Dysphagia Final

The greatest difficulty a laryngectomee may have with swallowing is in propulsion of the bolus through the oral cavity and pharyngoesophagus.

 Loss of hyoid bone as the foundation for the tongue
 Some data indicate that there is increased pressure in the pharyngoesophagus after TL, which requires the tongue base to increase the pressure generated to propel the bolus.
 Effects of pre or post-operative XRT
 Pharyngoesophageal strictures
 Pseudoepiglottis

 Xerostomia
 Tissue devascularization
 Fibrosis of the tongue, muscles of mastication and pharynx

 Dry mouth or reduced saliva production
 Logemann, et al. 2003 - study done over 12 months found that reduced saliva does not correlate with slowed or inefficient swallow. Instead, it changed the patients’ perceptions of their swallowing ability and subsequently, their diet choices.
 Empirically, patient’s will not eat a wide variety of foods from a normal diet.

 Can make tissue more friable placing patient at risk for fistulization.

 If fibrosis is in tongue and jaw, range of motion will be affected.
 Pharyngeal transit will be affected by pharyngeal fibrosis as well as reduced base of tongue retraction.

 Narrows the food channel and can cause accumulation of food above the stricture
 Reflux back into mouth or nose with boluses of liquid
 Can affect voice in VP users

 Alternate liquids and solids
 Multiple swallows
 Dilation of stricture
 Transcutaneous injection of botulinum toxin to PES if spasm is causing the stricture.
 Myotomy – less common

 A fold of mucous membrane and sometimes scar tissue coming from the lateral pharyngeal wall at the tongue base
 At rest, it often collapses against the base of tongue which is misleading on mirror examination

 Alternate liquids and solids
 Multiple swallows
 Crush pills or take in suspension
 Surgical removal

 Need longterm follow-up of swallowing in newly laryngectomized patients.
 Does base of tongue retraction push fold of mucous membrane to form pseudoepiglottis overtime?