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Objective This study analyzed clinical and radiological outcomes of a zero-profile anchored spacer (Zero-P) and conventional cage-plate (CCP) for single level anterior cervical discectomy and fusion (ACDF) to compare the incidence and difference of postoperative dysphagia with both devices. Methods We retrospectively reviewed our experiences of single level ACDF with the CCP and Zero-P. From January 2011 to December 2013, 48 patients who had single level herniated intervertebral disc were operated on using ACDF, with CCP in 27 patients and Zero-P in 21 patients. Patients who received more than double-level ACDF or combined circumferential fusion were excluded. Age, operation time, estimated blood loss (EBL), pre-operative modified Japanese Orthopaedic Association (mJOA) scores, post-operative mJOA scores, achieved mJOA scores and recovery rate of mJOA scores were assessed. Prevertebral soft tissue thickness and postoperative dysphagia were analyzed on the day of surgery, and 2 weeks and 6 months postoperatively. Results The Zero-P group showed same or favorable clinical and radiological outcomes compared with the CCP group. Postoperative dysphagia was significantly low in the Zero-P group. Conclusions Application of Zero-P may achieve favorable outcomes and reduce postoperative dysphagia in single level ACDF.

Background Dysphagia is experienced by many patients after antireflux surgery. This literature review examines factors associated with the development, prediction and management of postoperative dysphagia. Methods Published studies examining issues related to dysphagia, gastro-oesophageal reflux and fundoplication were reviewed. Results Postoperative dysphagia is usually temporary but proves troublesome for 5–10 per cent of patients. Technical modifications, such as a partial wrap, division of short gastric vessels and method of hiatal closure, have not conclusively reduced its incidence. There is no reliable preoperative test to predict dysphagia. Conclusion It is uncertain whether postoperative dysphagia arises from patient predilection or is largely a consequence of mechanical changes created by fundoplication. Anatomical errors account for a significant proportion of patients referred for correction of dysphagia but these are uncommon in large single-institution studies. Abnormal manometry cannot predict dysphagia and, on current evidence, ‘tailoring’ the operation does not prevent its occurrence.

In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

Objectives To examine postoperative complications and swallowing function associated with free jejunal patch graft transfer after partial hypopharyngectomy with laryngeal preservation. Design Retrospective medical record review. Setting Academic research. Patients A consecutive series of 43 patients who underwent free jejunal patch graft transfer after partial hypopharyngectomy with laryngeal preservation composed the study sample. They represented the following 3 groups based on the type of hypopharyngeal defect: 13 patients with defects of the posterior wall (PW group), 28 patients with defects extending to the unilateral piriform sinus (PS-PW group), and 2 patients with defects extending to the bilateral piriform sinuses (PS-PS group). Main Outcome Measures Postoperative complications and oral intake ability were compared among the groups. Results Except for 1 patient, all the patients in the PW and PS-PS groups resumed oral intake within 2 weeks after surgery. Four patients in the PS-PW group had severe dysphagia, 2 of whom could not discontinue tube feeding. Conclusions Free jejunal patch graft transfer after partial hypopharyngectomy allows satisfactory swallowing function, with a low complication rate. Postoperative dysphagia was slightly more common in the PS-PW group than in the PW group.

Objective: To determine the effectiveness of the two basic surgical types of uvulopalatopharyngoplasty (UPPP), as classified by us. The two basic surgical variations of UPPP differ for the width of the anteroposterior palatal resection, being 1 to 2 cm (type 1) and 0.5 to 1.0 cm (type 2). Design: Randomized, retrospective study. Patients: Eighty-seven patients with obstructive sleep apnea hospitalized in our department from 1983 to 1991. All patients had a complete preoperative and postoperative polysomnographic evaluation. Results: The operation was found to be an effective treatment of obstructive sleep apnea in most patients. Snoring improvement was found in 95% (29/31) of patients with type 1 UPPP and in 96% (54/56) of the patients with type 2 UPPP, whereas, apnea index improvement was detected in 65% (20/31) of the patients with type 1 UPPP vs 64% (36/56) of the patients with type 2 UPPP. Postoperative dysphagia was found in 94% (29/31) vs 79% (44/56), P =.0025; nasal reflux was found in 81% (25/31) vs 11% (6/56), P =.0001; and hypernasality was found in 100% (31/31) vs 13% (7/56), P =.0001, in type 1 and type 2 UPPP operations, respectively. Chi-square analysis shows highly significant differences. Conclusions: Type 2 UPPP is the recommended surgical procedure of obstructive sleep apnea, mainly due to the minimal postoperative morbidity. (Arch Otolaryngol Head Neck Surg. 1993;119:1023-1029)

Dysphagia commonly results from surgical resection of various structures within the oral, pharyngeal, and esophageal areas. The type and severity of swallowing dysfunction are based largely on the number and quantity of structures removed as well as the reconstructive procedure. Short term-recovery has been addressed in many studies. However, follow-up studies of long-term functional results and continuing swallowing problems following oral/pharyngeal surgery are unavailable. In this study, perception of swallowing dysfunction was compared with actual videofluoroscopic findings in subjects at least 1 year after oral/pharyngeal surgery. The comparative results of a questionnaire developed to evaluate patients' perception of continuing swallowing difficulty and an analysis of actual videofluoroscopic tapes indicated that the degree or type of dysphagia could not be determined from patients' subjective descriptions of the swallowing problem.

