Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-11T14:20:49.815Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of swallowing outcomes of laryngotracheal separation versus total laryngectomy in a validated ovine model of profound oropharyngeal dysphagia

Published online by Cambridge University Press:  26 January 2017

N N Venkatesan ,
C M Johnson ,
M T Siddiqui ,
D J Cates ,
M A Kuhn ,
G N Postma  and
P C Belafsky
N N Venkatesan
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
C M Johnson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical College of Georgia, Augusta University, USA
M T Siddiqui
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
D J Cates
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
M A Kuhn
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
G N Postma
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical College of Georgia, Augusta University, USA
P C Belafsky*
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
*
Address for correspondence: Dr Peter C Belafsky, Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, School of Medicine, University of California, Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA Fax: +1 916 703 5011 E-mail: pbelafsky@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To validate the ovine model of profound oropharyngeal dysphagia and compare swallowing outcomes of laryngotracheal separation with those of total laryngectomy.

Methods:

Under real-time fluoroscopy, swallowing trials were conducted using the head and neck of two Dorper cross ewes and one human cadaver, secured in lateral fluoroscopic orientation. Barium trials were administered at baseline, pre- and post-laryngohyoid suspension, following laryngotracheal separation, and following laryngectomy in the ovine model.

Results:

Mean pre-intervention Penetration Aspiration Scale and National Institutes of Health Swallow Safety Scale scores were 8 ± 0 and 6 ± 0 respectively in sheep and human cadavers, with 100 per cent intra- and inter-species reproducibility. These scores improved to 1 ± 0 and 2 ± 0 post-laryngohyoid suspension (p < 0.01). Aerodigestive tract residue was 18.6 ± 2.4 ml at baseline, 15.4 ± 3.8 ml after laryngotracheal separation and 3.0 ± 0.7 ml after total laryngectomy (p < 0.001).

Conclusion:

The ovine model displayed perfect intra- and inter- species reliability for the Penetration Aspiration Scale and Swallow Safety Scale. Less aerodigestive tract residue after narrow-field laryngectomy suggests that swallowing outcomes after total laryngectomy are superior to those after laryngotracheal separation.

Keywords

Deglutition DisordersLaryngectomyRespiratory AspirationExperimental Animal ModelSurgical Models
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 350 - 356
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Material in this manuscript was presented at the Dysphagia Research Society Meeting, 12–14 March 2015, Chicago, Illinois, USA, and at the American Broncho-Esophagological Association Meeting, 22–23 April 2015, Boston, Massachusetts, USA.

References

1 Cho, SY, Choung, RS, Saito, YA, Schleck, CD, Zinsmeister, AR, Locke, GR 3rd et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil 2015;27:212–19Google Scholar
2 Leder, SB, Suiter, DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000–2007. Gerontology 2009;55:714–18Google Scholar
3 Hoy, M, Domer, A, Plowman, EK, Loch, R, Belafsky, P. Causes of dysphagia in a tertiary-care swallowing center. Ann Otol Rhinol Laryngol 2013;122:335–8Google Scholar
4 Garcia-Peris, P, Paron, L, Velasco, C, de la Cuerda, C, Camblor, M, Breton, I et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr 2007;26:710–17Google Scholar
5 Altman, KW, Yu, GP, Schaefer, SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg 2010;136:784–9CrossRefGoogle ScholarPubMed
6 Takano, Y, Suga, M, Sakamoto, O, Sato, K, Samejima, Y, Ando, M. Satisfaction of patients treated surgically for intractable aspiration. Chest 1999;116:1251–6Google Scholar
7 Snyderman, CH, Johnson, JT. Laryngotracheal separation for intractable aspiration. Ann Otol Rhinol Laryngol 1988;97:466–70Google Scholar
8 Eisele, DW. Surgical approaches to aspiration. Dysphagia 1991;6:71–8Google Scholar
9 Cannon, CR, McLean, WC. Laryngectomy for chronic aspiration. Am J Otolaryngol 1982;3:145–9Google Scholar
10 Zrunek, M, Happak, W, Hermann, M, Streinzer, W. Comparative anatomy of human and sheep laryngeal skeleton. Acta Otolaryngol 1988;105:155–62Google Scholar
11 Cates, D, Plowman, EK, Mehdizadeh, O, Yen, K, Domer, A, Gilden, M et al. Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round. Laryngoscope 2013;123:721–6Google Scholar
12 Rosenbek, JC, Robbins, JA, Roecker, EB, Coyle, JL, Wood, JL. A penetration-aspiration scale. Dysphagia 1996;11:93–8Google Scholar
13 Belafsky, P, Kuhn, M. Fluoroscopy and dysphagia outcome measures. In: The Clinician's Guide to Swallowing Fluoroscopy. New York: Springer, 2014;61–2Google Scholar
14 Belafsky, PC. Manual control of the upper esophageal sphincter. Laryngoscope 2010;120(suppl 1):S1–16 Google Scholar
15 Belafsky, PC, Mehdizadeh, OB, Ledgerwood, L, Kuhn, M. Evaluation of hypopharyngeal suction to eliminate aspiration: the Retro-Esophageal Suction (REScue) catheter. Dysphagia 2015;30:74–9Google Scholar
16 Belafsky, PC, Plowman, EK, Mehdizadeh, O, Cates, D, Domer, A, Yen, K. The upper esophageal sphincter is not round: a pilot study evaluating a novel, physiology-based approach to upper esophageal sphincter dilation. Ann Otol Rhinol Laryngol 2013;122:217–21Google Scholar
17 Cook, SP. Candidate's Thesis: Laryngotracheal separation in neurologically impaired children: long-term results. Laryngoscope 2009;119:390–5Google Scholar
18 Hara, H, Hori, T, Sugahara, K, Ikeda, T, Kajimoto, M, Yamashita, H. Effectiveness of laryngotracheal separation in neurologically impaired pediatric patients. Acta Otolaryngol 2014;134:626–30Google Scholar
19 Gelfand, YM, Duncan, NO, Albright, JT, Roy, S, Montagnino, B, Edmonds, JL. Laryngotracheal separation surgery for intractable aspiration: our experience with 12 patients. Int J Pediatr Otorhinolaryngol 2011;75:931–4Google Scholar
20 Miller, FR, Eliachar, I. Managing the aspirating patient. Am J Otolaryngol 1994;15:1–17 CrossRefGoogle ScholarPubMed