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JAMA Otolaryngol Head Neck Surg. 2016 Jan;142(1):20-4. doi: 10.1001/jamaoto.2015.2562.

Dysphagia Following Airway Reconstruction in Adults.

Author information

1
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee.
2
Department of Speech and Language Pathology, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

IMPORTANCE:

Patients who undergo open airway reconstruction procedures are likely to experience some degree of postoperative dysphagia symptoms and delayed return to oral intake.

OBJECTIVE:

To review the duration of postoperative dysphagia symptoms and outcomes in a group of adult patients.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective review of the medical records of adult patients undergoing laryngotracheoplasty, posterior cricoid split laryngoplasty, tracheal resection, and cricotracheal resection in a tertiary hospital between July 2009 and September 2014.

EXPOSURES:

Laryngotracheoplasty, posterior cricoid split laryngoplasty, tracheal resection, and cricotracheal resection.

MAIN OUTCOMES AND MEASURES:

Demographic characteristics, etiology of airway stenosis, surgical procedure, stent type, and duration of dysphagia symptoms.

RESULTS:

Thirty-eight patients (14 men, 24 women; mean [SD; range] age, 48 [14.4; 20-80] years) fitting the inclusion criteria were identified. Twenty-four (63%) patients had laryngotracheal stenosis secondary to prolonged intubation, with 3 (8%), 5 (13%), and 6 (16%) cases being due to autoimmune, idiopathic, or other etiology, respectively. Twenty-five (66%) patients underwent tracheal or cricotracheal resection, and 13 (34%) underwent laryngotracheoplasty or posterior cricoid split laryngoplasty. Of the 17 patients with stents placed, 6 (35%) patients had a suprastomal stent sewn at the top with a polypropylene suture using a horizontal mattress technique, 6 (35%) patients had a suprastomal stent capped with an extended Silastic thoracic T-tube segment, and 5 (29%) patients had either a T-tube or hood bronchial stent. Eight of 17 patients used a nasogastric feeding tube while the stent was in place (up to 5 weeks). All patients returned to their preoperative diet. The mean (SD) duration of dysphagia symptoms in all patients (both those without a stent and following stent removal) was 8 (27.2) days (median, 1.5 days). The mean (SD) duration of dysphagia symptoms in patients who did not have a stent placed was 4.8 (5.3) days (median, 4 days).

CONCLUSIONS AND RELEVANCE:

In this study of adults who underwent open airway reconstruction, all returned to their preoperative diet, but those without stents had a shorter duration of dysphagia symptoms than those with stents. Approximately half as many patients with a stent had a prolonged course with dysphagia symptoms compared with those without a stent.

PMID:
26561927
DOI:
10.1001/jamaoto.2015.2562
[Indexed for MEDLINE]

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