Postoperative Swallowing Function Research Articles

Extent of abscess development in cervical abscesses and pathogenic bacteria related to swallowing function

Background Deep neck infections (DNIs) in the cervical fascial planes can cause severe complications such as airway obstruction, mediastinitis, and sepsis. Aims/objectives This study examines cervical abscess development, its relationship with postoperative swallowing function, and hospital stay duration. Material and methods A retrospective case series of 55 DNI patients was divided by hospital stay (<30 days: Group A, ≥30 days: Group B) and swallowing recovery (<6 days: Group C, ≥6 days: Group D). Swallowing was assessed using FOIS; abscesses were categorized via CT and surgery. Results Longer hospital stays (Group B) were associated with tracheostomy (p = .027) and thoracoscopic mediastinal drainage (p = .038), shorter time between symptom onset and surgery (p = .016), and abscesses in the anterior cervical (p = .007), retropharyngeal space (p = .026), and mediastinal spaces (p = .002). Dysphagia (Group D) was linked to longer hospital stays (p = .006), more abscesses in the anterior cervical (p = .049) and retropharyngeal spaces (p = .009), and higher cases of intubated feeding (p < .001). Streptococcus constellatus was more prevalent in Group D (p = .04), whereas Staphylococcus aureus was less common (p = .043). Conclusions and significance Dysphagia is associated with abscesses in the anterior cervical and retropharyngeal spaces and higher Streptococcus constellatus prevalence, indicating delayed oral intake recovery. Thoracoscopic mediastinal drainage and shorter time to surgery were linked to prolonged hospital stays.

Evaluation of the effect of endoscopic CO₂laser arytenoidectomy on re-operation for failed posterior cordotomy

Objective:To analyze the efficacy of endoscopic CO₂ laser arytenoidectomy in treating bilateral vocal cord paralysis. Methods:Ninety-five patients who underwent endoscopic CO₂ laser arytenoidectomy for bilateral vocal cord paralysis at the First Affiliated Hospital of Naval Medical University（Changhai Hospital） of Shanghai from January 2009 to December 2022 were included in this study. Among them, 59 patients underwent endoscopic CO₂ laser arytenoidectomy as their first glottic enlargement surgery（Group A）, while 36 patients, who had previously undergone two unsuccessful CO₂ laser-assisted posterior cordotomies, underwent endoscopic CO₂ laser arytenoidectomy as a subsequent surgery（Group B）. Swallowing function, electronic laryngoscopy, perceptual voice evaluation, and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy. Results:The extubation rate after the first surgery was 84.75% in Group A and 86.11% in Group B, with total extubation rates of 94.92% and 94.44%, respectively. There were no significant differences between the two groups in preoperative and postoperative swallowing function, glottic size, or various voice evaluation indicators（P>0.05）. Within-group comparisons showed that postoperative swallowing function, glottic closure during phonation, perceptual evaluations of G（grade of hoarseness）, A（asthenia）, and B（breathiness） significantly worsened, with increased grades. The maximum transverse diameter of the posterior glottis during inspiration significantly increased, and the VHI-10 score was significantly higher postoperatively. Jitter, shimmer, and the harmonics-to-noise ratio significantly deteriorated, and maximum phonation time significantly shortened（P<0.05）. No significant differences were observed in postoperative R（roughness） and S（strain） compared to preoperative values（P>0.05）. Conclusion:Endoscopic CO₂ laser arytenoidectomy can impair voice quality to some extent but effectively alleviates breathing difficulties in patients with bilateral vocal cord paralysis. For patients who did not achieve successful extubation with CO₂ laser-assisted posterior cordotomy, endoscopic CO₂laser arytenoidectomy is an effective reoperative method, ensuring a high extubation rate while preserving certain voice functions.

The pathophysiology of dysphagia post-lung transplant: A systematic review.

