Swallowing After Open Partial Horizontal Laryngectomy Type IIa: A Quantitative Videofluoroscopic Analysis Using the Analysis of Swallowing, Physiology, Events, Kinematics, and Timing.
Raphaela da Costa Miranda Barbosa, Andressa Silva de Freitas, Rayane Beltrão Alves Cerqueira and 3 others
After OPHLIIa surgery, 100 patients showed markedly reduced hyoid movement, poor pharyngeal constriction, and increased residue compared to healthy adults.
Aspiration, when it occurred, was silent. Compensatory mechanisms like prolonged laryngeal closure were present but did not eliminate the risk.
Key findings
1Compared to healthy adult reference values, the OPHLIIa group had markedly reduced hyoid peak position (83% below the typical threshold) and hyoid speed (59% below), poor pharyngeal constriction (98% above the typical area at maximum constriction), increased residue in every pharyngeal region (76% above the typical total residue threshold), and compromised laryngeal vestibule closure (34% with partial or incomplete closure versus a 4% reference frequency).
2When aspiration into the trachea occurred in this group, it was silent.
3Several timing and duration measures pointed in the direction of protective compensation: time-to-laryngeal closure was shorter than healthy reference (large effect), laryngeal closure duration was longer (large effect), and UES opening was wider (medium effect). These coexisted with the impairments listed above.
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What it does not show
Retrospective analysis of archived recordings; the researchers could not control the protocol, the number of swallows, or the consistencies used. Time from surgery to VFSS ranged from 2 to 219 months, so the sample mixes early and very late postoperative physiology. Some patients may still have been in a recovery window. Surgeries were performed over 22 years (1996 to 2018) by multiple surgeons whose individual variations were not recorded. Only a single thin liquid sip was analysed per patient, so variability across bolus volumes and consistencies is not captured. The swallow was cued by the investigator, which differs from the spontaneous-swallow protocol used to develop the ASPEKT reference values. The authors note this could have shortened reaction time, but the effect was not observed. No information was available on the type, intensity, or adherence to any swallowing rehabilitation the patients may have received, nor on their dietary status or gastrostomy tube use at the time of VFSS. 94% of the sample was male, limiting generalisability to women. It is unknown whether the compensatory timing changes reflect spontaneous adaptation, learned technique, or both.
Declared interests
One author was supported by a Brazilian higher-education fellowship (CAPES). Two authors were supported by a US National Institute on Aging grant (R01AG077481). No industry funding or conflicts of interest were declared.
The easy way to misread this
Do not read the prolonged laryngeal closure and wider UES opening as evidence that these patients are safely compensating. The same patients have compromised laryngeal closure, poor pharyngeal constriction, and increased residue, and when aspiration did occur it was silent. The authors mention supraglottic and effortful swallow as strategies to explore, but this study tests no intervention and draws no conclusions about the effectiveness of any specific exercise.
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