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significantly better in patients where primary closure still was possible than in patients needing free flap reconstruction. The same influences (size and type of reconstruction) are seen with total laryngectomy. In completely removing the larynx in patients with advanced laryngeal tumours the anatomic structure of the neck is significantly altered, and the application of reconstruction tissue may severely impact the pharyngeal swallowing movement. Swallowing problems (such as reduced strength, duration and contraction of the upper oesophageal sphincter) caused by a laryngectomy have been described extensively, with prevalence ranging among the studies between 10 and 60% (Graner, Kanter et al. 1982, Crary and Glowasky 1996, Prim Espada, Rabanal Retolaza et al. 1996, Armstrong, Isman et al. 2001, Manikantan, Khode et al. 2009, Ward, Coleman et al. 2010, Lips, Speyer et al. 2015).\u000D5.3.1.2 Diagnostic procedures for dysphagia\u000DDysphagia in head and neck cancer patients may be measured with static or dynamic screening tools. Static screening tools are aimed primarily at the detection of structural disorders, such as mucosal abnormalities, development disorders, tumours and possible stenosis. Examples of static diagnostics are, a.o. CT scan, MRI and a Modified Barium Swallow. Dynamic screening tools are aimed at the detection of pathophysiological disorders in the dynamics of the swallowing function, such as aspiration, neuromuscular incoordination, speed of swallowing, laryngeal elevation, pharynx retraction and residue. An example of dynamic examination is videofluoroscopy, i.e. an X-ray study of swallow (Logemann, Roa Pauloski et al. 1992). Another way of evaluating the swallowing function is through a flexible scope (fiberoptic endoscopic evaluation of swallowing; FEES) optionally accompanied by sensory testing (FEES-ST), manometrics (Pauloski, Rademaker et al. 2009, Deutschmann, McDonough et al. 2013), or electromyography (EMG) of the swallowing muscles using surface electrodes or a pH meter. These diagnostic tools may be used independently, but they also work well in combination. In addition to the diagnostic procedures mentioned above, scintigraphy is sometimes used, as well as cine-MRI (Kreeft, Rasch et al. 2012, Lafer, Achlatis et al. 2013), ultrasound, or auscultation during the swallowing movement. Furthermore, tongue strength can be measured with devices such as the IOPI (Iowa Oral Performance Instrument), as is described in a review by Adams et al. (Adams, Mathisen et al. 2013).\u000DThe most commonly used method to examine the oropharyngeal swallow is the videofluoroscopy. The Penetration-Aspiration Scale (PAS) allows for the scoring of the level of penetration and aspiration (Rosenbek, Robbins et al. 1996). Furthermore, the Modified Barium Swallow Impairment Profile (MBS- imp) or the oropharyngeal swallow efficiency (OPSE) index can be used to assess the grade of dysphagia (Rademaker, Pauloski et al. 1994, Martin-Harris, Brodsky et al. 2008).\u000DIn addition to these objective diagnostic tools, subjective quality-of-life questionnaires have been developed to measure the effects of dysphagia on daily life activities. Two commonly used questionnaires for which the Dutch translation has been validated are the Swallowing quality-of-life questionnaire (SWALQol) (Rinkel, Verdonck-de Leeuw et al. 2009) and the MD Anderson Dysphagia Inventory (MDADI) (Speyer, Heijnen et al. 2011). The SWALQol was developed by McHorney et al. to map out the impact of swallowing impairments on patients\u2019 quality of life (McHorney, Bricker et al. 2000, McHorney, Bricker et al. 2000, McHorney, Robbins et al. 2002). The questionnaire consists of 44 items divided over 10 domains. All questions are scored on a five-point scale, whereby a score of 1 indicates no swallowing difficulty and a score of 5 indicates severe swallowing difficulty. The overall score ranges from 0 (no swallowing difficulties) to 100 (severe swallowing difficulties) with a cut-off score of 15 (a score of 15 or higher indicates dysphagia). The MDADI was developed in 2001 by Chen\u000D105\u000D