Abstract Introduction Supracricoid laryngectomy (SCL CHEP) removes ~ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p<0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.

ABSTRACT Objective To describe the patterns of displacement of the hyoid bone in healthy individuals, considering their displacements during swallowing of different consistencies. Methods Two hundred one swallowing videofluoroscopy exams of 67 adult and elderly individuals without swallowing disorders were analyzed. Descriptive analysis was performed to identify and describe the patterns of displacement of the hyoid bone. Results Seven types of displacement of the hyoid bone were found: H1 (horizontal), H2 (short vertical and long horizontal), H3 (vertical and diagonal to upper), H4 (long vertical and short horizontal), H5 (vertical), H6 (diagonal), and H7 (brief). The standards were maintained in different consistencies. The most frequent pattern of displacement was type H2. The distribution of the types of displacement of the hyoid was different among men and women. Conclusion Seven patterns of displacement of the hyoid bone during swallowing of normal adults and older people have been described. The most frequent pattern of displacement was horizontal, with variations in distribution between men and women. The displacement pattern was maintained during the swallowing of the three different consistencies (thin, pasty and solid liquid).

ABSTRACT Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.

RESUMO Objetivo: Investigar a associação entre o envelhecimento e os aspectos funcionais da deglutição (penetração laríngea e aspiração laringotraqueal) em indivíduos submetidos à laringectomia supracricóidea no período tardio e sem queixas. Métodos: Setenta pacientes, sendo 56 (80%) >60 anos e 14 (20%) <60 anos, em acompanhamento ambulatorial, após tratamento oncológico e sem queixas de deglutição, realizaram avaliação funcional por meio da videofluoroscopia da deglutição. A classificação das imagens foi realizada por meio da escala de penetração-aspiração desenvolvida por Rosenbek. O teste do χ2 e a regressão logística foram aplicados para associação das categorias de idade aos desfechos (penetração e aspiração). Resultados: Os pacientes com idade acima de 60 anos apresentaram maior prevalência de penetração (24,29%) e aspiração (48,57%) do que aqueles com idade inferior a 60 anos. Nesta amostra, a aspiração se mostrou associada à idade. Pacientes acima de 60 anos tiveram chance 27% maior de penetração durante a deglutição do que os com menos de 60 anos. Pacientes acima de 60 anos tiveram chance aproximadamente quatro vezes maior de aspiração laringotraqueal do que pacientes com menos de 60 anos. Conclusão: Em pacientes sem queixas de deglutição no pós-operatório tardio de laringectomia supracricóidea, há maior chance de aspiração laringotraqueal em idosos acima de 60 anos do que em indivíduos abaixo de 60 anos.

ABSTRACT: Objective: To investigate the association between aging and the functional aspects of swallowing (laryngeal penetration and laryngotracheal aspiration) in individuals who underwent supracricoid laryngectomy in the late period and without complaints. Methods: A total of 70 patients, 56 (80%) aged >60 years and 14 (20%) <60 years, under outpatient follow-up, after cancer treatment and with no complaints of swallowing, performed functional evaluation using the swallowing videofluoroscopy. Image classification was performed using the penetration-aspiration scale developed by Rosenbek. The χ2 test and logistic regression were applied to associate the age categories to the outcomes (penetration and aspiration). Results: Patients aged over 60 years had a higher prevalence of penetration (24.29%) and aspiration (48.57%) than patients aged under 60 years. In this sample, aspiration was associated with age. Patients aged over 60 years were more likely to present penetration (27% more) during swallowing than patients under 60 years. Patients aged over 60 years had an approximately four-fold greater probability of laryngotracheal aspiration than patients aged under 60 years. Conclusion: In patients without complaints of swallowing in the late postoperative period of supracricoid laryngectomy, there is a greater probability of laryngotracheal aspiration in elderly aged over 60 years than in individuals under 60 years.

