J. Oeken et al., Swallowing function after endoscopic resection of supraglottic carcinoma with the carbon dioxide laser, EUR ARCH OT, 258(5), 2001, pp. 250-254
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.