Speech and Swallowing Outcomes of Surgically Managed Cervical Chordoma: A Case Series

Alice C Yu; Myungjun Ko; Albert Y Han; Maie St John; Dinesh K Chhetri

doi:10.1002/lary.31418

Speech and Swallowing Outcomes of Surgically Managed Cervical Chordoma: A Case Series

Laryngoscope. 2024 Mar 28. doi: 10.1002/lary.31418. Online ahead of print.

Authors

Alice C Yu¹, Myungjun Ko¹, Albert Y Han², Maie St John^{1

3}, Dinesh K Chhetri^{1

3}

Affiliations

¹ Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles (UCLA), Los Angeles, California, U.S.A.
² Department of Head and Neck Surgery, University of Southern California (USC), Los Angeles, California, U.S.A.
³ University of California Los Angeles, Los Angeles (UCLA) Head and Neck Cancer Program, Los Angeles, California, U.S.A.

PMID: 38544468
DOI: 10.1002/lary.31418

Abstract

Objectives: Cervical chordoma is a rare, low-grade primary bone tumor occurring in the axial skeleton. Due to challenges in surgical exposure caused by anatomic location, patients may experience dysfunction in speech and swallowing. The objective of this study was to characterize speech and swallowing outcomes for patients undergoing surgical resection of cervical chordoma. Moreover, we detail in-depth two cases with similar initial presentations to compare prognostic factors and management strategies.

Methods: Eleven patients with histologically confirmed cervical chordoma treated between 1993 and 2020 were included in this retrospective case series. Outcomes measured included overall survival, disease-free survival, need for enteral feeds, as well as results of modified barium swallow study (MBSS) and fiberoptic laryngoscopy.

Results: The mean age at diagnosis was 55.9 years. The patient population was 81.8% male. Mean survival after diagnosis was 96 months. Four (36.4%) patients required post-operative MBSS and demonstrated aspiration. All four of these patients presented with tumors in the superior cervical spine and received surgeries utilizing anterior approaches. Of the four, 2 required enteral feeds long-term. Four (36.4%) patients endorsed dysphonia. One patient developed post-operative right vocal fold paresis. The remaining three patients experienced stable dysphonia pre- and post-operatively. Additionally, three (27%) patients required tracheostomy placement, two of which remained in place long-term.

Conclusions: Dysphagia is a common side effect of cervical chordoma resection. It is associated with the use of an anterior approach during resection and with tumors located in the superior cervical spine. Patients with postoperative dysphagia should receive early multidisciplinary swallow rehabilitation.

Level of evidence: 4 Laryngoscope, 2024.

Keywords: cervical chordoma; speech; swallowing.