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Caetano G, Morgado F, Póvoa J, Branquinho F. Dysphagia After Partial Horizontal Supracricoid Laryngectomy: A Close Look. Cureus 2024; 16:e62124. [PMID: 38993424 PMCID: PMC11238017 DOI: 10.7759/cureus.62124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Partial horizontal supracricoid laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) is a conservative surgical alternative for laryngeal cancer in the glottic or supraglottic region. Dysphagia and aspiration are frequently reported consequences of this surgery. We describe the case of a 72-year-old male patient diagnosed with squamous cell carcinoma of the larynx (T2N0M0), who underwent SCPL with CHEP reconstruction. The patient was initially fed through a nasogastric tube post-surgery, later replaced by a percutaneous endoscopic gastrostomy (PEG) tube. Swallowing evaluations were periodically conducted in collaboration with a speech therapist using fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS). In FEES assessments, the patient consistently presented with laryngeal penetration and possible tracheal aspiration. These findings were confirmed by VFSS. Additionally, a narrowing of the initial segment of the cervical esophagus was observed, caused by a large osteophyte in the anterior region of the C5 vertebral body, compromising the passage of the bolus, and leading to its accumulation above the upper esophageal sphincter and subsequent entry into the airway. Rehabilitation exercises for swallowing were recommended, maintaining an exclusive PEG diet. Three months after rehabilitation, a follow-up VFSS revealed that, for pasty consistency, the accumulation of the bolus above the cervical osteophyte was resolved with multiple swallows, without evidence of penetration or aspiration. Thus, it was possible to introduce oral intake of pasty consistency. Considering the anatomical and physiological complexity of swallowing, along with patient-specific characteristics, predicting the rehabilitation time for reconstructive laryngeal surgery is challenging. This case emphasizes the importance of a collaborative evaluation involving otorhinolaryngologists, speech therapists, and radiologists in studying dysphagia in patients undergoing conservative laryngeal surgeries to adapt and personalize rehabilitation.
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Affiliation(s)
- Gonçalo Caetano
- Otolaryngology - Head and Neck Surgery, Hospital da Senhora da Oliveira, Guimarães, PRT
| | - Filipa Morgado
- Otolaryngology - Head and Neck Surgery, Hospital Beatriz Ângelo, Lisboa, PRT
| | - Joana Póvoa
- Otolaryngology - Head and Neck Surgery, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, PRT
| | - Francisco Branquinho
- Otolaryngology - Head and Neck Surgery, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, PRT
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da Costa Miranda Barbosa R, de Freitas AS, Cerqueira RBA, Mancopes R, Dias FL, Steele CM. Dysphagia in Open Partial Horizontal Laryngectomy Type IIa: Quantitative Analysis of Videofluoroscopy using the ASPEKT Method. Dysphagia 2024:10.1007/s00455-024-10677-3. [PMID: 38431893 PMCID: PMC11369121 DOI: 10.1007/s00455-024-10677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Open Partial Horizontal Laryngectomy (OPHL) Type IIa surgery is a conservative surgical technique used in the treatment of laryngeal carcinomas. In this pilot study, we aimed to characterize swallowing function and physiology in a series of patients after OPHL Type IIa surgery through comparison to healthy reference values for quantitative measures for videofluoroscopy. We performed retrospective quantitative analysis of videofluoroscopy recordings of thin liquid swallows for a preliminary sample of 10 male patients. Each videofluoroscopy clip was rated in triplicate by trained blinded raters according to the ASPEKT Method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). This preliminary sample of patients with previous OPHL surgery showed functional airway protection, with only 2 patients showing incomplete laryngeal vestibule closure (LVC) and associated airway invasion. However, the majority of patients (90%) showed prolonged latencies to LVC and upper esophageal sphincter (UES) opening. Prolonged durations of LVC and UES opening were also noted, but these were in the direction of compensation rather than impairment. Reduced pharyngeal area at rest was seen in 70% of the sample, and all patients showed poor pharyngeal constriction. Post-swallow residue was a prominent finding in ≥ 75% of these patients. In particular, reduced or absent constriction of the hypopharynx in the region of the pyriform sinuses was noted as a characteristic of swallowing in this sample. The data from these patients suggest that despite functional airway protection, severe swallowing dysfunction involving poor pharyngeal constriction and bolus clearance may be likely after OPHL surgery.
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Affiliation(s)
| | | | | | | | | | - Catriona M Steele
- KITE Research Institute-UHN, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Canada
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Dai Y, Cai J, Wang H, Zhang Y, Niu C, Wang Y. Effect of respiratory training on swallowing function in swallowing disorders: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:1069-1081. [PMID: 37843618 PMCID: PMC10858149 DOI: 10.1007/s00405-023-08280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE To determine the clinical efficacy of different respiratory training interventions on swallowing function in patients with swallowing disorders through the systematic review. METHODS We reviewed the literature regarding the application of respiratory training therapy in patients with swallowing disorders, followed by a PRISMA search of published literature in five databases (PubMed, Web of Science, The Cochrane Library, CINAHL and EMBASE) in December 2022. Two reviewers performed study selection, quality evaluation, and risk of bias, followed by data extraction and detailed analysis. RESULTS A total of six randomized controlled studies with a total sample size of 193 cases were included. Respiratory training improved swallowing safety (PAS (n = 151, SMD = 0.69, 95% CI - 1.11 to - 0.26, I2 = 36, p < 0.001)) and swallowing efficiency [residual (n = 63, SMD = 1.67, 95% CI - 2.26 to - 1.09, I2 = 23%, p < 0.001)] compared to control groups. The results of the qualitative analysis conducted in this study revealed that respiratory training enhanced hyoid bone movement but had no effect on swallowing quality of life. CONCLUSIONS Respiratory training interventions may improve swallowing safety and efficiency in patients with dysphagia. However, the level of evidence is low, and there is a limited amount of research on the effectiveness and physiology of this intervention to improve swallowing function. In the future, there is a need to expand clinical studies, standardize measurement tools, and improve study protocols.
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Affiliation(s)
- Yinuo Dai
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Jianzheng Cai
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Haifang Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Yingying Zhang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Chunyan Niu
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yalan Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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Medeiros AMC, Assis HS, Alves MVM, Silva Santana YF, Silva-Filho WJE, Barreto ÍDDC, Berretin-Felix G. Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers. Int Arch Otorhinolaryngol 2023; 27:e680-e686. [PMID: 37876700 PMCID: PMC10593519 DOI: 10.1055/s-0042-1759576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/22/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants (d = - 0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = - 0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.
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Affiliation(s)
| | - Herick Santos Assis
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe, São Cristóvão, SE, Brasil
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Evaluation of chronological changes in videofluorographic findings after transoral videolaryngoscopic surgery to reveal mechanism of dysphagia. Auris Nasus Larynx 2022; 50:374-382. [PMID: 36075789 DOI: 10.1016/j.anl.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Transoral surgery preserves good swallowing function in most cases, however, postoperative dysphagia sometimes leads to fatal complication such as aspiration pneumonia. We investigated the chronological changes in swallowing function have not been revealed relationship with dysphagia. The primary aim of this study was to reveal the mechanism of dysphagia following transoral surgery by analyzing chronological videofluorography (VF) findings. Moreover, the secondary aim of this study was to evaluate the relationship between mechanism of dysphagia and risk factors of patients to clarify the risk for dysphagia lead to prevention of postoperative complications. METHODS 22 patients who underwent transoral videolaryngoscopic surgery (TOVS) for either supraglottic or hypopharyngeal cancer were evaluated swallowing function. We performed VF during the preoperative, postoperative acute, and stable phases and investigated the chronological changes in the VF findings. The following parameters were evaluated by VF: horizontal distance of laryngeal movement, vertical distance of laryngeal elevation, laryngeal elevation delay time (LEDT), Bolus Residue Scale (BRS) scores, and Penetration Aspiration Scale (PAS) scores. Additionally, we evaluated risk factors for postoperative aspiration by investigating relationships between preoperative VF parameters, age of patients, history of radiation therapy, resection area, tumor (T) stage, postoperative Numeric Rating Scale (NRS), and PAS and BRS scores. RESULTS The median time at which oral feeding was resumed in this study was 9 (2-200) days. The patients who had postoperative acute PAS scores of 4 and above exhibited delays in resuming oral ingestion after surgery. TOVS did not impair laryngeal elevation and LEDT; however, the BRS and PAS scores temporarily worsened in the acute phase compared to the preoperative scores. These scores almost recovered to their preoperative states in the stable phase, and both the BRS and PAS scores worsened and recovered concurrently. Patients who exhibited poor vertical distance in laryngeal elevation as observed via preoperative VF or who had histories of radiation therapy had worse PAS scores in postoperative acute phase VF. Patients with broad resection areas had worse BRS scores in postoperative acute phase VF. CONCLUSION TOVS didn't impair the function of laryngeal elevation and elicitation of the swallowing reflex whereas pharyngeal bolus clearance, laryngeal penetration, and aspiration temporarily deteriorated concurrently but eventually almost recovered to their baseline values. Patients with histories of radiotherapy, poor laryngeal elevation, and broad resection areas are at the risk of postoperative dysphagia after TOVS. Patients with these risk factors need appropriate evaluation before resuming postoperative oral intake.
