The results of this nonconcurrent cohort study suggest that dysphagia therapy with transcutaneous electrical stimulation is superior to traditional dysphagia therapy alone in individuals in a long-term acute care facility.

The sensitivity of the MEBDT in predicting aspiration among individuals in our cohort was 82%. The sensitivity was even higher (100%) when performed on persons receiving mechanical ventilation. These results support the use of the MEBDT as a screening tool for persons with a tracheotomy tube. The specific technique of performing the MEBDT is imperative, and the results of the study must be differentiated from other reports evaluating the MEBDT that use a different test protocol.

Objective: Fistula remains a common complication of upper aerodigestive tract reconstruction. Optimal timing of oral feeding is unknown and the impact of early feeding on swallow function and fistula rates remains controversial. The purpose of this study is to better understand the effects of "early feeding" on fistula rate and swallow in patients with free flap reconstruction of upper aerodigestive tract defects.Methods: Retrospective cohort study. One hundred and four patients undergoing free flap reconstruction of mucosalized head and neck defects. Two groups, early feeding (oral intake on or before postoperative day 5) and late-feeding (oral intake after postoperative day 5). Primary outcome was incidence of salivary fistula.Secondary outcomes included Functional Oral Intake Scale scores.Results: Fistula rate was 16.5% in late-feeding group and 0% in early-feeding group (P = .035). Patients who were fed early had an association with progression to a full oral diet by 30 days (P = .027).Discussion: This cohort analysis suggests that in properly selected patients with free flap reconstruction for mucosal defects, early feeding may not increase risk of salivary fistula and may improve swallow functional outcomes earlier.

Background Best‐practice guidelines for head and neck cancer patients advise postoperative radiation therapy (PORT) initiation within 6 weeks of surgery. We report our institutional experience improving timeliness of adjuvant radiation in free‐flap patients. Methods Thirty‐nine patients met inclusion criteria in the 2017–2019 study period. We divided into “Early” (n = 19) and “Late” (n = 20) time‐period groups to compare performance over time. The primary endpoint was time to PORT initiation, with success defined as <6 weeks. Results The number of patients achieving timely PORT improved from 10.5% in the Early group to 50.0% in the Late group (p = 0.014). Patients undergoing concurrent adjuvant chemoradiation were more likely to meet the PORT target in the Late group (p = 0.012). Conclusions We ascribe this quality improvement in free‐flap patients to increased communication among multidisciplinary care teams, proactive consultation referrals, and a targeted patient‐navigator intervention. Though work is needed to further improve performance, insight gained from our experience may benefit other teams.

Majority of the patients in both groups were of stage (TNM 7 th edition) IVa (54% in 3D CRT and 66% in Tomo) followed by stage IVb (10% in each group). Of the patients in 3D CRT, 56.7% received concurrent chemotherapy (95% cisplatin, 5% cetuximab) while 86.8% of Tomo group received chemotherapy (92% cisplatin, 8% cetuximab). In 3D CRT, 67.3% of the patients completed all 6 cycles of chemotherapy compared to that 74.6% in Tomo group. Response was achieved in 93.8% cases in 3D CRT and 97.1% cases in Tomo group. In 3D CRT, 17 patients recurred locally and 8 developed distant metastases as compared to 14 and 10 respectively in Tomo group. With a median follow up of 42 months (range: 1-83), 1year and 5-year disease-free survival were 80% and 63.7% in 3D CRT vs 88.1% and 77.1% in Tomo group. One-year overall survival and 5-year survival were 85.5% and 54.2% in 3D CRT group vs 85.3% and 62.1% in Tomo group. The incidence of acute toxicities was higher in Tomo group given the higher percentage of patients received concurrent chemotherapy. However, there was a trend of lower incidence of late toxicities in the Tomo group: bone necrosis (7 patients in 3D CRT vs 3 in Tomo, PZ.52), complete xerostomia (18 vs 8, PZ.24), and laryngeal cartilage necrosis (5 vs 1, PZ.40). A significant difference was observed in late swallowing dysfunction requiring intervention (27 in 3D CRT vs 5 in Tomo, PZ.02). Conclusion: There was no statistical difference in DFS and OS between two groups; however, we observed a trend of lower incidence of late toxicities in patients treated with Tomotherapy, with a significant difference in late swallowing dysfunction.