A patient with carcinoma of the supraglottis (T2N0M0) is being considered for a supraglottic laryngectomy. Which of the following pre-operative assessments is MOST critical to determine candidacy for this procedure?

• A Pulmonary function tests assessing aspiration tolerance (FEV1 > 50% predicted) ✓
• B CT scan confirming absence of thyroid cartilage invasion
• C Videofluoroscopic swallow study to assess baseline swallowing function
• D MRI orbit to exclude distant metastases

Explanation

Supraglottic laryngectomy removes the epiglottis and false cords, leaving the true vocal cords intact for voice. The critical post-operative challenge is aspiration, since the supraglottic protective mechanism is eliminated. Adequate pulmonary reserve (FEV1 > 50% predicted) is essential to allow the patient to cough and clear aspirated material without developing aspiration pneumonia. Patients with compromised pulmonary function are not candidates for this procedure and should receive radiotherapy or total laryngectomy instead.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.