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Freitas ASD, Zica GM, Salles M, Silva ACAE, Silva TH, Dias FL, Santos IC. DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy. Int Arch Otorhinolaryngol 2022; 26:e357-e364. [PMID: 36109048 PMCID: PMC9282976 DOI: 10.1055/s-0041-1730306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Supracricoid laryngectomy (SCL CHEP) removes ∼ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global ( p < 0.001) and total ( p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol ( p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.
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Affiliation(s)
- Andressa Silva de Freitas
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Guilherme Maia Zica
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Mariana Salles
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Ana Catarina Alves e Silva
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Thiago Huaytalla Silva
- Departamento de Nutrição e Dietética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando Luiz Dias
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Izabella Costa Santos
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
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Chu F, De Benedetto L, Zurlo V, Mossinelli C, Zorzi S, Tagliabue M, De Berardinis R, Bandi F, Pietrobon G, Ansarin M. Modified transcervical lipofilling of the base of the tongue under local anaesthesia: Case series. EAR, NOSE & THROAT JOURNAL 2022:1455613221097201. [PMID: 35488405 DOI: 10.1177/01455613221097201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Laryngeal carcinoma represents one-third of all head and neck cancers and is burdened by significant morbidity and mortality for advanced-stage disease. Surgical treatments, including Open Partial Horizontal Laryngectomy (OPHL), are often followed by long-lasting swallowing rehabilitation and more rarely, persistent dysphagia. Some authors reported single cases, successfully treated with fat injection of the base of tongue, but nowadays, a standardized technique has never been described so far. We provide a step-by-step technique description of the trans-cervical lipofilling of the base of the tongue (BOT) under local anaesthesia in a case series of three patients. The functional results have been evaluated with a videofluoroscopic study of deglutition and Penetration-Aspiration Score. The procedure was well tolerated; all patients were discharged after 24 hours without any majorcomplications. After six months, all patients had a steady improvement in swallowing. During follow-up, the videofluoroscopic study of deglutition confirmed a sensitive amelioration of the Penetration-Aspiration Score and an empowered base of tongue retropulsion. Finally, the lipofilling of the BOT under local anaesthesia showed to be a feasible, and reproducible procedure, for dysphagia after OPHLs.
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Affiliation(s)
- Francesco Chu
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Luigi De Benedetto
- Integrated Therapies in Otolaryngology, 220431Campus Bio-Medico University, Rome, Italy
| | - Valeria Zurlo
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Mossinelli
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefano Zorzi
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Marta Tagliabue
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Rita De Berardinis
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco Bandi
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Giacomo Pietrobon
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Department of Otorhinolaryngology and Head and Neck Surgery, 9290European Institute of Oncology, IRCCS, Milan, Italy
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Freitas ASD, Zica GM, Freitas EQ, Silva ACAE, Dias FL, Santos IC. Residue localization and risk for aspiration in partial laryngectomy: the relevance of assertive therapeutic strategies and resources. EINSTEIN-SAO PAULO 2022; 20:eAO6262. [PMID: 35293434 PMCID: PMC8909125 DOI: 10.31744/einstein_journal/2022ao6262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.
