Flexible Laryngoscopy Research Articles

A Case of Transient Local Anesthetic Induced Bilateral Vocal Cord Palsy.

We report a rare case of bilateral vocal cord palsy following total thyroidectomy with successful extubation within 12 hours. The patient is a 33-year-old lady who underwent uneventful total thyroidectomy for compressive symptoms. Thirty minutes after extubation, she developed stridor and the flexible laryngoscopy showed bilaterally adducted vocal cords. The patient, thus, was reintubated and after 12 hours she met the extubation parameters and so she was extubated successfully. The repeated flexible laryngoscopy showed normal vocal cords. A review of the literature revealed limited information on this transient condition.

Management of Post-traumatic Laryngotracheal Stenosis: Our Experience.

To describe our experience in management of post-traumatic laryngo-tracheal stenosis by study of various surgical methods. To compare our results with different studies. To find out best surgical procedure. Retrospective study. 13 patients of LTS were analyzed within the period of 2009-2013 highlighting the important causes of stenosis, management based on type and severity of stenosis and outcome following the treatment given. Cases were diagnosed in detail with help of flexible laryngoscopy. Finer details of stenosis like site, length, associated injuries were studied with help of CT scan. Various modalities of treatment were used and outcome was assessed. There were 13 patients 9 males and 4 females. Of these 54% had iatrogenic stenosis and 46% had traumatic stenosis. 46% had true stenosis, remaining cases suffered from either soft stenosis or had associated injuries rendering the stenosis as a complex one. The patients underwent a combined surgical approach which included treatment modalities like T-tube insertion, endoscopic dilatation, laser, and open surgical intervention (tracheal resection and anastomosis). Of all the patient treated 69.2% were successfully decannulated and recovered well with a satisfactory airway outcome, (23.07%) cases remained T-tube dependent, 8% case died due to septicemia. It was evident that prolonged intubation remained most common cause of tracheal stenosis and the management varied depending on the type of stenosis. Simple soft stenosis could be managed well by endoscopic dilatation and laser while complete, complex stenosis required surgical intervention in form of T-tube stenting or open surgical intervention. Tracheal stenosis is a life threatening complication and difficult to manage. It requires multiple approaches and the successful outcome is assessed by patent airway and voice quality.

A Vocal Cord Polyp in a Pediatric Patient

Objective: To present a case of vocal cord polyp in a pediatric patient and discuss its differential diagnosis, assessment and management.
 
 Methods:
 Study Design: Case Report
 Setting: Tertiary Public Hospital
 Participant: One
 
 Results: A seven-year-old girl presented with hoarseness and a benign, unilateral mass seen at the junction of anterior and middle third of the vocal cord. The hoarseness resolved after excision, and histopathology confirmed an inflammatory vocal cord pseudo polyp.
 
 Conclusion: Vocal cord polyps occur infrequently in children and adolescents. These cases are seldomly seen and reported and may arise from chronic abuse of the larynx, vocal cord trauma or phonotrauma. Hoarseness is the most common presenting symptom. Differential diagnoses include recurrent respiratory papillomatosis, laryngeal cyst and laryngeal nodule. The management of vocal cord polyps involves surgical removal followed by speech therapy.
 Keywords: hoarseness, phonotrauma, vocal cord polyp, recurrent respiratory papillomatosis, vocal cord nodule, vocal cord cyst, flexible laryngoscopy, speech therapy

Acute vocal fold dystonic reaction to propofol: a case report

A 67-year old male underwent uneventful robotic-assisted thoracoscopic resection of a solitary pulmonary fibrous tumor. Immediately following extubation at the completion of the surgical procedure, the patient developed respiratory distress that did not resolve with treatment. Benadryl provided only temporary relief. Midazolam and hydromorphone were given for anxiolysis and analgesia respectively, which provided transient relief of symptoms. Propofol was given to decrease upper airway reflexes. Adequate reversal from nondepolarizing neuromuscular blockade was confirmed with nerve stimulator. A flexible laryngoscope was introduced nasally to visualize the vocal cords, which revealed intermittent tremulousness of the vocal cords, adduction of bilateral vocal cords to the midline, and minimal to absent opening with inspiration, without any apparent injury or blood, saliva, or vomit noted in or around the glottic opening. The patient was then given diazepam and reintubated. Given the patient's history of difficulty breathing after previous surgery and the lack of vocal cord movement, dystonic reaction to propofol was suspected. The patient remained intubated for two hours in the post-anesthesia care unit before being extubated uneventfully.

P112 Speech And Language Therapy By Skype For Vocal Cord Dysfunction And Chronic Cough

Introduction The Airways Service at Royal Preston Hospital receives tertiary referrals from across the UK. When a diagnosis of vocal cord dysfunction (VCD) or chronic cough is made and speech and language therapy (SLT) required, patients undergo weekly therapy (minimum four sessions), which some may struggle to attend due to pre-existing commitments and/or travel time. As SLT typically does not require ‘hands-on’ therapy we felt that Skype™ videoconferencing may be a useful mode of treatment delivery. We present our initial experience of this service. Methods A six-month pilot was completed whereby patients were offered SLT over Skype. Prior to therapy all patients were seen by the respiratory consultant and speech and language therapist for assessment and flexible laryngoscopy. Patients required confidential webcam access and proficiency. Symptom questionnaires were completed pre and post therapy (for VCD the 12 item VCDQ; for chronic cough the 19-item LCQ), and patient satisfaction questionnaires and flexible laryngoscopy performed post therapy. Results Eleven people have completed SLT over Skype™ to date, and all demonstrated improvement in symptoms following therapy. Patients with VCD showed a decrease in score on the VCDQ from median (range) 48 (12–53) pre therapy to 40 (7–42) post therapy [minimal clinical important difference (MCID) 5]. Patients with chronic cough showed an increase on the LCQ from median (range) 6.4 (4.6–8.2) pre therapy to 12.2 (10–14.6) post therapy (MCID 1.3). Improvements in laryngeal tension and sensitivity were noted in all cases. All patients gave positive feedback in their patient satisfaction questionnaire scoring “very satisfied” or greater. On three occasions Skype connection problems delayed sessions by a few days. Conclusions Virtual consultations provide the opportunity to treat patients in a more time efficient and practical way, and improvements in patient-reported symptoms and laryngeal appearances were similar to those of patients attending therapy sessions in chest clinic. This data gives support to pursue formalised tariffs for a specialised telehealth service. We feel that Skype should continue as a regular therapy option for patients and other members of the multi-disciplinary team (MDT) should consider this method of therapy delivery.

Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: A multi-institutional experience

Transcutaneous vocal cord ultrasonography (TVCUS) is a noninvasive study used to identify true vocal cord (TVC) mobility. Its sensitivity in predicting TVC paralysis when compared with indirect flexible laryngoscopy (IFL) ranges from 62 to 93%. This study aimed to evaluate the feasibility of surgeon-performed TVCUS in assessing TVC mobility in the outpatient setting. At 5 institutions, 510 consecutive patients underwent 887 TVCUS performed by 8 surgeons during initial surgical evaluation. IFL was obtained in selected patients. TVCUS was repeated during the first postoperative visit, and IFL was obtained only when judged necessary. Clinical parameters were collected and later correlated with TVC visualization. TVC visualization was possible in 688 of 887 TVCUS (77%); visibility ranged from 41 to 86% among performing surgeons. IFL was done in 81 patients (16%) and TVCUS predicted TVC paralysis in all cases when TVC were seen. TVC visualization was possible more often in females than males (83% vs 17%; P < .0005) and in patients without thyroid cartilage calcification than those with calcification (83% vs 42%; P < .0005). Experienced surgeon-ultrasonographers can use TVCUS to visualize TVC in most female patients and less so in males. TVCUS is highly sensitive, but operator dependent. This study demonstrates the feasibility of TVCUS and directs further attention to defining its optimal role in assessment of TVC mobility.

Intraoperative Vagus Nerve Monitoring: A Transnasal Technique during Skull Base Surgery.

Objectives Intraoperative vagus nerve monitoring during skull base surgery has been reported with the use of an oral nerve monitoring endotracheal tube. However, the intraoral presence of an endotracheal tube can limit exposure by its location in the operative field during transfacial approaches and by limiting superior mobilization of the mandible during transcervical approaches. We describe a transnasal vagus nerve monitoring technique. Design and Participants Ten patients underwent open skull base surgery. Surgical approaches included transcervical (five), transfacial/maxillary swing (three), and double mandibular osteotomy (two). The vagus nerve was identified, stimulated, and monitored in all cases. Main Outcome Measures Intraoperative nerve stimulation, pre- and postoperative vagus nerve function through the use of flexible laryngoscopy in conjunction with assessment of subjective symptoms of hoarseness, voice change, and swallowing difficulty. Results Three patients had extensive involvement of the nerve by tumor with complete postoperative nerve deficit, one patient had a transient deficit following dissection of tumor off of nerve with resolution, and the remaining patients had nerve preservation. One patient experienced minor epistaxis during monitor tube placement that was managed conservatively. Conclusions Transnasal vagal nerve monitoring is a simple method that allows for intraoperative monitoring during nerve preservation surgery without limiting surgical exposure.

English

INTRODUCTION: Congenital Laryngeal Cysts are a rare cause of neonatal airway obstruction. Most cases of the infants with Stridor are usually evaluated for laryngomalacia, croup, acute laryngotracheobronchitis and vocal cord paralysis. Flexible laryngoscopy in awake infant helps in identifying the cause for respiratory embarrassment. It can be easily managed once diagnosed. It will lead to high morbidity and mortality if one misses the true diagnosis. CASE PRESENTATION: A male infant aged 2 months was brought with the complaints of labored breathing since birth and developing Stridor since 3 days. Flexible awake laryngoscopy was done to diagnose the condition as Cyst of the Larynx. It was excised by micro laryngeal surgery. DISCUSSION: Various authors have classified the cysts of larynx depending upon their cell of origin, site of origin and its route of expansion. They are mainly ductal type and saccus type with or without endodermal elements. Treatment is either by endoscopic excision, marsupialization or excision through an external approach. CONCLUSION: Even though rare Cysts of larynx as a cause of infantile respiratory embarrassment should be kept in mind. Initial aspiration will confirm as well as help in intubation before undertaking micro surgery. Proper planning and total excision of the sac wall allowing the dependent drainage will avoid recurrence.

Time to Competency: Reliability of Flexible Transnasal Laryngoscopy by Resident Training Level

Objectives: Determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Methods: Prospective study of flexible transnasal laryngoscopy interpretations. Seventeen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally-recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class, and competency compared to attending interpretations. Results: Intraclass correlation of residents compared with attending physicians demonstrated significant improvements by year for left vocal fold immobility (ICC 0.85-0.96), right vocal cord immobility (ICC 0.80-0.97), subglottic stenosis (ICC 0.70-0.97), and level of concern (ICC 0.72-0.87). There were no trends for base of tongue abnormalities, pharyngeal abnormalities, pharyngeal masses, and hypopharyngeal masses. For vocal cord immobility, subglottic stenosis, and level of concern, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. Conclusions: Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by PGY-3 over key facets of the examination. Flexible laryngoscopy may be a useful metric for procedural competency assessment during residency training.

A Standardized Lingual Tonsil Grading System: Interexaminer Agreement

Objectives: Comparisons between studies involving the tongue base are limited by the lack of a universal system for grading lingual tonsils. The authors propose a new standardized grading system for lingual tonsil hypertrophy (LTH). Validation was assessed via an interexaminer agreement study. Methods: Video assessment: The proposed grading system consists of a 0 to 4 scale with: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covering entirety of the tongue base with limited vertical thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue &gt;1 cm in thickness (above tip of the epiglottis). A teaching video was created to demonstrate identification of this grading system. After viewing the teaching video, 8 trained otolaryngologists graded 25 video clips of the tongue base, recorded during flexible laryngoscopy. Live assessment: A second study was performed by 2 examiners directly examining the tongue base of 23 patients using flexible laryngoscopy during a routine clinic visit. Each examiner viewed and recorded the grade of the lingual tonsils independently. Results: Video assessment: The overall Fleiss kappa statistic was found to be κ = 0.449 ( P &lt; .0001). This value denotes moderate agreement. Live assessment: The overall kappa for nominal data were found to be κ = 0.8665 ( P &lt; .0001). This value denotes perfect agreement. Conclusions: The moderate interexaminer correlation demonstrated during video-assessment, and perfect interexaminer correlation demonstrated during live assessment, indicate that this proposed grading system may be a valuable and useful tool in creating a common language to describe lingual tonsils.