One of the most frequent complications after laparoscopic antireflux surgery is intrathoracic migration of the wrap ("slipped" Nissen fundoplication). The most common reasons for this are inadequate closure of the crura or disruption of the crural closure. The aim of this prospective study was to evaluate surgical outcomes in patients who underwent laparoscopic antireflux surgery with simple nonabsorbable polypropylene sutures for hiatal closure in comparison to patients who underwent routine mesh-hiatoplasty. Between 1993 and 1998, a group of 361 patients underwent primary laparoscopic Nissen or Toupet fundoplication with the use of simple nonabsorbable polypropylene sutures for hiatal closure. Since December 1998, in all patients (n = 170) who underwent laparoscopic antireflux surgery, a 1 × 3 cm polypropylene mesh was placed on the crura behind the esophagus to reinforce them. Functional outcome, symptoms of gastroesophageal reflux disease, and postoperative complications such as recurrent hiatal hernia with or without intrathoracic migration of the wrap have been used for assessment of outcomes. In the initial series of 361 patients, postoperative herniation of the wrap occurred in 22 patients (6.1%). Of these 22 patients, 17 of them (4.7%) had to undergo laparoscopic redo surgery. The remaining five patients were free of symptoms. In comparison to these results, in a second group of 170 patients there was only one (0.6%) who had postoperative herniation of the wrap into the chest. There have been no significant differences in objective data such as DeMeester scores or lower esophageal sphincter pressure between the two groups. Postoperative dysphagia was increased during the early period after surgery in patients undergoing mesh-hiatoplasty but resolved without any further treatment within the first year after laparoscopic antireflux surgery. We concluded that routine hiatoplasty with the use of a polypropylene mesh is effective in preventing postoperative herniation of the wrap and leads to a significantly better surgical outcome than closure of the hiatal crura with simple sutures, without any additional long-term side effects.

Case histories of 25 patients are reported in whom complications after a Nissen fundoplication were sufficiently severe to require reoperation. Patients were classified by complications as having postoperative dysphagia (14), recurrent reflux (seven), "gas bloat" syndrome (two), and paraesophageal hernia (two). Six of the 14 patients with dysphagia had no esophageal peristalsis, one had a panmural fibrous stricture, and had a "slipped" Nissen, and in six the wrap was presumed to have been fashioned too tightly. Too tight a wrap was also responsible for the seven instances of recurrent reflux and the two of "gas bloat" syndrome. Revision of the fundoplication relieved the symptoms in the 15 patients in whom it was done. A variety of surgical procedures were performed on the other 10, all but one of whom experienced a good result. Proper selection of patients for operation coupled with attention to certain technical surgical details will ensure good results in 90% of patients after a Nissen fundoplication.

Evaluation of postoperative swallowing ability in thirty-eight patients having had partial laryngectomy indicates that there are marked differences in the degree of dysphagia among individuals with similar surgical defects. This variation in swallowing disability, however, appears to have definable limits. Rehabilitation is possible for many patients disabled by postoperative dysphagia. A transoral surgical technic for reconstruction of the obliterated pyriform sinus is described.

The post-fundoplication symptoms were assessed in 226 patients who had symptomatical improvement of gastroesophageal reflux after Nissen fundoplication. Follow-up range was from 3 to 12 years (average 5,6 years). Of these patients, 24% were totally asymptomatic. All had transient postoperative dysphagia which improved within an average of 3-5 months. Forty four per cent had changes in habits of swallowing; 38% had increased abdominal meteorism; 31% were unable to vomit and 19% unable to belch; 12% had pain in the upper left abdominal quadrant; and 10% had dyspepsia. These symptoms were uncomfortable in 26% and disturbing in 10%. Diverse causes can be responsible for these symptoms; mechanical (narrowing of the cardia, postoperative adherences), functional (motor troubles, denervation), and depending of the patients (alimentary habits). The high frequency of post-fundoplication symptoms restrict clearly the success of Nissen fundoplication.

Patients undergoing laryngectomy in the 1980s have a low rate of acquisition of esophageal speech. The interaction of the factors of postoperative physical performance status, preoperative phonation duration, postoperative dysphagia, site of lesion, patient income, and postoperative radiation therapy correctly predict the acquisition of esophageal speech in 83% of cases and the failure to acquire esophageal speech in 96%. Such information may be helpful in selecting patients for alternative forms of postlaryngectomy speech rehabilitation.

