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Evaluation of the Effects of Primary Myotomy in Total Laryngectomy on the Neoglottis With the Use of Quantitative Videofluoroscopy
Bas M. R. Op de Coul, MD;
Frank J. A. van den Hoogen, MD, PhD;
Corina J. van As, PhD;
Henri A. M. Marres, MD, PhD;
Frank B. M. Joosten, MD, PhD;
Johannes J. Manni, MD, PhD;
Frans J. M. Hilgers, MD, PhD
Arch Otolaryngol Head Neck Surg. 2003;129:1000-1005.
Objective To evaluate the influence of primary myotomy on characteristics of the neoglottis in patients after laryngectomy.
Design Patient survey.
Setting University Medical Center St Radboud, Nijmegen, the Netherlands.
Patients Nineteen consecutive patients who underwent laryngectomy (12 with primary lateral myotomy of the upper esophageal sphincter [marked by metal clips]; 7 not requiring myotomy [according to intraoperative palpation]).
Interventions Videofluoroscopy.
Main Outcome Measures Visual assessments and quantitative measures of the neoglottis were used to study the relationships between myotomy, and anatomic and morphologic characteristics of the neoglottis.
Results Quantitative measurements showed no difference between the neoglottic characteristics of the patients with (n = 12) and without (n = 7) myotomy, who were all judged to have moderate (n = 4) or good (n = 15) voice quality. Results for the entire patient group during phonation showed only 1 single neoglottic bar, no hypertonicity of the neoglottis, and a significant shortening of the neoglottic bar (P = .007). Results for the myotomy group during phonation showed elevation of the caudal clip (P = .046), shortening of the myotomy (P = .01), and decreased overlap of the cranial clip and the neoglottic bar (P = .007). Furthermore, significant relationships were found between the various quantitative measures of the neoglottis and those of the myotomy.
Conclusions Quantitative videofluoroscopy enables study of the influence of myotomy on the anatomic and morphologic characteristics of the neoglottis. Our results suggest that a planned myotomy of the upper esophageal sphincter is beneficial when prosthetic voice rehabilitation is applied after total laryngectomy.
From the Departments of Oto-Rhino-Laryngology/Head & Neck Surgery (Drs Op de Coul, van den Hoogen, and Marres) and Radiology (Dr Joosten), University Medical Center St Radboud, Nijmegen, the Netherlands; Department of Otolaryngology/Head & Neck Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Drs van As and Hilgers); and Department of Oto-Rhino-Laryngology/Head & Neck Surgery, University Hospital Maastricht, Maastricht, the Netherlands (Dr Manni). The authors have no relevant financial interest in this article.
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