by Katrina M. Jensen, Fort Worth, Texas, USA
Radiation fibrosis can also account for a stiffening and luminal narrowing of the esophagus. The esophagus is a long, tubal structure, comprised of both circular as well as longitudinal muscle fibers which contract in a persistaltic manner . Peristalsis is the serial, wavelike contraction that initiates at the top of the esophagus, squeezing downward, thereby moving the food/liquid into the stomach. This persistaltic activity begins in the body of the esophagus, once the opening, referred to as the cricopharyngeus or upper esophageal sphincter, closes following the influx of material into the esophagus. This closing initiates the peristaltic activity with each swallow of food material.
In the case of radiation fibrosis to the region, a narrowing or stricture can develop. In laryngectomees, this is particularly true in the upper or cervical esophagus, where radiation doses have been most concentrated. In these cases, the opening to the esophagus is often very limited, with reduced peristaltic activity in the region affected by fibrosis.
In these cases, it becomes very difficult to successfully pass larger volumes of food material, particularly solids, into the esophagus.
The descriptions above provide a general guideline as to the nature and potential problems that might be affecting a laryngectomized patient experiencing dysphagia. But a comprehensive evaluation by a clinician trained in the diagnosis and management of dysphagia in the head and neck cancer population is what is required to adequately diagnose the nature of the dysphagia. Once this is determined, appropriate treatment may be identified and pursued.