RESUMO Em tumores transglóticos estendidos para base de língua, a indicação para ressecção do osso hioide descarta a possibilidade de realização de uma laringectomia parcial horizontal clássica, devido ao grande risco de complicações pulmonares oriundas de uma disfagia grave. O objetivo deste estudo foi descrever os aspectos funcionais de deglutição e voz de um paciente submetido à laringectomia supratraqueal ampliada com cricoglossohioidopexia. Trata-se de um homem de 69 anos, com tumoração transglótica na hemilaringe direita, submetido à laringectomia supratraqueal ampliada, com ampliação para base de língua, osso hioide e aritenoide direita. Na videofluoroscopia da deglutição, observou-se aspiração silente para líquido fino durante a deglutição e resíduo em base de língua, valécula, aritenoide, esfíncter esofágico superior e recessos piriformes em todas as consistências e volumes. Na videolaringoscopia, observou-se voz por meio da vibração da unidade cricoaritenóidea esquerda, associada à base de língua e constritores da faringe. No protocolo Consensus Auditory-Perceptual Evaluation of Voice (CAPE V), notou-se grau moderado de rouquidão e soprosidade. O paciente apresentou preservação parcial das funções laríngeas, grau moderado de disfonia e alimentação e hidratação exclusivas por via oral, com sólidos macios e líquido espessado em néctar, sem prejuízos à saúde pulmonar, até o momento.

ABSTRACT In transglottic tumors extended to the base of the tongue, the indication for resection of the hyoid bone rules out the possibility of performing a classic horizontal partial laryngectomy due to the high risk of pulmonary complications resulting from severe dysphagia. This study aims to describe the functional aspects of swallowing and voice of a patient undergoing an enlarged supratracheal laryngectomy with cricoglossohioidopexy. This is a 69-year-old man with a transglottic tumor in the right hemilarynx, who underwent an extended supratracheal laryngectomy with enlargement to the base of the tongue, hyoid bone and right arytenoid. In swallowing videofluoroscopy, silent aspiration was observed in fine liquid and residue on the basis of tongue, valecule, arytenoid, upper esophageal sphincter and pyriform recesses in all consistencies and volumes. In videolaryngoscopy, a voice was observed through the vibration of the left cricoarytenoid unit associated with the base of the tongue and constrictors of the pharynx. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE V) showed a moderate degree of hoarseness and breathiness. The patient had partial preservation of laryngeal functions, with a moderate degree of dysphonia and exclusive oral feeding and hydration with soft solids and thickened liquid in nectar without impairing lung health until the study.

RESUMO Objetivo Descrever os resultados funcionais e de qualidade de vida após a laringectomia supratraqueal alargada. Métodos No período de setembro de 2009 a janeiro de 2018, 11 indivíduos do sexo masculino foram submetidos à laringectomia supratraqueal alargada. As habilidades de deglutição foram avaliadas por meio da videofluoroscopia e da escala clínica Functional Communication Measures . As vozes foram classificadas por análise perceptivo-auditiva da Consensus Auditory-Perceptual Evaluation of Voice . Todos os voluntários preencheram um questionário de autoavaliação para voz e deglutição. Resultados A aspiração foi encontrada em quatro pacientes, e todos apresentaram estase em diferentes estruturas. Todos os sujeitos deste estudo apresentavam alimentação e hidratação exclusivas por via oral. Na avaliação da qualidade de vida na deglutição, os pacientes demonstraram médias >80 em todas as áreas (83,47 média dos escores). O grau geral e a presença de rugosidade foram os maiores escores médios na avaliação perceptivo-auditiva da voz (37,81 e 49,36 consecutivamente). A média de 33,36 (±22,56) demonstrou pouco impacto na qualidade de vida sob a perspectiva dos aspectos vocais. Conclusão Após a laringectomia supratraqueal, a deglutição foi suficientemente restaurada, e a qualidade de vida foi satisfatória. A voz apresenta qualidade gravemente comprometida com comunicação oral preservada, demonstrando baixo impacto nas atividades da vida diária. Todos os indivíduos que mantiveram duas unidades cricoaritenóideas apresentaram melhores resultados funcionais na deglutição e na voz.

ABSTRACT Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.

RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.

ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.