Schindler Antonio, Ginocchio Daniela, Peri Andrea, Felisati Giovanni, Ottaviani Francesco
Department of Clinical Sciences L. Sacco, University of Milan, Milan, Italy.
Ann Otol Rhinol Laryngol. 2010 Feb;119(2):71-6. doi: 10.1177/000348941011900201.
We describe the role of the laryngeal adductor reflex (LAR) and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in the rehabilitation of patients with oropharyngeal dysphagia after partial laryngectomy.
Ten patients with a mean age of 64 years (range, 45 to 72 years) were included in the study. Seven patients underwent supraglottic laryngectomy, and 3 had supracricoid laryngectomy. Six patients underwent additional radiotherapy (RT), and 8 had functional neck dissection (ND). FEESST was performed on each patient in order to establish a swallowing rehabilitation program.
In 2 patients, not submitted to either ND or RT, the LAR was preserved; in 6 patients, who underwent both procedures, the LAR was delayed or absent. In 2 patients who underwent ND but not RT, the LAR was preserved in 1 case and delayed in the other. The patients with an absent LAR presented severe aspiration, whereas in those with a preserved LAR, no penetration was found. Moderate aspiration was found in the remaining patients. In the patients with a reduced or absent LAR, tactile and chemical sensory stimulation was added to the rehabilitation program.
FEESST represents a useful tool in everyday clinical practice for the planning of swallowing rehabilitation after partial laryngectomy.
我们描述了喉内收肌反射（LAR）和纤维喉镜吞咽功能检查加感觉测试（FEESST）在部分喉切除术后口咽吞咽困难患者康复中的作用。
本研究纳入10例平均年龄64岁（范围45至72岁）的患者。7例患者接受了声门上喉切除术，3例接受了环状软骨上喉切除术。6例患者接受了额外的放疗（RT），8例进行了功能性颈清扫术（ND）。对每位患者进行FEESST以制定吞咽康复计划。
2例未接受ND或RT的患者，LAR保留；6例同时接受这两种手术的患者，LAR延迟或消失。2例接受ND但未接受RT的患者，1例LAR保留，另1例延迟。LAR消失的患者出现严重误吸，而LAR保留的患者未发现食物进入气道。其余患者发现有中度误吸。在LAR减弱或消失的患者中，触觉和化学感觉刺激被添加到康复计划中。
FEESST是日常临床实践中规划部分喉切除术后吞咽康复的有用工具。
