Evaluation of Swallowing Function in Relation to Oropharyngeal Dysphagia in Patients with Operated Unilateral Cleft Lip and Palate.

OBJECTIVE: To determine the occurrence of oropharyngeal dysphagia (OD) signs and symptoms in patients with operated unilateral cleft lip and palate (CLP). MATERIALS AND METHODS: This prospective study was conducted on 15 adolescents with operated unilateral CLP (CLP group) and 15 non-cleft volunteers (control group). Initially, the Eating Assessment Tool-10 (EAT-10) questionnaire was administered to subjects. OD signs and symptoms such as coughing, the sensation of choking, globus sensation, the need to clear the throat, nasal regurgitation, difficulties of bolus control multiple swallowing were evaluated by patient complaints and physical examination of swallowing function. Also, the Functional Outcome Swallowing Scale was used to determine the severity of the OD. Fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and crackers was performed. RESULTS: The prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (range, 6.7 to 26.7%), and nonsignificant differences were observed between the groups for these parameters as well as for EAT-10 scores. According to the Functional Outcome Swallowing Scale findings, 11 of 15 patients with CLP were asymptomatic. Fiberoptic endoscopic evaluation of swallowing indicated that post-swallow pharyngeal wall residues with yogurt were significant in the CLP group with a prevalence of 53% ( P < 0.05), whereas differences between the groups in terms of cracker and water residues were nonsignificant ( P > 0.05). CONCLUSION: OD in patients with repaired CLP was manifested mainly in the form of pharyngeal residue. However, it did not appear to cause significant increases in patient complaints compared with healthy individuals.

Long-term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment.

INTRODUCTION: Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. METHODS: Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. RESULTS: CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20 mL water according to the Penetration and Aspiration Scale (P < .05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20 ± 3.24 in the RT group (P < .05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P > .05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5 mL and 10 mL water, 5 mL and 20 mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P < .05). CONCLUSION: It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.

The effect of "xanthan gum-based fluid thickener" on hydration, swallowing functions and nutritional status in total maxillectomy patients.

PURPOSE: Swallowing functions are affected after total maxillectomy operations and adjuvant chemoradiotherapy. The purpose of our study is to assess the role of xanthan gum based thickening agents on swallowing and hydration of maxillectomy patients on a randomized controlled fashion. METHODS: 12 of the 22 patients diagnosed with maxillary carcinoma and planned to undergo total maxillectomy was identified as study group and 10 of them were identified as control group. The study group used "xantham based liquid thickener" for liquid foods up to 3 months postoperatively and the control group did not use. Dysphagia-related quality of life, bioimpedance analysis, EAT-10 scores, swallowing functions were evaluated both preoperative and postoperative period. RESULTS: The mean age of the study group was 56 ± 9.87, and 41.6% were women. The mean age of control group was 60 ± 15.63, and 50% were women. Postoperative EAT-10 scores were statistically significant higher than preoperative scores in both groups (p < 0.05). In both of the study and control groups, a statistically significant reduction in dysphagia related quality of life was detected postoperatively (p < 0.05). Intracellular water, extracellular water and total body water detected statistically significant higher in study group at postoperative month three. CONCLUSION: Swallowing functions are affected due to total maxillectomy and radiotherapy. With this study, it has been shown that, total maxillectomy and radiotherapy reduce dysphagia-related quality of life. Swallowing dysfunction and dehydration has been shown to affect total maxillectomy patients. Using of 'xanthan gum-based fluid thickener' helps to maintain intracellular water, extracellular water, and total body water.

Evaluation of swallowing in transverse maxillary deficiency patients before and after rapid maxillary expansion.

OBJECTIVES: To evaluate swallowing function in relation to oropharyngeal dysphagia (OD) in adolescents who had transverse maxillary deficiency with posterior crossbite and high-arched palate, before, and after rapid maxillary expansion (RME). MATERIALS AND METHODS: Twenty patients (mean age: 13.0 ± 3.1) with bilateral posterior crossbite and high-arched palate (RME group: RMEG) and 20 volunteers (mean age: 13.4 ± 2.6) with Class I crowding without posterior crossbite or high-arched palate (control group: CG) were recruited. OD signs and symptoms were evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaire, patient complaints, and physical examination of swallowing function before (T1) and 7 months after (T2) RME. Additionally, fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and cracker was performed. In CG, evaluation of swallowing was performed only once, corresponding to T1 of RMEG. RESULTS: Prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (5%-15%), and nonsignificant differences were observed between CG and RMEG at T1 for these parameters as well as for EAT-10 scores. Total post-swallow pharyngeal residue with yogurt was significantly different between CG and RMEG at T1, with a prevalence of 60% in RMEG (P < .05). There was no significant difference regarding residue with yogurt between T1 and T2 in RMEG (P > .05). CONCLUSION: Patients with a maxillary transverse deficiency were affected by pharyngeal residue as indicated by FEES, but it did not appear to improve in short-term follow-up in patients treated with RME.

A Case with Thyroid Cartilage Fracture after Sneezing.

Non-traumatic laryngeal injuries are unusual occasions. In the medical literature we found only six reports of cases that had laryngeal injury after sneezing. We report a case of a 34-year-old man diagnosed with thyroid cartilage fracture after a strong sneeze. In physical examination, edema and hematoma were seen in the right vocal cord and the right band. Computed tomography scan revealed an anterior thyroid cartilage fracture without separation. Antibiotics and steroids were administered. This is a very rare entity and the seventh case reported in the literature. Ear Nose Throat specialist should be aware of this situation.