One major consequence of lung transplantation is the development of oropharyngeal dysphagia. This systematic review aims to appraise and synthesize the available evidence of the use of instrumental assessments to outline the characteristics of post-lung transplant dysphagia. Following the identification of appropriate search terms for the question, a literature search was conducted in PubMed, Scopus, and the Health and Medical Collection of Proquest Research Library and included records between inception and September 14, 2023. Search strategies included the use of text words and subject headings (e.g., MeSH and Index terms) related to (1) dysphagia or swallowing (swallow*, deglutition disorder*), (2) lung transplant (lung transplant*, post-operative, post-lung), and (3) complications (adverse effects, *complications, treatment outcome). The literature search strategy yielded a total of 883 studies from the electronic database search, with no additional records identified through other sources. After the removal of duplicates (n = 96), a total of 787 studies were screened through title and abstracts which eliminated 775 studies. Six studies were ultimately included in the systematic review. The selected articles included patients who underwent lung transplantation and all but one study utilized a retrospective design. A lack of transparency regarding instrumental evaluation protocols (videofluoroscopic [VFSS] and Flexible Endoscopic Evaluation of Swallowing [FEES]) including the number and bolus types used during the instrumental evaluations appeared as a theme in the studies included. The Penetration-Aspiration Scale (PAS) was systematically utilized to measure dysphagia safety outcome. Handling of the PAS scale was not consistent across studies, however penetration or aspiration ranged from 52.4% up to 100%. Additionally, silent aspiration rates ranged from 14.2% to 61.9%. This review sought to describe the post-operative swallowing function and its physiological parameters following lung transplantation. We examined the results reported and the methods utilized in obtaining these results in the existing literature. Limited reporting practices for physiological parameters were found, however the airway invasion was reported in all studies with variation in degrees of swallowing safety related deficits, with PAS being the most widely used scale to describe airway invasion depth and response. Future studies exploring dysphagia outcomes post-lung transplant should comment on the altered physiological mechanisms of the swallow to further expand on the physiological deficits observed following transplantation in this group and allow for treatment planning. Level 1.

Adhesion Reduction Agent Guardix-SG® Versus MegaShield® for Postoperative Swallowing Function Analysis in Thyroidectomy Patients.

Antiadhesion products are essential for postoperative care in patients after thyroidectomy by providing a physical barrier to cover the exposed tissue and thus preventing abnormal adhesion of adjacent tissues. Since thyroidectomy may result in swallowing difficulties arising from damage or inflammation of the surrounding tissues, the use of antiadhesion agents such as MegaShield® or Guardix-SG® will help reduce scar formation. This may thus improve postoperative swallowing function in patients. Patients were enrolled and followed up between October 4, 2018, and March 26, 2020. Patients during the postoperative follow-up sessions were randomly allocated to the standard care with Guardix-SG® and clinical trial medical device application group with MegaShield® (test group) in a 1:1 ratio by the permuted block randomization method. Patient performance on penetration aspiration scale (PAS), National Institutes of Health-Swallow Safety Scale (NIH-SSS), videofluoroscopic dysphagia scale (VDS), Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) based on Videofluoroscopic swallowing study (VFSS) were collected. Nonadhesion-reducing agent patient data were used as a control group. No statistical significance was shown (P > .05) between the 2 groups of MegaShield® and Guardix-SG® in various phases from thick semisolid, thin semisolid to liquid for both PAS and NIH-SSS. Several statistical significances were reported in the results comparing various criteria of PAS, NIH-SSS, VDS at different oral and pharyngeal phases, and DIGEST in all 3 stages among MegaShield®, Guardix-SG®, and nonadhesion-reducing agent group. These results prove the noninferiority of MegaShield® compared with Guardix-SG® as an antiadhesion agent in postthyroidectomy care.

Significant enhancement of swallowing function and oral hygiene following multidisciplinary team nursing in tongue cancer patients after radical resection.

