| Impact of a laryngectomy and surgical closure technique on swallow biomechanics and Dysphagia severity. | |
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MedLine Citation:
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PMID: 21493382 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Objective. The incidence of self-reported dysphagia following a laryngectomy is high (72%). The impact, if any, of a surgical closure technique on swallowing biomechanics and dysphagia severity is not known. To date, there is no recommended standard procedure for pharyngeal reconstruction during laryngectomy surgery. The aim of this study was to determine how laryngectomy surgery alters swallowing biomechanics, pharyngeal peak deglutitive pressure, and hypopharyngeal intrabolus pressures and whether these changes in pressure correlate with specific surgical closure after total laryngectomy or with dysphagia severity. Study Design. Combined videoradiography and manometry was used to measure peak mid-pharyngeal, tongue, and intrabolus pressures; anatomical derangements; postswallow residue; and pharyngeal dimensions. Setting. Radiology Department, St George Hospital, Sydney, Australia. Subjects. Twenty-four patients following total laryngectomy surgery and age-matched control data. Results. When compared to controls, peak mid-pharyngeal pressures were significantly reduced in laryngectomy patients (P < .001). Hypopharyngeal intrabolus pressures were significantly higher in patients when compared to controls (P < .001). Patients who had undergone mucosa-and-muscle pharyngeal reconstruction had higher peak mid-pharyngeal pressures compared to those who had mucosa-alone closure (P ≤ .04). Combined mucosa-and-muscle closure was also associated with reduced postswallow residue, indicative of a more efficient swallow. Conclusion. Following laryngectomy surgery, pharyngeal pro-pulsive contractile forces are impaired, and there is increased resistance to bolus flow across the pharyngoesophageal segment. These adverse biomechanical effects can be influenced by surgical techniques, providing surgeons with evidence for optimum pharyngeal closure following a laryngectomy to improve swallowing outcomes. |
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Authors:
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Julia Maclean; Michal Szczesniak; Susan Cotton; Ian Cook; Alison Perry |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Volume: 144 ISSN: 1097-6817 ISO Abbreviation: Otolaryngol Head Neck Surg Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-04-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8508176 Medline TA: Otolaryngol Head Neck Surg Country: England |
Other Details:
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Languages: eng Pagination: 21-8 Citation Subset: IM |
Affiliation:
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Cancer Care Centre, St George Hospital, Sydney, Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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