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Hutcheson KA, Barbon CEA, Alvarez CP, Warneke CL. Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2. Cancer 2022; 128:1458-1466. [PMID: 34985765 DOI: 10.1002/cncr.34079] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a validated method to grade the severity of pharyngeal swallowing impairment as a toxicity of cancer based on the degree and patterns of penetration/aspiration and pharyngeal residue over a standardly acquired radiographic modified barium swallow (MBS) study. Since its implementation in 2016, areas for the refinement of grading mild safety impairments have been identified by clinical and research users. The objective of this study was to assess the performance and validity of refined DIGESTsafety grading criteria (per DIGEST version 2 [DIGESTv2 ]). METHODS Refined safety criteria were developed and vetted with clinical and research users. DIGESTv2 included 2 changes to the safety criteria. All MBSs with blinded DIGEST version 1 grading were sampled from a registry database (1331 patients underwent MBS over the period of December 2005 to July 2019). New criteria were applied to derive DIGESTsafety grading version 2. Measures of criterion validity, including the MD Anderson Dysphagia Inventory [MDADI] composite score, the Modified Barium Swallow Impairment Profile (MBSImP) pharyngeal total, the MBSImP hyolaryngeal components (items 8-11), and the Performance Status Scale for Head and Neck Cancer Patients [PSS-HN] diet, were correlated with DIGESTsafety and overall DIGEST grades from versions 1 and 2 and were compared pairwise between reassigned grades. RESULTS With the application of version 2 safety criteria, 112 of 1331 examinations (8.4%) and 79 of 1331 examinations (5.9%) changed in their DIGESTsafety and overall grades, respectively. The safety and overall DIGEST grades (versions 1 and 2) significantly correlated with criterion measures, including the MBSImP pharyngeal total, laryngeal MBSImP parameters of interest, MDADI, and PSS-HN (P < .0001); correlations maintained a similar magnitude between versions 1 and 2. Forty-six upgraded examinations (reassigned from safety grade 1 per version 1 to grade 2 per version 2) performed similarly to other safety grade 2 examinations (version 1), and this was likewise true for 66 downgraded examinations (reassigned from safety grade 1 per version 1 to grade 0 per version 2). CONCLUSIONS Refined criteria defining mild safety impairments with the DIGEST methodology changed grades in small numbers of examinations. DIGESTv2 criteria maintained criterion validity, demonstrated ordinality, and improved the performance of the method in these rare scenarios. LAY SUMMARY Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a method developed and validated by the investigators in 2016 to grade the severity of pharyngeal swallowing dysfunction (dysphagia) with a decision tree or flowsheet to guide the clinician's review of a standard radiographic modified barium swallow study. This work reports on the validity of updated DIGEST criteria (version 2) that incorporate 2 modifications to the decision tree.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carly E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clare P Alvarez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carla L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Freitas ASD, Santos IC, Furia C, Dornelas R, Silva ACAE, Dias FL, Salles GF. Prevalence and associated factors of aspiration and severe dysphagia in asymptomatic patients in the late period after open partial laryngectomy: a videofluoroscopic evaluation. Eur Arch Otorhinolaryngol 2022; 279:3695-3703. [PMID: 34982204 DOI: 10.1007/s00405-021-07231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to evaluate late and asymptomatic patients after open partial horizontal laryngectomy (OPHL), investigating the clinical-surgical and socio-demographic factors associated with aspiration and severe dysphagia. METHODS One-thousand videofluoroscopic swallowing studies were performed in 100 asymptomatic patients in the late period after OPHL(median 6.5 years). Aspiration and severe dysphagia were, respectively, assessed by the Penetration-Aspiration scale (PAS) and by the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) classification. Associated factors were investigated by multivariate logistic regressions. RESULTS 34% (95% CI 24.3-47.6%) of patients presented aspiration and 23% (95% CI 15.3-34.6%) had severe or life-threatening dysphagia (DIGEST grades 3-4). On logistic regression, the presence of aspiration was associated with lower preoperative serum albumin (odds ratio [OR]: 0.22; 95% CI 0.07-0.64; p = 0.005, for each 1 g/dL increment); a greater weight loss in early postoperative period (OR: 1.19, 95% CI 1.05-1.35; p = 0.008, for each 1 kg loss); older age at surgery (OR: 1.08; 95% CI 1.01-1.17, for each 1-year older); and with the presence of diabetes (OR: 5.16; 95% CI 1.09-27.47; p = 0.039). CONCLUSION Deglutition abnormalities are frequent in asymptomatic patients later after OPHL. Older patients, with lower preoperative serum albumin levels, with greater postoperative weight loss, and with diabetes compose the clinical profile at risk for having worse swallowing function in the late period after OPHL.
