Plast Reconstr Surg. 2022 Sep 1. doi: 10.1097/PRS.0000000000009639. Online ahead of print.
ABSTRACT
Previously, surgeons believed that after total glossolaryngectomy (TGL), swallowing is mainly dependent on gravity. However, swallowing function after TGL varies widely between patients, and a thorough analysis is lacking. We aimed to clarify the post-TGL swallowing function and determine whether it is primarily dependent on gravity. We retrospectively analyzed videofluorographic examinations (VFs) of patients who underwent TGL and free or pedicle flap reconstruction. We enrolled 20 patients (male, n=12; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient’s ability to swallow was dependent on gravity alone. VF showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3% of the patients with poor clearance showed adequate constriction, which was significantly different (p=0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance (p=0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to our previous understanding, the constriction of the remnant posterior pharyngeal wall played an important role in post-TGL swallowing, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after TGL.
PMID:36067466 | DOI:10.1097/PRS.0000000000009639
