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Risk factors for dysphagia following total laryngectomy.

Brooke Swain1, Clara D Si1, Daniel R S Habib1

  • 1Vanderbilt University School of Medicine, Nashville, TN, USA.

American Journal of Otolaryngology
|January 21, 2026
PubMed
Summary

Dysphagia is common after total laryngectomy (TL). Prior radiation, adjuvant radiation, pharyngectomy, and tongue base resection increase dysphagia risk. Salvage TL patients need counseling on potential esophageal dilations.

Keywords:
DysphagiaLaryngectomyPostoperative complicationsSpeech therapy

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Area of Science:

  • Otolaryngology
  • Head and Neck Surgery
  • Surgical Oncology

Background:

  • Dysphagia is a frequent complication after total laryngectomy (TL), significantly impacting patient quality of life.
  • Many patients undergoing TL require repeated esophageal dilations to manage swallowing difficulties.
  • Identifying risk factors for dysphagia post-TL is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify surgical and non-surgical risk factors associated with dysphagia following total laryngectomy.
  • To analyze factors contributing to both clinically diagnosed dysphagia and dysphagia requiring esophageal dilation.

Main Methods:

  • Retrospective cohort study of 787 patients who underwent TL between 1999 and 2024.
  • Outcomes assessed included clinically diagnosed dysphagia and dysphagia requiring esophageal dilations.
  • Logistic regression analysis was used to evaluate associations between dysphagia and covariates such as radiation, BMI, and surgical procedures.

Main Results:

  • 26.9% of patients reported dysphagia, and 16.6% required esophageal dilation.
  • Prior radiation (aOR: 2.51), adjuvant radiation (aOR: 1.86), and tongue base resection (aOR: 2.14) were independently associated with clinical dysphagia.
  • Prior radiation was the only factor independently associated with dysphagia requiring dilation (aOR: 2.92).

Conclusions:

  • Dysphagia is a significant and common sequela of total laryngectomy.
  • Factors such as prior radiation, adjuvant radiation, total pharyngectomy, tongue base resection, and pedicled reconstruction influence swallowing outcomes.
  • Patients undergoing salvage TL should be informed about the potential need for post-laryngectomy esophageal dilations.