Quantitative Analysis of Videofluoroscopy Following Total Laryngectomy Using the ASPEKT Method

Area of Science:

• Otolaryngology
• Swallowing Disorders
• Medical Imaging

Background:

• Swallowing dysfunction is a frequent complication following total laryngectomy.
• Standard videofluoroscopic swallow study (VFSS) protocols may not adequately assess anatomical changes in post-laryngectomy patients.

Purpose of the Study:

• To apply the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics & Timing) Method for quantifying swallowing mechanics in post-laryngectomy patients.
• To identify key kinematic and timing parameters influencing swallowing efficiency after total laryngectomy.

Main Methods:

• Retrospective analysis of VFSS data from 2011-2021 in post-total laryngectomy patients.
• Scoring VFSS using the ASPEKT method, focusing on swallow number, UES opening duration, pharyngeal area at maximum constriction (PhAMPC), and residue.
• Utilizing a mixed-effects beta regression model to predict pharyngeal residue.

Main Results:

• Patients frequently required more than two swallows per bolus.
• Increased UES opening duration was observed with multiple swallows.
• Significantly reduced PhAMPC (40.4% C2-C4) was associated with increased residue compared to single-swallow patients (22.2% C2-C4).
• PhAMPC was a significant predictor of pharyngeal residue (OR=22.58, p<0.001).

Conclusions:

• The ASPEKT Method provides precise analysis of VFSS in post-laryngectomy patients.
• Ineffective maximal pharyngeal constriction is a primary factor in post-laryngectomy swallowing dysfunction.
• Further research into these swallowing dynamics is essential for developing targeted treatments.