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

  • N N Venkatesan (a1), C M Johnson (a2), M T Siddiqui (a1), D J Cates (a1), M A Kuhn (a1), G N Postma (a2) and P C Belafsky (a1)...
Abstract Objectives:

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


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.


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).


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.

Corresponding author
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:
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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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1 Cho SY, Choung RS, Saito YA, Schleck CD, Zinsmeister AR, Locke GR 3rd et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil 2015;27:212–19
2 Leder SB, Suiter DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000–2007. Gerontology 2009;55:714–18
3 Hoy M, Domer A, Plowman EK, Loch R, Belafsky P. Causes of dysphagia in a tertiary-care swallowing center. Ann Otol Rhinol Laryngol 2013;122:335–8
4 Garcia-Peris P, Paron L, Velasco C, de la Cuerda C, Camblor M, Breton I et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr 2007;26:710–17
5 Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg 2010;136:784–9
6 Takano Y, Suga M, Sakamoto O, Sato K, Samejima Y, Ando M. Satisfaction of patients treated surgically for intractable aspiration. Chest 1999;116:1251–6
7 Snyderman CH, Johnson JT. Laryngotracheal separation for intractable aspiration. Ann Otol Rhinol Laryngol 1988;97:466–70
8 Eisele DW. Surgical approaches to aspiration. Dysphagia 1991;6:71–8
9 Cannon CR, McLean WC. Laryngectomy for chronic aspiration. Am J Otolaryngol 1982;3:145–9
10 Zrunek M, Happak W, Hermann M, Streinzer W. Comparative anatomy of human and sheep laryngeal skeleton. Acta Otolaryngol 1988;105:155–62
11 Cates D, Plowman EK, Mehdizadeh O, Yen K, Domer A, Gilden M et al. Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round. Laryngoscope 2013;123:721–6
12 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996;11:93–8
13 Belafsky P, Kuhn M. Fluoroscopy and dysphagia outcome measures. In: The Clinician's Guide to Swallowing Fluoroscopy. New York: Springer, 2014;61–2
14 Belafsky PC. Manual control of the upper esophageal sphincter. Laryngoscope 2010;120(suppl 1):S116
15 Belafsky PC, Mehdizadeh OB, Ledgerwood L, Kuhn M. Evaluation of hypopharyngeal suction to eliminate aspiration: the Retro-Esophageal Suction (REScue) catheter. Dysphagia 2015;30:74–9
16 Belafsky PC, Plowman EK, Mehdizadeh O, Cates D, Domer A, Yen K. The upper esophageal sphincter is not round: a pilot study evaluating a novel, physiology-based approach to upper esophageal sphincter dilation. Ann Otol Rhinol Laryngol 2013;122:217–21
17 Cook SP. Candidate's Thesis: Laryngotracheal separation in neurologically impaired children: long-term results. Laryngoscope 2009;119:390–5
18 Hara H, Hori T, Sugahara K, Ikeda T, Kajimoto M, Yamashita H. Effectiveness of laryngotracheal separation in neurologically impaired pediatric patients. Acta Otolaryngol 2014;134:626–30
19 Gelfand YM, Duncan NO, Albright JT, Roy S, Montagnino B, Edmonds JL. Laryngotracheal separation surgery for intractable aspiration: our experience with 12 patients. Int J Pediatr Otorhinolaryngol 2011;75:931–4
20 Miller FR, Eliachar I. Managing the aspirating patient. Am J Otolaryngol 1994;15:117
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The Journal of Laryngology & Otology
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  • EISSN: 1748-5460
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