Esophageal regurgitation as a cause of dyspnea after thyroplastic surgery

Abstract

Objectives: Tracheostomy is performed on patients suffering from dyspnea after thyroplastic surgery. Such dyspnea is due to edema of the arytenoid mucosa or hematoma formation during immediate postoperative period. We encountered 2 patients with dyspnea after arytenoid adduction. This study was aimed to assess the respiratory and swallowing functions of the 2 patients and to compare the results with those of other patients following thyroplastic operations but without postoperative dyspnea. Methods: Two patients underwent resection of esophagus with reconstruction utilizing gastric tube, 1 and 2 years prior to arytenoids adduction. Both experienced dyspneic attacks 24 and 48 hours after surgery and underwent tracheostomy. Inspection of the larynx and videoflourography were performed. Twenty-two patients, who underwent thyroplastic operations received respiratory and swallowing function tests. The former included forced expiratory volume at one second (FEV1.0%), peak expiratory flow rate (PEFR), and airway resistance (Raw). Results: Two patients showed wide glottis and prominent retention and regurgitation of barium. Stoma was closed a few days later without sequelae. Their postoperative Raws were 53.1% and 144.4%. Respiratory function of the 22 patients revealed minimal changes in FEV1.0% postoperatively. Seventy-five percent of patients showed a mild decrease of PEFR postoperatively. Pre- and postoperative Raws in average were 73.2% and 84.3%, respectively. Conclusion: Thyroplastic operations have a mild effect in narrowing the glottis during respiration. However, this change is not significant to cause dyspnea after the surgery. Esophageal regurgitation should be kept in mind as a possible cause of relatively late-onset dyspnea, especially on postesophagectomy patients.