Ösophagusfunktionsszintigraphie (99mTc-DTPA) - Darstellung eines Verfahrens zur Diagnostik der Schlucksuffizienz von Patienten mit Oro- und Hypopharynx-Tumoren*,**

BACKGROUND: Today more than 60% of 65-year-olds complain of dysphagia or odynophagia. The aim of this study was to use esophageal scintigraphy as a means of estimating quantitative, reproducible, and comparable parameters of the swallowing ability in patients with tumors of the oropharynx and hypopharynx before and after surgery. Another group of patients suffering from larynx tumors was also examined prior to and following laryngectomy. METHODS: Fifteen male patients with T3/4 tumors of the oropharynx or hypopharynx, which were dissected followed by plastic surgery with a radialis flap, were examined before and after surgery. Esophageal scintigraphy was performed in 10 patients in this age group with T3/4 larynx tumors. The mean transit time (MTT in seconds) and clearance (in%) were the parameters evaluated. Condensed images were determined by averaging. Analog Polaroid images were also obtained. RESULTS: The 15 patients who underwent radialis flap surgery as a reconstructive measure showed a 60% improvement in the ability to swallow. Four of the 10 patients showed an obvious postoperative improvement in the ability to swallow as determined by clearance. With respect to the mean transit time, 2 cases out of 10 showed an improvement in the swallowing process. CONCLUSIONS: In patients who underwent reconstructive radialis flap surgery, it was possible to reestablish the continuity of the orohypopharynx, which is a prerequisite for the restoration of the swallowing facilitation. As a result one can expect an improvement in swallowing kinetics postoperatively. The patients who underwent laryngectomy required adaptation time to learn how to swallow under altered anatomical conditions. The primary reason for this is the altered pressure in the hypopharynx. Esophageal scintigraphy provides easily comparable parameters that serve as an ideal method for the objective determination of the ability to swallow in patients with these tumors. This method is neither poorly tolerated nor invasive and compared to other methods is a less costly alternative for examining the swallowing process.