2016 Volume 20 Issue 3 Pages 149-155
The male patient was 71 years old at first examination. Resection of tongue base, horizontal laryngectomy, bilateral neck dissection, and tracheostomy were performed for oropharyngeal cancer at 62 years old, with additional chemoradiotherapy. No postoperative recurrence of the tumor was found, but the patient suffered repeated bouts of pneumonia, malnutrition, and dehydration. Feeding and swallowing rehabilitation intervention commenced during the summer at 71 years old, when the patient was hospitalized for aspiration pneumonia.
Progress after hospital admission: Endoscopic examination of swallowing was carried out on hospital day 3, and videofluoroscopic examinations of swallowing on day 5. Incomplete laryngeal closure and incomplete pharyngeal constriction were observed, confirming silent aspiration. Feeding commenced using a paste given with the patient reclining or in a side-lying position, and guidance for supraglottic swallow was given. As the patient learned to carry out supraglottic swallow, feeding moved to a seated position. Videofluoroscopic examination of swallowing carried out on day 19 of hospitalization showed that compensatory prevention of aspiration had been achieved by the supraglottic swallow. For the type of food, watery cooked rice, finely chopped food, and thickening of fluids were no longer considered necessary, and the patient was discharged to his home on the 21st day. No incidences of pneumonia were seen in the year following discharge. Aspiration due to incomplete laryngeal closure is a problem with horizontal laryngectomy for oropharyngeal cancer. In the present case, favorable progress was obtained using supraglottic swallow to prevent aspiration. Learning the supraglottic swallow prior to surgery is likely to prove useful for patients who scheduled to undergo horizontal laryngectomy.
