Advertisement

Dysphagia After Oropharyngeal Surgery

  • Samskruthi P. Murthy
  • Krishnakumar Thankappan
  • Subramania Iyer
Chapter

Abstract

Swallowing is a complex process. Oropharynx plays a pivotal role in aiding the bolus to the digestive tract and to generate adequate pharyngeal pressure to push the bolus into the esophagus. Surgery of oropharynx affects both voluntary oral phase and involuntary pharyngeal phase when the base of the tongue is resected. Management of oropharyngeal cancers has evolved over decades. Historically, tumors of oropharynx were treated with surgery, through an access mandibulotomy or transpharyngeal approach. Surgical morbidity associated with this mandible access or mandibulectomy surgeries ranged from 10% to 60%. Most of the morbidity was related to swallowing and speech. Even though transpharyngeal approach had lesser morbidity ranging from 7% to 38%, it would still significantly affect swallowing [1].

Supplementary material

Video 21.1

T1 mucoepidermoid carcinoma of the right base of tongue; preoperative, Case 1 (MP4 27689 kb)

Video 21.2

Early post-op, showing slough in the wound and vallecular pooling of saliva, left side of the base of the tongue and vallecula normal, Case 1 (MP4 37332 kb)

Video 21.3

One month after surgery, wound healed well; patient is swallowing well, Case 1 (MP4 47615 kb)

Video 21.4

Oral scopy showing flap, 5 days postoperative (MP4 85928 kb)

Video 21.5

FEES, Case 2, near normal (MP4 165990 kb)

Video 21.6

VFS, Case 2, near normal (MP4 60972 kb)

Video 21.7

Scopy, Case 3 (MP4 38112 kb)

Video 21.8

FEES, Case 3 (MP4 202692 kb)

Video 21.9

VFS, Case 3 (MP4 114722 kb)

Video 21.10

Scopy, Case 4, pre- and postoperative (MP4 56677 kb)

Video 21.11

VFS, Case 4 (MP4 31535 kb)

Video 21.12

Scopy, Case 5 (MP4 204264 kb)

Video 21.13

VFS, Case 5 (MP4 20505 kb)

