Investigation of factors affecting the kinematic parameters of swallowing in individuals with total laryngectomy

Dysphagia is a common problem after total laryngectomy (TL). The primary aim of this study is to investigate the changes in swallowing biomechanics after TL via kinematic analysis and to determine the factors affecting swallowing. A total of 34 subjects with TL were included in the study. After clinical swallowing examination, kinematic parameters including pharyngeal transit duration (PTD), maximum pharyngeal constriction ratio (MPCR), upper esophageal sphincter opening ratio (UESOR), upper esophageal sphincter opening duration (UESOD), and bolus clearance ratio (BCR) were investigated from Videofluoroscopic Swallowing Study (VFSS) records via Image J software. Symptomatic swallowing complaints were determined in 47.1% of the subjects (n=16). PTD, MPCR, and BCR parameters were found significantly higher in subjects with symptomatic swallowing complaints compared to those without. Significant correlations were found between age and PTD and also between the time after chemoradiotherapy and BCR. Subjects who communicate by writing and/or using sign language had higher value of BCR than those who use other communication methods. Compared to the subjects receiving other treatments, those receiving both chemotherapy and radiotherapy had significantly lower UESOR but significantly longer UESOD. There was no relationship between kinematic parameters and the surgical features including the type of incision, presence of neck dissection, presence and type of thyroidectomy, type of reconstruction, and type of mucosal closure. When feature studies confirm the current findings, it will be useful to include kinematic analysis in the swallowing assessment battery of individuals with TL.