Background: Swallowing is normally initiated voluntarily, and afterwards presumed controlled by brainstem reflexes. Resection of the hypopharynx with reconstruction using a jejunal autograft may conceivably affect this control.
Purpose: This study was an attempt to perform a biomechanical analysis of the motility in the small bowel graft and suggest possible implications for surgery. We also tried to describe how passage through the esophagus is affected by this surgery and compare our objective assessment of the patient s swallowing function with the patient s subjective experience.
Material and Methods: Five patients underwent a radiological examination of the neopharyngeal conduit and esophagus and completed a questionnaire.
Results: We observed a peculiar movement of the base of the tongue in all patients with varying degrees of thrust. The passage through the jejunal graft was passive and dependent on the tongue and gravity. Graft contractions were observed late in transit and only emptied a residual volume. Esophageal transport also appeared to be rather passive and largely depended upon the pull of gravity. Two out of five patients were not able to eat without restrictions regarding the consistence of the food. Their impaired swallowing resulted in severely reduced quality of life.
Conclusion: Tongue thrust is essential for swallowing after pharyngolaryngectomy with reconstruction using a jejunal autograft. We report a distinct movement of the tongue in these patients, probably a compensatory mechanism for achieving propulsion of food. It seems important to implant the jejunal graft properly stretched to restore the funnel shaped opening to the esophagus as well as to avoid blind ends and bends in the jejunal conduit.