Deglutition Assessment, Using Fiberoptic Endoscopic Evaluation of Swallowing in Patients underwent Frontolateral Laryngectomy

Abstract

Objective: To assess the long-term deglutition in patients that undergone frontolateral laryngectomy (FL) by fiberoptic endoscopic evaluation of swallowing (FEES) and to identify factors that might influence the swallowing outcomes of these patients Materials and Methods: A cross-sectional descriptive study in patients that undergone FL between 2004 and 2014 with postoperative time of six months or more. Three parameters, premature spillage of material, retention/pooling of material, and the presence of penetration or aspiration were evaluated. All parameters were graded from one (severe) to five (normal). Results: Thirty-six patients including 31 males and five females, with mean age of 58±12.9 years were included in the present study. Twenty-nine cases (80.6%) presented with stage I glottis cancers and seven cases (19.4%) presented with stage II glottis-subglottic cancers. For their treatment by surgery, 30 cases (83.3%) underwent FL and six cases (16.7%) underwent extended FL. Swallowing function was determined to be normal in 27 cases (75%), however, six cases or 16.7% had mild residue accumulation after food swallowing, whereas three cases (8.3%) had moderate symptoms of either minimal pharyngeal stasis plus unsafe airway or moderate pharyngeal residue accumulation. When considering each factor that may worsen post-operative swallowing function, the results suggested that there were significant associations with age of 65 years old or older (p=0.036), tumor stage II (p=0.049), and the presence of postoperative wound infection (p=0.012). Conclusion: In the present study, the authors confirmed that FL had minimal impacts on swallowing functions as the majority of patients who underwent FL recovered normal or near-normal swallowing function after six months as determined by FEES. However, long-term swallowing functions should be monitored especially in patients aged 65 years or older, patients with tumor stage II, and patients with postoperative wound infection.