Background & aims: Dysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. This study aims at Identifying the risk factors for dysphagia in ICU patients with COVID-19 pneumonia requiring invasive mechanical ventilation, and at determining the frequency of postextubation dysphagia in this population. Methods: Observational, descriptive, retrospective, cohort study of SARS-CoV-2 pneumonia patients admitted into the ICUs from March to May 2020. The Modified Viscosity Volume Swallowing Test (mV-VST) was used to screening for dysphagia during the first 48 h of extubation in patients requiring mechanical ventilation. Descriptive statistics, univariate and multivariate analyses were conducted. A logistic regression was applied to construct a predictive model of dysphagia. Results: A total of 232 patients were admitted into the ICUs (age [median 60.5 years (95% CI: 58.5 to 61.9)]; male [74.1% (95% CI: 68.1 to 79.4)]; APACHE II score [median 17.7 (95% CI: 13.3 to 23.2)]; length of mechanical ventilation [median 14 days (95% CI: 11 to 16)]; prone position [79% (95% CI: 72.1 to 84.6)]; respiratory infection [34.5% (95% CI: 28.6 to 40.9)], renal failure [38.5% (95% CI: 30 to 50)])). 72% (167) of patients required intubation; 65.9% (110) survived; and in 84.5% (93) the mV-VST was performed. Postextubation dysphagia was diagnosed in 26.9% (25) of patients. APACHE II, prone position, length of ICU and hospital stay, length of mechanical ventilation, tracheostomy, respiratory infection and kidney failure developed during admission were significantly associated (p < 0.05) with dysphagia. Dysphagia was independently explained by the APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p ¼ 0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1) p < 0.001). The predictive model forecasted dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9). Conclusions: Dysphagia affects almost one-third of patients with SARS-COV-2 pneumonia requiring intubation in the ICU. The risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy, and poorer prognosis on admission (worst APACHE II score).

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Introduction: Minimally invasive transoral surgery for oropharyngeal cancer is a challenge for head and neck surgeons because of the inside-out anatomic presentation and the confined workspace. This study was performed to describe the main neurovascular and muscular landmarks in a transoral approach. The authors propose an anatomic stratification for this surgery. Materials and Methods: Lateral wall of the oropharynx and base of the tongue of 15 formalin-fixed heads (30 sides) and 5 fresh cadaveric heads (10 sides) sagittal sectioned were dissected from the inside outwards. Dissection of 7 fresh cadaveric heads via an endoscopic transoral approach was also performed. Results: The lateral oropharyngeal wall was divided into 3 layers from medial to lateral, based in the styloid muscle diaphragm. The first layer, medial to styloid muscles, includes the tonsillar vascularization and the lingual branch of the glossopharyngeal nerve. The second layer, lateral to constrictor muscles, includes the pharyngeal venous plexus, the glossopharyngeal nerve, and the lingual artery. The third layer, lateral to styloid diaphragm, includes the parapharyngeal and submandibular spaces, the carotid vessels and lingual, vagus, glossopharyngeal and hypoglossal nerves. The base of the tongue was divided into central and lateral parts, which contain the lingual artery and lingual branches of the glossopharyngeal nerve. The main landmarks to find the neurovascular structures in each layer are described. Conclusion: The authors propose an anatomic division, which helps to plan oropharynx and base of the tongue surgery. This anatomic stratification is useful to surgeons when performing a reconstruction of the oropharynx with a transoral approach.

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BACKGROUND. Severe SARS-CoV-2 pneumonia has brought intensive care units (ICUs) and the consequences of prolonged hospitalisation, such as dysphagia, into focus.METHODS. Study population: Patients with severe pneumonia due to SARS-CoV-2 who required admission to critical units from March to June 2020. Dysphagia diagnostic method: Modified Viscosity Volume Swallowing Test (mV-VST). Objectives. To identify risk factors for dysphagia in patients with severe SARS-CoV-2 pneumonia requiring invasive mechanical ventilation and determine their incidence. Statistical analysis: Descriptive analysis of means or medians according to the normality of quantitative variables and proportions for the descriptive variables (95% CI). Univariate analysis of dysphagia using simple logistic regression. Multivariate analysis and construction of a predictive model for dysphagia using logistic regression.RESULTS. Descriptive analysis. Sample size: 232 patients; 72% (167) required intubation. Of these, 65.9% (110) survived and 84.5% (93) underwent the mV-VST, which diagnosed 26.9% (25) with dysphagia. Age: 60.5 years (95% CI: 58.5 to 61.9). Men: 74.1% (95% CI: 68.1 to 79.4). APACHE II score: 17.7 (95% CI: 13.3 to 23.2). Mechanical ventilation: 14 days (95% CI: 11 to 16); prone position: 79% (95% CI: 72.1 to 84.6); respiratory infection: 34.5% (95% CI: 28.6 to 40.9). Renal failure: 38.5% (95% CI: 30 to 50). Overall mortality: 25.9% (95% CI: 20.6 to 31.9). Mortality in intubated patients: 34.1% (95% CI: 27.3 to 41.7). No patient diagnosed with dysphagia died. Univariate analysis. APACHE II, prone position, days of mechanical ventilation and need for tracheostomy, respiratory infection, kidney failure developed during admission and length of ICU and hospital stay were significantly associated (p<0.05) with dysphagia. Multivariate analysis. Dysphagia is independently explained by APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p=0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1; p<0.001). The resulting predictive model predicts dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9)CONCLUSIONS. Dysphagia affects almost one-third of patients, and the risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy and greater severity on admission (APACHE II score).

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