Aspiration after supracricoid partial laryngectomy: Incidence, risk factors, management, and outcomes.
BACKGROUND
The aim of this study was to evaluate the incidence, risk factors, management, and outcome of postoperative aspiration in patients managed with a supracricoid partial laryngectomy (SCPL) for selected invasive squamous carcinoma of the larynx.


METHODS
In all, 457 patients underwent SCPL at an academic, tertiary referral care center, 1975-2000. The incidence of aspiration defined in accord with Pearson's scale was recorded. Univariate and multivariate analyses were performed for potential statistical relation with various variables. The management and outcome of aspiration are presented.


RESULTS
Normal swallowing without aspiration was noted in 259 patients (58.9%). Grades 1, 2, and 3 aspiration occurred in 87, 48, and 53 patients (19%, 10.5%, and 11.6%), respectively. A significant relationship was noted between aspiration and increased age, performing cricohyoidopexy, not repositioning the pyriform sinuses, and resecting an arytenoid cartilage. A prediction model, based on multinomial logistic regression, found that the probability that severe aspiration cases (grade 2-3) exceeded the subclinical ones (grade 0-1) occurred only when a cricohyoidopexy with partial or total arytenoid resection was performed in patients >70 years of age (p = .0000001). Management of aspiration required a temporary gastrostomy, a permanent gastrostomy, and a completion total laryngectomy in 65, 3, and 7 of 188 patients (34.5%, 1.6%, and 3.7%, respectively) who aspirated, and 65, 3, and 7 of 457 of the entire population (14.2%, 0.6%, and 1.5%, respectively). Aspiration-related death was not encountered in the current series.


CONCLUSIONS
Aspiration after SCPL is a common but rarely severe event, with a low incidence for permanent gastrostomy or completion laryngectomy. Aspiration can be minimized with careful patient selection and precise surgical technique.
Benito
José
J
Department of Oto-Rhino-Laryngology, Hospital Universitario Sant Joan, Reus, Spain.
Holsinger
F Christopher
FC
Pérez-Martín
Augustin
A
Garcia
Dominique
D
Weinstein
Gregory S
GS
Laccourreye
Ollivier
O
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001193:Arytenoid Cartilage / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003413:Cricoid Cartilage / Q000601:surgery; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056144:Pyriform Sinus / Q000601:surgery; D053120:Respiratory Aspiration / Q000145:classification / Q000209:etiology*; D012307:Risk Factors