Deglutition Function Research Articles

Esophageal substitution or esophageal elongation procedures in patients with complicated esophageal atresia? Results of a comparative study

BackgroundIn newborns with complex esophageal atresia, there are situations in which a primary anastomosis cannot be safely performed. The alternative is performing a late anastomosis after the esophageal ends have gone through a period of spontaneous growth or after elongations of the distant ends of the esophagus and create an anastomosis under tension which causes risks of morbidity. An alternative to the elongation procedures is to perform a cervical esophagostomy with a gastrostomy for nutritional support and later on an esophageal replacement. The purposes of this retrospective chart review study are to report on our experience with esophageal substitution procedures in such cases, address the quality of life of a group of patients, and compare our results with those of patients who underwent esophageal elongation procedures as reported in the literature. MethodsPatients with esophageal atresia underwent esophageal replacement procedures and quality of life was assessed in a group of esophagocoloplasty patients. ResultsFrom February 1978 to July 2019, 276 children (232 colonic interpositions and 44 total gastric transpositions) were studied; the most frequent complication was cervical anastomosis leakage [70 (30.2%) esophagocoloplasty patients and 7 (15.9%) gastric transposition patients], which sealed spontaneously in all but 4 patients. The quality of life was considered excellent or good in approximately 90% of the studied 70 out of the 276 patients; the comparison with the esophageal elongation procedures showed that esophageal substitution procedures promoted excellent long-term results with normal deglutition function (98.2% of patients, versus 33.3%, 36.5%, and 62.5%, respectively from the elongation series, P <0.0001 for all comparisons). ConclusionEsophagocoloplasty or total gastric transposition is a good alternative to treat patients with complex esophageal atresia. Type of studyRetrospective study. Level of evidenceLevel III.

Flip Technology for Assessing Esophageal Structural and Motor Disorders: a Skeptic's View.

Functional lumen impedance (FLIP) technology has become commercially available to assess structural and motor abnormalities of the esophagus. Increasing numbers of papers have described novel findings with this technology. This review examines the validity of the FLIP technique, how it compares with existing diagnostic modalities, and evidence to date on diagnostic accuracy. FLIP studies require deep sedation at the time of endoscopy to complete. They assess a simulated state of esophageal obstruction in only a distal part of the esophagus rather than deglutitive motor function of the entire esophagus. The available normative dataset is small and not matched to the older age of patients typically being evaluated. The test-retest agreement in health and disease is unknown, as is the operator dependence on performing and interpreting findings. Studies to date have largely excluded patients with structural disorders, which FLIP cannot reliably distinguish from motor disorders. FLIP is an expensive technology that has been made clinically available without its true utility being established. For FLIP to be deemed a device ready for widespread clinical use, additional studies on validity, diagnostic accuracy, and outcomes need to be performed. Prospective clinical studies need to include all patients and assess the incremental cost-effectiveness of FLIP over more innovative use of existing technology, such as high-resolution manometry with provocative challenges.

Effect of double-leaf perforator free flap posterolateral calf peroneal artery on reconstruction of oropharyngeal anatomy after ablation of advanced oropharyngeal carcinoma

To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma. Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm2. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition). All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation (P &lt; 0.05). The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.

Relationship between the Possibility of Discharge to Home and Deglutition Function in Elderly Cardiovascular Disease Patients: A Retrospective Cohort Study

Relationship between the Possibility of Discharge to Home and Deglutition Function in Elderly Cardiovascular Disease Patients: A Retrospective Cohort Study

Obturator Prosthesis for Edentulous Hemi-Maxillectomy patients: A Case Study

The maxillary tumors include various histological entities which are the subject of a very particular treatment. Clinical, radiological and anatomopathological criteria are used to determine the diagnosis. In spite of the evolution of reconstructive surgical techniques and the development of microsurgery, the conventional obturator prosthesis is still in use nowadays. In this context, it must restore the main functions of chewing, phonation and deglutition and give the patient a satisfactory aesthetic appearance.

