Swallowing function after endoscopic resection of supraglottic carcinoma with the carbon dioxide laser.
From April 1998 to May 2000, 14 patients with supraglottic cancer underwent transoral laser surgery (T-stage T1-2: 11 patients, T3: 3 patients). In three patients, an epiglottectomy or hemi-epiglottectomy was performed. In 11 patients, further structures (false cords, the valleculae and the base of the tongue and/or parts of the arytenoid cartilage) had to be resected. Thirteen patients had to undergo neck dissection and post-operative irradiation. Tracheostomy was carried out prophylactically in two cases. Every patient received a nasogastric tube perioperatively. One week after surgery, an evaluation of dysphagia was performed by video endoscopy (VEED). Aspiration was the main problem; in no case did dysphagia occur. The aspiration was graded according to videolaryngoscopical classification. Four patients had an occasional and ten patients a permanent aspiration after surgery. According to this assessment, an individual deglutition therapy management was established. Ten patients with permanent aspiration received a temporary percutaneous endoscopic gastrostomy (PEG) and were integrated in a rehabilitation programme (stimulation of the swallowing reflex, training of compensatory swallowing manoeuvres, dietary regime). Due to this training programme, the PEG could be removed in eight patients after 2-9 months. No patient needed a laryngectomy or a tracheostomy due to aspiration. There were no cases of aspiration-associated pneumonia. To obtain satisfying functional results after transoral laser surgery of supraglottic cancers with resection of the epiglottis, post-operative deglutition management, consisting of video endoscopy, a training programme and often a PEG, is necessary.
Oeken
J
J
Department of Otorhinolaryngology, University of Leipzig, Germany. oekj@server3.medizin.uni-leipzig.de
Hänsch
U
U
Thiel
S
S
Bootz
F
F
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology* / Q000534:rehabilitation; D004825:Epiglottis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005931:Glottis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D001239:Inhalation / Q000502:physiology; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D007828:Laryngoscopy / Q000009:adverse effects*; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D020127:Recovery of Function; D016896:Treatment Outcome; D014741:Video Recording