Previous Article in Journal
Rehabilitation for Women and Men Experiencing Sexual Dysfunction After Abdominal or Pelvic Surgery
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Surgeries
Volume 6
Issue 2
10.3390/surgeries6020041
surgeries-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

Pharyngeal Stenosis and Swallowing Dysfunction Following Laryngectomy: A Scoping Review †

by
Akash Halagur
1,
Amar Sheth
2,
Shannon Wu
2,
Michael Belsky
2 and
Edward J. Damrose
2,*
1
Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA
2
Department of Otolaryngology—Head and Neck Surgery, School of Medicine, Stanford University, 801 Welch Road, Stanford, CA 94305, USA
*
Author to whom correspondence should be addressed.
†
Presented at the American Academy of Otolaryngology/Head and Neck Surgery Annual Meeting, Miami, FL, USA, 28 September 2024.
Surgeries 2025, 6(2), 41; https://doi.org/10.3390/surgeries6020041
Submission received: 21 March 2025 / Revised: 11 May 2025 / Accepted: 13 May 2025 / Published: 20 May 2025
Browse Figures
Review Reports Versions Notes

Abstract

:
Background: Pharyngeal stenosis (PS) is a common sequela of a total laryngectomy (TL), and the most common cause of postoperative dysphagia. Its exact incidence is not known. A greater understanding of this clinical complication could serve to better inform patients considering a laryngectomy. Objective: Pharyngeal stenosis (PS) is a common sequela of a total laryngectomy (TL) and causes dysphagia. This systematic review aims to characterize PS as a sequela of a TL, specifically the incidence of dysphagia requiring dilation, and the frequency/timing of dilation interventions. Data Sources: We used PubMed. Review Methods: A search of all studies from PubMed published from conception to January 2024 was conducted. Cohort studies reporting PS requiring dilation following a TL were included. Data were collected on the incidence, recurrence, median time from TL to dilation, TL indication, and reconstructive approach. Two evaluators independently performed the study screening and data collection; all the differences were resolved by a third evaluator. Results: Eleven studies met the inclusion criteria. A total of 1421 patients underwent a TL, of which 659 (46.4%) were salvage, 286 (20.1%) were the primary treatment, and 153 (10.8%) were the primary with an adjuvant treatment. A total of 255 patients underwent reconstruction, among whom 86 (33.7%) had regional and 169 (66.3%) had free flaps. The mean age at the time of the TL was 64.1 (range 20–87) years, with a male-to-female ratio of 3.4:1. The overall incidence of dysphagia after a TL requiring dilation was 26%. Of the 370 patients who required dilation, 69.4% required multiple procedures. The median time to the first dilation post-TL ranged from 9 to 24 months. The overall complication rate was 4.3%, including perforation, infection, and diminished tracheoesophageal voice quality. Conclusions: Approximately one in four patients developed stenosis requiring dilation after a TL, of which two out of three required repeat dilations. Major complications, though rare, were predominantly observed during the first few dilation procedures.

1. Introduction

Pharyngoesophageal stenosis (PES) is a common and well-known complication of a total laryngectomy (TL), which can lead to substantial morbidity and poor quality of life among laryngectomees [1]. Stenosis can be exacerbated in settings with the creation of a neopharynx from the surrounding tissue, fibrosis resulting from adjuvant radiation, and from ongoing effects from previously irradiated fields. The resulting dysphagia from PES can have significant impacts on patients’ quality of life and wellbeing, especially as many patients identify swallowing as an important aspect of their surgical decision-making when opting for a laryngectomy. Prior studies have suggested that between 10% and 60% of laryngectomy patients experience some form of oropharyngeal dysphagia [2], which may begin with solids and progressively involve liquids if left unaddressed [3,4]. The presenting symptoms of dysphagia in these patients typically include feeding intolerance, nasopharyngeal regurgitation, a globus sensation, and prolonged mealtimes. The cause, in up to one-third of patients with oropharyngeal dysphagia following a laryngectomy, has been attributed to strictures [5].
A diagnosis of PES can be made endoscopically or radiographically. The endoscopic findings generally reveal a narrowed PE segment, and it may prove challenging to advance an endoscope beyond the stricture. The normal caliber of an adult esophagus is approximately 30 mm, and dysphagia to solids will generally be appreciated when the caliber is reduced to approximately 12–13 mm. Interestingly, a patient may continue to tolerate liquids to a far greater degree, with a caliber of 2–3 mm being the threshold for patients to notice dysphagia for liquids. Ingested barium or a gastrograffin– barium swallow, a modified barium swallowing study, esophogram, or gastrograffin swallow is used to identify and to quantitate PE strictures. Radio-opaque contrast agents are ingested orally and fluoroscopically tracked during a swallowing cycle. They provide a clear enhancement of the internal dimensions of the pharyngoesophageal lumen. An endoscopy may afford an increased chance of providing greater diagnostic information on the nature of the stricture (benign versus malignant) by allowing for the direct observation and subsequent biopsy of the area, but an endoscopy also carries the added risks of potential perforation (especially when coupled with dilation) and the need for anesthesia (monitored anesthesia care versus general anesthesia).
Stricture dilation, which involves the mechanical widening of a narrowed pharyngeal segment, is a commonly employed intervention to alleviate dysphagia in patients with PES. While stricture dilation procedures have shown efficacy for improving dysphagia, the heterogeneity among dilation techniques and laryngectomy surgical procedures, such as whether a free-tissue transfer was used and the effects of radiation fields, contributes to heterogeneous patient populations and limits the generalizability of prior studies [6]. Factors, such as the type of laryngectomy (salvage or primary), adjuvant therapies (chemotherapy and radiation), and reconstructive approaches (e.g., regional versus free flaps), may influence the incidence and management of pharyngeal stenosis.
The outcome measures of prior studies are varied, which precludes meaningful interpretations and conclusions about best practices. This scoping review seeks to address these gaps by characterizing the incidence of PES as a sequela of a TL, with attention to the distinct patient and surgical characteristics of prior studies. The secondary outcomes include the time from a TL to dilation, the mean total number of dilations, and the incidence of dysphagia recurrence after dilation. By synthesizing the existing literature, we aim to improve the understanding of PES post-TL, and provide recommendations to optimize shared decision-making, preoperative surgical planning, and expectation management about potential long-term sequelae and the need for further surgical interventions following the acute phase of laryngectomy. We also aim to illuminate the significant role that chemoradiation plays in the development of strictures and swallowing dysfunctions; the correlation between fistula and stricture formation and the factors predisposing individuals to fistula formation; the role of gastroesophageal reflux on stricture formation; the overall efficacy of dilation for the treatment of strictures and the outcome measures used to assess success; the negative impact of stricture formation on swallowing function and quality of life; and the heterogeneity of the patient-reported outcome measures for assessing postlaryngectomy swallowing function and the methods employed to improve it.

2. Methods

This study was considered exempt by the Stanford University Institutional Review Board (IRB). This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PRISMA flow diagram and search strategy for this study are presented in Figure 1. The PRISMA Extension for Scoping Reviews checklist was strictly followed and is included in the supplementary materials (Figure S1). A search was conducted of the PubMed database to identify relevant studies published up until January 2024. The search strategy utilized a combination of keywords and Medical Subject Heading (MeSH) terms. The key search terms included the following: “total laryngectomy”, “stenosis”, “deglutition disorders”, “dysphagia”, “dilation”, “adults”, and “humans”. These terms were used in varying combinations to ensure identification of studies related to PS, dysphagia, and dilation following TL.
Inclusion criteria were applied to studies with a minimum of 5 participants that reported on PS requiring dilation following TL. Inclusion criteria, according to the study designs, were any randomized controlled trial, prospective and retrospective cohorts, case–control study designs, and case series. Only studies reporting the incidence, recurrence, time to first dilation, adjuvant treatments, and reconstructive approaches were included. We excluded studies that focused on pediatric populations, those with fewer than five participants, and studies that primarily addressed conditions unrelated to TL or PS. Studies in foreign languages were also excluded.
Two authors (A.H. and S.W.) independently reviewed titles and abstracts to identify potentially eligible studies, applying the inclusion criteria. Any discrepancies or disagreements were resolved by a third author (A.S.). Duplicates were removed, and the reference lists of included articles were manually checked for additional relevant studies.
Data extraction was performed independently by two authors (A.H. and S.W.) using standardized data forms. The collected data included study design, sample size, demographics (e.g., age, sex), reconstructive approaches (regional vs. free flaps), adjuvant treatments (e.g., chemotherapy, radiotherapy), and patient outcomes related to the incidence and recurrence of dysphagia requiring dilation. Information regarding the number of dilations required, time to first dilation post-TL, and complications (e.g., perforation, infection, voice quality) was also recorded. Primary outcomes included the following: incidence of dysphagia requiring dilation after TL, time to dilation, and incidence of dysphagia recurrence. Secondary outcomes included the following: frequency of dilation; dilation technique, size, and setting; and post-dilation complications. A third author (A.S.) assisted in resolving any discrepancies during the data collection process, ensuring consistency in the data extracted.
Quality assessment of the studies was performed by two authors (A.H and S.W.), with disagreements resolved by a third author (A.S.) using the appropriate quality assessment tool available through the National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools (Accessed 10 June 2024). The tools consist of 9–14 criteria, assessing such qualities as patient selection, outcomes measures, randomization, blinding, length of follow-up, description of statistical methods, and follow-up. Each study was assigned an overall rating of “good”, “fair”, or “poor”, reflecting least risk of bias, some potential bias, or high risk of bias. For the only cross-sectional study in this review by Zhang et al., the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used. For the randomized controlled trial by Wu et al., the NHLBI Quality Assessment of Controlled Intervention Studies tool was used. For all other studies in this review, the NHLBI Quality Assessment Tool For Case Series Studies was used.

3. Results

A total of eleven studies met the inclusion criteria [7,8,9,10,11,12,13,14,15,16,17]. The studies are summarized in Table 1. A total of 1421 patients who underwent a total laryngectomy were assessed, of which 659 (46.4%) received salvage treatment, 286 (20.1%) sole primary treatment, and 153 (10.8%) primary with adjuvant treatment. In some cases, it could not be determined from a study whether a laryngectomy was performed primarily, as a form of salvage, or for other reasons (e.g., non-function and chronic aspiration). A total of 255 patients underwent reconstruction, among which 86 (33.7%) had regional and 169 (66.3%) had free flaps. The mean age at the TL was 64.1 (range 20–87) years, with a male-to-female ratio of 3.4:1. These data are summarized in Table 2. The overall incidence of dysphagia requiring dilation post-TL was 26% (Table 3). Among those who required dilation, 69.4% needed multiple dilation procedures. The median time to first dilation post-TL was 15.6 months and ranged from 9 to 24 months. The overall complication rate was 4.3%, including perforation, infection, and diminished tracheoesophageal voice quality. The quality ratings of the included studies are shown in Table 1. Most of the studies were rated as fair, indicating a potential bias that may have affected the validity of the studies. Two studies were rated as good, indicating a low risk of bias.

4. Discussion

4.1. Impact of Chemoradiation on Swallowing Function

Approximately 26% of patients undergoing a total laryngectomy will require postoperative dilation, and of these, two-thirds will require multiple dilations postoperatively in order to maintain symptomatic relief of their dysphagia (Figure 2). The overall complication rate of dilation is approximately 4%. One of the main predictors of stricture formation appears to be radiotherapy. Radiotherapy is one of the key treatment modalities in the management of advanced head and neck cancers, often coupled with chemotherapy. Patients with laryngeal cancer commonly receive radiation therapy alone for early disease (Stage 1 and 2 disease), in conjunction with chemotherapy as part of a laryngeal preservation protocol (Stage 3 disease), or postoperatively following a laryngectomy (Stage 4 disease) [17]. The deleterious effects of radiation therapy in this group may be particularly common since squamous cell carcinomas—the most commonly encountered malignant tumor type—often require treatment levels in excess of 6000 rads to achieve therapeutic effect. At these levels, the pharyngeal constrictor muscles may be particularly prone to fibrosis and subsequent scar contracture. When coupled with chemotherapy, the resulting mucositis may be more intense, leading to more pronounced inflammation, fibrosis, and scar formation. For tubular structures, such as the pharynx and esophagus, radial contracture leads to the narrowing and potential obliteration of the lumen needed for effective swallowing [18].
Dilation has been the mainstay of therapy for strictures for many years. An anterograde dilation can be accomplished with special weighted dilating instruments (e.g., Maloney, Savary-Gilliard) or with radially expanding balloons, usually under endoscopic guidance. Some patients may be taught to dilate themselves [19]. Such approaches are appropriate when a residual lumen can be identified. When the lumen has been totally obliterated, a combined anterograde–retrograde can be performed [20]. In this approach, an endoscope is usually placed transorally, and a flexible fiberoptic esophagoscope is passed in a cephalad direction via a gastrostomy. Transillumination can be used to determine the density and extent of the stricture. If light is visible from either end, usually the scar is considered to be of a thin enough caliber to allow for its puncture and subsequent dilation. Once traversed, the area is stented, usually with a nasogastric tube, and the patient undergoes serial dilation to maintain luminal patency.
When dilation is not an option, a complete reconstruction of the affected area using local, regional, and microvascular free flaps and stents may be needed [21]. Such approaches include a sternocleidomastoid myocutaneous flap and radial forearm, anterolateral thigh, jejunal, and gastro-omental free flaps [22]. Such approaches have several disadvantages: increased cost, the need for staged procedures, the need for prolonged stenting of the reconstructed conduit, and the need for prolonged hospitalization. In addition, all of these approaches are subject to failure and restenosis.
In postlaryngectomy patients, a stricture formation severe enough to require dilation occurs in approximately 22% of patients. Of the patients affected, nearly two-thirds will require repeat dilations to palliate their symptoms. Dilation appears to be generally effective and associated with a relatively low rate of complications (2%). Unfortunately, these complications can be serious (i.e., perforation). The etiology of stenosis is likely multifactorial, with fistula formation and radiation being commonly implicated. The use of free flaps, particularly in postradiation patients, may reduce the risk of fistula and the subsequent development of localized stenosis, but they are also associated with stricture formation when used as a tube [23].

