swallowing post-surgery.

Main Methods:

• Fifteen patients undergoing OPHL type IIa with arytenoid resection were evaluated.
• Videofluoroscopic examination of swallowing was conducted, analyzing ten spatial, temporal, and scalar parameters.
• The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale assessed swallowing safety and efficiency.

Main Results:

• Nearly half of the patients (46.7%) exhibited unsafe swallowing, and 40% had inefficient swallowing.
• Unsafe swallowing correlated with inadequate laryngeal closure (p=0.021).
• Inefficient swallowing was linked to prolonged pharyngeal transit time (p=0.008), reduced pharyngoesophageal segment opening (p=0.008), and diminished tongue base retraction (p=0.018 for solids, p=0.049 for semisolids).

Conclusions:

• Impaired laryngeal closure significantly impacts swallowing safety after OPHL.
• Swallowing efficiency is compromised by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and inadequate tongue base retraction.
• These identified mechanisms offer potential targets for optimizing dysphagia rehabilitation and surgical interventions post-OPHL.