MECHANISMS OF RECOVERY OF SWALLOW AFTER SUPRAGLOTTIC LARYNGECTOMY

This study examines oropharyngeal swallow disorders and measures of ph aryngeal and laryngeal movement during deglutition from videofluorogra phic studies of oropharyngeal swallow in 9 patients who had undergone supraglottic laryngectomy and 9 age-matched normal subjects. The swall ows of surgical patients were examined at 2 weeks and 3 months postope ratively. Two critical factors in recovery of swallowing were identifi ed: (a) airway closure at the laryngeal entrance, that is, the space b etween the arytenoid cartilage and the base of the tongue, and (b) the movement of the tongue base to make complete contact with the posteri or pharyngeal wall. When patients achieved these two functions, they r eturned to normal swallowing. The duration of tongue base contact to t he posterior pharyngeal wall and extent of anterior movement of the ar ytenoid increased significantly from 2 weeks to 3 months in the surgic al patients. At 2 weeks postsurgery, patients who had undergone suprag lottic laryngectomy exhibited significantly shorter airway closure and tongue base to pharyngeal wall contact, reduced laryngeal elevation, increased width of cricopharyngeal (CP) opening, and later onset of ai rway closure and tongue base movement than normal subjects. These sign ificant differences remained at 3 months postoperatively, although swa llow measures were moving toward normal in the patients who had underg one supraglottic laryngectomy. Comparison of patients not eating at 2 weeks with patients at the time of first eating revealed significantly longer duration of tongue base contact to the pharyngeal wall, longer duration of airway closure, and greater movement of the arytenoid in patients who were eating. Results indicate that the focus of swallowin g therapy after supraglottic laryngectomy should be on improvement of posterior movement of the tongue base and anterior tilting of the aryt enoid to close the airway entrance and improve bolus propulsion (in th e case of the tongue base).