出版社
WILEY
DOI: 10.1002/hed.27311
关键词
dysphagia; laryngectomy; pseudo-epiglottis; swallow; vertical closure
Incomplete closure of the pharynx after laryngectomy can lead to a protrusion of the anterior wall below the tongue base, known as a pseudo-diverticulum. The prolapsed mucosa separating the neopharynx from the pseudo-diverticulum is called a pseudo-epiglottis. Surgical division of the pseudo-epiglottis significantly improves swallowing function.
BackgroundVertical closure of the pharynx after laryngectomy can result in an outpouch of the anterior wall of the neopharynx below the tongue base, called a pseudo-diverticulum. The prolapsed mucosa that separates the rest of the neopharynx from the pseudo-diverticulum is termed a pseudo-epiglottis. MethodsProspective study of patients with pseudo-epiglottis. M. D. Anderson Dysphagia Inventory (MDADI) scores were used to assess swallowing outcomes pre- and post-pseudo-epiglottis division, including minimally clinically important difference (MCID) assessment. ResultsOf 16 patients with a pseudo-epiglottis, 12 had dysphagia (75%). Symptomatic patients had significantly worse global MDADI and subscale scores. After division, the mean composite MDADI increased from 48.3 to 64.7 (p = 0.035), including a high MCID (16.4) with a similar improvement in the global question rating findings (31.1 vs. 60, p = 0.021). The MCID was significant for all MDADI subscales. ConclusionsPseudo-epiglottis formation is associated with significantly worse global and subscale MDADI scores. A clinically- and statistically-significant improvement in the MDADI scores was found following surgical division.
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