Dysphagia After Hypopharyngeal Surgery

  • Narayana Subramaniam
  • Arya C. Jaya
  • Jayakumar R. Menon


The hypopharynx serves as a conduit between the oropharynx and the upper esophagus; any disruption in hypopharyngeal function secondary to surgery has a high propensity to cause dysphagia. Once the bolus enters the hypopharynx, there is a negative pressure driven suction-like action caused by the laryngeal elevation and the contraction of the constrictor muscles [1], which propels it downward. Following a relaxation of the upper esophageal sphincter (UES), the bolus now travels into the esophagus and then the stomach.

Supplementary material

Video 23.1

VFS, Case 1 (MP4 22,815 kb)

Video 23.2

VFS, Case 2 (MP4 18,721 kb)


  1. 1.
    McConnel FM, Cerenko D, Mendelsohn MS. Manofluorographic analysis of swallowing. Otolaryngol Clin N Am. 1988;21:625–35.Google Scholar
  2. 2.
    Ferguson DD. Evaluation and management of benign esophageal strictures. Dis Esophagus. 2005;18:359–64.CrossRefGoogle Scholar
  3. 3.
    Mura F, Bertino G, Occhini A, Benazzo M. Surgical treatment of hypopharyngeal cancer: a review of the literature and proposal for a decisional flow-chart. Acta Otorhinolaryngol Ital. 2013;33:299–306.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Vidhyadharan S, Augustine I, Kudpaje AS, Iyer S, Thankappan K. Site-wise differences in adequacy of the surgical resection margins in head and neck cancers. Indian J Surg Oncol. 2014;5:227–31.CrossRefGoogle Scholar
  5. 5.
    Eckel HE, Staar S, Volling P, Sittel C, Damm M, Jungehuelsing M. Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results. Otolaryngol Head Neck Surg. 2001;124:561–9.CrossRefGoogle Scholar
  6. 6.
    Clark JR, de Almeida J, Gilbert R, et al. Primary and salvage (hypo) pharyngectomy: analysis and outcome. Head Neck. 2006;28:671–7.CrossRefGoogle Scholar
  7. 7.
    Kraus DH, Zelefsky MJ, Brock HA, Huo J, Harrison LB, Shah JP. Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx. Otolaryngol Head Neck Surg. 1997;116:637–41.CrossRefGoogle Scholar
  8. 8.
    Rudert HH, Höft S. Transoral carbon-dioxide laser resection of hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol. 2003;260:198–206.PubMedGoogle Scholar
  9. 9.
    Park YM, Kim WS, Byeon HK, De Virgilio A, Jung JS, Kim SH. Feasibility of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma. Oral Oncol. 2010;46:597–602.CrossRefGoogle Scholar
  10. 10.
    Goyal RK. Disorders of the cricopharyngeus muscle. Otolaryngol Clin N Am. 1984;17:115–30.Google Scholar
  11. 11.
    Castell DO. Esophageal disorders in the elderly. Gastroenterol Clin N Am. 1990;19:235–54.Google Scholar
  12. 12.
    Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154:965–74.CrossRefGoogle Scholar
  13. 13.
    Sessions DG, Zill R, Schwartz SL. Deglutition after conservation surgery for cancer of the larynx and hypopharynx. Otolaryngol Head Neck Surg. 1979;87:779–96.CrossRefGoogle Scholar
  14. 14.
    Shiotani A, Tomifuji M, Araki K, Yamashita T, Saito K. Videolaryngoscopic transoral en bloc resection of supraglottic and hypopharyngeal cancers using laparoscopic surgical instruments. Ann Otol Rhinol Laryngol. 2010;119:225–32.CrossRefGoogle Scholar
  15. 15.
    Chan JY, Wei WI. Current management strategy of hypopharyngeal carcinoma. Auris Nasus Larynx. 2013;40:2–6.CrossRefGoogle Scholar
  16. 16.
    Ellies M, Steiner W. Peri-and postoperative complications after laser surgery of tumors of the upper aerodigestive tract. Am J Otolaryngol. 2007;28:168–72.CrossRefGoogle Scholar
  17. 17.
    Vilaseca I, Blanch JL, Bernal-Sprekelsen M, Moragas M. CO2 laser surgery: a larynx preservation alternative for selected hypopharyngeal carcinomas. Head Neck. 2004;26:953–9.CrossRefGoogle Scholar
  18. 18.
    Peretti G, Piazza C, Cattaneo A, De Benedetto L, Martin E, Nicolai P. Comparison of functional outcomes after endoscopic versus open-neck supraglottic laryngectomies. Ann Otol Rhinol Laryngol. 2006;115:827–32.CrossRefGoogle Scholar
  19. 19.
    Wang CC, Liu SA, Wu SH, et al. Transoral robotic surgery for early T classification hypopharyngeal cancer. Head Neck. 2016;38:857–62.CrossRefGoogle Scholar
  20. 20.
    Vandenbrouck C, Eschwege F, Rochefordiere D, et al. Squamous cell carcinoma of the pyriform sinus: retrospective study of 351 cases treated at the institut Gustave-Roussy. Head Neck Surg. 1987;10:4–13.CrossRefGoogle Scholar
  21. 21.
