Swallowing function after endoscopic resection of supraglottic carcinoma with the carbon dioxide laser

From April 1998 to May 2000, 14 patients with supraglottic cancer underwent transoral laser surgery (T-stage T1-2: 11 patients, T3: 3 patients). In th ree patients, an epiglottectomy or hemi-epiglottectomy was performed. In 11 patients, further structures (false cords, the valleculae and the base of the tongue and/or parts of the arytenoid cartilage) had to be resected. Thi rteen patients had to undergo neck dissection and post-operative irradiatio n. Tracheostomy was carried out prophylactically in two cases. Every patien t received a nasogastric tube perioperatively. One week after surgery, an e valuation of dysphagia was performed by video endoscopy (VEED). Aspiration was the main problem; in no case did dysphagia occur. The aspiration was gr aded according to videolaryn-goscopical classification. Four patients had a n occasional and ten patients a permanent aspiration after surgery. Accordi ng to this assessment, an individual deglutition therapy management was est ablished. Ten patients with permanent aspiration received a temporary percu taneous endoscopic gastrostomy (PEG) and were integrated in a rehabilitatio n programme (stimulation of the swallowing reflex, training of compensatory swallowing manoeuvres, dietary regime). Due to this training programme, th e PEG could be removed in eight patients after 2-9 months. No patient neede d a laryngectomy or a tracheostomy due to aspiration. There were no cases o f aspiration-associated pneumonia. To obtain satisfying functional results after transoral laser surgery of supraglottic cancers with resection of the epiglottis, post-operative deglutition management, consisting of video end oscopy, a training programme and often a PEG, is necessary.