Pharyngeal motility in patients submitted to type I thyroplasty

This study aims to compare the motility of the pharynx and upper esophageal sphincter in patients with unilateral vocal fold immobility before and after thyroplasty Type I.

Methods:

We prospectively studied 15 patients with unilateral vocal fold immobility who under-went thyroplasty Type I. Subjects were divided according to the topography of vagal injury and presence of dysphagia. High resolution manometry was performed before and 30 days after surgery. Time and pressure manometric parameters at the topography of the velopharynx, epiglottis and upper esophageal sphincter were recorded.

Results:

Dysphagia was present in 67% of patients. 63% had lower vagal injuries. Manometric parameters did not change after thyroplasty for the whole population. The group of dysphagic patients, however, had an increase in residual pressure at the upper esophageal sphincter after thyroplasty (1.2 vs. 5.2 mmHg; p = 0.05). Patients with low vagal injury developed higher peak pressure (100 vs. 108.9 mmHg p ≤ 0.001), lower rise time (347 vs. 330 ms p = 0.04), and higher up stroke (260 vs. 266.2 mmHg/ms p = 0.04) at the topography of the velopharynx after thyroplasty. Conclusion: Pharyngeal motility is affected by thyroplasty Type I in patients with dysphagia and low vagal injury.

KEYWORDS
Upper esophageal sphincter; Deglutition disorders; High resolution-manometry; Vocal fold immobility

	Bolus retention		Laryngeal penetration		Aspiration
	(%)	(n)	(%)	(n)	(%)	(n)
Puree bolus consistency LVL (n = 6)	100	6	33	2	0	0
HVL (n = 4)	100	4	100	4	100	4
Liquid bolus consistency LVL (n = 6)	50	3	50	3	0	0
HVL (n = 4)	100	4	100	4	100	4

	Pre surgery	After surgery	p
Swal Qol	431.97 (335–571)	830 (761–852)	(0.0004)

	Velopharynx			Epiglotis
	Preoperative	Postoperative	p	Preoperative	Postoperative	p
Peak pressure (mmHg)’	77 (26–102)	99 (42–127)	0.3	96 (43–115)	124 (53–145)	0.1
Rise time (ms)’	345 (282–391)	354 (278–424)	1	301 (282–337)	284 (266–308)	0.2
Upstroke (mmHg/ms)’	199 (112–292)	243 (78–296)	0.8	239 (11–339)	366 (154–500)	0.2
Recovery time (ms)’	304 (202–463)	320 (240–489)	0.8	225 (182–292)	260 (225–338)	0.5
Contraction duration (ms)’	678 (526–848)	695 (526–848)	0.5	526 (474–587)	556 (506–690)	1
	Upper esophageal sphincter
Basal pressure (mmHg)	58.3 (29.1–85.9)	46.6 (31–79)	0.9
Residual pressure (mmHg)	3.2 (0.1–3.2)	5.1 (3.8–7.45)	0.07
Relaxation time to nadir (ms)	235 (188–297)	239 (180–261)	0.8
Relaxation duration (ms)	660 (615–750)	674 (514–739)	0.5
Recovery time (ms)	374 (581–325)	434 (321–490)	0.7
Extension (cm)	3 (3–3)	3 (3–3)	0.7

	Velopharynx			Epiglotis
	Preoperative	Postoperative	p	Preoperative	Postoperative	p
Peak pressure (mmHg)’	56 (21–113)	96 (34–148)	0.4	57 (9–103)	76 (19–123)	0.4
Rise time (ms)’	298 (260–329)	276 (257–330)	0.5	361 (344–441)	353 (270–426)	0.4
Upstroke (mmHg/ms)’	143 (81–314)	278 (97–504)	0.3	167 (49–262)	142 (57–279)	0.7
Recovery time (ms)’	269 (216–294)	272 (243–351)	0.4	340 (258–501)	373 (232–516)	0.5
Contraction duration (ms)’	578 (512–587)	519 (519–744)	0.3	749 (609–875)	753 (530–882)	0.6
	Upper esophageal sphincter
Basal pressure (mmHg)	46 (23–79)	46 (23–68)	0.8
Residual pressure (mmHg)	1 (0–3)	5 (4–8)	0.02^* * Statiscally significant.
Relaxation time to nadir (ms)	248 (207–331)	241 (208–264)	0.8
Relaxation duration (ms)	676 (614–851)	641 (537–710)	0.6
Recovery time (ms)	365 (315–484)	356 (319–456)	0.7
Extension (cm)	3 (3–3)	3 (3–3)	1

	Epiglotis			Velopharynx
	Preoperative	Postoperative	p	Preoperative	Postoperative	p
Peak pressure (mmHg)’	112 (99–117)	131 (125–153)	0.1	100 (77–112)	108 (85–128)	0.0004^* * Statiscally significant.
Rise time (ms)’	305 (289–337)	284 (274–292)	0.09	347 (291–395)	330 (271–444)	0.004^* * Statiscally significant.
Upstroke (mmHg/ms)’	316 (247–355)	388 (324–521)	0.1	260 (184–293)	266.2 (182–300)	0.0007^* * Statiscally significant.
Recovery time (ms)’	213 (160–284)	258 (234–277)	0.3	316 (235–581)	296 (256–407)	0.5
Contraction duration (ms)’	515 (466–582)	550 (519–650)	0.3	725 (556–880)	657 (564–782)	0.7
	Upper esophageal sphincter
Basal pressure (mmHg)	64 (39–89)	69 (29–90)	0.8
Residual pressure (mmHg)	3 (1–6)	5 (3–6)	0.6
Relaxation time to nadir (ms)	247 (182–302)	234 (179–264)	0.6
Relaxation duration (ms)	669 (638–726)	688 (525–752)	0.8
Recovery time (ms)	392 (285–555)	460 (346–512)	0.7
Extension (cm)	3 (3–3)	3 (3–3)	1

	Velopharynx			Epiglotis
	Preoperative	Postoperative	p	Preoperative	Postoperative	p
Peak pressure (mmHg)’	6 (5–9)	12 (8–64)	0.3	15 (11–21)	18 (9–47)	0.8
Rise time (ms)’	312 (281–350)	325 (291–354)	0.7	268 (239–305)	259 (246–283)	1
Upstroke (mmHg/ms)’	28 (12–120)	26.(15–226)	0.6	69 (54–81)	63 (40–191)	0.8
Recovery time (ms)’	212 (176–270)	369 (190–605)	0.4	285 (258–359)	220 (115–397)	0.8
Contraction duration (ms)’	524 (458–621)	694 (481–959)	0.7	548 (491–664)	503 (345–721)	0.8
	Upper esophageal sphincter
Basal pressure (mmHg)	25 (13–42)	46 (39–51)	0.09
Residual pressure (mmHg)	−1 (−3–1)	6. (0–11)	0.3
Relaxation time to nadir (ms)	233 (183–281)	220 (173–283)	0.8
Relaxation duration (ms)	583 (536–698)	551 (441–630)	0.6
Recovery time (ms)	364 (352–431)	331 (268–346)	0.1
Extension (cm)	3 (3–3)	3 (3–3)	1

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] *Corresponding author. E-mail:brpinna@yahoo.com.br (B.R. Pinna).