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Background: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.&#x0D; Methods: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.&#x0D; Results: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2–42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1–44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6–27.5).&#x0D; Conclusions: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

Clinical application of intermittent oral gastrogavage in aged patients with dysphagia

Objective To explore the clinical effects of intermittent oral gastrogavage in aged patients with dysphagia. Methods Totally 66 aged patients with dysphagia hospitalized in the Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital between May 2016 and February 2018 were selected using convenient sampling and divided into the treatment group and the control group according to the random number table. Patients in the control group received nasogastric tube feeding, while patients in the treatment group received intermittent oral gastrogavage. The degree of aspiration, the effects on deglutition function and nutrition were compared between the two groups. Finally, totally 60 patients in the treatment group (n=30) and the control group (n=30) completed the study. Results After 3 months, patients in the treatment group showed Class Ⅰ-Ⅱ aspiration, while 3 patients in the control group were found with Class Ⅲ or Ⅳ aspiration (Z=-3.227, P<0.05) . The rehabilitation efficiency of deglutition function of the treatment group was higher than that of the control group (Z=-3.158, P<0.05) . The serum albumin and the pro-protein of the treatment group was (47.17±3.28) g/L and (0.32±0.08) g/L respectively, both higher than those of the control group (t=-10.500, 3.677; P<0.05) . Conclusions Intermittent oral gastrogavage can enhance the patients' deglutition function, reduce their aspiration levels and improve their nutritional status, which is worth promoting in clinical practice. Key words: Dysphagia; Aged; Intermittent oral gastrogavage; Nasogastric tube feeding

Results of surgical treatment alone for primary subglottic carcinoma

Primary subglottic carcinoma is rare and surgery is the most common therapeutic strategy for Chinese patients with this disease. To retrospectively evaluate surgically treated primary subglottic carcinoma treated with surgery. Patients with primary subglottic carcinoma who initially underwent surgery from 2005-2010 were grouped by surgical procedures with or without laryngeal function preservation and reviewed. Of 1815 patients with laryngeal cancer, 23 had a subglottic origin. Of these, 21 initially underwent surgery; 12 had ‘early’ (stage I/II) disease, and nine had ‘advanced’ (stage III/IV) disease. The actuarial 5-year OS was 73.9% [95% confidence interval (54.1% ∼ 93.7%)] for patients with squamous cell carcinoma. Among patients with early disease, the 5-year OS and DFS were 80% for partial laryngectomy and 71.4% for total laryngectomy. Patients with advanced disease underwent total laryngectomy, and the 5-year OS and DFS were 62.5%. Satisfactory oncologic outcomes can be achieved with initial surgery. Patients with early disease who underwent partial laryngectomy had a comparable prognosis to those who underwent total laryngectomy; deglutition and speech function were maintained.

Application of double-leaf perforator free flap of posterolateral calf peroneal artery in repairing facial through-and-through defect after oral cancer oblation

Objective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation. Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies, including 4 cases of buccal mucosa carcinoma, 2 cases of maxilla osteosarcoma, 1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma, were recruited from May, 2016 to May, 2018. The flap was used to repair the facial defect of recruited patients. The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm, respectively. The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate, the skin, subcutaneous tissue and mucosa of the cheek. The radiotherapy was performed 1.0-1.5 months after the operation. The prognosis including appearance, mouth opening, and the functions of deglutition, and language were assessed. Results Through 3-18 months outpatient followed-up, all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention. The patients were satisfied with the facial appearance, mouth opening, and the functions of deglutition and language at the 6 months follow-up. The radiotherapy had no damage on the survival of the bilobed perforator flap. There was no recurrence or metastasis in follow-up. Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel, abundant tissues, flexible design and operating methods. Key words: Oral cancer; Through-and-through defect; Double-leaf perforator free flap; Peroneal artery; Repair

Deglutition function assessment combined with physiological indicators for evaluating the time of retention of gastric tube after tracheal stenosis in infants with congenital heart disease

