Miller Claire Kane, Linck Jessica, Willging Jay Paul
Cincinnati Children's Hospital Medical Center, Aerodigestive Center/Interdisciplinary Feeding Team, United States.
Int J Pediatr Otorhinolaryngol. 2009 Apr;73(4):573-9. doi: 10.1016/j.ijporl.2008.12.024. Epub 2009 Feb 8.
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.
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.
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.
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.
接受气道重建手术的患者术后可能会出现一定程度的吞咽困难。本回顾性研究描述了30例儿科患者术后吞咽困难的持续时间及代偿策略的使用情况。
完成了对在六个月期间因气道重建术后吞咽评估而转诊的儿科患者的回顾性病历审查。总结并比较了年龄、性别、手术方式、支架类型、合并症因素、吞咽困难持续时间以及代偿性饮食调整和吞咽策略的使用情况。
接受单阶段前路或前路/后路移植手术的患者吞咽困难一般持续时间较短（1 - 5天）。接受后路移植联合T管的患者吞咽困难持续时间增加（10 - 14天）。吞咽困难持续时间最长（>2周）的患者是接受前路和后路移植联合T管，以及声带外展、会厌柄重新定位和/或杓状软骨切除术等额外手术的患者。术前存在喂养问题（如口腔厌恶或特定质地拒绝）以及病前需要补充管饲以补充经口摄入量的患者术后经口喂养困难可能性更大。代偿性吞咽策略在术后可有效减少经口进食者吞咽相关的误吸，并有助于恢复到基线吞咽技能。
接受前路/后路移植联合留置T管的患者总体吞咽困难持续时间增加，尤其是在联合额外手术时。发现有助于吞咽的代偿策略在术后阶段有效，包括使用改良的声门上吞咽序列，结合饮食调整，在吞咽时辅助代偿性气道关闭。无论重建手术类型如何，术前存在喂养问题（如口腔厌恶和/或质地抵抗）的患者术后均会出现喂养困难。
