Videofluoroscopic Measures of Swallowing After Partial Epiglottidectomy for Dysphagia.

Abstract

Partial epiglottidectomy has a role in improving dysphagia due to epiglottic obstruction. This study evaluates objective parameters of swallow function in patients who underwent partial epiglottidectomy. Retrospective study design. Tertiary Care University Academic Medical Center. A review was performed of patients who underwent CO₂ laser partial epiglottidectomy for the treatment of dysphagia at a single tertiary care academic center over a 4-year period. Objective swallowing parameters were evaluated from pre- and postoperative modified barium swallow studies using SwallowTail Advanced Measurement software using blinded reviewers. The postswallow pharyngeal residue (bolus clearance ratio or BCR), spatiotemporal swallowing variables (oropharyngeal [OPT], hypopharyngeal [HPT], and total pharyngeal transit times [TPT]), and airway protection (Penetration-Aspiration Scale [PAS]) were analyzed. Student paired t test was used to determine significant changes in outcome parameters pre- and postsurgery. Forty-three patients (age range 45-92 years, median 70) met the inclusion criteria. A majority (69.8%) had a history of external beam radiation therapy for head and neck cancer. BCR decreased significantly from a mean of 31.7% presurgery to 24.2% (p = .01) postsurgery. OPT, HPT, and TPT did not differ significantly postsurgery. The mean Eating Assessment Tool-10 score improved from 25.1 to 20.2 after treatment (p = .03). PAS score improved by 15.4% and remained stable at 66.2% after surgery. Partial epiglottidectomy improves pharyngeal bolus clearance in properly selected patients with dysphagia due to epiglottic obstruction. Patients demonstrated stable swallow function with the benefit of reduced postswallow residue following surgical intervention.