RECOVERY OF POSTOPERATIVE SWALLOWING IN PATIENTS UNDERGOING PARTIAL LARYNGECTOMY

This study assessed the achievement of postoperative swallowing in pat ients undergoing partial laryngectomy surgery. Oropharyngeal swallow e fficiency was used to predict time to achievement of outcome. Fifty-fi ve patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a v ideofluoroscopic evaluation enabled the measurement of swallowing effi ciency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial cu rves. Patients with hemilaryngectomies achieved swallowing rehabilitat ion sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did p atients undergoing supraglottic laryngectomies with tongue base resect ion (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. High er early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, fun ctional swallowing and eating may be achieved within 3 months of surge ry while for other types, significant impairment remains up to 9 month s postoperatively. Early radiographic assessments of swallowing functi on are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved or al intake before radiotherapy is started.