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dc.contributor.authorZhang, Teng
dc.contributor.authorSzczesniak, Michal Marcin
dc.contributor.authorMaclean, Julia C F
dc.contributor.authorBertrand, Paul P
dc.contributor.authorWu, Peter I
dc.contributor.authorOmari, Taher
dc.contributor.authorCook, Ian James
dc.date.accessioned2017-03-27T04:28:17Z
dc.date.available2017-03-27T04:28:17Z
dc.date.issued2016-04-26
dc.identifier.citationZhang T, Szczesniak M, Maclean J, Bertrand P, Wu PI, Omari T, Cook IJ. Biomechanics of Pharyngeal Deglutitive Function Following Total Laryngectomy. Otolaryngol Head Neck Surg. 2016 Aug;155(2):295-302.en
dc.identifier.issn0194-5998
dc.identifier.urihttp://hdl.handle.net/2328/37005
dc.descriptionCopyright © 2016 American Academy of Otolaryngology—Head and Neck Surgery Foundation. Reprinted by permission of SAGE Publicationsen
dc.description.abstractObjective: Post-laryngectomy surgery, pharyngeal weakness and pharyngoesophageal junction (PEJ) restriction are the underlying candidate mechanisms of dysphagia. We aimed to determine, in laryngectomees whether: 1) hypopharyngeal propulsion is reduced and/or PEJ resistance is increased; 2) endoscopic dilatation improves dysphagia; and 3) if so, whether symptomatic improvement correlate with reduction in resistance to flow across the PEJ. Methods: Swallow biomechanics were assessed in 30 total laryngectomees. Average peak contractile pressure (hPP) and hypopharyngeal intrabolus pressure (hIBP) were measured from combined high resolution manometry and video-fluoroscopic recordings of barium swallows (2, 5&10ml). Patients were stratified into severe dysphagia (Sydney Swallow Questionnaire (SSQ)>500) and mild/nil dysphagia (SSQ≤500). In 5 patients, all measurements were repeated after endoscopic dilatation. Results: Dysphagia was reported by 87%, and 57% had severe and 43% had minor/nil dysphagia. Laryngectomees had lower hPP than controls (110±14mmHg vs 170±15mmHg; p<0.05), while hIBP was higher (29±5mmHg vs 6±5mmHg; p<0.05). There were no differences in hPP between patient groups. However, hIBP was higher in severe than in mild/nil dysphagia (41±10mmHg vs 13±3mmHg; p<0.05). Pre-dilation hIBP (R2=0.97) and its decrement following dilatation (R2=0.98) were good predictors of symptomatic improvement. Conclusion: Increased PEJ resistance is the predominant determinant of dysphagia as it correlates better with dysphagia severity than peak pharyngal contractile pressure. While both baseline PEJ resistance and its decrement following dilatation are strong predictors of outcome following dilatation, the peak pharyngeal pressure is not. PEJ resistance is vital to detect as it is the only potentially reversible component of dysphagia in this context.en
dc.language.isoen
dc.publisherAmerican Academy of Otolaryngology—Head and Neck Surgery Foundationen
dc.rightsCopyright © 2016 American Academy of Otolaryngology—Head and Neck Surgery Foundation. Reprinted by permission of SAGE Publications.en
dc.subjectLaryngectomyen
dc.subjectPharynxen
dc.subjectDegltutitionen
dc.subjectSwallowen
dc.subjectDysphagiaen
dc.subjectHypopharyngeal Intrabolus Pressureen
dc.subjecthIBPen
dc.subjectHypopharyngeal peak contractile pressureen
dc.subjecthPPen
dc.titleBiomechanics of Pharyngeal Deglutitive Function Following Total Laryngectomyen
dc.typeArticleen
dc.identifier.doihttps://doi.org/10.1177/0194599816639249en
dc.rights.holder2016 American Academy of Otolaryngology—Head and Neck Surgery Foundationen
local.contributor.authorOrcidLookupOmari, Taher: https://orcid.org/0000-0001-5108-7378en_US


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