The frequency of postoperative dysphagia is variously assessed by authors and differs with different surgical techniques. After excluding early postoperative dysphagia, which is common and resolves in a few weeks in the great majority of cases, incomplete relaxation of the inferior esophageal sphincter may be proposed for some 20% of those operated. This last hypothesis can only be discussed after having excluded the hypotheses of secondary peptic stricture, slipping of the valve, and even aperistalsis (scleroderma, intermittent esophageal spasm, etc.).

A follow-up study of 35 patients was performed 1.5 to 22 years after simple closure and drainage of the esophagus for nonmalignant intrathoracic perforation or rupture, with special attention to dysphagia. Of the seven patients with spontaneous rupture, only one required supplementary postoperative treatment, for severe reflux esophagitis. None of the eight patients with iatrogenic lesion and no prior esophageal disorder had any dysphagia postoperatively. Postoperative swallowing problems were absent in 13 of the 20 patients with perforation caused by examination or treatment of an already diseased esophagus. Four required repeated esophageal dilation and three underwent further surgery. Simple closure and drainage of nonmalignant intrathoracic perforation or rupture of the esophagus is concluded to be a safe procedure in regard to late postoperative dysphagia.

Fortunately, this complex procedure is not systematically used for all patients. However, it becomes classical to use this objective method in comparing the surgical procedures for continence restitution.

Two hundred eighty-nine patients have been operated upon for hiatus hernia in the last ten years. A repair procedure has been developed in which a fascia lata graft is sutured to the under surface of the diaphragm. The approach is through a left thoracotomy incision and a circumferential incision in the diaphragm. The reason for adopting this technic are set out. One hundred patients have been followed up between three and six years after operation, and eight-nine have undergone a full and detailed evaluation. The results are described with emphasis on detailed facts rather than clinical qualitative impressions. Although the over-all recurrence rate is low (5 per cent), dissatisfaction is felt at the high incidence of postoperative dysphagia which, although mild in all but three patients, is undoubtedly due in the majority to failure to leave an adequate hiatus for the passage of a normal bolus.

Most fatalities directly related to operative procedures in the head and neck region occur from airway obstruction or exsanguinating hemorrhage. Other complications can be avoided by careful attention to anatomic structures, allowing definitive decision as to transection of nerves, avoidance of lymph fistulas, and proper cancer ablative procedures. Preoperative consideration of functional problems permits control and reconstruction to minimize postoperative dysphagia, drooling, and cosmetic deformities.

Intraoperative manometry was performed in 7 consecutive patients undergoing Nissen fundoplication for gastroesophageal reflux disease. The aim of the study was to assess the effectiveness of the technique of mechanical calibration of the fundoplication with a 60-french Maloney bougie. Results showed a statistically significant increase of lower esophageal sphincter pressure and length over preoperative values. The values remained stable at 1 week and 6 months after operation. No patient had postoperative dysphagia or abnormal esophageal acid exposure on 24-hour esophageal pH monitoring. We conclude that mechanical calibration of the Nissen fundoplication is very effective in constructing an adequate antirefiux barrier. Intraoperative manometry adds time to the operation, and the information gained is of little practical value.

A brief synopsis of problems with hiatus herniorrhaphy surgery over its 25-year history includes extensive surgery, recurrences, and postoperative swallowing difficulties. A review of the simple central tendon hiatal herniorrhaphy technic and seven-year results include the adoption of a mersilene strip rather than external rectus fascia in anchoring the esophagogastric junction to the central tendon. The same excellent exposure and visibility allowing the lower esophageal segment to be well secured definitely within the abdomen is completely illustrated. Seven-year results in 138 patients operated upon are reviewed including mortality, recurrence rates, postoperative dysphagia, gas-bloat, and loss of regurgitating ability.

Volume 2 of Complications in Otolaryngology–Head and Neck Surgery addresses recognition and management of a broad range of complications in head and neck surgery. The 49 contributors to this text are recognized authorities on the topics about which they have written. The volume has 32 chapters, each well illustrated with line drawings, black-and-white photographs, tables, and, occasionally, color plates. Each chapter begins with a short outline of its contents, which facilitates looking up specific complications. The scope of some chapters, such as "Postoperative Dysphagia" and "Complications of Myocutaneous Flaps," is very specific, while others, such as "Postoperative Infection," "Surgery of the Sinuses," and "Surgery of the Larynx and Hypopharynx," are more general. There are also chapters that cover nonsurgical complications such as those related to anesthesia, chemotherapy, and radiotherapy. Users of this textbook need to have familiarity or experience with head and neck diseases and their treatments. Although diagnosis of