Barium examination of the esophagus after total laryngectomy.

Abstract

Barium examination of the esophagus is often useful for evaluating the cause of dysphagia, a frequent condition in patients who have undergone total laryngectomy. The examination may be difficult to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor, or the operation itself. Radiographic and clinical information on 45 total-laryngectomy patients, whose follow-up periods ranged from six months to 17 years, were analyzed. A recurrent tumor was found in 15 patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in 14 patients appeared either as a long symmetrical narrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 13 patients and presaged the development of recurrent tumors in five. Cricopharyngeal muscular dysfunction accounted for dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium examination of the esophagus, and the radiographic findings often indicate the correct diagnosis with a high degree of confidence.

Preoperative risk assessment for gastrostomy tube placement in head and neck cancer patients

“…Postlaryngectomy patients experience dysphagia in up to 58% of cases. 14,15 Closure of the pharynx after removal of the anterior wall results in narrowing of the new lumen and absence of the negative pressure generated previously by elevation of the larynx and opening of the cricopharyngeus. Benign stricture of the hypopharynx is another important postoperative cause of dysphagia in this patient population.…”

Anteriores Pseudodivertikel nach Laryngektomie

“…Analog zur Technik beim Zenker-Divertikel [11] wurde der Hypopharynxtrichter mit dem Spreizlaryngoskop nach Weerda eingestellt, die Ösophagusrückwand mit einem gut befeuchteten Tupfer geschützt und das Narbensegel mit dem CO 2 [1,2,5].…”

“…Als weitere Ursache von Schluckstörungen nach Laryngektomie ist die Ausbildung einer divertikelartigen Aussackung ventral eines querliegenden Narbensegels zwischen Zungengrund und Hypopharynxtrichter in Betracht zu ziehen [1][2][3][4]. Für diese Aussackung wurde wegen der Ähnlichkeit mit einem Zenker-Divertikel der Begriff des "anterior neopharyngeal diverticulum" [3] bzw.…”

“…Diese gestattet zudem die Diagnose von weiteren Pathologien im Ösophagus [1,8]. Entscheidend für eine korrekte Beurteilung des radiologischen Befunds ist die Kenntnis der normalen Anatomie nach Laryngektomie, denn das Narbensegel imponiert wie eine Epiglottis und kann zu einer falschen radiologischen Befundung füh-ren [1].…”

Dysphagia after laryngeal surgery: Radiologic assessment

“…A reconstructive procedure was ultimately necessary. possible underlying causes is extensive and the contribution of physical examination is relatively small [17]. Videotaped fluoroscopy is therefore the usual method employed in the initial assessment.…”