Swallowing improvement surgeries

Abstract

Purpose: To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce the risk of aspiration without sacrificing vocal function.

Methods: We searched the PubMed database and used Google Scholar search engine to find studies discussing the different swallowing improvement surgeries. A manual search of references in selected articles and reviews was done as well. No chronologic limitation was set for the studies; however, only articles written in English and Japanese were considered. Due to the nature of this article, no particular inclusion or exclusion criteria were set when searching for studies to be used as references; however, all relevant studies were reviewed and agreed upon by the authors for inclusion in this review article.

Results/discussion: Surgeries to improve swallowing function can be categorized into those that reinforce nasopharyngeal closure or pharyngeal contraction, improve laryngeal elevation or pharyngoesophageal segment opening, and those that improve vocal fold closure to protect the airway during swallowing. They are an effective alternative treatment that may significantly improve these patients' quality of life. Swallowing rehabilitation with the altered pharyngolaryngeal structures is required post-operatively to significantly improve patients' dysphagia.

Conclusions: Surgeries to improve swallowing function address specific dysfunctional sites involved in the swallowing mechanism. Choosing the most appropriate surgery for each patient requires knowledge of the pathophysiology for their dysphagia and detailed pre-operative work-up.

Keywords: Cricopharyngeal myotomy; Dysphagia; Laryngeal suspension; Surgery; Swallowing.

Fig. 1

Anatomic sites addressed with swallowing improvement surgeries. Swallowing improvement surgeries focus on changing laryngeal, pharyngeal, and upper esophageal structures, depending on the underlying cause of dysphagia

Fig. 2

Surgeries to improve laryngeal elevation. Normal anatomy (a). Approximation of hyoid to mandible (b), thyroid cartilage to hyoid (c), thyroid cartilage to mandible (d), and thyroid cartilage to hyoid and hyoid to mandible (e)

Fig. 3

Videofluoroscopic swallowing study findings. a Pre-operative: inability of contrast to flow past upper esophageal sphincter (UES, white arrowhead); b post-operative: contrast flows smoothly past UES (white arrowhead)

Fig. 4

Videofluoroscopic swallowing study findings. a Pre-operative: inability of contrast to flow past upper esophageal sphincter (UES, white arrowhead); b post-operative: pharyngeal flap (white arrow) with contrast flowing past UES (white arrowhead)

Fig. 5

Videofluoroscopic swallowing study findings. a Pre-operative: excessive osteophyte (white arrowheads) at cervical spine; b post-operative: osteophyte reduced significantly (white arrows) with improved flow of contrast to esophagus