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Management of Oropharyngeal Dysphagia in Laryngeal and Hypopharyngeal Cancer

DOI: 10.1155/2012/157630

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On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results. 1. Introduction Dysphagia is defined as difficulty in swallowing. It is a symptom that expresses a disorder in the transport of food and endogenous secretions (saliva) through the upper digestive tract. Oropharyngeal dysphagia (OD) is a more anatomically restricted term referred to alterations in the transfer of the bolus from the mouth to the esophagus (that means, in bolus propelling from the mouth to the pharynx, in the pharyngeal reconfiguration during the swallow, or in the opening of the upper esophageal sphincter) [1]. OD is an inescapable concern in the management of patients with laryngeal and hypopharyngeal cancer. Being as a symptom at presentation, as an adverse effect during whatever the treatment, or as sequelae compromising the quality of life of the patients, swallowing disorders have to be adequately anticipated and dealt with [2]. Swallowing is one of the vital functions that the larynx is involved in. For an outcome to be considered functional, the patient has to be able to swallow in an effective and safe manner. Actually, preserving a functional deglutition is usually the most important goal of the different function-preserving surgical techniques on the larynx and the hypopharynx, as a larynx that does not prevent aspiration cannot be preserved. Even though OD has been specifically classified in the latest versions of the


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