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Comparison of swallowing outcomes of laryngotracheal separation versus total laryngectomy in a validated ovine model of profound oropharyngeal dysphagia

Published online by Cambridge University Press:  26 January 2017

N N Venkatesan ,
C M Johnson ,
M T Siddiqui ,
D J Cates ,
M A Kuhn ,
G N Postma  and
P C Belafsky
N N Venkatesan
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
C M Johnson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical College of Georgia, Augusta University, USA
M T Siddiqui
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
D J Cates
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
M A Kuhn
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
G N Postma
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical College of Georgia, Augusta University, USA
P C Belafsky*
Affiliation:
Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, University of California, Davis, USA
*
Address for correspondence: Dr Peter C Belafsky, Center for Voice and Swallowing, Department of Otolaryngology – Head and Neck Surgery, School of Medicine, University of California, Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA Fax: +1 916 703 5011 E-mail: pbelafsky@gmail.com
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Abstract

Objectives:

To validate the ovine model of profound oropharyngeal dysphagia and compare swallowing outcomes of laryngotracheal separation with those of total laryngectomy.

Methods:

Under real-time fluoroscopy, swallowing trials were conducted using the head and neck of two Dorper cross ewes and one human cadaver, secured in lateral fluoroscopic orientation. Barium trials were administered at baseline, pre- and post-laryngohyoid suspension, following laryngotracheal separation, and following laryngectomy in the ovine model.

Results:

Mean pre-intervention Penetration Aspiration Scale and National Institutes of Health Swallow Safety Scale scores were 8 ± 0 and 6 ± 0 respectively in sheep and human cadavers, with 100 per cent intra- and inter-species reproducibility. These scores improved to 1 ± 0 and 2 ± 0 post-laryngohyoid suspension (p < 0.01). Aerodigestive tract residue was 18.6 ± 2.4 ml at baseline, 15.4 ± 3.8 ml after laryngotracheal separation and 3.0 ± 0.7 ml after total laryngectomy (p < 0.001).

Conclusion:

The ovine model displayed perfect intra- and inter- species reliability for the Penetration Aspiration Scale and Swallow Safety Scale. Less aerodigestive tract residue after narrow-field laryngectomy suggests that swallowing outcomes after total laryngectomy are superior to those after laryngotracheal separation.

Keywords

Deglutition DisordersLaryngectomyRespiratory AspirationExperimental Animal ModelSurgical Models
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 350 - 356
Copyright
Copyright © JLO (1984) Limited 2017 

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Footnotes

Material in this manuscript was presented at the Dysphagia Research Society Meeting, 12–14 March 2015, Chicago, Illinois, USA, and at the American Broncho-Esophagological Association Meeting, 22–23 April 2015, Boston, Massachusetts, USA.

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