Deglutition and phonatory function recovery following partial laryngeal surgery: speech therapy methods and surgical techniques

Since the introduction of laryngeal surgery, practitioners have recognised the need for the rehabilitation of the two essential functions of the laryngeal system: swallowing and speech. In the early 1950s and then in 1970, European including Italian Authors established further milestones in conservative laryngeal surgery. Physiological anatomy of the operated larynx: A correct knowledge of the anatomy and physiology of the operated larynx is fundamental to the success of functional laryngeal cancer surgery. Herewith, an analysis is made of the anatomical and physiological foundation of the larynx in a multifactorial approach: the anatomical and physiological foundation of this kind of surgery is the cricoarytenoid unit (CAU). This structure has both a “classic” and an “updated” definition. These notes illustrate how the functional outcome, following laryngeal cancer surgery, relies on respecting all the elements in that constellation of factors that permit minimal anatomic and functional dignity of the neolarynx. Speech therapy rehabilitation: An analysis is made of the speech therapy rehabilitation programme; the purposes of re-education are: activation of the deglutition mechanisms, arytenoid mobilisation and activation of arytenoid mucosal vibration. We analyze the different steps of the rehabilitation programme that starts with diagnosis and continues during hospitalisation and after the patient’s discharge. Surgical rehabilitation: Another important chapter is the surgical rehabilitation. In fact, for many years, the alternative to functional procedures in which the glottic or supraglottic level are preserved (cordectomy of varying extents, supraglottic horizontal laryngectomy) was total laryngectomy, as replacement sphincteric function was not believed to be possible. In some cases, due to the persistence of swallowing difficulties, with progressive weight loss and the occurrence of repeated episodes of aspiration with bronchopneumonic complications, use of PEG can represent a provisional measure to allow an extension of the rehabilitation programme. If the functional situation does not improve sufficiently to allow adequate, risk-free eating, patients are often offered total laryngectomy. Since the late 1980s, some Authors have suggested surgical methods that aim to improve neoglottic competence and, consequently, the functions (swallowing and voice) related to the sphincteric ability of the larynx. This functional rehabilitation surgery is gradually being adopted, after the early experiences based exclusively on injective laryngoplasty techniques, in the light of more detailed evaluations of the various causes of deglutition failure. Moreover, only with injective methods is it possible to find solutions to minimal pre- and post-deglutition disorders. In parallel with the attempts to solve the problems of neoglottic insufficiency, a voice surgery technique has been developed with the aim of improving glottic competence following cordectomy to improve voice quality and eliminate the phonoasthenia that often represents the greatest handicap for these patients. Functional evaluation protocol and our caseload: For all these reasons, it is very important to evaluate the impact that surgery can have in terms of dysphagia and, when possible, the need to quantify it, in relation also to the patient’s quality of life. Correct deglutition, in fact, is the result of a precise coordination of the many structures present in the head and neck. Therefore, we analyse in detail the functional protocol, correlated with the data in our series, that is broken down into the analysis of the fundamental functions of the pharyngolaryngeal organ, i.e., an evaluation of swallowing, speech and respiratory functions, which together contribute to influencing the patient’s quality of life.