Introduction: Functional outcome analysis following treatment of head and neck cancer is critical to understanding posttreatment quality of life and essential to accurately appraising reconstructive success. Although the body of qualitative investigation of swallowing after surgical reconstruction for head and neck cancer continues to grow, data showing the effects of postoperative reconstructive physiology on swallowing outcomes are scarce. Few studies use objective methods to analyze function, relying instead on traditional subjective, qualitative assessments and patient self-reports. Furthermore, such studies frequently provide little information regarding functional outcomes and postoperative changes in swallowing physiology, making it difficult to refine ablative and reconstructive techniques to improve functional outcomes.

Purpose: To describe an objective protocol for physiologic examination of swallowing function.

Methods: An objective protocol used at M. D. Anderson to assess swallowing function was developed based on 25 years’ experience evaluating and treating patients with head and neck cancer. This reproducible protocol delineates a procedural hierarchy that combines important physiologic indicators from bedside and modified barium swallow studies to determine swallowing efficiency and safety. The protocol is described and, to illustrate swallowing outcomes assessment, exemplified in a group of select patients with complex oro-mandibulo-maxillary defects repaired with the free vertical rectus abdominus myocutaneous (VRAM) flap.

Results: Our protocol objectively evaluates postoperative swallowing function in patients treated for head and neck cancer and identified numerous deficits in oropharyngeal swallowing physiology associated with outcomes. Of the patients in our example group, only 17% were able to return to a full oral diet after reconstruction. The protocol consistently identified impaired laryngeal excursion, specifically, elevation and anterior movement, in 100% of patients, resulting in risk for aspiration in all patients and frank aspiration in 83%. Of the patients who aspirated, 60% were desensate to it. Other physiologic findings related to poor swallowing function identified using our protocol were restricted base-of-tongue opposition to posterior pharyngeal wall (67% of patients), decreased epiglottic deflection (67%), and decreased pharyngeal motility (50%).

Conclusions: Unlike traditional assessments of swallowing dysfunction, our objective protocol scientifically evaluates swallowing physiology and allows for translation of outcome data to the development of new and improved surgical techniques to repair postoperative defects and preserve swallowing function.