The integration of digital technology into medicine marks a new era, and dysphagia management is no exception. Videofluoroscopic swallowing studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) are commonly performed as standard assessments of swallowing function. VFSS is convenient for therapeutic assessment but lacks detailed structural resolution. FEES cannot assess oral function, aspiration or vocal fold movement during pharyngeal contraction.

Swallowing computed tomography (CT) visualizes four-dimensional swallowing dynamics by reconstructing continuous images acquired with a 320-row multidetector CT using dedicated software. The resulting dynamic images facilitate an intuitive understanding of structural changes in various regions. While swallowing CT offers clear dynamic imaging of structural changes, it also has limitations: high cost of the system and software, time-consuming reconstruction, and difficulty appreciating 3D anatomy due to 2D monitor display. To address these challenges, we developed, for the first time worldwide, a swallowing extended reality (XR) platform—comprising both virtual reality (VR) and three-dimensional visualization systems. These innovations enabled reduced reconstruction time, intuitive 3D visualization of structural changes, and significantly lower system costs.

Utilizing swallowing XR for swallowing CT and data visualization allows for the identification of conditions that were previously undetectable with conventional tests, providing more dynamic and spatial information than ever before. In this lecture, I will talk about swallowing CT and extended reality (ER)　system in clinical practice.

Swallowing disorders can be caused by a variety of etiologic factors, and the pathophysiology and findings of dysphagia in each patient are different. Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Surgical procedures for patients with severe dysphagia can be categorized into three types according to their purpose: tracheostomy to create a route for suctioning aspirated material and secretions from the lower respiratory tract through the trachea; swallowing function improvement surgeries to improve pharyngeal swallowing while preserving speech function; and aspiration prevention surgeries to prevent aspiration despite loss of speech function.

In Japan, aspiration prevention surgeries for patients with severe dysphagia have been practiced for more than three decades. Beyond total laryngectomy and laryngotracheal separation, various techniques have been developed. There are several types of aspiration prevention surgeries, such as removal of the larynx, altering the structure of the trachea, and closure of the larynx. Some of these procedures can be performed under local anesthesia, and certain methods have the potential to facilitate postoperative oral intake. However, worldwide recognition of aspiration prevention surgery is still limited.

In my practice, I determine the surgical approach based on a multifaceted assessment, including the patient’s primary diagnosis, systemic condition, anatomical features, and swallowing function. Voice loss and reduced olfactory function are common concerns following aspiration prevention surgery. In addition to postoperative swallowing rehabilitation, I also provide patients with guidance on alternative voice training and olfactory rehabilitation. This lecture will focus on patient-tailored aspiration prevention surgeries designed to enhance patients’ quality of life, drawing on my extensive surgical experience.