Faculty Bibliography

Importance/UNASSIGNED:Compromised cough effectiveness is correlated with dysphagia and aspiration. Glottic insufficiency likely yields decreased cough strength and effectiveness. Although vocal fold augmentation favorably affects voice and likely improves cough strength, few data exist to support this hypothesis. Objective/UNASSIGNED:To assess whether vocal fold augmentation improves peak airflow measurements during maximal-effort cough following augmentation. Design, Setting, and Participants/UNASSIGNED:This case series study was conducted in a tertiary, academic laryngology clinic. Participants included 14 consecutive individuals with glottic insufficiency due to vocal fold paralysis, which was diagnosed via videostrobolaryngoscopy as a component of routine clinical examination. All participants who chose to proceed with augmentation were considered for the study whether office-based or operative augmentation was planned. Postaugmentation data were collected only at the first follow-up visit, which was targeted for 14 days after augmentation but varied on the basis of participant availability. Data were collected from June 5, 2014, to October 1, 2015. Data analysis took place between October 2, 2015, and March 3, 2017. Main Outcomes and Measures/UNASSIGNED:Peak airflow during maximal volitional cough was quantified before and after vocal fold augmentation. Participants performed maximal coughs, and peak expiratory flow during the maximal cough was captured according to American Thoracic Society guidelines. Results/UNASSIGNED:Among the 14 participants (7 men and 7 women), the mean (SD) age was 62 (18) years. Three types of injectable material were used for vocal fold augmentation: carboxymethylcellulose in 5 patients, hyaluronic acid in 5, and calcium hydroxylapatite in 4. Following augmentation, cough strength increased in 11 participants and decreased cough strength was observed in 3. Peak airflow measurements during maximal cough varied from a decrease of 40 L/min to an increase of 150 L/min following augmentation. When preaugmentation and postaugmentation peak airflow measurements were compared, the median improvement was 50 L/min (95% CI, 10-75 L/min; P = .01). Immediate peak airflow measurements during cough collected within 30 minutes of augmentation varied when compared with measurements collected at follow-up (103-380 vs 160-390 L/min). Conclusions and Relevance/UNASSIGNED:Peak airflow during maximal cough may improve with vocal fold augmentation. Additional assessment and measurements are needed to further delineate which patients will benefit most regarding their cough from vocal fold augmentation.

Purpose: Edema is a frequent clinical observation after chemoradiation treatment (XRT) for oral/oropharyngeal cancer (O/OP Ca). Our aim is to quantify within-subject measures of edema from pre- and post-XRT videofluoroscopy (VF) and to explore the relationship between edema and aspiration. Method(s): Fourty patients (24 male; ages 38-76) diagnosed with O/OP Ca received radiotherapy (70 Gy, 7 weeks) and 3 weekly doses of cisplatin. VF was completed pre- and again 4 weeks post-XRT. 3 pixel-based measures captured edema from a post-swallow rest frame of a 5 ml thin liquid bolus: posterior pharyngeal wall (PPW) thickness, pharyngeal area (PA) and vallecular space (VS). Worst PAS scores categorized subjects as unsafe (>=3) or safe (<=2). Repeated measures ANOVAs were used to explore the relationship between the edema measure (pre- vs post-XRT) and swallow safety (safe vs unsafe). Result(s): The proportion of patients with unsafe swallows increased from 8/40 pre-XRT to 14/40 post-XRT, though this was not significant (p = 0.2). A significant main effect was confirmed in reduced PA post-XRT [F = 29.9, p = 0.00] and a trending increase was observed for PPW [F = 3.2, p = 0.08]. However, no significant differences between unsafe vs safe groups were found for any edema variables. Conclusions (Including Clinical Relevance): The data confirm that post-XRT edema can be quantified on VF by measuring PPW thickness and PA. A significant worsening in edema measures in individuals with unsafe compared with safe swallows was not detected. The data was limited by a low proportion of post-XRT aspirators. Future analyses will examine the relationship between edema and residue

Purpose: Facial composite defects resulting from trauma can cause devastating and life limiting deformities. Full face transplants have been restoring the oral cavity and the upper airway in a single stage procedure. Literature on face transplants mostly consists of detailed surgical techniques and allograft selection, but do not constitute a compilation of data on postoperative outcomes such as swallow function. This is the first reported case of systematic review of the swallowing rehabilitation course post-facial transplantation. Method(s): Fourty one-year old male with oropharyngeal dysphagia after full face vascularized allotransplant is presented. Videofluoroscopic swallow study (VFSS) was conducted prior to surgery and at 8 time points post-operatively (day 13, 26, 48, 63, 77, 105, 6 months and 9 months) to assess swallow function. Outcome measures included Penetration Aspiration Scale (PAS) and ordinal ratings of residue in the valleculae and pyriform sinuses for 3 and 5 ml thin liquid boluses. Worst PAS scores categorized subject as unsafe (>=3) or safe (<=2). Result(s): Despite rigorous daily swallow treatment, the patient's liquid dysphagia did not imrpove. Unsafe PAS (>=3) were present in the first 7 VFSS post-operatively for 3 ml and 5 ml thin liquid boluses. Worse residue was noted in pyriform sinuses vs. valleculae in all VFSS. Conclusions (Including Clinical Relevance): Early swallow treatment is crucial for safety and successful oral intake of thin liquid postfull facial transplantation. Future analyses will examine the relationship between post-operatively edema and residue with the longterm goal of maximizing therapeutic protocols