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Abstract Aim Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs). Methods This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non‐dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of

Aim: Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs). Methods: This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non‐dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses. Results: The incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non‐dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing‐care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non‐dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut‐off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high‐risk patients, the incidence of postoperative dysphagia was reduced by SSTs. Conclusions: The new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short‐term outcomes. This retrospective study included 267 patients of advanced age and was performed to identify predictive factors of dysphagia after emergency abdominal surgery and to explore the usefulness of swallowing screening tools. This study demonstrated that high intramuscular adipose tissue content, postoperative ventilator management, cerebrovascular disorder, and dementia were associated with postoperative dysphagia after emergency abdominal surgery in patients of advanced age. For patients at high risk as identified by our new prediction score that was created based on these risk factors, propensity score‐matching analysis showed that the use of swallowing screening tools can help to prevent postoperative dysphagia. [ABSTRACT FROM AUTHOR]

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Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications.

We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases. [ABSTRACT FROM AUTHOR]

Study designProspective cohort study.ObjectivesMost studies of dysphagia in the cervical spine have focused on a degenerative patient population; the rate of dysphagia following surgery for cervical deformity (CD) is unknown. This study aims to investigate if surgery for cervical deformity results in postoperative dysphagia.MethodsPatients with CD undergoing surgery from 2013 to 2015 were prospectively enrolled to evaluate dysphagia. Demographic, operative, and radiographic variables were analyzed. The Quality of Life in Swallowing Disorders (SWAL-QoL) was used to measure dysphagia. Paired t test, independent t tests, and bivariate Pearson correlations were performed.ResultsA total of 88 CD patients, aged 61.52 ± 10.52 years, were enrolled. All patients (100%) had 3-month SWAL-QoL for analysis. The baseline preoperative SWAL-QoL was 78.35. This is roughly the same level of dysphagia as an anterior cervical discectomy patient that is 3 weeks removed from surgery. Increasing body mass index (BMI) was correlated with decreased SWAL-QoL score (r = -0.30, P = .001). Age, gender, smoking, and Charlson Comorbidity Index (CCI) showed no significant correlations with preoperative SWAL-QoL. Patients with prior cervical surgery had a lower preoperative SWAL-QoL (P = .04). While 11 patients had acute postoperative dysphagia, CD surgery did not result in lower SWAL-QoL at 3 months (77.26 vs 78.35, P = .53). Surgical variables, including estimated blood loss (EBL), anterior or posterior fusion levels, steroid use, preoperative traction, staged surgery, surgical approach, anterior corpectomy, posterior osteotomy, and UIV (upper instrumented vertebrae) location, showed no impact on postoperative SWAL-QoL. Correction of cervical kyphosis was not correlated to 3-month SWAL-QoL scores or the change in SWAL-QoL scores.ConclusionsWhile patients undergoing surgery for cervical deformity had swallowing dysfunction at baseline, we did not observe a significant decline in SWAL-QoL scores at 3 months. Patients with prior cervical surgery and higher BMI had a lower baseline SWAL-QoL. There were no surgical or radiographic variables correlated to a change in SWAL-QOL score.

Abstract Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

ObjectiveThis study aimed to analyze the risk factors for dysphagia after C1-2 fusion in patients with C1-2 junction diseases.Summary of the background dataDysphagia is a common postoperative complication of posterior C1-2 junction surgery. The incidence is 9.5% to 26.3%. However, the etiopathogenisis of postoperative dysphagia remains controversial.MethodsThis retrospective study included patients who underwent C1-2 fusion from January 2016 to January 2020. The patients were divided into dysphagia group and control group in accordance with the Bazaz R dysphagia scoring system. The patients' age, gender, BMI(body mass index), cause of disease, and changes in the C01cobb, C02cobb, C12cobb, C27cobb, dC02cobb, dC01cobb, dC12cobb, d C27cobb angles before and after operation, were recorded. The parameters and changes were compared to analyze the risk factors for dysphagia after C1-2 fusion.Results65 cases (15, with dysphagia; 50, without dysphagia) were included. The incidence of postoperative dysphagia was 23%. The differences in age, gender ratio, and BMI between the two groups were not significant (P > 0.05). The differences among postoperative C12 (29.8° ± 11.24° vs. 20.46° ± 13.39°), postoperative C27cobb (10.56° ± 8.53° vs. 20.21° ± 13.21°), and dC12cobb (9.49° ± 5.16° vs. 1.07° ± 12.44°) between the two groups were significant (P 5° was a significant independent risk factor for postoperative dysphagia, And preoperative C27cobb was a preventive factor of postoperative dysphagia.ConclusionsDysphagia after the C1-2 fusion was common. dC02cobb and dC12cobb were the significant independent risk factors for postoperative dysphagia. Preoperative c27cobb was a preventive factor of dysphagia.