4.2. Fistula Precipitates Stricture Formation

A fistula is one of the most common complications in laryngectomized patients and is strongly associated with stricture formation. Therefore, understanding and mitigating the factors that predispose patients to a pharyngocutaneous fistula is critical for preventing a postlaryngectomy stricture. The factors facilitating fistula formation can be grouped according to patient factors, disease-related factors, and surgery-related factors [24]. The patient-related factors may include metabolic derangements, specifically anemia, severe protein-calorie malnutrition, diabetes mellitus, and hypothyroidism [25,26,27]. The American Society of Anesthesiologists’ physical status classification is used to stratify patients with multiple comorbidities with their anesthetic risk (ASA score), but studies that have examined the links between ASA scores and rates of fistulas are contradictory. Some studies have found a positive association, while others have not [28,29]. Several authors have described scoring systems to predict fistula formation, but none have gained widespread acceptance [27,30].
Disease-related factors have been widely studied and include tumor stage, tumor location, preoperative tracheostomy, and the role of radiation therapy [24]. Locally advanced disease has been identified as a predictor in several studies [31,32]. Tumor location—hypopharyngeal, supraglottic, and transglottic—has also been associated with increased fistula formation [28,31,33,34]. Because of the negative impact that large laryngeal tumors have on the airway, a pre-treatment tracheostomy may often be required in order to stabilize a patient prior to definitive treatment, and the performance of a tracheostomy has historically been associated with increased fistula formation. More recent analyses of a tracheostomy as a risk factor for fistulas have shown that the fistula risk is increased, potentially due to patients’ increased exposure to wound infection prior to a laryngectomy [25,26,27,31,32,33]. Radiation therapy, and more recently the concurrent use of radiation and chemotherapy, have shown to be strong predictors of fistula formation [27,28,29,32,33]. The risk may be higher when a laryngectomy is performed within one year of radiation therapy [34,35] or within 30 months of chemoradiotherapy [36].
A number of surgery-related variables have been described that may predispose a laryngectomized patient to fistula formation. A surgery duration of over 240 min has been associated with increased fistula formation, as has the performance of concurrent neck dissections [26,28,33,34,36]. A number of studies have suggested higher fistula rates with manual suture versus automatic staple closure of the pharyngeal defect [31,37]. Interestingly, while the incorporation of vascularized and non-irradiated muscle flaps into a repair would seem likely to reduce fistula formation, this has not been proven overwhelmingly to be the case [25,31,36,38]. Wound infection appears to be associated with fistula formation, although an infection may clinically be the consequence of a fistula itself [25,33,39].

4.3. Gastroesophageal Reflux and Stricture Formation

Gastroesophageal reflux (GERD), as a potential complicating factor in the development of stricture formation, deserves special attention. Patients with GERD who develop esophageal strictures secondary to caustic ingestions may require three times as many dilations to maintain luminal patency compared to those patients without GERD [40]. GERD has been implicated as a risk factor in 58–67% of patients with carcinoma of the upper aerodigestive tract [41,42]. Interestingly, the incidence may be as high as 82% in laryngectomees [43]. Smit et al. noted that a number of factors may influence the impact of reflux on the pharyngoesophageal (PE) segment after a laryngectomy. The upper esophageal sphincter may be deliberately disrupted, either through a myotomy or pharyngeal plexus neurectomy, facilitating the passage of gastric contaminants into the PE segment [43]. Radiation therapy negatively impacts salivary secretion, particularly of bicarbonate (which has a neutralizing effect on stomach acid). The incompetence of the lower esophageal sphincter, as well as decreasing esophageal clearance with age or radiation exposure, may increase the exposure of the PE segment to gastric contents [43]. Gastric fluids can harm the mucosa of the upper aerodigestive tract and potentiate the effects of radiation-induced mucositis [41,43]. The inflammatory effect of such exposure has been associated with the development of granulation tissue in the PE segment of laryngectomized patients who utilize voice prostheses [42]. Cocuzza et al. showed a reduction in or resolution of this inflammatory tissue in 83% of patients with GERD treated with twice-daily proton pump inhibitors [42].

4.4. Outcome Measures and Efficacy of Dilation

The efficacy of dilation for PES in patients who underwent radiation for head and neck malignancies was recently reviewed by Abu Ghanem et al. [6]. The literature on the subject is by no means uniform, which can complicate its interpretation. Not surprisingly, the efficacy varies with the technique and with the diagnosis. Adjunctive measures include the use of a CO2 laser to perform a myotomy and scar lysis; the use of fluoroscopy to more precisely localize the location and extent of a stricture; and the use of injectables, such as steroids and botulinum toxin, to mitigate wound healing and maximize the therapeutic effect. As discussed earlier, while anterograde approaches are most commonly used, a combined anterograde/retrograde approach is needed in patients with total stenosis.
Complicating the interpretation of the existing literature is the lack of standardized outcome measures and follow-up. The methods used to evaluate the preoperative severity of PES are fairly consistent, and primarily include either a barium swallow, endoscopy, or both; the presence of a gastrostomy tube; and notation on the effectiveness of oral intake. Postintervention metrics have included the technical success (as measured by the increase in the pharyngoesophageal lumen); an improvement in the oral intake of 50% above the preoperative level of function; the removal of the gastrostomy tube, if present preoperatively; a postprocedure barium swallow demonstrating an improvement or resolution of the stricture; an objective measurement of swallowing function using the Flexible Endoscopic Evaluation of Swallowing (FEES); and an assessment of changes in the oral intake scores, using instruments such as the Functional Outcome Swallowing Scale (FOSS).
As a result of this lack of standardization, the outcomes using endoscopic methods are subject to wide interpretation. Studies generally suffer from small sample sizes, a lack of long-term follow-up, and patient selection biases, making a comparison of outcomes between studies very difficult. If one takes the assembled literature as a whole, “success” varies from 27% to 100%, depending on the study cited. The number of dilations required to achieve an improvement or resolution of symptoms can range from 3 to 42 in different studies. Major complications can and do occur, including perforation and death. Given the variability in the literature regarding the outcomes of dilation for resolving radiation-associated swallowing problems in patients undergoing treatment for head and neck cancer, it is clear that more work remains to be performed in order to provide patients more exact information regarding how likely they are to have long-term swallowing problems, and how likely it is that therapeutic interventions will be able to resolve their symptoms.

