Duration and extent of dysphagia following pediatric airway reconstruction

• Published in: International journal of pediatric otorhinolaryngology 2009-04, Vol.73 (4), p.573-579
• Main Authors: Kane Miller, Claire, Linck, Jessica, Willging, Jay Paul
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Dysphagia; Female; Humans; Infant; Laryngostenosis - complications; Laryngostenosis - surgery; Laryngotracheal reconstruction; Larynx - surgery; Male; Otolaryngology; Pediatric; Pediatrics; Postoperative Complications - diagnosis; Reconstructive Surgical Procedures; Respiratory System Abnormalities - complications; Respiratory System Abnormalities - surgery; Retrospective Studies; Subglottic stenosis
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2008.12.024

Summary Objective Patients who undergo open airway reconstruction procedures are likely to experience some degree of post-operative dysphagia. This retrospective review describes the duration of post-operative dysphagia and the use of compensatory strategies in a group of 30 pediatric patients. Methods A retrospective chart review of pediatric patients referred for post-operative swallowing assessment following airway reconstruction during a six-month period was completed. Age, sex, surgical procedure, stent type, co-morbid factors, duration of dysphagia, and use of compensatory dietary modifications and swallowing strategies was summarized and compared. Results Dysphagia was generally of short duration (1–5 days) in patients undergoing single stage procedures with anterior or anterior/posterior grafts. Duration of swallowing difficulty was increased in patients undergoing posterior grafts in combination with T tubes (10–14 days). The longest duration of difficulty (>2 weeks) occurred in patients who had anterior and posterior grafting with T tubes, combined with additional procedures such as vocal fold lateralization, epiglottic petiole repositioning, and/or arytenoidectomy. There was a greater likelihood of oral feeding difficulty post-operatively in patients presenting with pre-operative feeding issues such as oral aversion or specific texture refusal, and the pre-morbid need for supplemental tube feeding to supplement oral intake. Compensatory swallowing strategies were effective in decreasing aspiration associated with swallowing in oral feeders post-operatively, and in facilitating return to baseline swallowing skills. Conclusions The duration of dysphagia overall was increased in patients undergoing anterior/posterior grafts in conjunction with in-dwelling T tubes, especially when combined with additional procedures. Compensatory strategies to assist with swallowing were found to be effective in the post-operative phase and included the use of a modified supraglottic swallowing sequence to assist with compensatory airway closure during swallowing in conjunction with diet modifications. Post-operative feeding difficulty occurred in patients with pre-existing feeding issues such as oral aversion and/or texture resistance regardless of reconstructive surgical procedure type.