Noninvasive versus Rigid Endoscopic Evaluation of Upper Aerodigestive Tract in Penetrating Neck Trauma

Objectives: (1) Describe the effectiveness of current diagnostic modalities in diagnosing upper aerodigestive tract injuries. (2) Recognize the potential complications of rigid endoscopy in trauma patients. Methods: This is a retrospective chart review of patients admitted between January 1998 to May 2008 with penetrating neck trauma in all zones who underwent assessment with physical examination, barium swallow, computed tomography, and/or endoscopy. The sensitivity and specificity of these modalities were calculated and compared. Results: Physical examination appears to be unreliable due to poor sensitivity in this study. Direct laryngoscopy appears to be more sensitive than flexible laryngoscopy. Bronchoscopy was not frequently performed and 1 patient (2%) had tracheal repair diagnosed with rigid bronchoscopy. Rigid esophagoscopy was performed more commonly than flexible esophagoscopy. Both types of esophagoscopies detected the 2 (4%) esophageal injuries. Computed tomography scan was nonspecific due to presence of subcutaneous air in most patients. Barium swallow had a 100% negative predictive value in our study and did not miss any injuries. There were 5 patients (10%) who had postprocedure symptoms that can be potentially attributed to rigid endoscopy including teeth injury, and upper and lower extremity weakness and paresthesias. Conclusions: Barium swallow appears to be a reliable study which did not miss any significant injuries. Endoscopic studies, especially rigid ones, carry a risk of C-spine complications that should be recognized in trauma patients.

Predictors of Outcome in Angiotensin Converting‐Enzyme Inhibitor‐Induced Angioedema

Objectives: (1) Identify high-risk symptoms and anatomical regions involved in Angiotensin Converting-Enzyme Inhibitor-Induced Angioedema (AIIA) that may affect admission and placement, hospital length of stay, need for airway intervention, and clinical improvement versus deterioration. (2) Describe a clinical algorithm for the management and treatment of AIIA that would dictate placement of patients (ICU, general medical floor, observation unit, or discharge home), medical therapy, and the need for airway intervention (intubation or tracheostomy). Methods: A retrospective chart review of adult patients presenting to the emergency department (ED) at Detroit Medical Center diagnosed with AIIA from July 2010 to July 2013. Patients were followed from initial presentation until discharge. Descriptive statistics (frequency, means, and standard deviations) were calculated for all predictor, outcome, and control variables. Results: A total of 302 patients who were diagnosed with AIIA in the ED were evaluated with flexible laryngoscopy by an otolaryngologist. A total of 94% of patients were African American, with a slight female predominance of 63%. The most frequent presenting sign was lip swelling (62%). Angioedema confined to the lips was a negative predictor for airway intervention ( P &lt; .01). Also, patients with isolated lip swelling were less likely to have progression of symptoms ( P &lt; .05), and were less likely to require ICU monitoring ( P &lt; .05). Conclusion: This is the largest patient series to date of AIIA. Using the information from this study, a clinical algorithm was developed that details management of AIIA based on presenting signs and anatomic location, with otolaryngologists playing a vital role in the decision making process.

Office‐Based Resection of Large Vocal Process Granulomas

Objectives: (1) Describe techniques to appropriately anesthetize the larynx to facilitate complete resection of large granulomas in an unsedated patient. (2) Implement transnasal and transoral techniques to resect granulomas in conjunction with fiber-guided lasers. Methods: This is a retrospective review of patients undergoing resection of large symptomatic vocal process granulomas in the office environment. Three patients were treated with resection of granulomas with primarily transoral excision, with transnasal resection and laser ablation utilized as adjunct techniques. Botox injections were also used in a subset of patients to optimize healing. All procedures were documented with video. All patients received only topical anesthesia with no periprocedural sedation. Results: All patients had resolution of their granulomas or self-reported their vocal function to have returned to baseline after healing. Conclusions: Large vocal process granulomas can be treated in a single session in the laryngology procedure suite on the unsedated patient. An excellent outcome can be attained with readily available technology to include rigid endoscopy, flexible tranasal laser laryngoscopy, and Botox injections. Consideration should be given to treating these bulky granulomas in the office-based environment.

A New Coupling Device to Record Fiber‐Optic Laryngoscopies onto a Smartphone: A Pilot Study

Objectives: Evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded directly onto smartphones using a novel coupling device. Methods: Prospective, blinded study at a tertiary referral hospital. Inpatients requiring laryngoscopy underwent bedside flexible fiberoptic endoscopy. A smartphone was then attached to the endoscope using a novel coupling device and the same examination was recorded. The laryngologist performing the live examination documented their findings on a standardized scoring sheet. A second laryngologist, blinded to the findings of the first, evaluated the recorded examination using an identical scoring sheet. Results: Eighteen patients were evaluated from July 2013 to January 2014. Evaluation of airway patency was identical (Kappa 1.0, P &lt; .001). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa 0.687, P &lt; .001). There was no disagreement on the sidedness of the vocal fold involved (3 left, 1 right, 1 bilateral). There was 1 paretic-paralytic and 2 normal-paretic discrepancies. Subjective evaluation of the mucosa over each subsite showed moderate reliability (Kappa 0.515, P &lt; .001). Conclusions: There is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings of those examinations using a coupling device to transfer the recordings on to smart phones. Critical findings such as airway patency and vocal fold motion showed the highest correlation, subjective evaluation of the quality of the mucosa showed more variability.

Hoarseness After Metastatic Colon Cancer Treatment

Awoman in her 60s presented to the otolaryngology clinic with a 1-month history of hoarseness. Her medical history was significant for metastatic colon cancer for which she had received primary surgical therapy in 1999. She subsequently developed lungmetastases and was treated by her oncologist with different combinations of capecitabine, irinotecan, fluorouracil, leucovorin, and oxaliplatin. Following progression despite use of these agents, she received fluorouracil plus bevacizumab, an anti–vascular endothelial growth factor (VEGF) monoclonal antibody. One week after her third cycle of anti-VEGF treatment, she reported new-onset, rapidly progressive hoarseness. On examination, she exhibited severe dysphonia and flexible transnasal laryngoscopy revealed bilateral, symmetric, white membranous true vocal fold lesions sparing the anterior commissure (Figure). Vocal fold mobility was unaffected, but videostroboscopy demonstrated near-complete loss of bilateral mucosal waves. The patient was never a smoker, did not drink alcohol, and had no other symptoms indicative of laryngopharyngeal reflux. Empirical treatment with systemic antifungal therapy had no effect. What is your diagnosis? A B

Google Glass in Head and Neck Surgery

Objectives: (1) Implement the use of Google Glass in the operating room and in the office for teaching purposes and intraoperative consultations. (2) Recognize the potential for wearable technologies to maximally leverage the electronic medical record (EMR) as a platform to optimize communication between physicians and care for patients. Methods: Google Glass is a wearable camera with an optical head mounted display (OHMD) with voice control and internet connectivity via either wireless or Bluetooth-smartphone tethering. The OHMD was used for procedures including tonsillectomy, endoscopic nasal polypectomy, office-based vocal cord injection, and flexible transnasal laser laryngoscopy. Results: The smartphone technology was used to successfully broadcast the surgical procedures to consultant surgeons off-site as well as mentor resident physicians during procedures. Procedures were performed without complications on patients under general anesthesia as well as patients under local anesthesia without sedation. Conclusions: We report, to our knowledge, the first uses of Google Glass in head and neck surgery. This feasibility study will review potentials for Google Glass, including resident teaching and intraoperative consultations. We will address lessons learned thus far in optimizing the view obtained from the OHMD. We will also discuss implications of wearable technology in the hospital environment from the standpoint of the future of telemedicine, the consent process, and the potential for novel user interfaces with the EMR.

Emergency Airway Management for Pediatric Blunt Neck Trauma

Pediatric laryngotracheal injuries as a result of blunt neck trauma are exceedingly rare, but they have the potential for fatal consequences if not identified and managed appropriately. Two cases on the spectrum of laryngotracheal trauma are presented followed by an overview of pediatric laryngotracheal trauma with a focus on acute airway management. Special considerations must be taken into account when evaluating and treating children with laryngotracheal injuries. Standard orotracheal intubation by direct laryngoscopy is risky, and awake tracheostomy is often not feasible. Flexible or rigid bronchoscopic airway management is the preferred method of tracheal intubation prior to tracheostomy. The airway surgeon must be prepared to perform an efficient, emergency tracheostomy. In stable patients, flexible fiberoptic laryngoscopy is an important diagnostic tool in the evaluation of laryngotracheal injuries. After ensuring a secure airway, further goals of management are aimed at preserving normal laryngeal function: airway patency, voice, and swallowing.

