Biomechanics of Pharyngeal Deglutitive Function following Total Laryngectomy.
Postlaryngectomy, pharyngeal weakness, and pharyngoesophageal junction (PEJ) restriction are the candidate mechanisms of dysphagia. The aims were, in laryngectomees, whether (1) hypopharyngeal propulsion is reduced and/or PEJ resistance is increased, (2) dilatation improves dysphagia, and (3) whether symptomatic improvement correlates with reduced PEJ resistance.



Multidisciplinary cross-sectional study.



Tertiary academic hospital.



Swallow biomechanics were assessed in 30 laryngectomees. Patients were stratified into severe dysphagia (Sydney Swallow Questionnaire >500) and mild/nil dysphagia (Sydney Swallow Questionnaire ≤500). Average hypopharyngeal peak (contractile) pressure (hPP) and hypopharyngeal intrabolus pressure (hIBP) were measured from high-resolution manometry with concurrent videofluoroscopy based on barium swallows (2.5 and 10 mL). In consecutive 5 patients, measurements were repeated after dilatation.



Dysphagia was reported by 87%, and 57% had severe and 43% had mild/nil dysphagia. hIBP increased with larger bolus volumes (P < .0001), while hPP stayed stable and PEJ diameter plateaued at 9 mm. Laryngectomees had lower hPP (110 ± 14 vs 170 ± 15 mm Hg; P = .0162) and higher hIBP (29 ± 5 vs 6 ± 5 mm Hg; P = .156) than controls. There were no differences in hPP between patient groups. However, hIBP was higher in severe than in mild/nil dysphagia (41 ± 10 vs 13 ± 3 mm Hg; P = .02). Predilation hIBP (R(2) = 0.97) and its decrement postdilatation (R(2) = 0.98) well predicted symptomatic improvement.



PEJ resistance correlates better with dysphagia severity than peak pharyngeal pressure and is more sensitive to bolus sizes than PEJ diameter. Both baseline PEJ resistance and its decrement following dilatation are strong predictors of treatment outcome. PEJ resistance is vital to detect, as it is reversible and can predict the response to dilatation regimens.
Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia School of Medicine, University of New South Wales, Sydney, Australia teng.zhang@unsw.edu.au.
Teng
T
Zhang
Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia School of Medicine, University of New South Wales, Sydney, Australia.
Michal
M
Szczesniak
Department of Speech Pathology, St George Hospital, Sydney, Australia.
Julia
J
Maclean
School of Medical Science, University of RMIT, Melbourne, Australia.
Paul
P
Bertrand
School of Medicine, University of New South Wales, Sydney, Australia.
Peter I
PI
Wu
School of Medical Science, Flinders University, Adelaide, Australia.
Taher
T
Omari
Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia School of Medicine, University of New South Wales, Sydney, Australia.
Ian J
IJ
Cook
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007825:Laryngectomy; D007828:Laryngoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology* / Q000628:therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
biomechanics; deglutition; dilatation; dysphagia; high-resolution manometry; hypopharyngeal intrabolus pressure; hypopharyngeal peak contractile pressure; laryngectomy; motility; pharynx; resistance; videofluoroscopy