    Spector JG, Sessions DG, Emami B, et al. Squamous cell carcinoma of the pyriform sinus: a non-randomized comparison of therapeutic modalities and long-term results. Laryngoscope. 1995;105:397–406.CrossRefGoogle Scholar
  22. 22.
    Ogura JH, Marks JE, Freeman RB. Results of conservation surgery for cancers of the supraglottis and pyriform sinus. Laryngoscope. 1980;90:591–600.CrossRefGoogle Scholar
  23. 23.
    Laccourreye O, Merite-Drancy A, Brasnu D, et al. Supracricoid hemilaryngopharyngectomy in selected pyriform sinus carcinoma staged as T2. Laryngoscope. 1993;103:1373–9.CrossRefGoogle Scholar
  24. 24.
    Brehmer D, Laubert A. Diagnosis of postoperative dysphagia and aspiration. Fiberoptic- endoscopic controlled methylene blue drinking. HNO. 1999;47:479–84.CrossRefGoogle Scholar
  25. 25.
    Chevalier D, Watelet JB, Darras JA, Piquet JJ. Supraglottic hemilaryngopharyngectomy plus radiation for the treatment of early lateral margin and pyriform sinus carcinoma. Head Neck. 1997;19:1–5.CrossRefGoogle Scholar
  26. 26.
    Steiner W, Ambrosch P, Hess CF, Kron M. Organ preservation by transoral laser microsurgery in piriform sinus carcinoma. Otolaryngol Head Neck Surg. 2001;124:58–67.CrossRefGoogle Scholar
  27. 27.
    Genden EM, Desai S, Sung CK. Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck. 2009;31:283–9.CrossRefGoogle Scholar
  28. 28.
    Boudreaux BA, Rosenthal EL, Magnuson JS, et al. Robot- assisted surgery for upper aerodigestive tract neoplasms. Arch Otolaryngol Head Neck Surg. 2009;135:397–401.CrossRefGoogle Scholar
  29. 29.
    Julieron M, Kolb F, Schwaab G, et al. Surgical management of posterior pharyngeal wall carcinomas: functional and oncologic results. Head Neck. 2001;23:80–6.CrossRefGoogle Scholar
  30. 30.
    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
  31. 31.
    Logemann JA. Dysphagia: evaluation and treatment. Folia Phoniatr Logop. 1995;47:140–64.CrossRefGoogle Scholar
  32. 32.
    Farrington WT, Weighill JS, Jones PH. Post-cricoid carcinoma. J Laryngol Otol. 1986;100:79–84.CrossRefGoogle Scholar
  33. 33.
    Axon PR, Woolford TJ, Hargreaves SP, Yates P, Birzgalis AR, Farrington WT. A comparison of surgery and radiotherapy in the management of post-cricoid carcinoma. Clin Otolaryngol Allied Sci. 1997;22:370–4.CrossRefGoogle Scholar
  34. 34.
    Sweeny L, Golden JB, White HN, Magnuson JS, Carroll WR, Rosenthal EL. Incidence and outcomes of stricture formation postlaryngectomy. Otolaryngol Head Neck Surg. 2012;146:395–402.CrossRefGoogle Scholar
  35. 35.
    Schusterman MA, Shestak K, Swartz W, et al. Reconstruction of the cervical esophagus: free jejunal transfer versus gastric pull-up. Plast Reconstr Surg. 1990;85:16–21.CrossRefGoogle Scholar
  36. 36.
    Briel JW, Tamhankar AP, Hagen JA, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004;198:536–41.CrossRefGoogle Scholar
  37. 37.
    Poghosyan T, Gaujoux S, Chirica M, Munoz-Bongrand N, Sarfati E, Cattan P. Functional disorders and quality of life after esophagectomy and gastric tube reconstruction for cancer. J Visc Surg. 2011;148:e327–35.CrossRefGoogle Scholar
  38. 38.
    Maclean J, Szczesniak M, Cotton S, Cook I, Perry A. Impact of a laryngectomy and surgical closure technique on swallow biomechanics and dysphagia severity. Otolaryngol Head Neck Surg. 2011;144:21–8.CrossRefGoogle Scholar
  39. 39.
    Patel UA, Moore BA, Wax M, et al. Impact of pharyngeal closure technique on fistula after salvage laryngectomy. JAMA Otolaryngol Head Neck Surg. 2013;139:1156–62.CrossRefGoogle Scholar
  40. 40.
    Hanasono MM, Lin D, Wax MK, Rosenthal EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck. 2012;34:580–8.CrossRefGoogle Scholar
  41. 41.
    Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg. 2003;138:303–8.CrossRefGoogle Scholar
  42. 42.
    Samlan RA, Webster KT. Swallowing and speech therapy after definitive treatment for laryngeal cancer. Otolaryngol Clin N Am. 2002;35:1115–33.CrossRefGoogle Scholar
  43. 43.
    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

  • Narayana Subramaniam
    • 1
  • Arya C. Jaya
    • 1
  • Jayakumar R. Menon
    • 2
    • 3
  1. 1.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia
  2. 2.Department of LaryngologyKerala Institute of Medical SciencesThiruvananthapuramIndia
  3. 3.Dysphagia Unit, Department of Head and Neck SurgeryAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia

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