Swallowing outcomes after tracheal resection and anastomosis: full versus mini infrahyoid laryngeal drop.

INTRODUCTION: Tracheal resection anastomosis has been established as the definitive surgery for high grade postintubation subglottic stenosis. To achieve a relaxed tension-free anastomosis, various laryngeal release techniques were discussed in literature with potential effect on postoperative swallowing dysfunction. This study aims to compare the difference in swallowing outcomes following two methods of infrahyoid laryngeal release: with and without fracture of the superior thyroid horns. METHODS: A retrospective cohort study was carried out at our tertiary referral hospitals including cases with grade III and IV subglottic stenosis treated by partial crico-tracheal resection with thyro-tracheal anastomosis. The patients were divided into two groups according to the method used in laryngeal release; mini infrahyoid release (group A) or infrahyoid full release (group B) where full means with fracture of the superior thyroid horn bilaterally while mini means their preservation. Swallowing assessment preoperatively and postoperatively was done by comparing swallowing dysfunction symptoms, Gugging swallowing screen (GUSS) score and fiberoptic endoscopic evaluation of swallowing (FEES) according to penetration aspiration scale (PAS). RESULTS: A total of 71 patients were included; 46 in Group A and 25 in Group B. Clinical swallowing evaluation one week postoperatively showed statistically significant difference between the two groups being affected in 80.04% and 100% of patients in group A and B, respectively. The mean postoperative GUSS were 18 ± 1.32 in group A patients in comparison to 8.84 ± 5.18 in group B (p-value < 0.001). With FEES assessment, group A had full improvement of their swallowing abilities one month after the surgery while patients in group B had significantly lower PAS scores. Unfavourable scores for both the GUSS test and PAS were associated with increasing patients' age in group B. CONCLUSION: In this retrospective cohort study, cases with mini infrahyoid laryngeal release had significantly better swallowing outcomes and full resolution of dysphagia in comparison to full laryngeal release. Also, full laryngeal release is associated with delayed resolution of swallowing difficulty in older patients. This point should be considered during preoperative patient selection and counselling.

Surgical Management of Bilateral Abductor Paralysis: Diode Laser Versus Coblation; A Prospective Study.

OBJECTIVES: We aimed to compare the results of both diode laser and coblation in the treatment of bilateral vocal fold immobility (BVFI). MATERIALS AND METHODS: This prospective clinical study was performed on 80 non-tracheostomised patients with bilateral vocal fold paralysis divided into two groups; Group A: diode laser, Group B: coblation. Medical Research Council "mMRC" Dyspnea scale, maximal phonatory time (MPT), Voice handicap index (VHI), and functional outcome swallowing scale (FOSS) were assessed preoperatively and postoperatively. Also, the VAS pain scale and operative time of both groups are recorded. RESULTS: Within each group, there was a statistically significant decrease in the mMRC dyspnea scale and maximum phonation time and a significant increase in VHI (P < 0.001). There was a statistically significant difference between the studied groups postoperative and regarding the percent change of the MPT ( more decrease in the coblation group). Concerning the operative time and the VAS pain score, there was a statistically significant difference between the studied groups regarding operating time and the VAS pain scale (significantly lower in the coblation group) (P < 0.001). CONCLUSION: Both Coblation and diode laser are effective tools in the treatment of BVFI with similar minimal voice quality affection. The maximum phonation time decreased more in the coblation group, while the voice handicap index did not significantly differ between both groups. However, Coblation may be superior to diode laser in terms of less operative pain and shorter intraoperative time. Coblation may be more favorable for patients at risk of prolonged general anesthesia duration.

Impact of duloxetine on succinylcholine-induced postoperative myalgia after direct microlaryngoscopic surgeries: Randomized controlled double-blind study.

BACKGROUND: Succinylcholine is a preferred muscle relaxant for rapid sequence intubation. Postoperative myalgia (POM) is one of its commonest adverse effects with unknown pathogenesis. Various modalities were examined to reduce POM. We hypothesized that duloxetine may reduce the incidence and severity of fasciculation or succinylcholine-induced POM in outpatient surgeries. METHODS: This randomized double-blinded trial involved controlled 70 adult participants scheduled for elective direct microlaryngoscopic surgeries. Before induction of general anesthesia by 2 h, 35 patients received duloxetine 30 mg orally (group D) and 35 patients received similar oral starch placebo capsules (group C). Fasciculations, POM, sedation score, time to first rescue analgesia, total analgesic consumption 24 h after surgery, patients' satisfaction, and adverse effects were recorded. RESULTS: Incidence of fasciculation was 77.1% and 94.3% in groups D and C (p value = 0.04), whereas its severity was not significant between groups (p value = 0.09). Incidence and severity of POM were significantly lower in group D (p values = 0.004 and 0.021). Positive correlation was recorded between fasciculations and POM scores (r = 0.732 and p < 0.001). Time required for first analgesia was prolonged in group D (p value < 0.001) with less total analgesic consumption (p value = 0.039). The potassium and creatine kinase levels showed significant differences between both groups after 30 min and 24 h, respectively (p value < 0.05). Sedation scores and patients' satisfaction were better in duloxetine group (p value < 0.05) with no severe complications. CONCLUSIONS: Preoperative oral duloxetine 30 mg administration decreased incidence and severity of succinylcholine-related muscle POM and fasciculations. It was also effective in reducing postoperative rescue analgesic requirement with better patients' satisfaction and no serious adverse effects.

Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital.

PURPOSE: The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. METHODS: We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. RESULTS: Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. CONCLUSIONS: Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention.