Videofluoroscopic follow up of the neohypopharynx in laryngectomized patients after radiotherapy

Dysphagia is a common complaint after laryngectomy (LE). It progresses after postoperative radiotherapy (PORT) and is associated with a decrease of the quality of life. The aim of the study was to evaluate the changes in the neohypopharynx (NHP) as a result of PORT in laryngectomees by video fluoroscopy (VFS).

The charts and digital VFS images of patients subjected to VFS in the early postoperative period after LE and later after PORT, were retrospectively analyzed. The NHP dimensions in lateral projection were measured at the levels of the cervical vertebrae and at the segment with minimal lumen. The measurements were calibrated to the height of C3. The dimensions at the individual levels, their mean value and the dimensions and location of the narrowest lumen before and after PORT, were compared.

A total of 16 patients with VFS before and after PORT were identified (all male, mean age 60.5 ± 7years). In 4 patients, the archived images didn't allow accurate analysis and they were excluded. All were subjected to LE for advanced carcinoma (5xT3, 6xT4, 2xN2c, 1xN1, 8xN0) with an uniform surgical technique. The mean time between the two VFS examinations was 6 ± 4months. The second VFS was performed 4.4 ± 7months after PORT. In all patients changes in the size of the NHP were detectable after PORT. In 7 (63.6%) patients, a reduction in mean NHP size was observed with an average of 12.6%, of them 1 (6.3%) had NHP narrowing at all levels by 40.5% on average. In 4 (36.34%) there was an increase by 18.6% on average, of them 1 patient (6.3%) had an increase in NHP size at all levels, averaging 20.5%.

The VFS before and after PORT in laryngectomees doesn't detect a tendency for NHP stenosis. The worsening of dysphagia in such patients can hardly be associated with mechanical stenosis.

Publication History

Publication Date:
23 April 2019 (online)