An attempt to achieve "functional swallow" after total glossectomy with laryngectomy

Between April 2006 and January 2016, 18 patients underwent total glossectomy with laryngec-tomy and free or pedicle flap reconstruction. Postoperative videofluorography was performed in all 18 patients and the results analyzed. Fourteen patients (77.8%) achieved complete oral intake without the aid of gastric tube feeding. In 7 patients (38.9%), clearance of the pharynx was excellent and the contrast medium entered the esophagus within a few minutes of swallowing. These patients were able to take the contrast medium smoothly into the esophagus of their own volition, without the help of gravity. Their method of swallowing was defined in this study as acquiring "functional swallow", while in 11 patients who did not acquire "functional swallow", clearance of the pharynx was poor and the contrast medium did not enter the esophagus despite repeated swallowing. This was caused mainly by optional contraction of the remnant posterior pharyngeal wall ; contraction of the remnant posterior pharyngeal wall was very weak, and the passage of the contrast medium was partly dependent on gravity. These patients were thus taking contrast medium into the esophagus with the help of gravity. Statistical analyses were performed to compare those patients who acquired "functional swallow" with those who did not: the parameters included age, radiotherapy dose, neck dissection, lip closure, velopharyngeal competence, constriction of the poste-rior pharyngeal wall, reconstructed pharyngeal shape, and the type of flap used. Strong contraction of the remnant posterior pharyngeal wall, the ability to close the lips, and velopharyngeal competence showed statistically significant differences. To achieve "functional swallow" after total glossectomy with laryngectomy, not only is strong contraction of the remnant pharyngeal constrictor muscle considered necessary, but also the ability to close the lips and the presence of velopharyngeal competence. In patients who have strong pharyngeal constrictor muscle power, but without lip insufficiency and velopharyngeal incompetence, the pharyngeal space could be reconstructed slightly narrower, not "funnel-shaped", in order to create strong swallowing pressure.