Mechanisms of Recovery of Swallow After Supraglottic Laryngectomy This study examines oropharyngeal swallow disorders and measures of pharyngeal and laryngeal movement during deglutition from videofluorographic studies of oropharyngeal swallow in 9 patients who had undergone supraglottic laryngectomy and 9 age-matched normal subjects. The swallows of surgical patients were examined at 2 weeks and 3 months postoperatively. Two critical ... Research Article
Research Article  |   October 01, 1994
Mechanisms of Recovery of Swallow After Supraglottic Laryngectomy
 
Author Affiliations & Notes
  • Jeri A. Logemann
    Northwestern University, Evanston, IL
  • Patricia Gibbons
    Northwestern University, Evanston, IL
  • Alfred W. Rademaker
    Northwestern University, Cancer Center, Chicago, IL
  • Barbara Roa Pauloski
    Northwestern University, Evanston, IL
  • Peter J. Kahrilas
    Northwestern University, Evanston, IL
  • Mary Bacon
    Rush-Presbyterian Medical Center, Chicago, IL
  • Julia Bowman
    M.D. Anderson Cancer Center, Houston, TX
  • Ellen McCracken
    University of Chicago, Chicago, IL
  • Contact author: Jeri A. Logemann, PhD, Department of Communication Sciences and Disorders, Northwestern University, 2299 North Campus Drive, Evanston, IL 60208-3540.
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Swallowing, Dysphagia & Feeding Disorders / Speech / Research Articles
Research Article   |   October 01, 1994
Mechanisms of Recovery of Swallow After Supraglottic Laryngectomy
Journal of Speech, Language, and Hearing Research, October 1994, Vol. 37, 965-974. doi:10.1044/jshr.3705.965
History: Received May 20, 1993 , Accepted March 16, 1994
 
Journal of Speech, Language, and Hearing Research, October 1994, Vol. 37, 965-974. doi:10.1044/jshr.3705.965
History: Received May 20, 1993; Accepted March 16, 1994

This study examines oropharyngeal swallow disorders and measures of pharyngeal and laryngeal movement during deglutition from videofluorographic studies of oropharyngeal swallow in 9 patients who had undergone supraglottic laryngectomy and 9 age-matched normal subjects. The swallows of surgical patients were examined at 2 weeks and 3 months postoperatively. Two critical factors in recovery of swallowing were identified: (a) airway closure at the laryngeal entrance, that is, the space between the arytenoid cartilage and the base of the tongue, and (b) the movement of the tongue base to make complete contact with the posterior pharyngeal wall. When patients achieved these two functions, they returned to normal swallowing. The duration of tongue base contact to the posterior pharyngeal wall and extent of anterior movement of the arytenoid increased significantly from 2 weeks to 3 months in the surgical patients. At 2 weeks postsurgery, patients who had undergone supraglottic laryngectomy exhibited significantly shorter airway closure and tongue base to pharyngeal wall contact, reduced laryngeal elevation, increased width of cricopharyngeal (CP) opening, and later onset of airway closure and tongue base movement than normal subjects. These significant differences remained at 3 months postoperatively, although swallow measures were moving toward normal in the patients who had undergone supraglottic laryngectomy. Comparison of patients not eating at 2 weeks with patients at the time of first eating revealed significantly longer duration of tongue base contact to the pharyngeal wall, longer duration of airway closure, and greater movement of the arytenoid in patients who were eating. Results indicate that the focus of swallowing therapy after supraglottic laryngectomy should be on improvement of posterior movement of the tongue base and anterior tilting of the arytenoid to close the airway entrance and improve bolus propulsion (in the case of the tongue base).

Acknowledgment
This research was funded by NIH P01CA 40007.
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