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The role of videofluoroscopic swallow examination after total laryngectomy

Bozhidar Nikolov, Nora Dimitrova, Blagovesta Todorova, Nikolay Sapundzhiev

Abstract

Introduction: Laryngectomy (LE) is a standard procedure for the treatment of advanced laryngeal malignancies. Laryngeal extirpation is followed by the placement of a nasogastric tube (NGT), sutur­ing of the pharyngeal defect and forming of a tracheal stoma. In the early postoperative period a vid­eo fluoroscopic swallowing exam (VFSE) may be performed in an attempt to evaluate the pharyngeal reconstruction and the swallowing function.

Materials and methods: VFSE includes preparation of the contrast agent, specific positioning of the patient and capturing of series of x-ray images. The oral agent, used in VFSE is a non-ionic water sol­uble contrast. During the examination the patient is placed in a lateral position in order to examine all swallowing phases and to detect abnormalities. The act of swallowing includes 3 phases: oral, pha­ryngeal and esophageal. Defects can be observed in each one of these phases.

Results: Dysphagia is the most common complication in patients after total LE. This symptom has a number of causes - early postoperative insufficiency of the plasty, pharyngeal dysmotility, develop­ment of a stricture, pseudo-diverticulum, pharyngocutaneous fistulas or recurrence of the cancer.

Conclusion: The VFSE results give information about the types of esophageal dysphagia after total LE. According to the data from the VFSE a decision can be taken whether to remove the NGT and start oral feeding, or leave it in place, in case of suspected insufficiency. The videofluoroscopic aspect of the defect may help for the selection of an appropriate treatment: operative or conservative. All these factors are important for the duration of the hospital stay.


Keywords

laryngectomy; videofluoroscopy; swallow




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4710

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