Management of swallowing in supraglottic and extended supraglottic laryngectomy patients

Background. Aspiration of food and liquid following supraglottic and suprac ricoid laryngectomy has been documented and found to be the most frequent m ajor postoperative complication that extends hospitalization. The advantage s as well as disadvantages of discharging a patient with percutaneous endos copic gastrostomy (PEG) placement and home therapy versus an aggressive in- hospital dysphagia management program remain controversial. The present inv estigation examines an aggressive in-patient postoperative dysphagia manage ment program following decannulation. Methods. Twenty-one patients participated in a four-part dysphagia manageme nt program following decannulation: patient education, indirect therapy, sw allowing evaluation, and nutrition education. Results. Eleven patients achieved functional swallowing goals prior to disc harge with no reports of pneumonia or rehospitalization over a 3-month foll ow-up period. Six patients were discharged with a tracheostomy and duo tube ; five of these patients were started on an oral diet the same day of decan nulation. Four patients decannulated prior to discharge did not achieve fun ctional swallowing. Conclusion. Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group wer e exceeded by charges for PEG placement and in-home therapy according to pr icing guidelines for the hospital where these patients were treated. Specif ic patient profiles of those who were unsuccessful relate to extent of surg ery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + voc al fold (SUPRA + VF) resection, and non-compliance. Complicated patients of ten require longer rehabilitation and may benefit from a PEG at the time of surgery. (C) 2001 John Wiley & Sons, Inc.