Safety and Efficacy of Infant Transoral Flexible Laryngoscopy in the Office Setting

Objectives: The technique of transoral infant laryngoscopy was described a decade ago, but has not gained wide acceptance. We present a 10-year experience with the method as an alternative to transnasal examination in newborns and edentulous infants, focusing on practicality, safety, and quality of examination. Methods: We queried a prospectively accrued database of 22,000 office examinations to identify all transoral flexible laryngoscopy examinations performed from 2001 to 2011 by the senior author. Records were reviewed for patient age, indication for laryngoscopy, diagnoses, and adverse events. Results: One hundred forty infants, aged 2 days to 10 months, were evaluated. Fifty-seven patients were female and 83 were male. Stridor was the most common indication for laryngoscopy (90.7%) and 89 (63.6%) patients were diagnosed with laryngomalacia. The larynx was well seen in 99.3% of examinations. There were no episodes of airway obstruction or bleeding. Two children experienced emesis (1.4%). Conclusions: Transoral flexible laryngoscopy is a safe method for examining the infant larynx. It permits rapid, comfortable examination using a conventional-sized office fiberscope in most infants prior to dental eruption. It avoids the need for topical anesthesia, vasoconstrictors, sedation, or general anesthesia for most children. Office examination is not advised for infants with severe upper airway obstruction.

Factors Associated with Hypertrophy of the Lingual Tonsils

Objectives: Identify factors that may be associated with lingual tonsil hypertrophy (LTH). Methods: Retrospective chart review identified 380 patients from August 2013 to January 2014 with graded lingual tonsils, documented during routine flexible laryngoscopy. Lingual tonsils were graded using a 0 to 4 scale: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covers entirety of tongue base with limited thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue &gt;1 cm in thickness (above tip of epiglottis). Reflux symptom index (Reflux Symptom Index (RSI)–collected during patient intake), presence of obstructive sleep apnea (OSA; confirmed by polysomnogram), smoking habits, and basic demographics were gathered. Ï•2 and linear multi-variate regression analyses were used to identify significant correlating demographics with LTH. Results: Overall, 59.5% were male with a mean age of 50.2 ± 16.5 years and body mass index (BMI) of 30.1 ± 18.0. Ï•2 analysis revealed no significant relationship between OSA and LTH ( P = .059). When RSI was stratified to ≥10 or &lt;10, a Cochran-Armitage test supported the trend hypothesis that as RSI increases lingual tonsil grading increases. Significant univariate correlates included age ( r = –0.307, P &lt; .001) and smoking ( r = 0.186, P = .002). Multivariate regression revealed the combination of age and smoking ( r = –0.297, P &lt; .001) to be a significant correlate. Conclusions: LTH does not seem to be associated with OSA in this group of patients. Abnormal RSI may be a factor associated with increased lingual tonsil thickness. Younger patients who smoke are more likely to have LTH.

Long-term functional outcomes and quality of life after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer

Conclusions: Surgery for oral or oropharyngeal cancer with free-flap reconstruction is associated with moderate but persistent functional and quality of life (QoL) problems. Patient age, tumor stage, tumor site, and radiotherapy were the main predictors of functional outcome. Objectives: To evaluate long-term functional outcomes and QoL, and to determine their predictive factors in patients with oral or oropharyngeal cancer after oncologic surgery and free-flap reconstruction. Methods: Patients who underwent surgery with free-flap reconstruction for oral or oropharyngeal cancer between 2000 and 2009 who were alive at least 1 year after therapy were included in this study. Patients completed the Voice Handicap Index (VHI-10) questionnaire and the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30 and H&N35. Swallowing was evaluated using the Dysphagia Outcome and Severity Scale (DOSS) and by flexible fiberoptic laryngoscopy. Results: Sixty-four patients were included in the study. VHI-10 mean score was 11.2 ± 9 and its predictive factors were T stage (p = 0.005) and tumor involvement of the tongue base (p = 0.01). The mean DOSS score was 4 ± 0.8. Age (p = 0.008), gender (p = 0.04), and radiotherapy (p = 0.001) were the main predictive factors of the DOSS score.