Swallowing-aspiration functional assessment in patients undergoing supracricoid subtotal laryngectomy with cricohyoidoepiglottopexy

Abstract

Introduction: Supracricoid subtotal laryngectomy associated with cricohyoidoepiglottopexy is the most efficient conservative surgical technique to preserve laryngeal functions in patients with locally advanced carcinoma of the larynx. The most feared complication of this intervention is aspiration at the moment of swallowing and secondary pneumonia; there are several ways to evaluate aspiration and its degree. We present a novel form to identify even small amounts of tracheobronchial aspiration. Method: Patients undergoing subtotal laryngectomy and cricohyoidoepiglottopexy due to laryngeal cancer were included; all of them were postoperatively assessed with radioactive-swallow. Based on the symptoms and the scintigraphy result, prolonging the feeding time by nasogastric tube was decided. Results: Thirty-seven patients were included; 4 of them had received radiotherapy; aspiration rate was 29.7 %; 50 % of patients who had received radiation had aspiration; 18 % of subjects with tracheobronchial aspiration required prolongation of feeding time by nasogastric tube, none required total laryngectomy for aspiration that hindered swallowing. Conclusions: Postoperative evaluation of patients undergoing subtotal laryngectomy with radioactive-swallow, allows to identify even minimal amounts of fluid aspirated into the bronchial tree and to plan the moment for swallowing to be started.