Deglutition following supraglottic horizontal laryngectomy

Area of Science:

• Otolaryngology
• Surgical Oncology
• Deglutition Science

Background:

• Swallowing difficulties (dysphagia) are a potential complication after supraglottic horizontal laryngectomy.
• Understanding the specific surgical factors contributing to dysphagia is crucial for improving patient outcomes.

Purpose of the Study:

• To identify surgical factors associated with deglutition problems following supraglottic horizontal laryngectomy and its modifications.
• To evaluate the impact of various surgical elements on swallowing function.

Main Methods:

• Retrospective review of clinical records for 38 patients who underwent supraglottic horizontal laryngectomy.
• Analysis of factors including patient demographics, tumor characteristics, extent of surgical resection (epiglottis, aryepiglottic folds, arytenoid cartilages, false folds, base of tongue, hyoid bone, vocal folds, thyroid cartilage), neck dissection, cricopharyngeal myotomy, and complications.

Main Results:

• Removal of the arytenoid cartilage was identified as a significant contributor to deglutition problems.
• Asymmetrical removal of the false folds also correlated with increased swallowing difficulties.
• Standard supraglottic horizontal laryngectomy with laryngeal base-of-tongue approximation and cricopharyngeal myotomy generally resulted in manageable deglutition issues.

Conclusions:

• Arytenoid cartilage removal is a key factor leading to significant deglutition problems and aspiration after supraglottic horizontal laryngectomy.
• Reconstruction of the removed arytenoid cartilage is essential to prevent severe aspiration.
• Standard surgical techniques, when performed without extensive arytenoid resection, are associated with fewer serious swallowing complications.