Duration and extent of dysphagia following pediatric airway reconstruction.
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.
Miller
Claire Kane
CK
Cincinnati Children's Hospital Medical Center, Aerodigestive Center/Interdisciplinary Feeding Team, United States. claire.miller@cchmc.org
Linck
Jessica
J
Willging
Jay Paul
JP
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000150:complications / Q000601:surgery*; D007830:Larynx / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D019651:Plastic Surgery Procedures; D015619:Respiratory System Abnormalities / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies