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Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study

Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent...

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Autores principales: Pizzorni, Nicole, Schindler, Antonio, Castellari, Micol, Fantini, Marco, Crosetti, Erika, Succo, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520791/
https://www.ncbi.nlm.nih.gov/pubmed/30999620
http://dx.doi.org/10.3390/cancers11040549
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author Pizzorni, Nicole
Schindler, Antonio
Castellari, Micol
Fantini, Marco
Crosetti, Erika
Succo, Giovanni
author_facet Pizzorni, Nicole
Schindler, Antonio
Castellari, Micol
Fantini, Marco
Crosetti, Erika
Succo, Giovanni
author_sort Pizzorni, Nicole
collection PubMed
description Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure (p = 0.021). Inefficient swallowers presented a longer pharyngeal transit time (p = 0.008), a reduced pharyngoesophageal segment opening lateral (p = 0.008), and a worse tongue base retraction (p = 0.018 with solids and p = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL.
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spelling pubmed-65207912019-05-31 Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study Pizzorni, Nicole Schindler, Antonio Castellari, Micol Fantini, Marco Crosetti, Erika Succo, Giovanni Cancers (Basel) Article Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure (p = 0.021). Inefficient swallowers presented a longer pharyngeal transit time (p = 0.008), a reduced pharyngoesophageal segment opening lateral (p = 0.008), and a worse tongue base retraction (p = 0.018 with solids and p = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL. MDPI 2019-04-17 /pmc/articles/PMC6520791/ /pubmed/30999620 http://dx.doi.org/10.3390/cancers11040549 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pizzorni, Nicole
Schindler, Antonio
Castellari, Micol
Fantini, Marco
Crosetti, Erika
Succo, Giovanni
Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study
title Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study
title_full Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study
title_fullStr Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study
title_full_unstemmed Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study
title_short Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study
title_sort swallowing safety and efficiency after open partial horizontal laryngectomy: a videofluoroscopic study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520791/
https://www.ncbi.nlm.nih.gov/pubmed/30999620
http://dx.doi.org/10.3390/cancers11040549
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