Phagosurgery: Surgical Management of Dysphagia

  • Jayakumar R. Menon
  • Manju E. Issac
  • Subramania Iyer
  • Krishnakumar Thankappan


Head and neck cancers by themselves can adversely affect the swallowing efficacy. Unfortunately, even their treatment options, namely, surgery, radiotherapy, and chemotherapy, can also be detrimental to the act of swallowing. Dysphagia may be confined to just one phase, or it may involve more than one and occasionally even all the phases of swallowing. The purpose of this chapter is to discuss various surgical and other interventional options in the management of dysphagia associated with head and neck cancer.

Supplementary material

Video 14.1

Injection laryngoplasty with fat. Fat is injected lateral to the vocal process of the right vocal cord. Inferior lip of the vocal cord is bulging initially and then spreading across the whole cord. The cord gets medialized (MPG 37482 kb)

Video 14.2

Medialization thyroplasty with silastic block. Left vocal cord palsy. Pre-procedure shows the phonatory gap and pooling of the left pyriform sinus. Post-procedure, there is no phonatory gap and no pooling (MP4 36285 kb)

Video 14.3

Stroboscopy in a case of left vocal cord palsy with significant arytenoid asymmetry and phonatory gap. Underwent both medialization thyroplasty and arytenoid rotation. Phonatory gap completely closed and arytenoid asymmetry improved. Voice is near normal (MP4 54443 kb)

Video 14.4

Videofluoroscopy of a case with massive aspiration. Patient will require a cuffed tracheostomy (MP4 8561 kb)

Video 14.5

Botox injection technique (MP4 72865 kb)

Video 14.6

Videofluoroscopy before and after Botox injection (MP4 27259 kb)

Video 14.7

Videofluoroscopy in a patient with total cricopharyngeal stenosis following thyroidectomy. Patient improved with cricopharyngeal myotomy (MP4 7826 kb)


  1. 1.
    McCulloch TM, Andrews BT, Hoffman HT, et al. Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope. 2002;112:1235–8.CrossRefGoogle Scholar
  2. 2.
    Bhattacharyya N, Kotz T, Shapiro J. Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Ann Otol Rhinol Laryngol. 2002;111:672–9.CrossRefGoogle Scholar
  3. 3.
    Shama L, Connor NP, Ciucci MR, McCulloch TM. Surgical treatment of dysphagia. Phys Med Rehabil Clin N Am. 2008;19:817–35.CrossRefGoogle Scholar
  4. 4.
    Ergun GA, Kahrilas PJ. Medical and surgical treatment interventions in deglutitive dysfunction. In: Perlman AL, Schulze-Delreiu K, editors. Deglutition and its disorders. San Diego, CA: Singular; 1997. p. 463–90.Google Scholar
  5. 5.
    Kwon TK, Buckmore R. Injection laryngoplasty for management of unilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg. 2004;12:538–42.CrossRefGoogle Scholar
  6. 6.
    King JM, Simpson CB. Modern injection augmentation for glottic insufficiency. Curr Opin Otolaryngol Head Neck Surg. 2007;15:153–8.CrossRefGoogle Scholar
  7. 7.
    Courey MS. Injection laryngoplasty. Otolaryngol Clin N Am. 2004;37:121–38.CrossRefGoogle Scholar
  8. 8.
    Sato K, Kurita S, Hirano M, et al. Distribution of elastic cartilage in the arytenoids and its physiologic significance. Ann Otol Rhinol Laryngol. 1990;99:363–8.CrossRefGoogle Scholar
  9. 9.
    McCulloch TM, Hoffman HT, Andrews BT, et al. Arytenoid adduction combined with GoreTex medialization thyroplasty. Laryngoscope. 2000;110:1306–11.CrossRefGoogle Scholar
  10. 10.
    Butcher RB. Treatment of chronic aspiration as a complication of cerebrovascular accident. Laryngoscope. 1982;92:681–5.CrossRefGoogle Scholar
  11. 11.
    Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116:455–78.CrossRefGoogle Scholar
  12. 12.
    Sullivan CA, Jaklitsch MT, Haddad R, et al. Endoscopic management of hypopharyngeal stenosis after organ sparing therapy for head and neck cancer. Laryngoscope. 2004;114:1924–31.CrossRefGoogle Scholar
  13. 13.
    Urken ML, Jacobson AS, Lazarus CL. Comprehensive approach to restoration of function in patients with radiation-induced pharyngoesophageal stenosis: report of 31 patients and proposal of new classification scheme. Head Neck. 2012;34:1317–28.CrossRefGoogle Scholar
  14. 14.
    Franzmann EJ, Lundy DS, Abitbol AA, Goodwin WJ. Complete hypopharyngeal obstruction by mucosal adhesions: a complication of intensive chemoradiation for advanced head and neck cancer. Head Neck. 2006;28:663–70.CrossRefGoogle Scholar
  15. 15.
    Hu HT, Shin JH, Kim JH, Park JH, Sung KB, Song HY. Fluoroscopically guided balloon dilation for pharyngoesophageal stricture after radiation therapy in patients with head and neck cancer. AJR Am J Roentgenol. 2010;194:1131–6.CrossRefGoogle Scholar
  16. 16.
    Williams LR, Kasir D, Penny S, Homer JJ, Laasch HU. Radiological balloon dilatation of post-treatment benign pharyngeal strictures. J Laryngol Otol. 2009;123:1229–32.CrossRefGoogle Scholar
  17. 17.
    Prisman E, Miles BA, Genden EM. Prevention and management of treatment-induced pharyngo-oesophageal stricture. Lancet Oncol. 2013;14:e380–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Jayakumar R. Menon
    • 1
    • 2
  • Manju E. Issac
    • 1
  • Subramania Iyer
    • 3
  • Krishnakumar Thankappan
    • 3
  1. 1.Department of LaryngologyKerala Institute of Medical SciencesThiruvananthapuramIndia
  2. 2.Dysphagia Unit, Department of Head and Neck SurgeryAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia
  3. 3.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia

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