Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry

Abstract

Introduction: Understanding of swallowing pressures after total laryngectomy (TL) and what constitutes a “functional” swallow are limited. Mobile structures are altered or removed after TL, with consequent effects on pressure profiles. High-resolution manometry (HRM) can characterize these pressures. Methods: Six TL subjects without dysphagia and 6 controls underwent pharyngeal HRM. Timing and pressure variables for the velopharynx, mesopharynx, and upper esophageal sphincter (UES) were compared. Changes in variables due to bolus volume were evaluated in TL subjects. Results: The TL subjects had increased duration of velopharyngeal pressure ( P = .012). Maximum mesopharyngeal pressure was lower versus controls ( P = .003). Maximal and total pre-opening ( P = .002, P = .002) and post-closure ( P = .001, P = .002) UES pressures were lower. Maximum mesopharyngeal pressure ( P = .032) decreased with increasing bolus volume. Conclusions: Increased velopharyngeal pressure duration and total swallow duration reflect separation of the pharynx into distinct conduits for air and food, thus ensuring successful bolus passage without the need for respiration. Decreased UES pressure highlights the effects of disrupting the cricopharyngeal and rostral esophageal muscle fibers from their attachments to the larynx and performing a cricopharyngeal myotomy. Additional studies including subjects with dysphagia could further characterize the functional TL swallow and identify aspects susceptible to dysfunction.