Comparison of the glottic closure reflex in traditional "open" versus endoscopic laser supraglottic laryngectomy.
OBJECTIVE
Cancer of the supraglottic larynx may be surgically treated with either traditional "open" supraglottic laryngectomy (OSL) or endoscopic laser supraglottic laryngectomy (ELSL). Pharyngeal dysphagia is a well-documented consequence of traditional OSL from which near-normal swallowing characteristically recovers 14 to 40 days after surgery. Conversely, ELSL results in the resumption of serviceable swallowing within 2 to 7 days after surgery.


METHODS
A prospective assessment of the glottic closure reflex in 6 consecutive patients who had ELSL was performed by fiberoptic endoscopic evaluation of swallowing with sensory testing.


RESULTS
All 6 patients with ELSL demonstrated an intact glottic closure reflex both before surgery and 48 to 72 hours after surgery. In contrast, 7 of 8 historical control patients who had OSL demonstrated a persistent absence of the glottic closure reflex 3 weeks to 12 years later.


CONCLUSIONS
Although a number of clinical factors influence swallowing recovery, one important factor separating our patient groups was the preservation of the glottic closure reflex in patients who underwent endoscopic laser resection. Because the loss of the glottic closure response persists for years after traditional OSL, it is concluded that the sensory field deficit caused by superior laryngeal nerve section is largely not recoverable; however, compensatory mechanisms remain important in serviceable recovery, even if delayed after operation. Indeed, preservation of the glottic closure response appears to enhance swallowing recovery when equivalent compensatory mechanisms are used.
Sasaki
Clarence T
CT
Section of Otolaryngology, Dept of Surgery, Yale School of Medicine, 333 Cedar St, PO Box 208041, New Haven, CT 06520-8041, USA.
Leder
Steven B
SB
Acton
Lynn M
LM
Maune
Steffen
S
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation; D004724:Endoscopy / Q000379:methods*; D004750:Enteral Nutrition; D005260:Female; D005336:Fiber Optic Technology; D005931:Glottis / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007821:Laryngeal Muscles / Q000503:physiopathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000601:surgery; D007823:Laryngeal Nerves / Q000503:physiopathology / Q000601:surgery; D007825:Laryngectomy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012018:Reflex