4.5. Swallowing Function and Quality of Life

The survivorship data suggest that the ability to swallow well strongly impacts the quality of life in patients who undergo treatment for head and neck cancer [44,45]. It is also clear that swallowing function may deteriorate years later following treatment, as much as five years or longer, and is distinctly different from the acute changes that occur during treatment. Sellstrom et al. referred to this phenomenon as late RAD (late radiation-associated dysphagia) [46]. PES is simply one manifestation of the changes that are responsible for late RAD. Interestingly, because of the slowly progressive nature of the process, many patients may remain relatively asymptomatic in the early years following treatment, while instrumental evaluations, such as FEES, begin to show signs of swallowing dysfunction [47,48].
Because of the complex nature of RAD, a multidisciplinary team (MDT) approach to assessment, monitoring, and treatment may be helpful in maximizing the quality of life of these patients [46]. As has been discussed earlier, while a barium swallow and endoscopy are objective measures for assessing PES, they are not the only instruments. Helpful measures to assess the impact of RAD, its progression, and its response to interventions include clinical assessments, clinician-rated outcomes, and patient-reported outcomes [46]. Clinically administered assessments include barium swallows and FEESs, which are subsequently scored based on the severity with which the swallowed materials interact with the airway, using the Penetration–Aspiration Scale and DIGEST (Dynamic Imaging Grade of Swallowing Toxicity). Electromyography, high-resolution manometry, and the water swallow test have also been employed. It is important to remember that not all studies are offered by all institutions, or even by all speech and language therapists. Therefore, the uniformity of clinical assessment may vary from state to state and country to country.
Clinician-rated measures, which assess a patient’s dietary restrictions and the relative degrees to which oral and tube feeding are apportioned, are also used to assess RAD and, like clinically administered assessments, are variably administered among institutions [46]. These measures included the Performance Status Scale—Head and Neck (PSS-HN) Normalcy of Diet, Functional Oral Intake Scale, Outcome Measure for Swallowing, and the Dysphagia Outcome and Severity Scale.

4.6. Patient-Reported Outcome Measures for Assessing Swallowing Function

Finally, patient-reported outcome measures (PROMS) assess swallowing function from the perception of the patient, perhaps the most important factor in determining the quality of life [46]. These measures include some well-known and some lesser-known instruments, which again speaks to the geographic variability that characterizes swallowing assessments: Australian Therapy Outcomes Measures; European Organisation for Research and Treatment of Cancer; MD Anderson Dysphagia Inventory; Swallowing Quality of Life; and the University of Washington Quality of Life.
Despite the variety of assessments available for assessing patient function, approximately one-third of patients are unaware of late RAD [47]. This lack of awareness represents a failure in patient education and raises the question of whether or not patients have been fully informed as to the long-term consequences of the treatment decisions they initially made. More concerningly, there is little evidence to support modalities other than dilation for treating RAD [48]. Langmore found no value in transcutaneously administered electrical stimulation in a randomized clinical trial comparing electrical stimulation with swallowing therapy to swallowing therapy alone [49]. Trials evaluating manual therapy and home-based treatment of chronic RAD (the HIT-CRAD trial) are currently underway and will hopefully provide insight into additional options for patients suffering from RAD [50]. It is apparent, however, that starting therapy late is associated with poorer swallowing outcomes [51].
Once patients develop symptomatic stenoses, the majority of patients will require periodic dilations for the recurrence of symptoms. This is likely secondary to the late effects of radiation, as well as the nature of scar contraction on a tubed structure. Uncontrolled GERD may also play a significant role, not only in the development of PES, but also in the clinical response and duration of response to dilation. As noted, the use of proton pump inhibitors has been shown to have a healing effect on granulation tissue at the site of voice prostheses in laryngectomized patients [42]. It is unclear if the long-term use of proton pump inhibitors could prevent the development of PES or otherwise mitigate the effects of late RAD in laryngectomized patients. Our observations of our patients with voice prostheses have suggested to us that local inflammation at the site of the device is common, and that strictures tend to develop immediately above the device. To our knowledge, this has not been studied systematically.
When considering the decisions patients and treating clinicians make in determining the best treatment for a patient, it is clear that swallowing function is of significant concern, and it is also clear that swallowing function is negatively impacted by chemoradiation, whether administered as part of a laryngeal preservation protocol or postlaryngectomy [52]. The question arises, then, as to whether or not, when considering the swallowing outcome alone, there is a clear advantage to undergoing a laryngectomy as the primary treatment for advanced laryngeal cancer, or a laryngectomy following chemoradiotherapy—salvage laryngectomy—in the event that the primary treatment is ineffective, or organ preservation has failed.
Lawrence et al. attempted to address this question in a study of 125 patients, using the function oral intake scale [53]. They found that following a salvage laryngectomy, swallowing function plateaued at 3–6 months following surgery, with patients able to consume an oral diet but requiring special preparation and consistencies. In contrast, those patients who underwent a primary laryngectomy showed continual improvement in swallowing function up to 15 months after treatment, with most patients achieving an unrestricted oral diet.
Not surprisingly, stricture formation plays a significant role in determining the swallowing outcomes in the salvage population. Schuman et al. noted a surprisingly high rate of stricture formation in patients who underwent a salvage laryngectomy [8]. They studied 233 patients who underwent a salvage laryngectomy, evaluating the rate of stricture formation, need for dilation, and timing of dilation. Overall, they noted that 40% of their patients developed a PES. These patients were twice as likely to require dilation if they had experienced a postoperative fistula. A total of 60% of these patients required multiple dilations to maintain their oral intake. Interestingly, the likelihood of requiring dilation increased by 10% annually following the completion of XRT/CRT, suggesting that deteriorating tissue function can be expected in patients who have been treated with prior radiation therapy.

