title: Predictable swallowing function after open horizontal supraglottic partial laryngectomy.
abstract: OBJECTIVE
  After horizontal supraglottic partial laryngectomy, patients have an increased risk of dysphagia as they are not able to close the laryngeal entrance during swallowing, especially if the surgical defect of the tongue base has increased. There is no investigation that studies risk factors for impaired swallow function, or that predicts postoperative swallow outcomes based on radiologically determined tumor dimensions. The present study investigated the impact of the tongue base tumor extension (determined by CT scan in patients undergoing partial laryngectomy) on the recovery rate of swallow function.
  
  
  METHODS
  The retrospective study in a tertiary hospital between 2000 and 2015 included all patients who underwent open horizontal supraglottic partial laryngectomy due to oropharyngeal cancer of the tongue base, or supraglottic laryngeal cancer with tongue base infiltration. All clinicopathological data were collected. The dimension of tongue base infiltration was measured using CT scan. Swallow function was recorded by Fiberoptic Endoscopic Evaluation of Swallowing and determined by evaluating both the duration until nasogastric tube removal and changing of the cuffed tracheostomy tube for an uncuffed speech cannula.
  
  
  RESULTS
  The study included 26 patients (44-76 years, median 59 years). The clinical tumor (cT) classification included cT2 and cT3, while the pathologic tumor (pT) classification included pT2 and pT3 in 90% and pT1 and pT4 in 10% respectively. The duration until using the speech cannula was not associated with clinicopathological data, including the investigated radiologic tumor dimensions (biggest tumor diameter, tongue base infiltration depth, width, height, area and volume). The duration until nasogastric tube removal was significantly associated with the tongue base infiltration width (p=0.012), height (p=0.026) and area (p<0.0001). The patients were divided into two groups according to the median tongue base infiltration area estimated as 6.20cm(2). In patients <6.20cm(2), 50% of the nasogastric tubes were removed after 4 days (95% CI 0-8.6 days) and in patients ≥6.20cm(2), 50% were removed after 22 days (95% CI 6.8-37.2 days; p<0.0001).
  
  
  CONCLUSIONS
  The postoperative swallow function after open horizontal supraglottic partial laryngectomy depends on the tumor extension of the tongue base. The tongue base infiltration area is a useful tool for surgical planning as it can be used to predict postoperative swallow function. In foreseeably permanent dysphagia, as well as permanent and necessary tracheotomy tube cuffs after organ-preserving surgery, alternative therapy methods should be particularly preferred as the primary chemoradiation.
authors: Department of Otolaryngology at UKB, Hospital of the University of Berlin, Charité Medical School, Berlin, Germany.
authors: Christine
authors: C
authors: Breunig
authors: Department of Radiology at UKB, Hospital of the University of Berlin, Charité Medical School, Berlin, Germany.
authors: Philipp
authors: P
authors: Benter
authors: Department of Otolaryngology at UKB, Hospital of the University of Berlin, Charité Medical School, Berlin, Germany.
authors: Rainer O
authors: RO
authors: Seidl
authors: Department of Otolaryngology at UKB, Hospital of the University of Berlin, Charité Medical School, Berlin, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. Electronic address: annekatrin.coordes@charite.de.
authors: Annekatrin
authors: A
authors: Coordes
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003679:Deglutition; D003680:Deglutition Disorders / Q000503:physiopathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D014059:Tongue / Q000000981:diagnostic imaging*; D014062:Tongue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014139:Tracheostomy
keywords: Dysphagia; Horizontal supraglottic partial laryngectomy; Speech cannula; Swallow function; Tracheotomy tube