To determine the effects of multidisciplinary team (MDT) nursing mode on the swallowing function and oral hygiene in patients after radical resection of tongue cancer (TC). The data of 88 patients with TC treated in West China School/Hospital of Stomatology, Sichuan University were analyzed retrospectively. Among them, 42 patients who received routine nursing between February 2019 and February 2020 were assigned to a control group, and 46 patients who received MDT nursing between March 2020 and February 2022 were assigned to an observation group. The two groups were compared in the changes of postoperative swallowing function and oral hygiene, postoperative swallowing-related quality of life (QoL), and the survival rate for myocutaneous flap. The risk factors affecting swallowing function were analyzed through Logistic regression. After one month of nursing, the score of swallowing function decreased notably in both groups, with notably lower score in the observation group than that in the control group (P < 0.05). The control group exhibited notably lower oral cleanliness than the observation group after nursing (P < 0.05). Additionally, a notably lower survival rate of myocutaneous flap was found in the control group than that in the observation group (P < 0.05). The QoL scores of the two groups increased notably after nursing, and the observation group had notably higher QoL score than the control group (P < 0.05). The extent of glossectomy and nursing plan were independent risk factors impacting the recovery of swallowing function (P < 0.05). MDT nursing have a positive impact on oral hygiene as well as the swallowing function of patients after radical resection of TC, and MDT is a protective factor for swallowing function in the patients after radical resection.

Predictive value of intraoperative vagus nerve corticobulbar motor evoked potentials to assess the risk of dysphagia in fourth ventricle surgery.

Dysphagia is a significant complication in fourth ventricle surgery. Corticobulbar motor evoked potentials (CB-MEPs) of the lower cranial nerves may provide real-time information possibly correlating with postoperative swallowing dysfunction, and the vagus nerves may prove ideal for this purpose. However, the literature is heterogeneous, non-systematic, and inconclusive on this topic. The object of this retrospective study was to evaluate the correlation between CB-MEPs of the vagus nerve and postoperative worsening or new-onset swallowing deficits in intraaxial fourth ventricle surgery. In 21 consecutive patients undergoing surgery for fourth ventricle intraaxial tumors between February 2018 and October 2022, endotracheal tubes with two applied electrodes contacting the vocal cords were used to record vagus nerve MEPs including values at baseline, the end of surgery, and the minimum value during the operation. From the mean value of right and left vagus nerve MEP amplitudes, the minimum-to-baseline amplitude ratio (MBR) and final-to-baseline amplitude ratio (FBR) were calculated. These indexes were correlated with postoperative swallowing function. Given their clinical significance, receiver operating characteristic curves were obtained to evaluate the performance of these indexes in predicting postoperative swallowing function. The area under the curve (AUC) was 0.850 (p < 0.001) and the best cutoff for FBR was 67.55% for the worsening of swallowing in the postoperative period. The AUC was 0.750 (p = 0.026) and the best cutoff was 46.37% in MBR for the absence of a swallowing disorder at the late follow-up. This study confirmed that vagus nerve MEPs are reliable predictors of postoperative swallowing function in fourth ventricle surgery and can be feasibly used as an intraoperative monitoring technique.

Postoperative Swallowing Function in Patients with Deep Neck Infection

Introduction: Early detection of dysphagia risk, initiating rehabilitation, and resumption of appropriate diet based on swallowing function is important during deep neck infection (DNI) control. This study aimed to evaluate the extent of cervical abscess development, particularly in the deep neck space, and its relationship to postoperative swallowing function. Methods: A retrospective chart review was performed for all DNI cases treated between April 2015 and April 2021. Deep neck spaces were divided into categories based on computed tomography findings. Functional Oral Intake Scale (FOIS) scores of 4 or higher was defined as normal or slight swallowing disorder and 3 or lower as dysphagia. Results: Seventeen cases were included in the analysis. Based on FOIS, 14 cases were classified into the dysphagia group at 2 weeks after surgery, 11 cases at 4 weeks, and 8 cases at 8 weeks. There was no significant difference between the location of the abscess and dysphagia at 2 weeks after surgery. Patients with anterior cervical space abscess significantly increased dysphagia 4 weeks (p = 0.018) and 8 weeks (p = 0.036) after surgery. Conclusion: Abscess formation in the anterior cervical space may be associated with prolonged dysphagia after treatment due to inflammation and scarring of the muscles associated with swallowing.

Deglutition Assessment, Using Fiberoptic Endoscopic Evaluation of Swallowing in Patients underwent Frontolateral Laryngectomy

Objective: To assess the long-term deglutition in patients undergone frontolateral laryngectomy (FL) by fiberoptic endoscopic evaluation of swallowing (FEES) and to identify factors that might influence the swallowing outcomes of these patients Materials and Methods: A cross-sectional descriptive study in patients undergone FL between 2004 and 2014 with postoperative time of 6 months or more. Three parameters: premature spillage of material, retention/pooling of material, and the presence of penetration or aspiration were evaluated. All parameters were graded from one (severe) to five (normal). Results: Total of 36 patients, 31 male and 5 female, with mean age of 58±12.9 years were included in the present study. Twenty-nine cases (80.6%) presented with stage I glottis cancers and 7 cases (19.4%) presented with stage II glottis-subglottic cancers. For their treatment by surgery, 30 cases (83.3%) underwent FL and 6 cases (16.7%) underwent extended FL. Swallowing function was determined to be normal in 27 cases (75%), however, 6 cases (16.7%) had mild residue accumulation after food swallowing, whereas 3 cases (8.3%) had moderate symptoms of either minimal pharyngeal stasis plus unsafe airway or moderate pharyngeal residue accumulation. When considering each factor that may worsen post-operative swallowing function, the results suggested that there were significant associations with age of ≥65 years old (p=0.036), tumor stage II (p=0.049), and the presence of postoperative wound infection (p=0.012). Conclusion: In the present study, the authors confirmed that FL had minimal impacts on swallowing functions as the majority of patients who underwent FL recovered normal or near-normal swallowing function after 6 months as determined by FEES. However, long-term swallowing functions should be monitored especially in older patients (≥65 years of age), or patients with tumor stage II or postoperative wound infection. Keywords: Frontolateral laryngectomy; Glottic cancer; Fiberoptic endoscopic evaluation of swallowing; FEES; Penetration and aspiration; Deglutition

Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy.

Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.

Effectiveness of vocal fold medialization surgery on the swallowing function of patients with unilateral vocal fold paralysis.

Vocal fold medialization surgery is generally considered a phonosurgical procedure for improvement of vocal function in patients with glottic insufficiency. However, the literature describing this procedure for the management of dysphagia is limited. This study aims to assess the effects of medialization surgery on swallowing function in patients with unilateral vocal fold paralysis (UVFP). We enrolled 32 patients with UVFP undergoing vocal fold medialization surgery (medialization laryngoplasty combined with arytenoid adduction [ML + AA], 12 cases; injection laryngoplasty [IL], 20 cases). We assessed the aerodynamic vocal function including maximum phonation time and mean flow rate to evaluate glottal closure status. The Hyodo score determined by flexible endoscopic evaluation and Functional Oral Intake Scale (FOIS) were evaluated pre- and postoperatively. Almost 60% of patients with UVFP had dysphagia, and one-third were at high risk for aspiration. Aerodynamic parameters effectively improved after IL and ML + AA. With regard to swallowing, both the FOIS and total Hyodo score were significantly improved postoperatively. We found a particularly significant improvement in pharyngeal clearance. However, patients with high vagal nerve paralysis and postoperative insufficient glottal closure showed poor swallowing benefits after the interventions. In patients with recurrent laryngeal nerve palsy, there were no significant differences in postoperative swallowing function between the ML + AA and IL groups. Vocal fold medialization surgery was effective in improving swallowing function in most cases with UVFP, except for those with high vagal paralysis and insufficient postoperative glottal closure. Both IL and ML + AA showed an equivalent effect on swallowing improvement. 3b.

