Does laryngectomy improve swallowing after chemoradiotherapy? A case study.
Organ preservation protocols of high-dose chemoradiotherapy have become fairly common to treat head and neck cancers. However, significant swallowing problems can occur. This study examines swallowing, oral tongue pressures, and tongue base-to-pharyngeal wall pressures in a patient who underwent total laryngectomy for improvement of swallowing after chemoradiotherapy for treatment of a hypopharyngeal tumor. The patient underwent concurrent videofluorographic and manometric examination of swallowing and examination of oral tongue pressures after the laryngectomy. One healthy subject was used as a control. After the laryngectomy, the patient no longer aspirated; however, he could swallow only liquids and pureed foods. He demonstrated difficulty with bolus clearance through the oral cavity and pharyngocervical esophagus. Pharyngeal pressures were reduced compared with those of the control subject. While total laryngectomy will stop unremitting aspiration, swallowing after chemoradiation may be severely compromised. This may not be overcome by total laryngectomy.
Lazarus
Cathy
C
Voice, Speech and Language Service and Swallowing Center, Northwestern University Medical School, 201 E Huron St, Suite 10-205, Chicago, IL 60611, USA. claz@northwestern.edu
Logemann
Jeri A
JA
Shi
Guoxiang
G
Kahrilas
Peter
P
Pelzer
Harold
H
Kleinjan
Kara
K
D000368:Aged; D003679:Deglutition / Q000502:physiology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D007825:Laryngectomy; D008297:Male; D008365:Manometry; D014059:Tongue / Q000503:physiopathology; D016896:Treatment Outcome