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Unless otherwise noted, the publisher, which is the American Speech-Language- Hearing Association (ASHA), holds the copyright on all materials published in Perspectives on Swallowing and Swallowing Disorders, both as a compilation and as individual articles. Please see Rights and Permissions for terms and conditions of use of Perspectives content: http://journals.asha.org/perspectives/terms.dtl

Dysphagia After Total Laryngectomy

Mario A. Landera

Department of Otolaryngology, University of Miami Miami, FL

Donna S. Lundy

Department of Otolaryngology, University of Miami Miami, FL

Paula A. Sullivan

Neurology Service, Division of Speech Pathology, Malcom Randall Veterans Medical Center Gainesville, FL

Abstract

Previous thought was that total laryngectomy and difficulty with swallowing were incongruous. Patients were counseled that the loss of their larynx would leave them without a vocal source, but that swallowing would not be affected. Successful rehabilitation was defined as being cancer-free and regaining functional communication. Patients were not queried and frequently did not complain of dysphagia as long as they were able to maintain an oral diet. Knowledge has changed, and this article will focus on dysphagia in the patient with laryngectomy and will discuss anatomical sites to physiologic problems.

Introduction

Historically, the first total laryngectomy completed for cancer was performed by Dr. Billroth in 1873. A pharyngo-cutaneous fistula developed post-operatively complicating swallowing function and eventually closed, allowing the patient returned to an oral diet. However, he developed a recurrence of his disease and later demised from it. For more than 100 years thereafter, total laryngectomy became a common and curative treatment for advanced laryngeal carcinoma with the expectation that individuals would retain normal swallowing function and regain a functional means of speaking. Since that time, many variations on surgical procedures have been developed, and most of the emphasis has been on preventing complications and improving means of communication. Organ preservation treatment became a possibility about 25 years ago and encompasses attempts at curative treatment with combined chemo-radiation and retaining speech and swallowing function (Agrawal & Goldenberg, 2008; Bajaj et al., 2009; Chu & Kim, 2008). In addition, variations on partial laryngectomy procedures from the original more common supraglottic and hemi-vertical laryngectomy to modifications including near-total, supra-cricoid, and other surgeries have developed that preserve enough structure to allow voicing and facilitate swallowing function.

Today, a total laryngectomy typically is performed as a primary or secondary treatment for laryngeal carcinoma. When indicated for a primary, untreated tumor, it is usually for advanced disease that cannot be adequately managed in a more conservative manner. Organ

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