Preliminary experience of gasless transoral vestibular robotic thyroidectomy

Objective: To explore the feasibility and safety of the gasless transoral vestibular robotic thyroidectomy using skin suspension. Methods: The clinical data of 20 patients underwent gasless transoral vestibular robotic thyroidectomy in the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from February 2022 to May 2022 were retrospectively analyzed. Among them, 18 were females and 2 were males, aged (38.7±8.0) years old. The intraoperative blood loss, operation time, postoperative hospital stay, postoperative drainage volume, postoperative pain visual analogue scale (VAS) score, postoperative swallowing function swallowing impairment score-6 (SIS-6), postoperative aesthetic VAS score, postoperative voice handicap index-10 (VHI-10) voice quality, postoperative pathology and complications were recorded. SPSS 25.0 was used for statistical analysis of the data. Results: The operations were successfully completed without conversion to open surgery in all patients. Pathological examination showed papillary thyroid carcinoma in 18 cases, retrosternal nodular goiter in 1 case, and cystic change in goiter in 1 case. The operative time for thyroid cancer was 161.50 (152.75, 182.50) min [M (P25, P75), the same below] and the average operative time for benign thyroid diseases was 166.50 minutes. The intraoperative blood loss 25.00 (21.25, 30.00) ml. In 18 cases of thyroid cancer, the mean diameter of the tumors was (7.22±2.02) mm, and lymph nodes (6.56±2.14) were dissected in the central region, with a lymph node metastasis rate of 61.11%. The postoperative pain VAS score was 3.00 (2.25, 4.00) points at 24 hours, the mean postoperative drainage volume was (118.35±24.32) ml, the postoperative hospital stay was 3.00 (3.00, 3.75) days, the postoperative SIS-6 score was (4.90±1.58) points at 3 months, and the postoperative VHI-10 score was 7.50 (2.00, 11.00) points at 3 months. Seven patients had mild mandibular numbness, 10 patients had mild cervical numbness, and 3 patients had temporary hypothyroidism three months after surgery and 1 patient had skin flap burn, but recovered one month after surgery. All patients were satisfied with the postoperative aesthetic effects, and the postoperative aesthetic VAS score was 10.00 (10.00, 10.00). Conclusion: Gasless transoral vestibular robotic thyroidectomy using skin suspension is a safe and feasible option with good postoperative aesthetic effect, which can provide a new treatment option for some selected patients with thyroid tumors.

Partial Horizontal Supracricoid Laryngectomy: Which Factors Impact on Post-decannulation Swallowing Outcomes? A Prospective Single-Center Experience.

Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term.

A prospective evaluation of postoperative swallowing function and dysphagia following endoscopic laryngopharyngeal surgery.

Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery for superficial pharyngeal and laryngeal cancer, but dysphagia occasionally occurs post-treatment. We investigated dysphagia following ELPS and its risk factors. Of the 145 patients who underwent ELPS, 92 were evaluated in this study using the Hyodo score, Functional Outcome Swallowing Scale, Eating Assessment Tool-10 along with the total scores for the three items of the method of intake, time, and food preoperatively and on postoperative 1, 3, and 6months. We examined the 6-month trends of these values. Furthermore, the fasting period post-surgery, the need for swallowing rehabilitation by a speech therapist, and postoperative pneumonia episodes were set as outcomes reflecting the short-term swallowing function. We determined the associations between these outcomes and patient background factors. Postoperatively, the Hyodo score worsened at 1month but recovered at 3months. The Hyodo scores of all patients who underwent postcricoid ELPS did not worsen. The diameter of the resected specimen (DRS) was significantly associated with the need for swallowing rehabilitation and postoperative fasting time. A DRS ≥ 35mm was considered the threshold for the need of swallowing rehabilitation, postoperative pneumonia, and prolonged postoperative fasting time. ELPS exerts a temporal and limited impact on the swallowing function, which recovers within 3months in every swallowing evaluation. This necessitates additional care during the treatment of patients with mucosal defects ≥ 35mm, owing to the significant association between the DRS and short-term swallowing function.

Therapeutic effect on pyriform sinus carcinoma resection via paraglottic space approach.