Objective To explore the best time for indwelling gastric tube after tracheal stenosis in infants with congenital heart disease, so as to shorten the indwelling time and relieve the pain of children with tracheal tube. Methods A total of 50 infants with congenital heart disease combined with tracheal stenosis were divided into observation group (26 cases) and control group (24 cases) by the admission order. The observation group accepted swallowing function evaluation combined with physiological indicators to determine the timing of removal of indwelling gastric tube while the control group just conventionally evaluating swallowing function. Results The ICU retention time and total hospitalization days was (4.35±0.94), (23.15±4.92) d in the observation group, and (6.27±1.42), (27.42±6.43) d in the control group, and the difference between the two groups was statistically significant (Z=5.589, 2.621, P<0.05). The extubation time was (2.85±0.23), (4.50±0.27) days in the observation group and the control group, and the difference was statistically significant (χ2= 15.595, P<0.01). Conclusions Deglutition function assessment combined with physiological indicators for evaluating the time of retention of gastric tube after tracheal stenosis in infants with congenital heart disease could be more effective to reduce the occurrence of secondary intubation and postoperative complications,shorten the course of the disease, improve infants comfort level,promote postoperative recovery. Key words: Infant; Tracheal stenosis; Congenital heart disease; Gastric tube

Application of family empowerment program based on comprehensive geriatric assessment among geriatric patients with dysphagia

Objective To explore the effects of family empowerment program based on comprehensive geriatric assessment (CGA) on care readiness of main caregivers, patients' deglutition function and nutritional status among geriatric patients with dysphagia. Methods From January 2016 to June 2017, we selected 120 dysphagia patients and their 120 main caregivers of Nanjing Drum Tower Hospital as subjects by convenience sampling. All of the subjects were divided into control group (n=60) and experimental group (n=60) with the method of the random number table. Control group carried out routine nursing. On the basis of that in control group, experimental group applied family empowerment program based on CGA. The care readiness of caregivers, patients' deglutition function and nutritional status were compared between two groups. Results Through the course of study, a total of 13 patients quitted with 56 cases included in experimental group and 51 included in control group. After intervention, the scores of care readiness of main caregivers of experimental group and control group were (23.55±2.26) and (15.40±1.70) respectively with a statistical difference (t=-20.919, P<0.01) . The total effective rate of the deglutition function improvement of experimental group and control group were 85.71% and 68.63% respectively with a statistical difference (Z=-2.035, P<0.05) . Three months after intervention, blood albumin, hemoglobin and the score of mini nutritional assessment of experimental group were (34.360±1.978) g/L, (120.900±9.031) g/L and (7.450±1.638) respectively statistically superior than those of control group (t=29.586, 17.370, 6.049; P<0.05) . Conclusions Family empowerment program based on CGA can effectively improve care readiness of main caregivers among geriatric patients with dysphagia, the deglutition function and nutritional status of dysphagia patients. Key words: Aged; Comprehensive geriatric assessment; Family empowerment program; Deglutition disorders; Deglutition function; Nutritional status; Care readiness

Feasibility of carbon-ion radiotherapy for oral non-squamous cell carcinomas.

BackgroundThis study evaluated carbon‐ion radiotherapy (C‐ion RT) for oral non‐squamous cell carcinomas (non‐SCC).MethodsWe retrospectively obtained data from 74 patients who underwent C‐ion RT for oral malignancies between April 1997 and March 2016. The C‐ion RT was administered in 16 fractions at a total dose of 57.6 or 64.0 Gy (relative biological effectiveness).ResultsForty‐three patients had salivary gland carcinomas, 29 patients had mucosal melanoma, and 2 patients had other types of pathologies. The tumors were classified as T1‐T3 (24 cases), T4a (21 cases), or T4b (29 cases). The median follow‐up was 49 months. The 5‐year rates were 78.8% for local control, 36.2% for progression‐free survival, and 58.3% for overall survival. Although 10 patients developed grade 3 osteoradionecrosis after C‐ion RT, all patients maintained their mastication and deglutition functions after sequestrectomy and prosthesis placement.ConclusionC‐ion RT was effective for oral non‐SCC and had acceptable toxicities.

