Impact of a Laryngectomy and Surgical Closure Technique on Swallow Biomechanics and Dysphagia Severity

Abstract

Objective. The incidence of self-reported dysphagia following a laryngectomy is high (72%). The impact, if any, of a surgical closure technique on swallowing biomechanics and dysphagia severity is not known. To date, there is no recommended standard procedure for pharyngeal reconstruction during laryngectomy surgery. The aim of this study was to determine how laryngectomy surgery alters swallowing biomechanics, pharyngeal peak deglutitive pressure, and hypopharyngeal intrabolus pressures and whether these changes in pressure correlate with specific surgical closure after total laryngectomy or with dysphagia severity. Study Design. Combined videoradiography and manometry was used to measure peak mid-pharyngeal, tongue, and intrabolus pressures; anatomical derangements; postswallow residue; and pharyngeal dimensions. Setting. Radiology Department, St George Hospital, Sydney, Australia. Subjects. Twenty-four patients following total laryngectomy surgery and age-matched control data. Results. When compared to controls, peak mid-pharyngeal pressures were significantly reduced in laryngectomy patients ( P < .001). Hypopharyngeal intrabolus pressures were significantly higher in patients when compared to controls ( P < .001). Patients who had undergone mucosa-and-muscle pharyngeal reconstruction had higher peak mid-pharyngeal pressures compared to those who had mucosa-alone closure ( P ≤ .04). Combined mucosa-and-muscle closure was also associated with reduced postswallow residue, indicative of a more efficient swallow. Conclusion. Following laryngectomy surgery, pharyngeal pro-pulsive contractile forces are impaired, and there is increased resistance to bolus flow across the pharyngoesophageal segment. These adverse biomechanical effects can be influenced by surgical techniques, providing surgeons with evidence for optimum pharyngeal closure following a laryngectomy to improve swallowing outcomes.