Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
J Voice. 2020 Jan;34(1):121-126. doi: 10.1016/j.jvoice.2018.08.011. Epub 2018 Oct 16.
Vocal fold movement impairment may significantly compromise postoperative recovery and quality of life of patients following thoracic or cardiothoracic surgery or prolonged intubation. The literature is limited and there is no standard screening protocol for the optimal postoperative swallowing and aspiration evaluations. We performed retrospective review of adult patients undergoing early vocal fold (VF) injection laryngoplasty for acute postoperative Vocal fold movement impairment (<30 days) that had both pre- and postinjection speech language pathologist (SLP) performed swallowing/aspiration evaluations. Records were reviewed for demographics, clinical characteristics, procedural details, and short-term outcome measures of oral intake. In total, 30 patients were included, and had data on swallowing/aspiration studies before and after the VF injection laryngoplasty. Most of the patients were injected within 5 days following the laryngologist evaluation and within 14 days following the iatrogenic recurrent laryngeal nerve injury (23/30, 76.7%). The majority of patients were injected at the bedside by awake transcutaneous injection (22/30, 73.3%), six patients were injected in the operating room under general anesthesia, and two at the outpatient clinic. Pre- and postinjection SLP evaluations included clinical bedside assessment or instrumental evaluation. Following VF injection laryngoplasty, oral diet advancement was noted in 81.8% of the patients that were nil per os before the injection (18/22). No complications were noted. In conclusions, acute VFMI following surgery requires immediate diagnosis and therapeutic strategy to minimize postoperative complications and to overcome impairments in the voice, swallow, and cough. Otolaryngology-SLP interdisciplinary aspiration and swallowing assessment protocol is proposed based on our experience and an extensive literature review.
声带运动障碍可能会严重影响胸科或心胸外科手术后或长时间插管的患者的术后恢复和生活质量。文献有限，目前尚无用于最佳术后吞咽和吸痰评估的标准筛选方案。我们对因急性术后声带运动障碍（<30 天）而行早期声带（VF）注射成形术的成年患者进行了回顾性研究，这些患者在注射前和注射后均由言语语言病理学家（SLP）进行了吞咽/吸痰评估。对人口统计学、临床特征、程序细节以及经口摄入的短期结果测量进行了记录回顾。共纳入 30 例患者，他们均有关于 VF 注射成形术前和术后吞咽/吸痰研究的数据。大多数患者在喉科医生评估后 5 天内和医源性喉返神经损伤后 14 天内（23/30，76.7%）进行了注射。大多数患者通过清醒的经皮注射在床边进行注射（22/30，73.3%），6 例患者在全身麻醉下于手术室进行注射，2 例患者在门诊进行注射。注射前和注射后的 SLP 评估包括临床床边评估或仪器评估。在进行 VF 注射成形术后，22 例注射前经口禁食的患者中有 81.8%（18/22）可以经口进饮食。没有观察到并发症。总之，手术后继发性声带运动障碍需要立即诊断和治疗策略，以最大程度地减少术后并发症，并克服声音、吞咽和咳嗽方面的障碍。根据我们的经验和广泛的文献回顾，提出了耳鼻喉科-言语语言病理师联合的吸痰和吞咽评估方案。