Definition

Definition Tim Cassedy (bio) As an enslaved teenager in Baltimore in the 1830s, Frederick Douglass kept hearing about something called "abolition"—a word whose meaning he did not know. "If a slave killed his master, set fire to a barn, or did anything very wrong in the mind of a slaveholder," he observed, "it was spoken of as the fruit of abolition. Hearing the word in this connection very often, I set about learning what it meant." He looked up abolition in a dictionary and found the definition: abolition. n.s.: The act of abolishing.1 Though technically unimpeachable, this definition was not helpful to Douglass. "Here I was perplexed," he noted drily some decades later, for "it left me in ignorance at the very point where I most wanted information—and that was, as to the thing to be abolished." When he eventually did learn the meaning of abolition, it was not from a definition but from context: he read a newspaper article advocating the "abolition of slavery" and realized that this was the "abolition" in question. Thus, Douglass pointedly observed, the newspaper "gave me the incendiary information denied me by the dictionary."2 Douglass was evidently familiar with the norm that if you don't know what a word means, you should look up its definition in a dictionary. This is far from the only imaginable strategy for learning the meanings of words, and as Douglass's experience illustrates, it's not always an effective one. Douglass doesn't specify how he learned to expect a dictionary to disclose the meaning of an unfamiliar word—but I acquired the same expectation, and I know where I learned it: it was taught to me in grade school, implicitly as well as overtly, and at least once in song. "Oh, the dic-dic-dictionary / is very necessary," trilled an old LP that played repeatedly in a classroom of my early childhood: Imaginary or contrary, any old word you've seen,estuary, dromedary: find out what they mean.3 [End Page 345] The lyrics make a dictionary out as a kind of key that can unlock hidden realms of knowledge. "Look inside if you've a mind / to learn the answers first," the song continues, rising to the preposterous conclusion that "it's the perfect book, you'll find, / to quench your mental thirst."4 Although I doubt very much that a dictionary has ever been the perfect book to quench any child's mental thirst, it is true that there are circumstances under which a choice definition can help you understand something you didn't understand before. But the lexicographical promise to help you understand coexists awkwardly with the overwhelming tendency of dictionary definitions to be at least as obscure as the words they ostensibly illuminate. Douglass was not the first to discover this irony. Already by the 1780s, Samuel Johnson's definition of the word network was proverbial for its un-helpfulness: "Any thing reticulated or decussated, at equal distances, with interstices between the intersections."5 The rhetoric of definitions is distinctive and peculiar, often involving the words "that which …," "one who …," "the quality or state of …," "belonging to or resembling …," and especially "of or pertaining to. …" Etymologically speaking, a definition is not an opening of meaning but a closing-off: a bounding, a hemming-in, a delimiting, a conferring of the "finitude" at the word's center. Ambrose Bierce would parody the self-obfuscating tendency of dictionary definitions in thirty years' worth of newspaper columns that he later compiled into The Devil's Dictionary (1911): eat, v. i. To perform successively (and successfully) the functions of mastication, humectation, and deglutition.6 Unlike a gloss, which is tasked with getting you close enough to a word's meaning that you can understand it, a definition is tasked with circumscribing that meaning and showing where it begins and ends, like a fence or hedgerow. The worth of doing this is not obvious unless you have been educated to value it—for example, via a recorded voice insisting in chorus after chorus that "the dic-dic-dictionary / is very necessary." When the psychologist A. R. Luria wanted Soviet peasants...

Appraisal of Function After Rehabilitation With Tongue Prosthesis.

