title: Laryngopharyngeal dysfunction independent of vocal fold palsy in infants after aortic arch interventions.
abstract: OBJECTIVE
  Laryngopharyngeal dysfunction contributes significantly to morbidity, length of stay, and increased resource utilization after aortic arch interventions in infants. Previous studies have focused on postoperative evaluation of selected symptomatic patients with vocal fold palsy (VFP). A prospective evaluation of laryngopharyngeal function was undertaken to assess and determine its importance in perioperative management.
  
  
  METHODS
  A routine preoperative and postoperative assessment was done by flexible fiber optic laryngoscopy, oral feeding evaluation (OFE), and modified barium swallow (mBS) on 101 infants undergoing 113 procedures on the aortic arch (2003 to 2011). The primary outcome was the ability to take full nutrition orally at discharge.
  
  
  RESULTS
  Preoperative OFE was abnormal in 33.3% of patients. VFP occurred in 39.3%, 30 of 57 patients had an abnormal OFE. Factors predictive of abnormal postoperative feeding evaluation included genetic syndromes (odds ratio [OR], 5.1; confidence interval [CI], 1.1-23.2) and preoperative mechanical ventilation (OR, 24.1; 95% CI, 2.5-226.6). An abnormal postoperative OFE was highly predictive (OR, 7.0; 95% CI, 1.8-27.1) of an abnormal postoperative mBS. There was a trend toward decreased long-term survival among patients who were intubated or had an abnormal preoperative feeding evaluation (P = .07).
  
  
  CONCLUSIONS
  Postoperative laryngopharyngeal dysfunction is common among infants undergoing aortic arch interventions, and is largely independent of vocal fold function. Preoperative evaluation demonstrates significant intrinsic abnormalities in sensory and motor function. Routine, comprehensive, multimodality preoperative and postoperative evaluation is required to identify at-risk children and reduce morbidity and resource utilization.
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del; Thomas Jefferson University, Philadelphia, Pa. Electronic address: rdavies@nemours.org.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Davies
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del.
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Carver
authors.affiliation: Department of Otolaryngology, Nemours/A.I. duPont Hospital for Children, Wilmington, Del; Thomas Jefferson University, Philadelphia, Pa.
authors.forename: Richard
authors.initials: R
authors.lastname: Schmidt
authors.affiliation: Division of Speech Pathology, Nemours/A.I. duPont Hospital for Children, Wilmington, Del.
authors.forename: Heather
authors.initials: H
authors.lastname: Keskeny
authors.affiliation: Division of Speech Pathology, Nemours/A.I. duPont Hospital for Children, Wilmington, Del.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Hoch
authors.affiliation: Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, Del; Thomas Jefferson University, Philadelphia, Pa.
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery*; D016009:Chi-Square Distribution; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005247:Feeding Behavior; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007828:Laryngoscopy; D007830:Larynx / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010614:Pharynx / Q000503:physiopathology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality