Following a total laryngectomy, alterations in the pharyngeal musculature and changes in the pharyngo-oesophageal segment due to reconstruction, results in altered bolus transit. Swallowing dysfunction after total laryngectomy for head and neck squamous cell carcinoma can vary from 10%-90%. There is wide variation in terms of the tools used to measure dysphagia as well as the definition of dysphagia, contributing to variation in how swallowing outcomes are reported, particularly in laryngectomy patients, as often the presence of a larynx is assumed. As such, this study is novel in its use of the swallowing outcomes after laryngectomy (SOAL) questionnaire. A total of 221 complete questionnaires were assessed.
One significant finding in this study was the association with poorer self-reported swallowing outcomes in patients who underwent chemo radiotherapy (CRT) either prior to or following laryngectomy vs. no additional treatment (p= <0.001). Primary or adjuvant radiotherapy did not result in a significant difference in outcome.
Type of surgical reconstruction was also important; those who had a free jejunum flap reconstruction reported a significantly worse outcome vs. primary closure (p= <0.001). This was also compared with gastric pull up and pectoralis major reconstruction, with no statistically significant difference. Additionally, patients who were older and less than five years post laryngectomy also reported worse outcomes (although these findings were not significant in regression analysis) Overall, this study highlights some of the specific factors affecting swallowing in laryngectomy patients using the validated SOAL questionnaire. - DB