Prosthetic rehabilitation following total glossectomy is very complex procedure from clinical as well as laboratory point of view. The basic objective of prosthodontic rehabilitation is to deliver a comfortable as well as esthetically suitable prosthesis, which restores the impaired speech and deglutition function. Prosthetic rehabilitation of patients after total glossectomy with tongue prosthesis to evaluate improvement in speech as well as swallowing function. Tongue prostheses were fabricated with high-temperature vulcanizing silicone and heat-polymerizing acrylic to restore the functions affected after surgical resection of tongue. Patient's speech was evaluated with Dr Speech software version 4. The speech software was used to assess different speech parameters such as maximum phonation time, fundamental frequency, intensity, jitter, and shimmer. Deglutition assessment was done subjectively by using a standardized questionnaire designed by the speech pathologist. Speech was recorded for assessment before prosthetic rehabilitation and 2 weeks after delivery of the tongue prosthesis. After analysis of various speech parameters frequency range was improved with prosthesis (ie, 172.19 Hz) as compared to without prosthesis (ie, 111.47 Hz). Speech intelligibility was improved with tongue prosthesis. Deglutition assessment revealed that patient's deglutition abilities were improved. Tongue prosthesis helps to improve speech and articulation in patients with total glossectomy. Apart from that deglutition capability is also significantly improved. Total glossectomy affects speech, mastication, and swallowing to a greater proportion. It may also lead to psychological impairment of the patient. Tongue prosthesis efficiently improves speech and deglutition abilities of the patient leading to a better quality of life.

Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: A pilot study

PurposeLee Silverman Voice Treatment (LSVT LOUD®) is an effective therapy for phonation in Parkinson's Disease (PD) but little is known about any additional spread of effects to swallowing and cough function. This pilot study examined the effect of LSVT LOUD on pharyngeal swallowing parameters and reflexive cough strength. MethodsTwenty participants (14 men, 6 women; mean 68years, SD3.5) with PD referred for LSVT LOUD with complaints of voice deterioration were recruited. Mean duration of PD was 6yrs., SD 3. Self-reported Eating Assessment Tool-10 scores ranging from 0 to 25 (normal<3). Prior to LSVT LOUD, 1-week post- and 6-months post-treatment, participants undertook a videofluoroscopic study of swallowing and aerodynamic measures of involuntary cough. ResultsAll participants completed the LSVT LOUD programme; 3 participants were lost to follow-up at 6-months. All participants made significant gains in average sound pressure level (dB SPL). Aspiration was not observed. Pharyngeal residue (p<0.05) and pharyngeal area at rest reduced (p<0.01) while maximal opening of pharyngoesophageal segment (PES) (p<0.05) and PES opening duration (p<0.05) significantly increased. There was a significant improvement in involuntary cough peak expiratory flow rate and peak expiratory flow rise time. All changes were maintained at 6-months. ConclusionLSVT LOUD demonstrates additional spread effects on pharyngoesophageal deglutitive function and involuntary cough effectiveness in people with mild PD referred with voice complaints. Consequently, LSVT LOUD has potential to provide additional benefits for swallowing safety and efficiency in this patient group.

Conduits for esophageal replacement: alternatives

Background: Native esophageal replacement after esophageal resection is a problem that has challenged the surgeons over a century. Conduit must be long enough to bridge between cervical esophagus and abdomen. It must have reliable vascular supply, so that it can perform its function of deglutition. Stomach, colon and jejunum all these are used since long. However, there are times when the stomach is unavailable for use as a conduit. It is in these instances that an esophageal surgeon must have an alternative conduit in their armamentarium. Present study is aimed to discuss technical aspects of stomach, colonic, interposition in 32 cases of benign and malignant pathology, we review recent literature with a focus on outcomes, advantages and disadvantages of all options.Methods: A retrospective study of 32 cases between 2009 to 2016 at teaching institute in central India. 32 cases of benign and malignant esophageal disease needing esophageal resection and replacement. The record of each patient was reviewed for age, gender, indication for esophageal resection, type of operation, indication for selection of conduit, morbidity and mortality. The patient’s gastrointestinal symptoms were graded as excellent, good, fair or poor. Survival was estimated by the Kaplan-Meier method using the date of operation as the starting point.Results: Study includes 24 males and 8 females, 25 cases cancer esophagus with 6 patients caustic stricture, 1 patient had radiation stricture. Gastric conduit was used in 29 patients while 3 patients had colonic interposition. No complications noted in colonic group, while cervical anastomotic leak along with cardiovascular and respiratory complications noted in 6 patients. Gastric replacement was less time consuming than colonic interposition. There was hospital mortality of 4 patients. There is no difference in survival of these patients whether you use gastric or colonic conduit.Conclusions: Clinical decision making in the treatment of esophageal cancer consists of balancing the risks of a particular treatment against potential benefits gained in survival and quality of life. The choice of conduit for reconstruction may have significant impact on the quality of life. Stomach is the most commonly used organ for replacement but when it is not available then colon can safely be used as an esophageal replacement.

