Changes of esophageal motility after total laryngectomy

OBJECTIVE. Total laryngectomy completely interrupts the continuity of the proximal digestive tract and may lead to derangement in esophageal motility. The purpose of this investigation was to find out how total laryngectomy changes the resting and the maximum contracting pressures of the upper esophageal sphincter muscle and how it affects the coordination of the contraction and the relaxation between the pharynx and the upper esophageal sphincter muscles. If changes in the function of the upper esophageal sphincter muscle should occur, this study will also demonstrate how it affects the motility of the esophagus and the lower esophageal sphincter muscle. METHODS. In an attempt to explain postoperative motility changes, the stationary pull through method of manometric evaluation was used to quantify the alteration in esophageal motility. For the manometric evaluation of the esophagus, a polyethylene catheter with 8 internal tubes was used. The study was performed on a group of 15 patients with total laryngectomy and 15 people without esophageal disease or symptoms as the control group. RESULTS: There was a statistically significant difference between the laryngectomy group and the control group for both the resting and maximum contraction pressures as well as for coordination and relaxation of the upper esophageal sphincter. (P < 0.05) In the laryngectomy group, 3 patients who complained of postoperative dysphasia showed more severe functional changes. The proximal esophageal body pressure and peristaltic waves were significantly decreased in the laryngectomy group. No significant difference between the laryngectomy group and the control group was noted in terms of the lower esophageal resting sphincter pressure and the postdeglution pressure. There also was no significant difference between the two groups in the degree of lower esophageal sphincter coordination and relaxation. CONCLUSION. From these results, it may be concluded that interruption of the cricopharyngeal muscle and pharyngeal plexus after laryngectomy not only may produce local derangement of upper esophageal sphincter function but also may produce abnormalities in peristalsis of the proximal esophageal body. However, the function of lower esophageal sphincter did not show any significant difference between the laryngectomy group and the control group.