IALP 2025

Long-term Clinical Course of 7 Cases of Epiglottis Resection and Epiglottis Loss

Shinichi Taniai 1 M.D.,Ph.D. Koji Araki 1 M.D.,Ph.D. Kosuke Uno 1 Ph.D. Isamu Shibamoto 2 M.D.,Ph.D. Akihiro Shiotani 1
1Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Japan
2Graduate program of Rehabilitation Sciences, Seirei Christopher University, Japan

Background

The epiglottis is thought to invert and close the larynx during swallowing. However, its precise role in swallowing remains controversial. This study reports on the long-term clinical course of seven patients who underwent epiglottis resection or lost their epiglottis.

Methods

The subjects were patients who underwent transoral videolaryngoscopic surgery (TOVS) for epiglottis resection or had lost their epiglottis due to a disease and were followed up for more than six months at the department of otolaryngology between 2012 and 2023. Clinical course factors included age, number of days to start oral intake after epiglottis resection or loss, compensatory methods at the start of oral intake, Functional Outcome Swallowing Scale (FOSS) and Penetration-Aspiration Scale (PAS) at three months, observation period, and FOSS at the final observation.

Results

The study included three cases of supraglottic cancer, two of oropharyngeal cancer, one of laryngeal papilloma, and one of mucocutaneous ulcers. There were four male and three female patients, with a median age of 67 years (ranges: 33–86 years). The median time　to oral intake initiation post-surgery was 8 days. At the start of oral intake, three used the Supraglottic Swallow (SGS), three used neck lateral flexion, and one patient used both SGS and neck lateral flexion. At three months, four patients had a FOSS score of 0, while the remaining three had scores of 2, 3, and 5, respectively. The median follow-up was 38 months. At the final follow-up, five patients had a FOSS score of 0, while the remaining two had scores of 2 and 3. The final PAS scores were 1 in three patients, 2 in three patients, and 8 in one patient.

Discussion

Despite epiglottis resection or loss of epiglottis, most patients could resume oral intake relatively soon after surgery and maintain their preoperative dietary forms in the long term. However, some patients experienced fever and an increased inflammatory response during the course, requiring careful training and guidance.