Table 6.
Diagnosis and treatment effect for oropharyngeal dysphagia after TLE
| Author and ref. | Level of evidence | Number of subjects and TLE patients | Study aim | Swallowing assessment method(s) | Authors' key findings |
|---|---|---|---|---|---|
| Sweeny et al32 | B (retrospective cohort study) |
N = 263 TLE | Determine the incidence and risk factors for stricture formation; and survey the differences between patients who received neoadjuvant or concurrent radiation versus surgery as initial treatment G1: Stricture group (n = 49) G2: Nonstricture group (n = 214) Intervention: Endoscopic dilatation |
VFSS | One‐third of the TLE patients experienced dysphagia, whereas 19% developed a stricture (rates were similar for TLE versus salvage TLE). Neopharyngeal strictures could be managed with single or serial dilatations to maintain nutritional intake. |
| Zhang et al44 | B (cross‐sectional study) |
N = 30 TLE | Characterize pharyngeal biomechanics in patients with dysphagia after TLE Intervention: Endoscopic dilatation of PEJ |
Videomanometry; SSQ | Both impaired pharyngeal propulsion and increased pharyngeal outflow resistance were reported. Increased pharyngeal outflow resistance was the major contributing factor for dysphagia. Baseline PEJ resistance and its decrement postdilatation were predictors of treatment outcome. |
| Pitzer et al54 | C (case series) |
N = 20 TLE | Investigate the incidence, symptoms, and treatment for a neopharyngeal pseudodiverticulum after TLE Intervention: Endoscopic CO2‐laser treatment |
Barium swallow; interview; clinical assessment | Fifty‐five person of the TLE patients had a pseudodiverticulum of which 82% had dysphagia. Eighty‐nine percent of the patients with a pseudodiverticulum gained relief of the dysphagic symptoms after treatment with a CO2 laser. |
| Oursin et al55 | C (case series) |
N = 20 TLE | Determine the frequency and correlation with clinical symptoms of a pseudodiverticulum Intervention: Endoscopic laser therapy |
Barium swallow; indirect laryngoscopy | Sixty percent of the TLE patients had a pseudodiverticulum of which two‐thirds complained of dysphagia. All symptomatic patients were successfully treated with endoscopic laser therapy. |
| Barrett et al56 | C (case series) |
N = 17 TLE | Assess the effect of postoperative radiation on swallow function in patients with a jejunal interposition graft after pharyngolaryngo‐esophagectomy Intervention: Endoscopic dilatation |
Subjective swallow function; body weight; gastrostomy tube; jejunal dilatations; barium swallow | The jejunal interposition grafts were irradiated, usually with good swallow outcomes: 71% of the patients with an irradiated jejunal interposition graft were able to obtain adequate oral nutrition and 29% required (intermittent) dilatations to maintain nutrition. |
Abbreviations: PEJ, pharyngoesophageal junction; SSQ, Sydney swallow questionnaire; TLE, total laryngectomy; VFSS, videofluoroscopic swallowing study.