S161 – Surgical Management of Dysphagia and Dysphonia

Objectives Learn to surgically manage dysphonia and dysphagia. Methods 22 patients treated for HNC between July 2004‐December 2005 received in‐clinic evaluation for dysphonia and modified barium swallow for dysphagia. Patients were divided into 4 groups based on function of their pharynx and larynx. All patients had a tracheotomy and gastric feeding tube (G‐tube). Treatment outcomes were determined by removal of both. Group I: Patients tolerated puree diet at the time of evaluation, and were placed on swallowing therapy protocol developed in our institution (n=53). Group II: Patients could not swallow due to obliteration of hypopharyngeal lumen but good glottic closure and cough reflex. They underwent pharyngeal reconstruction with preservation of the larynx through transcervical approach (n=5). Group III: Patients had obstruction at the hypopharynx with loss of supraglottic sensation and aspiration of saliva. These had no functional voice. They underwent laryngectomy and pharyngeal reconstruction using myocutaneous flap (n=10). Group IV: Patients had obliteration of the pharyngeal lumen and laryngeal inlet due to fusion of epiglottis and post‐cricoid area to the posterior pharyngeal wall. They underwent micro‐endoscopic laryngopharyngeal reconstruction (MELPR)(n=6). Results At the end of treatment, all tolerated a regular diet and were decannulated. In Group I, G‐tube was removed after completion of CRT. In Groups II‐IV, G‐tube was removed 3–6 weeks after all procedures. For dysphonia, all patients in Groups I, II, and IV recovered voice function. In Group III, 6/10 had voice rehabilitation with use of prostheses. Conclusions Surgical management of dysphagia and dysphonia is best attained through categorization of pharyngeal and laryngeal function.