Dysphagia following total laryngectomy: a myth or a reality? How can we help

Abstract

Total laryngectomy leads to drastic anatomical changes in the swallowing and breathing mechanism. Reduced tongue base retraction, poor pharyngeal clearance, stricture and prominence in the posterior pharyngeal wall have been reported to cause swallowing difficulties in individuals with total laryngectomy. The present case study describes the swallowing characteristics in an individual with total laryngectomy and discusses efficacy of swallowing maneuvers in total laryngectomy. A 55 yr/male, operated case of total laryngectomy using TEP reported with complaint of food getting stuck in the throat and vomiting sensation. He was fed orally and could tolerate only thick liquids. Swallowing assessment was carried out by clinical and instrumental tools (modified barium swallow) which revealed cricopharyngeal prominence, poor pharyngeal clearance and significant post swallow residue. Effortful swallow was attempted to explore the change in swallowing mechanism. Relaxation of pharyngeal wall with better pharyngeal clearance was seen with the maneuver. Clinically, the case reported of ability to swallow semisolids and solids well with the maneuver. At 3 month follow up, the case reported no difficulty in swallowing semisolids and solids orally. The above case study highlights on radiological evidence of swallowing abnormalities following total laryngectomy and further on the efficacy of maneuver on mechanism of swallowing. Hence, it can be noted that swallowing intervention has strong implications in patients with total laryngectomy.