title: A prospective study of long-term dysphagia following total laryngectomy.
abstract: OBJECTIVE
  To evaluate the degree of dysphagia in patients before and after total laryngectomy using the Performance Status Scale for Head and Neck Cancer Patients (PSS) and to determine the effects of post-operative radiation therapy, neck dissection, and pharyngoesophageal spasm on PSS scores.
  
  
  METHODS
  We performed a controlled, prospective study at a tertiary referral university hospital. Twenty consecutive patients undergoing laryngectomy were included. Patients were followed for at least two years post-operative, without evidence of local, regional, or distant disease. Only patients with squamous cell carcinoma limited to the endolarynx requiring total laryngectomy with or without elective neck dissection for surgical management of cancer and with no pre-operative treatment were included. Dysphagia was evaluated by PSS prior to surgery and again two years postoperatively with an emphasis on eating in public and normalcy of diet domains. Video fluoroscopic evaluation of swallowing was performed one year after treatment.
  
  
  RESULTS
  The relative number of patients with low mean scores in PSS (i.e. usually swallow paste of fluid food in presence of some selected persons or alone; < or = 50) increased after total laryngectomy (p = 0.04). Patients with lower scores reported more frequent spasm of the pharyngoesophageal segment (p = 0.005). Mean scores of both domains decreased after surgery (p < 0.05).
  
  
  CONCLUSIONS
  Eating in public and normalcy of diet scores decreased in 50% of patients after total laryngectomy.
authors.affiliation: Department of Otolaryngology, Head and Neck, University of Campinas, Unicamp, Campinas, São Paulo, Brazil. carloschone@uol.com.br
authors.forename: C T
authors.initials: CT
authors.lastname: Chone
authors.forename: A L
authors.initials: AL
authors.lastname: Spina
authors.forename: I H
authors.initials: IH
authors.lastname: Barcellos
authors.forename: H H
authors.initials: HH
authors.lastname: Servin
authors.forename: A N
authors.initials: AN
authors.lastname: Crespo
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome