Laryngotracheal reconstruction and swallowing: A review

Ha, Jennifer F.; Driver, Lynn E.; Zopf, David

doi:10.1016/j.ijporl.2017.09.015

Cited by 5 publications

(9 citation statements)

References 16 publications

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“…Short-term and long-term swallowing dysfunctions are well-described sequelae of airway reconstructive surgery. 8,10,11 Careful assessment of swallowing preoperatively and postoperatively is important to limit aspiration risk postoperatively. Willging et al have demonstrated that patients with tracheostomies, less than 2 years of age, and with multiple underlying diagnoses (particularly neurologic), have worse preoperative feeding assessments after airway reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children

et al. 2021

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Objectives/Hypothesis: Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG).Methods: Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes.Results: Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation.Conclusion: LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Short‐term and long‐term swallowing dysfunctions are well‐described sequelae of airway reconstructive surgery 8,10,11 . Careful assessment of swallowing preoperatively and postoperatively is important to limit aspiration risk postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children

et al. 2021

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“…Existing studies on dysphagia as a primary outcome of LTS and airway reconstruction have explored data such as duration of tube feeding post-reconstruction [ 16 ] and a clinician-rated scale to assess changes in swallowing function before and after surgery [ 11 ]. The clinical presentation and best practice management of dysphagia in this population has been reported in both the adult and paediatric literature [ 17 , 18 ]. There are no adult studies that have focussed on the biomechanical mechanism of dysphagia as a result of LTS or airway surgeries, however clinical experience shows that for the majority of patients significant dysphagia is short-term, and is related to a combination of reduced swallow efficiency and safety [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Not Just Dyspnoea: Swallowing as a Concern for Adults with Laryngotracheal Stenosis Undergoing Airway Reconstruction

et al. 2021

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Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient’s experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.

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“…This is due to the necessary disruption an LTR causes to the laryngeal framework as acknowledged in pediatric literature. [43][44][45] However, the current evidence base does not prove or disprove this theory, which limits the information available to patients prior to their surgery.…”

Section: Discussionmentioning

confidence: 99%

“…For example, it can be hypothesized that swallowing could be more adversely affected by an LTR procedure compared to CTR. This is due to the necessary disruption an LTR causes to the laryngeal framework as acknowledged in pediatric literature 43–45 . However, the current evidence base does not prove or disprove this theory, which limits the information available to patients prior to their surgery.…”

Section: Discussionmentioning

confidence: 99%

Voice and Swallowing Outcomes Following Airway Reconstruction in Adults: A Systematic Review

Clunie¹,

Roe²,

Alexander³

et al. 2020

The Laryngoscope

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Objectives Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery. Study Design Systematic review. Methods Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results A total of 143 abstracts were reviewed, with 67 articles selected for full‐text review. Twenty studies met the inclusion criteria. Data extraction was completed with the Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence‐Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non‐Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous, and there was limited information provided about rationale or reliability. Conclusions The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there are no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement. Laryngoscope, 131:146–157, 2021

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Laryngotracheal reconstruction and swallowing: A review

Cited by 5 publications

References 16 publications

Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children

Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children

Not Just Dyspnoea: Swallowing as a Concern for Adults with Laryngotracheal Stenosis Undergoing Airway Reconstruction

Voice and Swallowing Outcomes Following Airway Reconstruction in Adults: A Systematic Review

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