5. Limitations

The limitations of this study include the heterogeneous patient population, encompassing various reconstructive techniques, radiation therapy, and postoperative management. The lack of standardized pre- and postintervention assessments also limited our ability to fully assess the impact of dilation on subsequent swallowing function and patient QOL. Despite these limitations, the scope of this paper can hopefully provide surgeons and oncologists with clearer information on the overall rate of stenosis in laryngectomized patients, in order to inform and to prepare patients for this common complication and the future treatments that will be required to manage it.

6. Conclusions

Patients undergoing a total laryngectomy are at risk for postoperative swallowing dysfunction and PES. PES has a negative impact on quality of life and can significantly impact a patient’s oral intake, often requiring dietary modification or even tube-feed supplementation. Approximately 26% of patients will develop a symptomatic stricture requiring dilation, and most patients will require multiple dilations to maintain optimum oral intake. The chances of requiring dilation also appear to increase annually following the completion of radiation therapy. Radiation therapy, whether given pre- or post laryngectomy, and alone or in concert with chemotherapy, has a negative impact on swallowing function and predisposes patients to stricture formation. Fistula formation is strongly associated with the development of PES, and fistula formation is highest in laryngectomized patients who have undergone prior treatment with chemoradiation. Free flaps, interestingly, when incorporated to reconstruct the pharyngoesophageal lumen, are prone to stricture formation, and paradoxically can be associated with worse swallowing outcomes, although their use is intended to decrease fistula formation.
Patients are not well informed as to the risks of swallowing deterioration following treatment for their laryngeal cancer. Unfortunately, outcome measures to track and to quantitate the degree of swallowing dysfunction are not uniformly applied nor are they uniformly available. Objective measures, such as the FEES, may reveal evidence of swallowing dysfunction in advance of subjective patient complaints. More unfortunately, the interventions designed to address swallowing dysfunction postlaryngectomy are limited in terms of their efficacy. Dilation is the most widely employed surgical intervention, but its efficacy varies widely, must be periodically repeated, and must be repeated with increasing frequency in the years following a total laryngectomy. It is also not without its complications, such as perforation, and rarely, mediastinitis and death. Other therapeutic modalities, such as swallowing therapy, are limited, and adjunctive measures, such as transcutaneous musculoskeletal stimulation, have not proven helpful.
Patients, and the clinicians who support them, may often prioritize laryngeal preservation when selecting the treatment option for an advanced laryngeal cancer. This is not unreasonable, given the negative impact on quality of life that the loss of pulmonary-driven speech and the presence of a permanent stoma may have on a patient. However, swallowing dysfunction may not be as carefully considered, or the impact of swallowing dysfunction secondary to radiation therapy may be considered a late-term phenomenon, a factor to be weighed after the disease has been cured. Patients undergoing a laryngectomy, especially following prior radiation therapy, should be advised that swallowing dysfunction may be a chronic problem for which there may not be a good solution.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/surgeries6020041/s1. Figure S1: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist.

