Scintigraphic assessment of swallowing after horizontal supraglottic laryngectomy.
OBJECTIVE
Oral-pharyngo-esophageal scintigraphy (OPES) proved to be able to demonstrate the pharyngeal residue of the radioactive bolus after deglutition and the presence and amount of tracheobronchial aspiration, and to calculate exactly the transit time of the various swallowing phases. The aim of this study was to evaluate the real objective effectiveness of OPES in order to assess the degree of swallowing recovery after horizontal supraglottic laryngectomy (HSL).


METHODS
Nineteen patients entered the study, and 17 healthy subjects were included as control group (group 1). Nineteen patients in whom HSL had been performed at least 1 year before underwent OPES. They were divided into two groups: 13 patients (group 2) in whom the tracheal cannula had been removed and swallowing, phonatory, and respiratory functions were satisfactory and 6 patients (group 3) in whom the tracheostomy tube was still in situ for aspiration of liquids and scarring of the laryngeal vestibule.


RESULTS
Our results showed that in the patients who underwent HSL, all scintigraphic semiquantitative parameters and particularly aspiration percentage values and Pharyngeal Ritention Index (PRI) at 10 and 60 seconds were able to pinpoint some residual "subclinical" alteration and/or minimal surgical sequelae frequently observed after this kind of functional surgery, even though a substantially satisfactory recovery was achieved clinically (group 2 versus group 1). In addition, aspiration amounts in group 3 were markedly higher than those in group 2 (p < .0002), and mean PRI values at 10 and 60 seconds were significantly different (p < .0001) from normal mean control values (group 1).


CONCLUSIONS
Oral-pharyngo-esophageal scintigraphy may be regarded as a noninvasive, well-tolerated technique, with a radiation body burden within satisfactory limits of radioprotection. It appeared to be also sensitive in assessing the swallowing recovery after HSL.
Galli
J
J
Institutes of Otolaryngology and Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
Valenza
V
V
Ottaviani
F
F
D'Alatri
L
L
Almadori
G
G
D'Errico
G F
GF
Serra
F
F
De Rossi
G
G
Paludetti
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003679:Deglutition / Q000502:physiology*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018709:Statistics, Nonparametric; D013671:Technetium Tc 99m Sulfur Colloid
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid