Is nasogastric tube feeding necessary after hypopharyngeal diverticulum surgery?

OBJECTIVES: Nasogastric tubes (NGT) are often placed after surgery for cricopharyngeal muscle pathology due to risk of infection and mediastinitis. The aim of this study was to examine if this practice is necessary. METHODS: A retrospective case series of subjects who underwent surgery for hypopharyngeal diverticula or cricopharyngeal bars from March 2011 to June 2018 was conducted. Demographic data, type of surgery, placement of feeding tube, initiation of oral feeding, and any complications were recorded. RESULTS: Sixty-four surgeries were performed for Zenker's diverticula (ZD; N = 52), Killian-Jamieson diverticula (N = 2), and cricopharyngeal bar (N = 10). Mean age and ZD pouch size were 74.0 ± 10.6 years and 3.1 ± 1.8 cm, respectively. Procedures included 48 carbon dioxide laser-assisted myotomies, 14 open diverticulectomies, and 2 endoscopic stapler-assisted diverticulotomies. Of the 64 patients, 19 (29.7%) received intraoperative NGTs while the remaining 45 (70.3%) did not receive NGTs. The former cohort had the NGTs removed on post-operative day (POD) 4.5 ± 2.5, and the non-NGT cohort started clear liquid diet (CLD) on POD 1.2 ± 0.7 days, where 38 patients (84.4%) started CLD on POD 1, and 5 patients (7.8%) were started on oral diet on POD 2-4. Over time, fewer NGTs were placed and oral diets were started sooner. There were 5 complications occurring in 3 patients from the NGT cohort (15.5%) and 2 from the non-NGT cohort (4.4%). CONCLUSIONS: Surgery for hypopharyngeal diverticula and CPB may not require routine perioperative NGT placement which can be associated with higher rates of complication. Patients can safely receive CLD on POD 1.

Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study.

OBJECTIVES: There have been many advancements in laryngeal imaging using optical coherence tomography (OCT), with varying system design and probes for use in research, office, and operating room settings. We evaluated the performance of six distinct OCT systems in imaging porcine vocal folds (cords) using computational image processing and segmentation. METHODS: Porcine vocal folds were scanned using six OCT systems. Imaging system and probe performance were quantitatively assessed for signal penetration, layer differentiation, and epithelium (EP) measurement. Fitted exponential decay curves with corresponding α constant and intensity thresholding segmentation were utilized to quantify the aforementioned parameters. RESULTS: The smallest average α constant and deepest signal penetration was of the SS-OCT 1700 nm 90 kHz microscope system (α = -1.74), followed by the SS-OCT 1310 nm 200 kHz VCSEL microscope system (α = -1.99), and SS-OCT 1310 nm 50 kHz rigid forward viewing endoscope system (α = -2.23). The EP was not readily visualized for three out of six systems, but was detected using automated segmentation. Average EP thickness (mean ± SD) was calculated as 55.79 ± 31.86 µm which agrees favorably with previous literature. CONCLUSION: Comparisons of OCT systems are challenging, as they encompass different probe design, optical path, and lasers, depending on application. Practical evaluation of different systems using computer based quantitative image processing and segmentation revealed basic, constructive information, such as EP measurements. To further validate the comparisons of system performance with clinical usability, in vivo human laryngeal imaging will be conducted. Further development of automated image processing and segmentation can be useful in rapid analysis of information. Lasers Surg. Med. 51:412-422, 2019. © 2019 Wiley Periodicals, Inc.

Transoral Removal of an Extruded Odontoid Screw Causing Dysphagia and Dysphonia.

A 77-year-old male underwent open reduction and internal fixation with placement of odontoid screws after sustaining C1 arch and odontoid fractures in a fall 14 months prior to presentation to the laryngology clinic for combined surgery with orthopedics. Serial imaging after the initial surgery demonstrated loosening of a screw and its entry into the pharyngeal lumen. The patient reported odynophagia, dysphagia, and dysphonia. He reported taking small bites and using liquid assist, vocal fatigue, and difficulty with pitch control. A surgical screw entering the pharynx just inferior to the level of the tip of the epiglottis was seen on flexible laryngoscopy. On phonation, the screw made intermittent contact with the right arytenoid resulting in restriction of full abduction of the right vocal fold. On flexible endoscopic evaluation of swallowing, there was pharyngeal and vallecular residue, and residue around the screw itself. The patient was taken to the operating room with orthopedic surgery, the screw was visualized with a combination of mouth gag and endoscopes. It was gently rocked with an orthopedic screw grabber and tapped toward the caudal pharynx. After successful removal, the mucosal defect was sutured. The patient reported improvement in swallowing postoperatively. Dysphagia is a described sequela of cervical spine surgery. We describe the presentation and treatment of a patient with a history of cervical spine surgery and subsequent exposure of an orthopedic screw in the pharynx. Laryngoscope, 131:1078-1080, 2021.

Identification and Management of Chronic Laryngitis.

Chronic laryngitis is an inflammatory process of at least 3 weeks duration and affects phonation, breathing, and swallowing. This article describes the infectious, inflammatory, and autoimmune causes of chronic laryngitis. Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy.

Categorization and Analysis of Nasal Base Shapes Using a Parametric Model.

IMPORTANCE: Nasal base view is important for rhinoplasty analysis. Although some descriptors of nasal base shape exist, they are largely subjective and qualitative. OBJECTIVE: To evaluate a parametric model of nasal base shape and compare it with categorization by surgeons to create an objective classification system for clinical evaluation and communication. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort review of deidentified photographs of 420 patients evaluated for possible facial plastic surgery at a tertiary care academic medical center between January 2013 and June 2017. The nasal bases were classified into 6 shape categories (equilateral, boxy, cloverleaf, flat, round, and narrow) via visual inspection. The contour of each nasal base was traced using MATLAB software (MathWorks Inc). The software then performed a curve fit to the parametric model with output of values for 5 parameters: projection-to-width ratio, the anterior-posterior positioning of the tip bulk, symmetry, degree of lateral recurvature of the nasal base, and size. The differences among shape categories for each parameter were analyzed using 1-way analysis of variance. Pairwise comparisons were then performed to ascertain how the various shapes differed. Finally, a multinomial logistic regression model was used to predict nasal base shape using parameter values. Data were analyzed between April 2017 and January 2018. MAIN OUTCOMES AND MEASURES: An algorithm that categorized nasal base shapes into 6 categories. RESULTS: The 420 nasal base photographs of patients evaluated for possible plastic surgery were categorized into 1 of 6 categories; 305 photographs were readily classified, and the remaining 115 were termed unclassified and were categorized. For both the classified and unclassified nasal base groups, there were statistically significant differences between projection-to-width ratio (classified, F5,299 = 21.51; unclassified, F4,100 = 10.59; P < .001), the anterior-posterior positioning of the tip bulk (classified, F5,299 = 3.76; P = .003; unclassified, F4,110 = 4.54; P = .002), and degree of lateral recurvature of the nasal base (classified, F5,299 = 24.14; unclassified, F4,100 = 7.21; P < .001). A multinomial logistic regression model categorization was concordant with surgeon categorization in 201 of 305 (65.9%) cases of classified nasal bases and 38 of 115 (33.0%) unclassified nasal bases. CONCLUSIONS AND RELEVANCE: The parametric model may provide an objective and numerical approach to analyzing nasal base shape. LEVEL OF EVIDENCE: NA.

Gender and age in benign vocal fold lesions.

OBJECTIVE/HYPOTHESIS: Certain lesions appear to occur predominantly in one gender or in younger or older patients. We examined a large sample from a treatment-seeking population to describe gender and age associations of an array of benign vocal fold lesions. STUDY DESIGN: Retrospective review. METHODS: The medical records and evaluations of all adult patients presenting for care over a 5-year period were examined for demographic characteristics and lesion type. A total of 641 lesions in 602 patients were grouped into 13 broad categories, and prevalence was compared between male and female patients and three age groups. RESULTS: Pseudocysts and bilateral midfold lesions occurred principally in young (18-39 years old) females (P < 0.0001). Reinke's edema was found in older (> 39 years old) women (P < 0.012). Polyps, contact lesions, leukoplakia (all P < 0.0001), and sulcus (P < 0.0002) were found predominantly in men. CONCLUSION: Certain benign mucosal lesions are strongly associated with age and especially with gender. These differences may be explained by intrinsic differences in laryngeal anatomy and phonatory physiology in these groups, including differences in phonatory frequency and air pressure, and in the ability of the membranous vocal fold to withstand phonotrauma. Such inherent differences have implications for treatment expectations and approaches.