الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Swallowing complications after conservative laryngeal surgery are very common. The severity and duration of these complications vary between different methods. In this study we analyzed the swallowing functional outcomes after conservative laryngeal surgery for early glottic and supraglottic carcinoma using either TLM or open partial laryngectomy.
190 patients affected by T1 and T2 glottic and supraglottic laryngeal carcinoma were treated in two institutes using transoral laser microsurgery (TLM) and external surgical partial laryngectomy. Between April 2014 and December 2015, in the study there were 6 groups:
A- Glottic carcinoma:
1- group 1 (79 patients): T1 glottic tumors (all managed using TLM).
2- group 2 (40 patients): T2 glottic tumors managed using TLM.
3- group 3 (16 patients): T2 glottic tumors managed using vertical hemilaryngectomy.
B- Supraglottic carcinoma:
4- group 4 (18 patients): T1 supraglottic tumors (all managed using TLM).
5- group 5 (17 patients): T2 supraglottic tumors managed using TLM.
6- group 6 (20 patients): T2 supraglottic tumors managed using open neck supraglottic laryngectomy.
In the glottic carcinoma groups type III, IV, and different subtypes of V cordectomy were done in group 1 and group 2 while vertical hemilaryngectomy was done in group 3. In the supraglottic carcinoma groups type I, II, III, and IV resection were done in group 4 and group 5 while open supraglottic laryngectomy was done in group 6. Classical operation was used in most of the cases and the resection was extended in few cases.
Analysis of post-operative swallowing function was done and compared between groups using videofluoroscopy (VFS), functional endoscopic evaluation of swallowing (FEES), and subjectively using MD Anderson dysphagia inventory. Objective evaluation of swallowing has been made by obtaining different measures from VFS (pharyngeal transit time, pharyngeal constriction ratio, maximum hyoid displacement, airway closure duration, and opening of the upper esophageal sphincter (size and duration). These measures were obtained from lateral and anteroposterior views during VFS. Analysis also included the need and duration of tracheostomy and nasogastric tube, ICU admission, and hospitalization time. Statistical analysis was performed with the Mann–Whitney U and Pearson Chi-square tests.
The results showed that the swallowing functional outcome after management of T1 glottic tumors was significantly better than those after management of T2 glottic tumors using TLM in both conditions. Using VFS and FEES, the degree of aspiration in T1 group was significantly better than the degree of aspiration in T2 (p ≤ 0.05). Subjectively, the MDADI score was significantly better in the T1 group (p ≤ 0.01). The duration of aspiration was significantly lower in the T1 group (p ≤ 0.01).
Also, analysis of results of T2 glottic groups managed using TLM and open-neck vertical hemilaryngectomy showed that the swallowing functional outcome was significantly better in the laser group than in the open surgery group (p ≤ 0.05) using both objective and subjective evaluation. This difference was not evident 3 months after surgery with all modalities of evaluation of swallowing. Mostly, this is due to the complete recovery of swallowing functions after both approaches. The duration of aspiration was significantly lower in the laser group (p ≤ 0.01).
The analysis of swallowing functions after management of supraglottic tumors showed quite similar results. Comparing the swallowing functional outcome objectively after management of T1 and T2 supraglottic tumors using TLM in both groups revealed significantly lower degree of aspiration early after operation (p ≤ 0.01) in the T1. MDADI scoring of T1 group was significantly better than the scoring of T2 group (p ≤ 0.05). The duration of aspiration was also significantly lower in the T1 group (p ≤ 0.05).
On the other hand, comparing the swallowing outcomes objectively after management of T2 supraglottic tumors using either TLM or open supraglottic laryngectomy showed faster recovery in the TLM group, where the degree of aspiration was significantly lower (p ≤ 0.01) in the laser group. Also, the duration of aspiration was significantly shorter in the laser group (p ≤ 0.01).
The results of comparison of other outcomes (the duration of ICU, tracheostomy, nasogastric tube, and hospital stay) were in the same context. Mostly, results of laser groups were better than open neck group, also results of T1 group were better than T2 group when both groups were managed by TLM
In conclusion, this study revealed faster swallowing recovery and better swallowing outcomes after management of T2 glottic and supraglottic carcinoma using TLM than after open approach surgical resection. Furthermore, TLM has less morbid post-operative course and shorter hospital stay than open approach partial laryngectomy.
After endoscopic management of T1 glottic and supraglottic, swallowing and perioperative morbidity are significantly less than after endoscopic management T2 glottic and supraglottic carcinoma respectively.
Because it is a definitive technique for anatomical and physiological study of swallowing, measures obtained from VFS are useful for detection and follow-up of postoperative aspiration.