Biomechanics of Pharyngeal Deglutitive Function Following Total Laryngectomy

dc.contributor.author Zhang, Teng
dc.contributor.author Szczesniak, Michal Marcin
dc.contributor.author Maclean, Julia C F
dc.contributor.author Bertrand, Paul P
dc.contributor.author Wu, Peter I
dc.contributor.author Omari, Taher
dc.contributor.author Cook, Ian James
dc.date.accessioned 2017-03-27T04:28:17Z
dc.date.available 2017-03-27T04:28:17Z
dc.date.issued 2016-04-26
dc.description Copyright © 2016 American Academy of Otolaryngology—Head and Neck Surgery Foundation. Reprinted by permission of SAGE Publications en
dc.description.abstract Objective: Post-laryngectomy surgery, pharyngeal weakness and pharyngoesophageal junction (PEJ) restriction are the underlying candidate mechanisms of dysphagia. We aimed to determine, in laryngectomees whether: 1) hypopharyngeal propulsion is reduced and/or PEJ resistance is increased; 2) endoscopic dilatation improves dysphagia; and 3) if so, whether symptomatic improvement correlate with reduction in resistance to flow across the PEJ. Methods: Swallow biomechanics were assessed in 30 total laryngectomees. Average peak contractile pressure (hPP) and hypopharyngeal intrabolus pressure (hIBP) were measured from combined high resolution manometry and video-fluoroscopic recordings of barium swallows (2, 5&10ml). Patients were stratified into severe dysphagia (Sydney Swallow Questionnaire (SSQ)>500) and mild/nil dysphagia (SSQ≤500). In 5 patients, all measurements were repeated after endoscopic dilatation. Results: Dysphagia was reported by 87%, and 57% had severe and 43% had minor/nil dysphagia. Laryngectomees had lower hPP than controls (110±14mmHg vs 170±15mmHg; p<0.05), while hIBP was higher (29±5mmHg vs 6±5mmHg; p<0.05). There were no differences in hPP between patient groups. However, hIBP was higher in severe than in mild/nil dysphagia (41±10mmHg vs 13±3mmHg; p<0.05). Pre-dilation hIBP (R2=0.97) and its decrement following dilatation (R2=0.98) were good predictors of symptomatic improvement. Conclusion: Increased PEJ resistance is the predominant determinant of dysphagia as it correlates better with dysphagia severity than peak pharyngal contractile pressure. While both baseline PEJ resistance and its decrement following dilatation are strong predictors of outcome following dilatation, the peak pharyngeal pressure is not. PEJ resistance is vital to detect as it is the only potentially reversible component of dysphagia in this context. en
dc.identifier.citation Zhang T, Szczesniak M, Maclean J, Bertrand P, Wu PI, Omari T, Cook IJ. Biomechanics of Pharyngeal Deglutitive Function Following Total Laryngectomy. Otolaryngol Head Neck Surg. 2016 Aug;155(2):295-302. en
dc.identifier.doi https://doi.org/10.1177/0194599816639249 en
dc.identifier.issn 0194-5998
dc.identifier.uri http://hdl.handle.net/2328/37005
dc.language.iso en
dc.oaire.license.condition.license In Copyright
dc.publisher American Academy of Otolaryngology—Head and Neck Surgery Foundation en
dc.rights Copyright © 2016 American Academy of Otolaryngology—Head and Neck Surgery Foundation. Reprinted by permission of SAGE Publications. en
dc.rights.holder 2016 American Academy of Otolaryngology—Head and Neck Surgery Foundation en
dc.subject Laryngectomy en
dc.subject Pharynx en
dc.subject Degltutition en
dc.subject Swallow en
dc.subject Dysphagia en
dc.subject Hypopharyngeal Intrabolus Pressure en
dc.subject hIBP en
dc.subject Hypopharyngeal peak contractile pressure en
dc.subject hPP en
dc.title Biomechanics of Pharyngeal Deglutitive Function Following Total Laryngectomy en
dc.type Article en
local.contributor.authorOrcidLookup Omari, Taher: https://orcid.org/0000-0001-5108-7378 en_US
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