Q18. When or how should oral intake resume post total laryngectomy?

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Q18. When or how should oral intake resume post total laryngectomy?

Summary

There are two level II studies, (one positive, one neutral quality), one level III-2 neutral quality, three level III-3 neutral quality and two level IV neutral quality which address commencement of early oral intake (from day 2 to day 7) versus delayed oral intake (from day 7 to day 14) post total laryngectomy. There is no evidence for other surgical procedures. The concept of early oral intake is not well defined in the literature as each study has different individual approaches as to how oral feeding should be introduced or progressed and also different tube feeding options. The level II positive quality study showed no significant difference in terms of length of stay and fistula rates [1]. The level II neutral quality study showed no difference in fistula rates and a reduction in length of stay in the early feeding group [2].

The level III-2 study also has similar findings although had no statistical data to support the findings [3], but the three level III-3 studies did [4][5][6].

The level IV studies are of little use here as there is no comparative data [7][8].

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Recommendation Grade
Early oral feeding post primary total laryngectomy (from as early as 1 day post op to 7 days) should be considered to reduce length of stay as there has been no difference in fistula rates compared to delayed oral feeding from >7 days.


However, there may be different variables of the patient and surgery that need to be considered by the team in this decision making, therefore collaboration with the multidisciplinary team including the surgeons and speech pathologist on how and when oral intake should be resumed and progressed is advised.

B

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References

  1. Seven H, Calis AB, Turgut S. A randomized controlled trial of early oral feeding in laryngectomized patients. Laryngoscope 2003 Jun;113(6):1076-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12782826.
  2. Rodríguez-Cuevas S, Labastida S, Gutierrez F, Granados F. Oral feeding after total laryngectomy for endolaryngeal cancer. Eur Arch Otorhinolaryngol 1995;252(3):130-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7662344.
  3. Prasad KC, Sreedharan S, Dannana NK, Prasad SC, Chandra S. Early oral feeds in laryngectomized patients. Ann Otol Rhinol Laryngol 2006 Jun;115(6):433-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16805374.
  4. Aswani J, Thandar M, Otiti J, Fagan J. Early oral feeding following total laryngectomy. J Laryngol Otol 2009 Mar;123(3):333-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18501033.
  5. Medina JE, Khafif A. Early oral feeding following total laryngectomy. Laryngoscope 2001 Mar;111(3):368-72 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11224763.
  6. Timmermans AJ, Lansaat L, Kroon GV, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Early oral intake after total laryngectomy does not increase pharyngocutaneous fistulization. Eur Arch Otorhinolaryngol 2014 Feb;271(2):353-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23625389.
  7. Eustaquio M, Medina JE, Krempl GA, Hales N. Early oral feeding after salvage laryngectomy. Head Neck 2009 Oct;31(10):1341-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19373787.
  8. Saydam L, Kalcioglu T, Kizilay A. Early oral feeding following total laryngectomy. Am J Otolaryngol 2002;23(5):277-81 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12239692.

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