To analyse the surgical indications, surgical efficacy and key influencing factors of prognosis of using a novel surgical approach for pyriform sinus carcinoma resection utilising the paraglottic space. From 2014 to 2017, 93 patients with squamous cell carcinoma originating in the pyriform sinus were resected through the paraglottic space approach. The postoperative laryngeal function preservation, complications, survival rate and prognostic factors were analysed. All patients were followed up for more than 5 years. The 2, 3 and 5 year overall survival rates of the patients were 77.2%, 61.6% and 47.4%, respectively. The univariate analysis of survival rate showed that primary tumour T stage and N stage had a statistically significant effect on the survival rate of patients (P = 0.047 and P < 0.001, respectively). Multivariate analysis with the Cox regression model revealed that N stage is an independent risk factor for postoperative survival (P = 0.042). The preservation rate of laryngeal function was 65.6% (61/93). Pharyngeal fistula incidence was 4.3% (4/93). Systemic distant metastasis and second primary cancer were found to be the main causes of death. As a novel surgical approach for the resection of pyriform sinus carcinoma, the paraglottic space approach can better expose the tumour, effectively improve the retention rate of laryngeal function, reduce the incidence of pharyngeal fistula and result in the better recovery of postoperative swallowing function with satisfactory long-term survival. N stage is an independent risk factor for postoperative survival.

The Early Effects of Longus Colli Muscle and Anterior Longitudinal Ligament Reconstructions on Swallowing Function after Anterior Cervical Surgery: A Six-Month Follow-Up Study.

Anterior cervical discectomy and fusion (ACDF) is the gold standard surgery used to treat cervical degenerative disease. Dysphagia and hoarseness are the two most common complications that occur after anterior cervical surgery (ACS). In this study, we aim to evaluate the early effects of longus colli muscle (LCM) and anterior longitudinal ligament (ALL) reconstructions on swallowing function after ACS. We recruited 91 patients (35 males and 56 females; mean age: 49.41 ± 8.60 years [range: 26-72 years]) who have undergone either ACDF or anterior cervical corpectomy and fusion (ACCF) between August 2019 and October 2021. Patients were divided into LCM and ALL suture group (Group A), and LCM and ALL non-suture group (Group B). Assessments of the incidence of dysphagia and the swallowing quality of life (SWAL-QOL) were completed in 2 days, 1 week, 1 month, 3 months and 6 months after surgery. Average prevertebral soft tissue thickness (APSTT) were measured on lateral cervical spine radiographs taken with X-rays 2 days, 1 month, 3 months and 6 months after surgery. In the 2-day, 1-week and 1-month postoperative follow-up, the incidence of dysphagia in group A was significantly lower than that in group B (p < 0.05), and the SWAL-QOL scores of group A were significantly higher than those of group B (p < 0.05). In the 3-month and 6-month postoperative follow-up, no significant differences were found between groups A and B in terms of the incidence of dysphagia (p > 0.05). In the 6-month postoperative follow-up, no significant differences were found between the groups in terms of SWAL-QOL scores (p > 0.05). There were no significant differences in APSTT between groups during postoperative follow-up (p > 0.05). The reconstructions of LCM and ALL in ACS can effectively improve short-term postoperative swallowing function.

Analysis of swallowing function after anterior/posterior surgery for cervical degenerative disorders and factors related to the occurrence of postoperative dysphagia