Author Contributions

A.H.: study design, conduct, analysis, and manuscript preparation. A.S.: study design, conduct, and presentation. S.W.: study design, conduct, and analysis. M.B.: study design, conduct, and analysis. E.J.D.: study design, analysis, and manuscript preparation. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Hanubal, K.S.; Chheda, N.N.; Dziegielewski, P.T. Neopharyngeal Stricture following Laryngectomy. Semin. Plast. Surg. 2022, 37, 31–38. [Google Scholar] [CrossRef] [PubMed]
  2. Harris, B.N.; Hoshal, S.G.; Evangelista, L.; Kuhn, M. Reconstruction technique following total laryngectomy affects swallowing outcomes. Laryngoscope Investig. Otolaryngol. 2020, 5, 703–707. [Google Scholar] [CrossRef]
  3. Landera, M.A.; Lundy, D.S.; Sullivan, P.A. Dysphagia After Total Laryngectomy. Perspect. Swallowing Swallowing Disord. Dysphagia 2010, 19, 39–44. [Google Scholar] [CrossRef]
  4. Piotet, E.; Escher, A.; Monnier, P. Esophageal and pharyngeal strictures: Report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur. Arch. Oto-Rhino-Laryngol. 2008, 265, 357–364. [Google Scholar] [CrossRef] [PubMed]
  5. Balfe, D.M.; Koehler, R.E.; Setzen, M.; Weyman, P.J.; Baron, R.L.; Ogura, J.H. Barium examination of the esophagus after total laryngectomy. Radiology 1982, 143, 501–508. [Google Scholar] [CrossRef]
  6. Abu-Ghanem, S.; Sung, C.-K.; Junlapan, A.; Kearney, A.; DiRenzo, E.; Dewan, K.; Damrose, E.J. Endoscopic Management of Postradiation Dysphagia in Head and Neck Cancer Patients: A Systematic Review. Ann. Otol. Rhinol. Laryngol. 2019, 128, 767–773. [Google Scholar] [CrossRef]
  7. Harris, R.L.; Grundy, A.; Odutoye, T. Radiologically guided balloon dilatation of neopharyngeal strictures following total laryngectomy and pharyngolaryngectomy: 21 years’ experience. J. Laryngol. Otol. 2009, 124, 175–179. [Google Scholar] [CrossRef]
  8. Sweeny, L.; Golden, J.B.; White, H.N.; Magnuson, J.S.; Carroll, W.R.; Rosenthal, E.L. Incidence and Outcomes of Stricture Formation Postlaryngectomy. Otolaryngol. Neck Surg. 2011, 146, 395–402. [Google Scholar] [CrossRef]
  9. Maejima, R.; Iijima, K.; Koike, T.; Ara, N.; Uno, K.; Hatta, W.; Ogawa, T.; Watanabe, K.; Katori, Y.; Shimosegawa, T. Endoscopic balloon dilatation for pharyngo-upper esophageal stricture after treatment of head and neck cancer. Dig. Endosc. 2014, 27, 310–316. [Google Scholar] [CrossRef]
  10. Zhang, T.; Szczesniak, M.; Maclean, J.; Bertrand, P.; Wu, P.I.; Omari, T.; Cook, I.J. Biomechanics of Pharyngeal Deglutitive Function following Total Laryngectomy. Otolaryngol. Neck Surg. 2016, 155, 295–302. [Google Scholar] [CrossRef]
  11. Petersen, J.F.; Pézier, T.F.; van Dieren, J.M.; van der Noort, V.; van Putten, T.; Bril, S.I.; Janssen, L.; Dirven, R.; Brekel, M.W.v.D.; de Bree, R. Dilation after laryngectomy: Incidence, risk factors and complications. Oral Oncol. 2019, 91, 107–112. [Google Scholar] [CrossRef]
  12. Stoner, P.L.; Fullerton, A.L.; Freeman, A.M.; Chheda, N.N.; Estores, D.S. Endoscopic Dilation of Refractory Postlaryngectomy Strictures: A Case Series and Literature Review. Gastroenterol. Res. Pract. 2019, 2019, 8905615. [Google Scholar] [CrossRef] [PubMed]
  13. Wu, P.I.; Szczesniak, M.M.; Maclean, J.; Graham, P.H.; Quon, H.; Choo, L.; Cook, I.J. Endoscopic dilatation improves long-term dysphagia following head and neck cancer therapies: A randomized control trial. Dis. Esophagus 2018, 32, doy087. [Google Scholar] [CrossRef] [PubMed]
  14. Farlow, J.L.; Birkeland, A.C.; Hardenbergh, A.; Lyden, T.; Brenner, J.C.; Shuman, A.G.; Chinn, S.B.; Stucken, C.L.; Malloy, K.M.; Moyer, J.S.; et al. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur. Arch. Oto-Rhino-Laryngol. 2020, 277, 1459–1465. [Google Scholar] [CrossRef]
  15. Schuman, A.D.; Birkeland, A.C.; Farlow, J.L.; Lyden, T.; Blakely, A.; Spector, M.E.; Rosko, A.J. Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy. Laryngoscope 2020, 131, 1229–1234. [Google Scholar] [CrossRef] [PubMed]
  16. Schimberg, A.S.; Wellenstein, D.J.; Schutte, H.W.; Honings, J.; Marres, H.A.M.; Takes, R.P.; Broek, G.B.v.D. Feasibility and Safety of Office-Based Transnasal Balloon Dilation for Neopharyngeal and Proximal Esophageal Strictures in Patients with a History of Head and Neck Carcinoma. Dysphagia 2021, 37, 93–98. [Google Scholar] [CrossRef]
  17. Cortina, L.E.; Wu, M.P.; Meyer, C.D.; Feng, A.L.; Varvares, M.A.; Richmon, J.D.; Deschler, D.G.; Lin, D.T. Predictors of multiple dilations and functional outcomes after total laryngectomy and laryngopharyngectomy. Head Neck 2023, 46, 138–144. [Google Scholar] [CrossRef]
  18. Forastiere, A.A.; Zhang, Q.; Weber, R.S.; Maor, M.H.; Goepfert, H.; Pajak, T.F.; Morrison, W.; Glisson, B.; Trotti, A.; Ridge, J.A.; et al. Long-Term Results of RTOG 91-11: A Comparison of Three Nonsurgical Treatment Strategies to Preserve the Larynx in Patients With Locally Advanced Larynx Cancer. J. Clin. Oncol. 2013, 31, 845–852. [Google Scholar] [CrossRef]
  19. Lazarus, C.L. Effects of chemoradiotherapy on voice and swallowing. Curr. Opin. Otolaryngol. Head Neck Surg. 2009, 17, 172–178. [Google Scholar] [CrossRef]
  20. Mendelson, A.H.; Small, A.J.; Agarwalla, A.; Scott, F.I.; Kochman, M.L. Esophageal Anastomotic Strictures: Outcomes of Endoscopic Dilation, Risk of Recurrence and Refractory Stenosis, and Effect of Foreign Body Removal. Clin. Gastroenterol. Hepatol. 2014, 13, 263–271. [Google Scholar] [CrossRef]
  21. Lew, R.J.; Kochman, M.L. A Review of Endoscopic Methods of Esophageal Dilation. J. Clin. Gastroenterol. 2002, 35, 117–126. [Google Scholar] [CrossRef]
  22. Urken, M.L.; Jacobson, A.S.; Lazarus, C.L. Comprehensive approach to restoration of function in patients with radiation-induced pharyngoesophageal stenosis. Head Neck 2012, 34, 1317–1328. [Google Scholar] [CrossRef]
  23. Paknezhad, H.; Borchard, N.A.; Lee, G.K.; Damrose, E.J. The Sternocleidomastoid Myocutaneous Flap: A Laryngeal Preservation Option for Total Hypopharyngoesophageal Stenosis. Otolaryngol. Neck Surg. 2019, 161, 186–189. [Google Scholar] [CrossRef] [PubMed]
  24. Penêda, J.F.; Fernandes, J.; Monteiro, E. Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy. Indian J. Otolaryngol. Head Neck Surg. 2022, 75, 485–491. [Google Scholar] [CrossRef] [PubMed]
  25. Lebo, N.L.; Caulley, L.; Alsaffar, H.; Corsten, M.J.; Johnson-Obaseki, S. Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: Analysis of a large multi-institutional patient cohort. J. Otolaryngol. Head Neck Surg. 2017, 46, 1–8. [Google Scholar] [CrossRef]
  26. Dedivitis, R.A.; Aires, F.T.; Cernea, C.R.; Brandão, L.G. Pharyngocutaneous fistula after total laryngectomy: Systematic review of risk factors. Head Neck 2015, 37, 1691–1697. [Google Scholar] [CrossRef] [PubMed]
  27. Cecatto, S.B.; Soares, M.M.; Henriques, T.; Monteiro, E.; Moura, C.I.F.P. Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: Systematic review. Braz. J. Otorhinolaryngol. 2014, 80, 167–177. [Google Scholar] [CrossRef]
  28. Timmermans, A.J.; Lansaat, L.; Theunissen, E.A.R.; Hamming-Vrieze, O.; Hilgers, F.J.M.; Brekel, M.W.M.v.D. Predictive Factors for Pharyngocutaneous Fistulization After Total Laryngectomy. Ann. Otol. Rhinol. Laryngol. 2014, 123, 153–161. [Google Scholar] [CrossRef]
  29. Casasayas, M.; Sansa, A.; García-Lorenzo, J.; López, M.; Orús, C.; Peláez, X.; Quer, M.; León, X. Pharyngocutaneous fistula after total laryngectomy: Multivariate analysis of risk factors and a severity-based classification proposal. Eur. Arch. Oto-Rhino-Laryngol. 2018, 276, 143–151. [Google Scholar] [CrossRef]
  30. Morton, R.P.; Mehanna, H.; Hall, F.T.; McIvor, N.P. Prediction of pharyngocutaneous fistulas after laryngectomy. Otolaryngol. Neck Surg. 2007, 136, 46–49. [Google Scholar] [CrossRef]
  31. Benson, E.M.; Hirata, R.M.; Thompson, C.B.; Ha, P.K.; Fakhry, C.; Saunders, J.R.; Califano, J.A.; Arnaoutakis, D.; Levine, M.; Tang, M.; et al. Pharyngocutaneous fistula after total laryngectomy: A single-institution experience, 2001–2012. Am. J. Otolaryngol. 2015, 36, 24–31. [Google Scholar] [CrossRef] [PubMed]
  32. Kim, Y.H.; Roh, J.L.; Choi, S.H.; Nam, S.Y.; Kim, S.Y. Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma. Head Neck 2019, 41, 3002–3008. [Google Scholar] [CrossRef]
  33. Kiliç, C.; Tuncel, U.; Cömert, E. Pharyngocutaneous fistulae after total laryngectomy: Analysis of the risk factors and treatment approaches. B-ENT 2015, 11, 95–100. [Google Scholar]
  34. Basheeth, N.; O’Leary, G.; Sheahan, P. Pharyngocutaneous fistula after salvage laryngectomy: Impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection. Head Neck 2014, 36, 580–584. [Google Scholar] [CrossRef] [PubMed]
  35. Formeister, E.J.; Alemi, A.S.; El-Sayed, I.; George, J.R.; Ha, P.; Knott, P.D.; Ryan, W.R.; Seth, R.; Tamplen, M.L.; Heaton, C.M. Shorter interval between radiation therapy and salvage laryngopharyngeal surgery increases complication rates following microvascular free tissue transfer. Am. J. Otolaryngol. 2018, 39, 548–552. [Google Scholar] [CrossRef] [PubMed]
  36. Lansaat, L.; van der Noort, V.; Bernard, S.E.; Eerenstein, S.E.J.; Plaat, B.E.C.; Langeveld, T.A.P.M.; Lacko, M.; Hilgers, F.J.M.; de Bree, R.; Takes, R.P.; et al. Predictive factors for pharyngocutaneous fistulization after total laryngectomy: A Dutch Head and Neck Society audit. Eur. Arch. Oto-Rhino-Laryngol. 2018, 275, 783–794. [Google Scholar] [CrossRef]
  37. Ismi, O.; Unal, M.; Vayisoglu, Y.; Yesilova, M.; Helvaci, I.; Gorur, K.; Ozcan, C. Stapler Esophageal Closure During Total Laryngectomy. J. Craniofacial Surg. 2017, 28, e35–e40. [Google Scholar] [CrossRef]
  38. Guimarães, A.V.; Aires, F.T.; Dedivitis, R.A.; Kulcsar, M.A.V.; Ramos, D.M.; Cernea, C.R.; Brandão, L.G. Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review. Head Neck 2015, 38, e2317–e2321. [Google Scholar] [CrossRef]
  39. Šifrer, R.; Aničin, A.; Pohar, M.P.; Žargi, M.; Pukl, P.; Soklič, T.; Strojan, P. Pharyngocutaneous fistula: The incidence and the risk factors. Eur. Arch. Oto-Rhino-Laryngol. 2016, 273, 3393–3399. [Google Scholar] [CrossRef]
  40. Cardoso, A.J.; Sandy, N.S.; Gomez, G.S.; Servidoni, M.d.F.; Lomazi, E.A.; Bellomo-Brandao, M.A. Factors associated with a higher number of esophageal dilations in children with a history of alkaline ingestion. Arch. Gastroenterol. 2024, 61, e23061. [Google Scholar] [CrossRef]
  41. Koufman, J.A. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): A clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991, 101, 1–78. [Google Scholar] [PubMed]
  42. Cocuzza, S.; Bonfiglio, M.; Chiaramonte, R.; Aprile, G.; Mistretta, A.; Grosso, G.; Serra, A. Gastroesophageal reflux disease and postlaryngectomy tracheoesophageal fistula. Eur. Arch. Oto-Rhino-Laryngol. 2012, 269, 1483–1488. [Google Scholar] [CrossRef] [PubMed]
  43. Smit, C.F.; Tan, J.; Mathus-Vliegen, L.M.H.; Devriese, P.P.; Brandsen, M.; Grolman, W.; Schouwenburg, P.F. High incidence of gastropharyngeal and gastroesophageal reflux after total laryngectomy. Head Neck 1998, 20, 619–622. [Google Scholar] [CrossRef]
  44. Gilmore, K.R.; Hutcheson, K.A.; Chapman, P.H.; Bi, W.; Goepfert, R.; Pytynia, K.B.; Rodriguez, M.A. Symptom profile of head and neck patients initiating care in a survivorship clinic. J. Clin. Oncol. 2022, 40, e24047. [Google Scholar] [CrossRef]
  45. Nilsen, M.L.; Mady, L.J.; Hodges, J.; Wasserman-Wincko, T.; Johnson, J.T. Burden of treatment: Reported outcomes in a head and neck cancer survivorship clinic. Laryngoscope 2019, 129, E437–E444. [Google Scholar] [CrossRef]
  46. Sellstrom, D.; Haighton, C.; Finch, T.; O’Hara, J.; Patterson, J.M. Assessment and management of late radiation-associated dysphagia after treatment for head and neck cancer: A scoping review and survey of UK speech and language therapists. Int. J. Lang. Commun. Disord. 2025, 60, e13154. [Google Scholar] [CrossRef]
