Swallowing After Open Partial Horizontal Laryngectomy Type IIa: A Quantitative Videofluoroscopic Analysis Using the Analysis of Swallowing, Physiology, Events, Kinematics, and Timing.

Abstract

The purpose of this study was to characterize swallowing physiology on sips of thin liquid in patients following open partial horizontal laryngectomy Type IIa (OPHLIIa) using videofluoroscopic swallow study (VFSS) data, rated using the Analysis of Swallowing Physiology: Events, Kinematics, and Timing (ASPEKT) method. This retrospective study involved secondary analysis of archived data for a cross-sectional sample of 100 patients (94 men, six women;= 67 years) who underwent VFSS after OPHLIIa surgery at the Brazilian National Cancer Institute (mean time postsurgery = 44 months). For each patient, the first available comfortable sip of thin liquid barium was rated using ASPEKT parameters and additional hypopharyngeal area and cricopharyngeal tissue redundancy measures. Ratings were performed by trained speech-language pathologists using ImageJ software. Values were compared to reference data for adults without dysphagia usingtests and odds ratio analysis. After OPHLIIa surgery, patients in this sample exhibited elevated frequencies and significantly increased odds of atypical findings across multiple swallowing parameters. With respect to impaired swallowing safety and efficiency, these included clinically significant Penetration-Aspiration Scale scores (22%), partial/incomplete laryngeal vestibule closure (LVC; 34%), and increased pharyngeal residue, both overall (76%) and by subspace: valleculae (49%), pyriform sinuses (63%), and elsewhere in the pharynx (57%). Other parameters showing significantly increased odds of atypical findings included reduced pharyngeal constriction (98%), reduced hyoid peak position (83%) and speed (59%), a prolonged hyoid-burst-to-upper-esophageal-sphincter-opening interval (45%), and the presence of redundant cricopharyngeal muscle tissue (39%). The analyses highlighted poor hypopharyngeal constriction as a feature of swallowing post-OPHLIIa and revealed apparent compensations in the form of significantly shorter time-to-LVC and prolonged LVC and upper esophageal sphincter opening durations. Swallowing dysfunction following OPHLIIa is marked by structural and physiological changes that impair both swallowing safety and efficiency. These findings highlight critical physiological impairments, particularly reduced pharyngeal constriction and compromised airway protection, which should be considered during clinical evaluation and decision making.