BACKGROUND CONTEXTDysphagia is one of the postoperative complications of cervical degenerative disorders. However, few studies have evaluated the pre- and postoperative swallowing function in detail. PURPOSETo analyze pre- and postoperative swallowing dynamics kinetically and investigate factors associated with postoperative dysphagia in patients with cervical degenerative disorders. STUDY DESIGNRetrospective review of prospectively collected data. PATIENT SAMPLEA total of 41 consecutive patients who underwent an anterior approach (anterior cervical discectomy/corpectomy and fusion (ACDF, ACCF), hybrid surgery (ACDF+ACCF) and total disc replacement) and 44 consecutive patients who underwent a posterior approach (laminoplasty and laminoplasty/laminectomy with fusion). OUTCOME MEASURESWe compared the pre- and postoperative functional oral intake scale (FOIS), dysphagia severity scale (DSS), esophageal dysphagia, anterior/superior hyoid movement, upper esophageal sphincter (UES) opening, pharyngeal transit time, bolus residue scale (BRS), and the number of swallows. METHODSVideofluoroscopy was performed on the day before surgery and within two weeks after surgery. Data related to age, gender, disease, surgical procedure, surgical site, operative time, and blood loss were collected from the medical records. Pre- and postoperative data were compared for each item in the anterior and posterior approaches. The odds ratio of dysphagia after an anterior approach was also calculated. RESULTSIn the anterior approach, DSS, FOIS, the anterior and superior hyoid movements, maximum UES opening, BRS, and number of swallows worsened postoperatively (p<.05, respectively). In the posterior approach, DSS, FOIS, the anterior hyoid movement, and BRS worsened postoperatively (p<.05, respectively). The factors associated with dysphagia were a proximal surgical site above C3 (OR: 14.40, CI: 2.84−73.02), blood loss >100 mL (OR: 9.60, CI: 2.06−44.74), an operative time >200 minutes (OR: 8.18, CI: 1.51−44.49), and an extensive surgical field of more than three intervertebral levels (OR: 6.72, CI: 1.50−30.07). The decline in swallowing function after the posterior approach was related to aging (p=.045). CONCLUSIONSEach approach may decrease swallowing function, especially because of the limitation on the anterior hyoid movement. Dysphagia after anterior approaches was associated with the operative site, operative time, and blood loss.

Long-Term Outcomes of End-Flexible-Rigidscopic Transoral Surgery for Pharyngolaryngeal Cancer.

End-flexible-rigidscopic transoral surgery (E-TOS) is a new and minimally invasive transoral surgery for resection of Tis-selected T3 pharyngolaryngeal cancers. We evaluated long-term oncological outcomes and whether postoperative voice and swallowing function were preserved following E-TOS. In this retrospective single-center study, 154 patients treated with E-TOS using a curved retractor, flexible-tip rigid endoscope, and thin curved instruments were included. Their survival rate, larynx preservation rate, and disease control rate were estimated using the Kaplan-Meier method. Postoperative voice function was evaluated using both objective and subjective tests. Postoperative swallowing function was assessed using the Hyodo score and the functional outcome swallowing scale. The 3-year and 5-year overall survival, disease-specific survival, disease-free survival, laryngectomy-free survival, local control, and loco-regional control rates post E-TOS were 89.8% and 82.2%, 95.6% and 92.3%, 78.5% and 70.3%, 87.2% and 80.9%, 93.9% and 92.5%, and 87.2% and 85.7%, respectively. Both objective and subjective postoperative voice and swallowing function tests were within normal limits in more than 90% of the patients. E-TOS is an effective, safe, low-cost, and minimally invasive transoral surgery for Tis-selected T3 pharyngolaryngeal cancer; it also preserves postoperative voice, larynx, and swallowing function. 4 Laryngoscope, 133:1415-1424, 2023.

Examination of Suprahyoid Muscle Resection and Other Factors Affecting Swallowing Function in Patients With Advanced Oral Cancer After Surgical Resection and Reconstruction.

Dysphagia is one of the most common adverse effects associated with oral cancer therapy and could greatly impair postoperative quality of life. The objective of this study was to analyze postoperative swallowing outcomes and factors influencing postoperative swallowing function in patients with advanced oral cancer who underwent primary reconstruction after surgical resection to identify patients at risk of experiencing severe dysphagia after immediate reconstruction of surgical defects, and to determine an ideal approach to provide appropriate perioperative interventions. The swallowing status was evaluated at 4 week postoperatively using the Functional Oral Intake Scale. We also analyzed the effects of patient, tumor, surgical, and other factors on postoperative swallowing function. The study included 67 patients. At 4 weeks postoperatively, 11 patients showed reduced swallowing function, whereas 56 patients showed good swallowing function. The number of resected suprahyoid muscles (odds ratio, 1.55; 95% confidence interval, 1.03-2.32; P=0.035) was an independent factor influencing postoperative swallowing function. Thus, among patients who underwent radical resection of oral cancer with primary reconstruction, those with extensive resection of the suprahyoid muscles were at higher risk of developing postoperative dysphagia. These findings are expected to facilitate increased vigilance for dysphagia, better counseling, and appropriate rehabilitation interventions.