  47. Stradling, E.J.; Barnhart, M.K.; Robinson, R.A.; Mogg, P.J.; Ward, E.C.; Smee, R.I. Implementing flexible endoscopic evaluationof swallow screening within annual cancer surveillance appoint-ments to monitor for late-stage radiation-induced dysphagia: A feasibility study. Head Neck 2024, 46, 615–662. [Google Scholar] [CrossRef]
  48. Ebersole, B.; McCarroll, L.; Ridge, J.A.; Liu, J.C.; Bauman, J.; Donnelly, S.; Galloway, T.J. Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic. Head Neck 2021, 43, 2124–2135. [Google Scholar] [CrossRef]
  49. Langmore, S.E.; McCulloch, T.M.; Krisciunas, G.P.; Lazarus, C.L.; Van Daele, D.J.; Pauloski, B.R.; Rybin, D.; Doros, G. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial. Head Neck 2015, 38, E1221–E1231. [Google Scholar] [CrossRef]
  50. Massonet, H.; Goeleven, A.; Steen, L.V.D.; Vergauwen, A.; Baudelet, M.; Van Haesendonck, G.; Vanderveken, O.; Bollen, H.; van der Molen, L.; Duprez, F.; et al. Home-based intensive treatment of chronic radiation-associated dysphagia in head and neck cancer survivors (HIT-CRAD trial). Trials 2022, 23, 893. [Google Scholar] [CrossRef]
  51. Van Daele, D.J.; Langmore, S.E.; Krisciunas, G.P.; Lazarus, C.L.; Pauloski, B.R.; McCulloch, T.M.; Gramigna, G.D.; Ma, B.P.M.; Wagner, C.W.; Mott, S.L. The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program. Head Neck 2019, 41, 606–614. [Google Scholar] [CrossRef] [PubMed]
  52. Lee, M.T.; Govender, R.; Roy, P.J.; Vaz, F.; Hilari, K. Factors affecting swallowing outcomes after total laryngectomy: Participant self-report using the swallowing outcomes after laryngectomy questionnaire. Head Neck 2020, 42, 1963–1969. [Google Scholar] [CrossRef] [PubMed]
  53. Lawrence, A.C.; King, S.; Renslo, B.; Sawaf, T.; Karadaghy, O.; Kraft, S. Functional Oral Intake in Primary Versus Salvage Laryngectomy. Otolaryngol. Head Neck Surg. 2024, 171, 756–763. [Google Scholar] [CrossRef] [PubMed]
Surgeries 06 00041 g001
Figure 1. PRISMA flow diagram.
Figure 1. PRISMA flow diagram.
Surgeries 06 00041 g001
Surgeries 06 00041 g002
Figure 2. Summative figure.
Figure 2. Summative figure.
Surgeries 06 00041 g002
Table 1. Cited studies.
Table 1. Cited studies.
Paper
Author/Year		Study Design
(Timeframe)		Literature
Quality		PatientsMale (%)Mean AgePrimary (P) vs. Salvage (S)
Laryngectomy 		Number of Patients Undergoing Dilation (%)
Harris et al., 2010 [7]Retrospective case series
(1989–2006)		Fair11217 (85%)64.59 (P); 6 (S)15 (13.4%)
Sweeny et al., 2012 [8]Retrospective cohort
(2003–2009)		Fair263214 (81%)59118 (P); 145 (S)45 (17%)
Maejima et al., 2015 [9]Retrospective cohort
(2010–2013)		Fair1918 (95%)66.317 (P); 2 (S)17 (89%)
Zhang et al., 2016 [10]Cross-sectional study
(2014–2015)		Good3123 (74%)68NS5 (16.1%)
Petersen et al., 2019 [11]Retrospective cohort
(2000–2016)		Fair477385 (81%)64193 (P); 211 (S)111 (23%)
Stoner et al., 2019 [12]Retrospective case series
(2013–2017)		Fair74 (57%)606 (P); 1 (S)7 (100%)
Wu et al., 2019 [13]Randomized controlled trial
(2013–2017)		Good2114 (66%)65.1NS11 (100%)
Farlow et al., 2020 [14]Retrospective case series
(2000–2018)		Fair3230 (70%)6132 (S)32 (100%)
Schuman et al., 2021 [15]Retrospective cohort
(1997–2016)		Fair233185 (80%)59.8233 (S)68 (39.2%)
Schimberg et al., 2022 [16]Prospective case series
(2018–2019)		Fair1010 (83%)72.25 (P); 5 (S)10 (100%)
Cortina et al., 2024 [17]Retrospective cohort
(2013–2022)		Fair21739 (80%)6519 (P); 30 (S) 49 (23%)
NS: not specified.
Table 2. Characteristics of total laryngectomy patients.
Table 2. Characteristics of total laryngectomy patients.
Total Number of Patients1421
Male:Female3.4:1
Mean age at TL, years64.1
Resection, n (%)
Sole primary treatment286 (20)
Salvage659 (46)
Primary followed by adjuvant treatment153 (11)
Reconstruction, n (%)
Primary1166 (82)
Locoregional86 (6)
Free flap169 (12)
Table 3. Dilational outcome by study.
Table 3. Dilational outcome by study.
Paper
Author/Year		Number of Patients Undergoing Dilation (%)TechniqueSetting
(Office vs. OR)		Mean Dilations
Per Patient
(Range)		Patients Requiring
≥1 Dilation (%)		Median Time from Laryngectomy to Dilation (Months)Complications (%)Overall Rate of Post-Dilation Complications
Harris et al., 2010 [7]15 (13.4%)BalloonOR2.25 (1–6)10 (75%)18None0 (0%)
Sweeny et al., 2012 [8]45 (17%)NSNSNS22 (45%) NSNone0 (0%)
Maejima et al., 2015 [9] 17 (100%)BalloonOR6.6 (1–30) 15 (88%)23.1Bleeding (6%)
Pharyngeal edema (6%)		2 (12%)
Zhang et al., 2016 [10]5 (16.1%)Bougie dilatorOR10NSNSNA
Petersen et al., 2019 [11]111 (23%)Bougie dilatorOR3 (1–113)84 (76%)9Perforation (5%)
Loss of voice prosthesis (5%)		12 (11%)
Stoner et al., 2019 [12]7 (100%)Bougie dilatorOR12 (7–48)7 (100%)14.5None0 (0%)
Wu et al., 2019 [13]11 (100%)Bougie dilatorOR3.5 (1–13) 27 (66%)NSThroat pain (4.76%)1 (9%)
Farlow et al., 2020 [14]32 (74%)NSNSNS19 (60%) 24NS0 (0%)
Schuman et al., 2021 [15]68 (29.2%)NSBothNS41 (60.3%) 10–15 NS0 (0%)
Schimberg et al., 2022 [16]10 (100%)Transnasal balloon Office2.2NSNSLocal infection (10%)1 (10%)
Cortina et al., 2024 [17]49 (22.5%)Bougie dilatorOR435 (71%) 8.6None0 (0%)
NS: not specified.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Halagur, A.; Sheth, A.; Wu, S.; Belsky, M.; Damrose, E.J. Pharyngeal Stenosis and Swallowing Dysfunction Following Laryngectomy: A Scoping Review. Surgeries 2025, 6, 41. https://doi.org/10.3390/surgeries6020041

AMA Style

Halagur A, Sheth A, Wu S, Belsky M, Damrose EJ. Pharyngeal Stenosis and Swallowing Dysfunction Following Laryngectomy: A Scoping Review. Surgeries. 2025; 6(2):41. https://doi.org/10.3390/surgeries6020041

Chicago/Turabian Style

Halagur, Akash, Amar Sheth, Shannon Wu, Michael Belsky, and Edward J. Damrose. 2025. "Pharyngeal Stenosis and Swallowing Dysfunction Following Laryngectomy: A Scoping Review" Surgeries 6, no. 2: 41. https://doi.org/10.3390/surgeries6020041

APA Style

Halagur, A., Sheth, A., Wu, S., Belsky, M., & Damrose, E. J. (2025). Pharyngeal Stenosis and Swallowing Dysfunction Following Laryngectomy: A Scoping Review. Surgeries, 6(2), 41. https://doi.org/10.3390/surgeries6020041

Article Metrics

Back to TopTop