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Original Investigation |

Dysphagia Following Airway Reconstruction in Adults

Christen J. Lennon, MD1; Alexander Gelbard, MD1; Carmin Bartow, MS2; C. Gaelyn Garrett, MD1; James L. Netterville, MD1; Christopher T. Wootten, MD1
[+] Author Affiliations
1Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
2Department of Speech and Language Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Otolaryngol Head Neck Surg. 2016;142(1):20-24. doi:10.1001/jamaoto.2015.2562.
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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.

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Duration of Dysphagia Symptoms Following Open Airway Reconstruction (After Stent Removal Where Appropriate)
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