Tubed Supraglottic Laryngeal Closure to Treat Chronic Aspiration After Radiotherapy for Head and Neck Cancer

Laryngoscope. 2021 Apr;131(4):E1234-E1243. doi: 10.1002/lary.29217. Epub 2020 Oct 30.

Abstract

Objectives/hypothesis: To evaluate the long-term swallowing outcomes after surgical treatment for chronic aspiration in patients treated with radiotherapy for head and neck cancer.

Study design: This was a retrospective study.

Methods: The data of patients who underwent radiotherapy for head and neck cancer and who subsequently required a laryngectomy or a tubed supraglottic laryngeal closure (TSLC) for recurrent aspiration pneumonia between 2004 and 2017 were retrieved from a tertiary referral hospital dysphagia clinic. The Functional Oral Intake Scale (FOIS) and the Swallowing Performance and Status Scale (SPSS) were used to assess swallowing function.

Results: Of the 17 patients who required surgery for chronic aspiration secondary to radiotherapy for head and neck cancer, two underwent a laryngectomy and 15 a TSLC. During a mean follow-up of 77 months, the FOIS and SPSS scores significantly improved at 12, 24, and 36 months after laryngectomy and TSLC relative to the baseline (P < .05). Both patients who underwent laryngectomy and 11 of the 15 (73.3%) who underwent a TSLC resumed oral feeding. Both laryngectomy patients had episodes of recurrent aspiration pneumonia after surgery due to leakage through the tracheoesophageal puncture or prosthesis, whereas none of the TSLC patients had these episodes.

Conclusion: A tubed supraglottic laryngeal closure, which is a reversible procedure that preserves the larynx and allows for natural phonation, should be considered an alternative to laryngectomy for the control of chronic aspiration.

Level of evidence: 4 Laryngoscope, 131:E1234-E1243, 2021.

Keywords: Dysphagia; aspiration; cancer; head and neck; surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Deglutition Disorders / physiopathology
  • Female
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Laryngectomy / methods*
  • Laryngoplasty / methods*
  • Male
  • Middle Aged
  • Pneumonia, Aspiration / prevention & control*
  • Retrospective Studies