Caetano Gonçalo, Morgado Filipa, Póvoa Joana, Branquinho Francisco
Otolaryngology - Head and Neck Surgery, Hospital da Senhora da Oliveira, Guimarães, PRT.
Otolaryngology - Head and Neck Surgery, Hospital Beatriz Ângelo, Lisboa, PRT.
Cureus. 2024 Jun 11;16(6):e62124. doi: 10.7759/cureus.62124. eCollection 2024 Jun.
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.
部分水平环状软骨上喉切除术（SCPL）联合环状软骨舌骨会厌固定术（CHEP）是声门或声门上区喉癌的一种保守手术选择。吞咽困难和误吸是该手术常见的后果。我们描述了一名72岁男性患者的病例，该患者被诊断为喉鳞状细胞癌（T2N0M0），接受了SCPL联合CHEP重建术。患者术后最初通过鼻胃管进食，后来改为经皮内镜下胃造口术（PEG）管进食。与言语治疗师合作，定期使用纤维内镜吞咽功能评估（FEES）和电视透视吞咽造影检查（VFSS）进行吞咽评估。在FEES评估中，患者持续出现喉穿透和可能的气管误吸。这些发现通过VFSS得到证实。此外，观察到颈段食管起始段变窄，这是由C5椎体前部的一个大骨赘引起的，阻碍了食团通过，导致食团在上食管括约肌上方积聚并随后进入气道。建议进行吞咽康复训练，维持仅通过PEG管进食的饮食方式。康复训练三个月后，随访VFSS显示，对于糊状食物，食团在颈段骨赘上方的积聚通过多次吞咽得到解决，没有穿透或误吸的迹象。因此，可以开始经口摄入糊状食物。考虑到吞咽的解剖和生理复杂性以及患者的个体特征，预测喉重建手术的康复时间具有挑战性。该病例强调了耳鼻喉科医生与言语治疗师和放射科医生合作评估在研究接受保守喉手术患者吞咽困难以调整和个性化康复方案方面的重要性。