Handgrip strength predicts early postoperative dysphagia after thoracoscopic-laparoscopic esophagectomy in male patients with esophageal cancer.

Dysphagia after esophagectomy, especially in the early postoperative period, remains a severe complication. The association between sarcopenia and dysphagia has received attention in geriatric non-cancer populations. This study aimed to determine the associations between sarcopenia parameters and early postoperative dysphagia after esophagectomy. This retrospective observational study included 201 consecutive male patients undergoing thoracoscopic-laparoscopic esophagectomy (TLE) for esophageal cancer between October 2018 and December 2020. We used three sarcopenia parameters: handgrip strength (HGS), skeletal muscle index, and gait speed. Postoperative swallowing function was assessed by videofluoroscopy using the penetration-aspiration scale (PAS; range 1-8). Logistic regression analyses were used to predict factors associated with postoperative aspiration (PAS 6-8). Furthermore, we compared values in patients with symptomatic aspiration (PAS 6-7) and with silent aspiration (PAS 8). Aspiration occurred in 38 of 201 patients (18.9%). On multivariate analysis, significant predictors of aspiration included age [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.05-1.17; p < 0.001], low HGS (OR 3.05; 95% CI 1.06-8.78; p = 0.039), upper third esophageal cancer (OR 2.79; 95% CI 1.03-7.54; p = 0.044) and recurrent laryngeal nerve palsy (OR 2.98; 95% CI 1.26-7.06; p = 0.013). Furthermore, among patients with aspiration (PAS 6-8), low HGS was significantly associated with silent aspiration (OR 6.43; 95% CI 1.06-39.00; p = 0.043). Low HGS was significantly associated with early postoperative aspiration and impairment of airway protective reflexes after TLE.

Risk Stratification of Dysphagia After Surgical Treatment of Hypopharyngeal Cancer.

ObjectiveHypopharyngeal cancer is managed by either surgical resection or radiation therapy-based treatment. In choosing the treatment modality, the patient’s swallowing function should be considered to achieve optimal treatment outcomes. This study aimed to stratify the risk factors predictive of postoperative dysphagia in hypopharyngeal cancer.Study DesignRetrospective study.SettingTertiary referral center.MethodsWe enrolled 100 patients who were diagnosed with hypopharyngeal cancer and underwent curative surgery between January 2010 and December 2019, and retrospectively reviewed their medical records.ResultsPostoperative dysphagia occurred in 29 patients (29%) who required a tracheostomy tube or percutaneous gastrostomy tube for feeding or preventing aspiration; additionally, the overall survival rate was lower in those patients than in those without dysphagia. The univariate analysis revealed that postoperative dysphagia was associated with clinical T stage (p = 0.016), N stage (p = 0.002), and surgical resection extent of the larynx and pharynx (p < 0.001). Patients who underwent total laryngectomy with total/partial pharyngectomy were more likely to have dysphagia than those in the larynx-preserving pharyngectomy groups (odds ratio [OR] = 3.208, 95% confidence interval [CI] 1.283–8.024, p = 0.011). Concerning the posterior pharyngeal wall (PPW), which has an important role in swallowing, patients who underwent resection of ≥1/2 of the PPW were more likely to have dysphagia (OR = 7.467, 95% CI 1.799–30.994, p = 0.003).ConclusionsSurgical resection extent was proportionally associated with dysphagia in hypopharyngeal cancer patients. Patients with smaller lesions but no laryngeal invasion had better postoperative swallowing function than patients with larger lesions or laryngeal involved lesions. Preserving the larynx and hypopharyngeal mucosa (especially the PPW) as much as possible can help preserve postoperative swallowing function.