OBJECTIVES: Cancer of the supraglottic larynx may be surgically treated with either traditional "open" supraglottic laryngectomy (OSL) or endoscopic laser supraglottic laryngectomy (ELSL). Pharyngeal dysphagia is a well-documented consequence of traditional OSL from which near-normal swallowing characteristically recovers 14 to 40 days after surgery. Conversely, ELSL results in the resumption of serviceable swallowing within 2 to 7 days after surgery. METHODS: A prospective assessment of the glottic closure reflex in 6 consecutive patients who had ELSL was performed by fiberoptic endoscopic evaluation of swallowing with sensory testing. RESULTS: All 6 patients with ELSL demonstrated an intact glottic closure reflex both before surgery and 48 to 72 hours after surgery. In contrast, 7 of 8 historical control patients who had OSL demonstrated a persistent absence of the glottic closure reflex 3 weeks to 12 years later. CONCLUSIONS: Although a number of clinical factors influence swallowing recovery, one important factor separating our patient groups was the preservation of the glottic closure reflex in patients who underwent endoscopic laser resection. Because the loss of the glottic closure response persists for years after traditional OSL, it is concluded that the sensory field deficit caused by superior laryngeal nerve section is largely not recoverable; however, compensatory mechanisms remain important in serviceable recovery, even if delayed after operation. Indeed, preservation of the glottic closure response appears to enhance swallowing recovery when equivalent compensatory mechanisms are used.
OBJECTIVES: Cancer of the supraglottic larynx may be surgically treated with either traditional "open" supraglottic laryngectomy (OSL) or endoscopic laser supraglottic laryngectomy (ELSL). Pharyngeal dysphagia is a well-documented consequence of traditional OSL from which near-normal swallowing characteristically recovers 14 to 40 days after surgery. Conversely, ELSL results in the resumption of serviceable swallowing within 2 to 7 days after surgery. METHODS: A prospective assessment of the glottic closure reflex in 6 consecutive patients who had ELSL was performed by fiberoptic endoscopic evaluation of swallowing with sensory testing. RESULTS: All 6 patients with ELSL demonstrated an intact glottic closure reflex both before surgery and 48 to 72 hours after surgery. In contrast, 7 of 8 historical control patients who had OSL demonstrated a persistent absence of the glottic closure reflex 3 weeks to 12 years later. CONCLUSIONS: Although a number of clinical factors influence swallowing recovery, one important factor separating our patient groups was the preservation of the glottic closure reflex in patients who underwent endoscopic laser resection. Because the loss of the glottic closure response persists for years after traditional OSL, it is concluded that the sensory field deficit caused by superior laryngeal nerve section is largely not recoverable; however, compensatory mechanisms remain important in serviceable recovery, even if delayed after operation. Indeed, preservation of the glottic closure response appears to enhance swallowing recovery when equivalent compensatory mechanisms are used.
Authors: Soon-Hyun Ahn; Hyun Jun Hong; Soon Young Kwon; Kee Hwan Kwon; Jong-Lyel Roh; Junsun Ryu; Jun Hee Park; Seung-Kuk Baek; Guk Haeng Lee; Sei Young Lee; Jin Choon Lee; Man Ki Chung; Young Hoon Joo; Yong Bae Ji; Jeong Hun Hah; Minsu Kwon; Young Min Park; Chang Myeon Song; Sung-Chan Shin; Chang Hwan Ryu; Doh Young Lee; Young Chan Lee; Jae Won Chang; Ha Min Jeong; Jae-Keun Cho; Wonjae Cha; Byung Joon Chun; Ik Joon Choi; Hyo Geun Choi; Kang Dae Lee Journal: Clin Exp Otorhinolaryngol Date: 2017-01-03 Impact factor: 3.372