Reconstruction of tissue defects after resection of tonsillar cancer by mandibular swing approach

Objective:To explore the reconstruction methods of oropharyngeal defects after resection of tonsillar cancer by mandibular swing approach.Method:Twenty four cases of patients with tonsillar carcinoma hospitalized in our institution from January, 2010 to December, 2015 were analyzed. Based on the degree and extent of tissue defects, they were divided into three categories.①Small defects, including loss of tonsillar fossa and pharyngeal arches; ②Moderate defects, including small defects of soft palate or tongue root besides lateropharyngeal defects; ③Large defects, including large defects of soft palate and tongue root besides lateropharyngeal defects. The tissue defects of 8 patients belonged to small defects, of whom 4 cases were repaired with mid-thick skin and the others were restored by radial forearm flaps. There were 5 cases of patients with moderate oropharyngeal defects after surgery of tonsillar carcinoma. These defects were reconstructed by radial forearm flaps(2 cases) and anterolateral femoral skin flaps (3 cases) respectively, while the remaining large defects of 11 patients were renovated using pectoralis major myocutaneous flaps(9 cases) and anterolateral femoral skin flaps(2 cases). Result:All the patients healed by first intention after surgery.Four transplanted skin grafts on the regions of small defects survived completely.5 cases of radial forearm flaps and anterolateral femoral skin flaps also survived well, whereas only one radial forearm flap suffered from vascular crisis leading to failure at 5 days postoperatively. The necrotic flaps were then removed by submaxillary space and oral cavity and the wounds were self-healed. The tissue defects were successfully repaired by pectoralis major myocutaneous flaps. Although the surgical wounds swelled, they were obviously relieved half a year later. In the tonsillar cancer patients encroached on soft palates, one occurred nasopharyngeal reflux and 3 spoke vaguely but understandably. The other patients' function of chewing, deglutition, respiration and speech were restored well. Conclusion:Small defects after resection by mandibular swing approach could be repaired by mid-thick skin or radial forearm flaps. Moderate defects of T3 tonsillar cancer could be restored using radial forearm flaps or anterolateral femoral skin flaps, while anterolateral femoral skin flaps or pectoralis major myocutaneous flaps could reconstructed the large defects of T3 or T4 tonsillar cancer.

Pediatric Eating Assessment Tool-10 as an indicator to predict aspiration in children with esophageal atresia