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Affiliation(s)
- Andressa Silva de Freitas
- Department of Head and Neck Surgery, Brazilian National Cancer Institute, INCA, Praça da Cruz Vermelha, 23, Rio de Janeiro, RJ, 20230-130, Brazil.
| | - Izabella C Santos
- Department of Head and Neck Surgery, Brazilian National Cancer Institute, INCA, Praça da Cruz Vermelha, 23, Rio de Janeiro, RJ, 20230-130, Brazil
| | - Cristina Furia
- Ceilandia Faculty, Universidade de Brasilia, Brasilia, Brazil
| | - Rodrigo Dornelas
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Catarina Alves E Silva
- Department of Head and Neck Surgery, Brazilian National Cancer Institute, INCA, Praça da Cruz Vermelha, 23, Rio de Janeiro, RJ, 20230-130, Brazil
| | - Fernando Luiz Dias
- Department of Head and Neck Surgery, Brazilian National Cancer Institute, INCA, Praça da Cruz Vermelha, 23, Rio de Janeiro, RJ, 20230-130, Brazil
| | - Gil F Salles
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Fantini M, Crosetti E, Affaniti R, Sprio AE, Bertotto I, Succo G. Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies. Head Neck 2021; 43:3459-3467. [PMID: 34405480 DOI: 10.1002/hed.26845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In minority of cases, the clinical recovery of the neolarynx after open partial horizontal laryngectomies (OPHLs) can be challenging, possibly affecting the final functional outcome. METHODS One hundred and twenty-three patients who underwent OPHLs were selected. A series of clinical preoperative independent variables were considered. All patients were monitored for the following dependent outcome variables: sequelae; need for percutaneous endoscopic gastrostomy positioning; days before tracheal cannula removal and nasogastric tube removal; and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify significant associations between preoperative clinical variables and outcomes variables. RESULTS Multivariate analysis confirmed age, cT classification, body mass index, and smoking habits as significant prognostic factors for worse functional and clinical recovery outcomes. CONCLUSIONS Knowing what variables are significantly associated with worse clinical and functional outcomes can guide clinicians in defining the best surgical choice not only from an oncological perspective, but also for a better postoperative recovery.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Riccardo Affaniti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy.,Oncology Department, University of Turin, Orbassano (TO), Italy
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12
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Freitas ASD, Zica GM, Silva ACAE, Dias FL, Freitas EQ, Santos IC. Supracricoid laryngectomy: the impact of senescence on swallowing safety. EINSTEIN-SAO PAULO 2021; 19:eAO5715. [PMID: 33978098 PMCID: PMC8081437 DOI: 10.31744/einstein_journal/2021ao5715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: To investigate the association between aging and the functional aspects of swallowing (laryngeal penetration and laryngotracheal aspiration) in individuals who underwent supracricoid laryngectomy in the late period and without complaints. Methods: A total of 70 patients, 56 (80%) aged >60 years and 14 (20%) <60 years, under outpatient follow-up, after cancer treatment and with no complaints of swallowing, performed functional evaluation using the swallowing videofluoroscopy. Image classification was performed using the penetration-aspiration scale developed by Rosenbek. The χ2 test and logistic regression were applied to associate the age categories to the outcomes (penetration and aspiration). Results: Patients aged over 60 years had a higher prevalence of penetration (24.29%) and aspiration (48.57%) than patients aged under 60 years. In this sample, aspiration was associated with age. Patients aged over 60 years were more likely to present penetration (27% more) during swallowing than patients under 60 years. Patients aged over 60 years had an approximately four-fold greater probability of laryngotracheal aspiration than patients aged under 60 years. Conclusion: In patients without complaints of swallowing in the late postoperative period of supracricoid laryngectomy, there is a greater probability of laryngotracheal aspiration in elderly aged over 60 years than in individuals under 60 years.
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Affiliation(s)
| | - Guilherme Maia Zica
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil
| | | | - Fernando Luiz Dias
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil
| | | | - Izabella Costa Santos
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil
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13
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Ozturk K, Turhal G, Durusoy D, Sahin E, Akagunduz O, Eyigor S, Akyildiz S, Esassolak M. Long-term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment. Clin Otolaryngol 2020; 46:340-346. [PMID: 33248015 DOI: 10.1111/coa.13674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/09/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. METHODS Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. RESULTS CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20 mL water according to the Penetration and Aspiration Scale (P < .05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20 ± 3.24 in the RT group (P < .05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P > .05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5 mL and 10 mL water, 5 mL and 20 mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P < .05). CONCLUSION It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.
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Affiliation(s)
- Kerem Ozturk
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Goksel Turhal
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Duygu Durusoy
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Emre Sahin
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Ozlem Akagunduz
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Sibel Eyigor
- Department of Physical Therapy and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Akyildiz
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
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14
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Zica GM, Freitas ASD, Silva ACAE, Dias FL, Santos IC, Freitas EQ, Koch HA. Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy. EINSTEIN-SAO PAULO 2020; 18:eAO5390. [PMID: 32428067 PMCID: PMC7233281 DOI: 10.31744/einstein_journal/2020ao5390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.
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