References

  1. 1.
    Clayburgh DR, Gross N. Surgical innovations. Otolaryngol Clin N Am. 2013;46:615–28.CrossRefGoogle Scholar
  2. 2.
    Wolf GT, Hong K, Fisher S. The Department of Veterans Affairs Laryngeal Cancer Study Group: induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685–90.CrossRefGoogle Scholar
  3. 3.
    Olsen SM, Moore EJ, Garcia JJ, Janus JR, Price DL, Olsen KD. Transoral surgery alone for human-papillomavirus-associated oropharyngeal squamous cell carcinoma. Ear Nose Throat J. 2013;92:76–83.PubMedGoogle Scholar
  4. 4.
    Weinstein GS, O’Malley BW, Snyder W, Sherman E, Quon H. Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg. 2007;133:1220–6.CrossRefGoogle Scholar
  5. 5.
    Dean NR, Rosenthal EL, Carroll WR, et al. Robotic-assisted surgery for primary or recurrent oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2010;136:380–4.CrossRefGoogle Scholar
  6. 6.
    Mcconnel F, Logemann JA, Rademaker AW, et al. Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: a pilot study. Laryngoscope. 1994;104:87–90.PubMedGoogle Scholar
  7. 7.
    Logemann JA, Kahrilas PJ, Cheng JO, et al. Closure mechanisms of laryngeal vestibule during swallow. Am J Phys. 1992;262:G338–44.Google Scholar
  8. 8.
    Kahrilas PJ, Logemann JA, Lin S, Ergun GA. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;103:128–36.CrossRefGoogle Scholar
  9. 9.
    Mcconnel F. Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope. 1988;98:71–8.PubMedGoogle Scholar
  10. 10.
    Jacob P, Kahrilas PJ, Logemann JA, Shah V, Ha T. Upper esophageal sphincter opening and modulation during swallowing. Gastroenterology. 1989;97:1469–78.CrossRefGoogle Scholar
  11. 11.
    Shawker TH, Sonies B, Stone M, Baum BJ. Real-time ultrasound visualization of tongue movement during swallowing. J Clin Ultrasound. 1983;11:485–90.CrossRefGoogle Scholar
  12. 12.
    Pauloski BR, Logemann JA, Fox JC, Colangelo LA. Biomechanical analysis of the pharyngeal swallow in postsurgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction. J Speech Hear Res. 1995;38:110–23.CrossRefGoogle Scholar
  13. 13.
    Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Pathol. 1996;5:23–30.CrossRefGoogle Scholar
  14. 14.
    Walther EK. Dysphagia after pharyngolaryngeal cancer surgery. Part I: pathophysiology of postsurgical deglutition. Dysphagia. 1995;10:275–8.CrossRefGoogle Scholar
  15. 15.
    McConnel F, Mendelsohn MS, Logemann JA. Examination of swallowing after total laryngectomy using manofluorography. Head Neck Surg. 1986;9:3–12.CrossRefGoogle Scholar
  16. 16.
    McConnel FM, Mendelsohn MS, Logemann JA. Manofluorography of deglutition after supraglottic laryngectomy. Head Neck Surg. 1987;9:142–50.CrossRefGoogle Scholar
  17. 17.
    Hamlet S, Mathog R, Fleming S, Jones L, Muz J. Modification of compensatory swallowing in a supraglottic laryngectomy patient. Head Neck. 1990;12:131–6.CrossRefGoogle Scholar
  18. 18.
    Brown JS, Rogers SN, Lowe D. A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes. Int J Oral Maxillofac Surg. 2006;35:208–14.CrossRefGoogle Scholar
  19. 19.
    Christopoulos E, Carrau R, Segas J, Johnson JT, Myers EN, Wagner RL. Transmandibular approaches to the oral cavity and oropharynx: a functional assessment. Arch Otolaryngol Head Neck Surg. 1992;118:1164–7.CrossRefGoogle Scholar
  20. 20.
    Stanley RB. Mandibular lingual releasing approach to oral and oropharyngeal carcinomas. Laryngoscope. 1984;94:596–600.PubMedGoogle Scholar
  21. 21.
    Donias HW, Karamanoukian HL, D’ancona G, Hoover EL. Minimally invasive mitral valve surgery: from port access to fully robotic-assisted surgery. Angiology. 2003;54:93–101.CrossRefGoogle Scholar
  22. 22.
    Weinstein GS, O’Malley BW Jr, Desai SC, Quon H. Transoral robotic surgery: does the ends justify the means? Curr Opin Otolaryngol Head Neck Surg. 2009;17:126–31.CrossRefGoogle Scholar
  23. 23.
    Sinclair CF, McColloch NL, Carroll WR, Rosenthal EL, Desmond RA, Magnuson JS. Patient-perceived and objective functional outcomes following transoral robotic surgery for early oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2011;137:1112–6.CrossRefGoogle Scholar
  24. 24.
    Gillespie MB, Brodsky MB, Day TA, Sharma AK, Lee FS, Martin-Harris B. Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer. Arch Otolaryngol Head Neck Surg. 2005;131:615–9.CrossRefGoogle Scholar
  25. 25.
    Dziegielewski PT, Teknos TN, Durmus K, et al. Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg. 2013;139:1099–108.CrossRefGoogle Scholar
  26. 26.
    Arrese LC, Lazarus CL. Special groups: head and neck cancer. Otolaryngol Clin N Am. 2013;46:1123–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Samskruthi P. Murthy
    • 1
  • Krishnakumar Thankappan
    • 1
  • Subramania Iyer
    • 1
  1. 1.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia

Personalised recommendations