AimAirway aspiration is a common problem in children with esophageal atresia (EA). Pediatric Eating Assessment Tool-10 (pEAT-10) is a self-administered questionnaire to evaluate dysphagia symptoms in children. A prospective study was performed to evaluate the validity of pEAT-10 to predict aspiration in children with EA. MethodsPatients with EA were evaluated for age, sex, type of atresia, presence of associated anomalies, type of esophageal repair, time of definitive treatment, and the beginning of oral feeding. Penetration-aspiration score (PAS) was evaluated with videofluoroscopy (VFS) and parents were surveyed for pEAT-10, dysphagia score (DS) and functional oral intake scale (FOIS). PAS scores greater than 7 were considered as risk of aspiration. EAT-10 values greater than 3 were assessed as abnormal. Higher DS scores shows dysphagia whereas higher FOIS shows better feeding abilities. ResultsForty patients were included. Children with PAS greater than 7 were assessed as PAS+ group, and scores less than 7 were constituted as PAS− group. Demographic features and results of surgical treatments showed no difference between groups (p>0.05). The median values of PAS, pEAT-10 and DS scores were significantly higher in PAS+ group when compared to PAS- group (p<0.05). The sensitivity and specificity of pEAT-10 to predict aspiration were 88% and 77%, and the positive and negative predictive values were 22% and 11%, respectively. Type-C cases had better pEAT-10 and FOIS scores with respect to type-A cases, and both scores were statistically more reliable in primary repair than delayed repair (p<0.05). Among the postoperative complications, only leakage had impact on DS, pEAT-10, PAS and FOIS scores (p<0.05). ConclusionsThe pEAT-10 is a valid, simple and reliable tool to predict aspiration in children. Patients with higher pEAT-10 scores should undergo detailed evaluation of deglutitive functions and assessment of risks of aspiration to improve safer feeding strategies. Level of evidenceLevel II (Development of diagnostic criteria in a consecutive series of patients and a universally applied “gold standard”).

Formulación de criterios para registrar posición lingual en pacientes con deglución atípica mediante Glumap

Within everyday clinical setting in Colombia, it is difficult to access instrumental tests that allow the evaluator to truthfully determine the presence of atypical swallowing as these are sporadic and rarely permanents over a long period of time. The investigation’s objective was to determine the efficiency and efficacy of GLUMAP, as an alternative to conventional testing techniques, in diagnosing atypical and adapted swallowing. Theresearch involved the participation of 12 subjects between 11 and 25 years old, who used GLUMAP plates, three times each. Data were analyzed on a percentage basisand a statistical multivariate analysis. Although from the use of GLUMAP cannot determine a single criterion of gel behavior in people with atypical swallowing, one top of the fact that it allows professionals to track and determine treatment efficacy, this instrument can objectively measure the lingual behavior within the oral cavity after deglutition functions and therefore can be considered as a complementary tool in clinical practice

Biomechanics of Pharyngeal Deglutitive Function following Total Laryngectomy.

Postlaryngectomy, pharyngeal weakness, and pharyngoesophageal junction (PEJ) restriction are the candidate mechanisms of dysphagia. The aims were, in laryngectomees, whether (1) hypopharyngeal propulsion is reduced and/or PEJ resistance is increased, (2) dilatation improves dysphagia, and (3) whether symptomatic improvement correlates with reduced PEJ resistance. Multidisciplinary cross-sectional study. Tertiary academic hospital. Swallow biomechanics were assessed in 30 laryngectomees. Patients were stratified into severe dysphagia (Sydney Swallow Questionnaire >500) and mild/nil dysphagia (Sydney Swallow Questionnaire ≤500). Average hypopharyngeal peak (contractile) pressure (hPP) and hypopharyngeal intrabolus pressure (hIBP) were measured from high-resolution manometry with concurrent videofluoroscopy based on barium swallows (2.5 and 10 mL). In consecutive 5 patients, measurements were repeated after dilatation. Dysphagia was reported by 87%, and 57% had severe and 43% had mild/nil dysphagia. hIBP increased with larger bolus volumes (P < .0001), while hPP stayed stable and PEJ diameter plateaued at 9 mm. Laryngectomees had lower hPP (110 ± 14 vs 170 ± 15 mm Hg; P = .0162) and higher hIBP (29 ± 5 vs 6 ± 5 mm Hg; P = .156) than controls. There were no differences in hPP between patient groups. However, hIBP was higher in severe than in mild/nil dysphagia (41 ± 10 vs 13 ± 3 mm Hg; P = .02). Predilation hIBP (R(2) = 0.97) and its decrement postdilatation (R(2) = 0.98) well predicted symptomatic improvement. PEJ resistance correlates better with dysphagia severity than peak pharyngeal pressure and is more sensitive to bolus sizes than PEJ diameter. Both baseline PEJ resistance and its decrement following dilatation are strong predictors of treatment outcome. PEJ resistance is vital to detect, as it is reversible and can predict the response to dilatation regimens.