Evaluation of the effects of primary myotomy in total laryngectomy on the neoglottis with the use of quantitative videofluoroscopy

Objective: To evaluate the influence of primary myotomy on characteristics of the neoglottis in patients after laryngectomy. Design: Patient survey. Setting: University Medical Center St Radboud, Nijmegen, the Netherlands. Patients: Nineteen consecutive patients who underwent laryngectomy (12 with primary lateral myotomy of the upper esophageal sphincter [marked by metal clips] 7 not requiring myotomy [according to intraoperative palpation]). Interventions: Videofluoroscopy. Main Outcome Measures; Visual assessments and quantitative measures of the neoglottis were used to study the relationships between myotomy, and anatomic and morphologic characteristics of the neoglottis. Results: Quantitative measurements showed no difference between the neoglottic characteristics of the patients with (n = 12) and without (n = 7) myotomy, who were all judged to have moderate (n = 4) or good (n = 15) voice quality. Results for the entire patient group during phonation showed only I single neoglottic bar, no hypertonicity of the neoglottis, and a significant shortening of the neoglottic bar (P = .007). Results for the my otomy group during phonation showed elevation of the caudal clip (P = .046), shortening of the myotomy (P = .01), and decreased overlap of the cranial clip and the neoglottic bar (P = .007). Furthermore, significant relationships were found between the various quantitative measures of the neoglottis and those of the myotomy. Conclusions: Quantitative videofluoroscopy enables study of the influence of myotomy on the anatomic and morphologic characteristics of the neoglottis. Our results suggest that a planned myotomy of the upper esophageal sphincter is beneficial when prosthetic voice rehabilitation is applied after total laryngectomy.