PDF(Pubmed)
Abstract：
Partial horizontal supracricoid laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) is a conservative surgical alternative for laryngeal cancer in the glottic or supraglottic region. Dysphagia and aspiration are frequently reported consequences of this surgery. We describe the case of a 72-year-old male patient diagnosed with squamous cell carcinoma of the larynx (T2N0M0), who underwent SCPL with CHEP reconstruction. The patient was initially fed through a nasogastric tube post-surgery, later replaced by a percutaneous endoscopic gastrostomy (PEG) tube. Swallowing evaluations were periodically conducted in collaboration with a speech therapist using fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS). In FEES assessments, the patient consistently presented with laryngeal penetration and possible tracheal aspiration. These findings were confirmed by VFSS. Additionally, a narrowing of the initial segment of the cervical esophagus was observed, caused by a large osteophyte in the anterior region of the C5 vertebral body, compromising the passage of the bolus, and leading to its accumulation above the upper esophageal sphincter and subsequent entry into the airway. Rehabilitation exercises for swallowing were recommended, maintaining an exclusive PEG diet. Three months after rehabilitation, a follow-up VFSS revealed that, for pasty consistency, the accumulation of the bolus above the cervical osteophyte was resolved with multiple swallows, without evidence of penetration or aspiration. Thus, it was possible to introduce oral intake of pasty consistency. Considering the anatomical and physiological complexity of swallowing, along with patient-specific characteristics, predicting the rehabilitation time for reconstructive laryngeal surgery is challenging. This case emphasizes the importance of a collaborative evaluation involving otorhinolaryngologists, speech therapists, and radiologists in studying dysphagia in patients undergoing conservative laryngeal surgeries to adapt and personalize rehabilitation.
摘要：
部分水平上上喉癌切除术（SCPL）和环孔会厌切除术（CHEP）是声门或声门上区域喉癌的保守手术选择。吞咽困难和误吸是经常报道的这种手术的后果。我们描述了一名72岁的男性患者被诊断患有喉鳞状细胞癌（T2N0M0）的情况，接受了CHEP重建的SCPL。患者最初在手术后通过鼻胃管进食，后来被经皮内镜胃造瘘术（PEG）管取代。与言语治疗师合作，使用光纤内窥镜吞咽评估（FEES）和视频透视吞咽研究（VFSS）定期进行吞咽评估。在费用评估中，患者始终表现为喉部穿透和可能的气管抽吸。VFSS证实了这些发现。此外,观察到颈食管的初始部分变窄，由C5椎体前部的大量骨赘引起，损害食团的通过，并导致其在食管上括约肌上方积聚并随后进入气道。建议进行吞咽康复练习，保持独特的PEG饮食。康复三个月后,VFSS的后续调查显示，为了糊状的稠度，多次吞咽解决了宫颈骨赘上方的推注积累，没有穿透或误吸的证据.因此，可以引入糊状稠度的口服摄入。考虑到吞咽的解剖和生理复杂性，以及患者特有的特征，预测喉重建手术的康复时间是一项挑战。该案例强调了涉及耳鼻喉科医师的协作评估的重要性，言语治疗师,和放射科医生研究保守喉部手术患者的吞咽困难，以适应和个性化康复。
