{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T06:34:07Z","timestamp":1762842847485,"version":"build-2065373602"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pharyngeal fistula (PF), a critical complication in 10%\u201330% of total laryngectomy (TL) patients, delays recovery and increases healthcare costs. Current guidelines lack consensus on non-surgical prevention strategies, particularly nursing-led interventions. This study introduces an evidence-based structured swallowing training protocol integrating viscosity-modified diets, breath-holding exercises, and sensory stimulation, which was associated with reduced PF risk under systematic nursing supervision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center retrospective cohort study, 430 TL patients were enrolled: 220 received structured swallowing training initiated 10\u201314 days postoperatively (3\u00d7\/day for 4 weeks), while 210 received standard care. The intervention comprised (1) diet progression with dry swallowing exercises, (2) seated breath-holding to trigger glottic closure, (3) tongue resistance and laryngeal elevation, and (4) sensory stimulation (preoperative taste activation, intraoperative pharyngeal brushing, postoperative imagery). Primary outcomes were PF incidence and severity; multivariate logistic regression was used to identify independent predictors (adjusted OR, 95% CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Swallowing training was associated with a 34.2% lower PF incidence (10.0% vs. 15.2%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.034) and fewer severe cases (68.2% mild vs. 37.5%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.021). Multivariate analysis confirmed training as an independent protective factor (adjusted OR = 0.55, 95% CI = 0.32\u20130.95,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.031), while intraoperative blood loss \u2265 400 mL was an independent risk factor (adjusted OR = 1.75, 95% CI = 1.02\u20133.00,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.043). Adherence was high (84.1%), and protocol fidelity reached 98.6%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nursing-led structured swallowing training was independently associated with a 45% lower risk of PF after TL, providing a scalable and cost-effective rehabilitation framework that underscores the essential role of nursing in postoperative complication prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1632382","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T06:31:14Z","timestamp":1762842674000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between swallowing training after total laryngectomy and the incidence of pharyngeal fistula a retrospective study with nursing-related 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