Radiological analysis of swallowing and functional outcomes after hypopharyngo-laryngectomy with reconstruction using a jejunal autograft.
CONCLUSIONS
We report a distinct pattern of tongue movement. This is interpreted as a compensatory mechanism after hypopharyngo-laryngectomy with reconstruction using a jejunal autograft. Passage through the oesophagus is mainly passive.


OBJECTIVE
Swallowing is normally initiated voluntarily, and afterwards presumed to be controlled by brainstem reflexes. Resection of the hypopharynx with reconstruction may affect this control. This study attempted to perform a biomechanical analysis of the motility in the small bowel graft and suggest possible implications for surgical management. We also analysed how oesophageal passage is affected by surgery.


METHODS
Five patients underwent a radiological examination of the neopharyngeal conduit and oesophagus and completed a simple questionnaire.


RESULTS
The radiological examinations revealed a distinct pattern of tongue movement in all patients, resulting in varying degrees of thrust. Passage through the jejunal graft was mainly passive, but observations of progressive reduction in diameter of the graft indicated muscular tone that may preserve pressure generated by the lingual thrust. The oesophageal transport appeared to be rather passive and largely depended upon the effect of gravity. Two of five patients were unable to eat normal food. Their impaired swallowing resulted in severely reduced quality of life.
Bakkan
Nils
N
Department of surgery, Vestfold Hospital, Tønsberg, Norway. nils.bakkan@gmail.com
Boysen
Morten E
ME
Line
Pål-Dag
PD
Aasen
Steinar
S
D000368:Aged; D001696:Biomechanical Phenomena; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003679:Deglutition; D004947:Esophagus / Q000000981:diagnostic imaging / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007583:Jejunum / Q000000981:diagnostic imaging / Q000502:physiology / Q000637:transplantation*; D007825:Laryngectomy; D008875:Middle Aged; D010614:Pharynx / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D014182:Transplantation, Autologous