Background Context: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure. There is markedly less data on outcomes after three- and four-level cases than one- and two-level cases.Purpose: To compare perioperative 90-day adverse events and 5-year reoperation rates between isolated one-, two-, three-, and four-level ACDF cases.Study Design/setting: Retrospective review of a large national database.Patient Sample: Overall, 97,081 patients undergoing ACDF were identified, of which one-level cases were 42,382 (43.7%), two-level cases were 24,055 (24.8%), three-level cases were 28,293 (29.1%), and four-level cases were 2,361 (2.4%).Outcome Measures: Ninety-day adverse events and 5-year reoperation rates.Methods: The 2010 to Q1 2020 PearlDiver database was queried to identify patients who underwent elective ACDF for degenerative pathology without corpectomy or concomitant posterior procedures. Univariate and multivariate analyses were performed to compare outcomes of subcohorts with varying number of levels addressed by ACDF.Results: Of the 97,081 cases identified, patient characteristics and complication rates differed between the cohorts defined by levels treated. Univariate analyses revealed statistically different rates of 90-day any, serious, and minor adverse event rates between the groups, but the differences were all less than 2.5%. Readmission rates were statistically different by 2.9%, dysphagia by 3.2%, and prolonged length of stay by 6.3%.By multivariate analyses, three-level ACDF cases were not found to have greater 90-day adverse outcomes than two-level cases. Four-level ACDF cases were found to have significantly greater odds ratios of readmission, dysphagia, and prolonged length of stay (relative to one-level cases, OR 1.28, 1.63, and 1.97, respectively) but not other 90-day adverse events. Reoperation rates at five years for one-, two-, three-, and four-level cases were 13.0%, 13.5%, 15.0%, and 22.1%, respectively (log-rank p<.001).Conclusions: The current study represents one of the largest comparative studies of patients undergoing one-, two-, three-, and four-level ACDF. While odds of 90-day adverse events were not greater for three- versus two-level cases, four-level cases had several that were higher odds than one-level cases. Reoperation and dysphagia rates were higher for four-level cases than lesser levels. While these outcomes were found to be acceptable, they should help guide hospital planning and patient counseling. [ABSTRACT FROM AUTHOR]

Abstract Background PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). Methods Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. Results Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA

We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases.

Background: The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability.Case Presentation: A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient's mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required.Conclusions: The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability. [ABSTRACT FROM AUTHOR]

Esophageal fistulae are rare, though serious, complications of anterior cervical surgery. Hardware-related issues are important etiologic factors. Patient-specific implants (PSIs) have increasingly been adapted to spinal surgery and offer a range of benefits. Zero-profile implants are a recent development primarily aimed at combating postoperative dysphagia. We report the first use of a 3-dimensional (3D)-printed zero-profile PSI in managing implant failure with migration and a secondary esophageal fistula. A 68-year-old female had a prior C5-7 corpectomy with cage and plate fixation, as well as posterior C3-T1 lateral mass fixation, complicated by anterior plate displacement, resulting in pseudoarthrosis and an esophageal fistula. A 3D-printed zero-profile PSI was designed and implanted as part of a revision procedure to assist in recovery, prevent recurrence, and facilitate bony fusion. Optimal implant placement was achieved on the basis of preoperative virtual surgical planning. By 1 month postoperatively the patient had significantly improved, with evidence of esophageal fistula resolution and radiographic evidence of optimal implant placement. Zero-profile 3D-printed PSIs may combat common and serious complications of anterior cervical surgery including postoperative dysphagia and esophageal fistulae. Further research is required to validate their widespread use for either cervical corpectomy or diskectomy and interbody fusion. [ABSTRACT FROM AUTHOR]

Background: PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF).Methods: Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia.Results: Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA <90° in predicting dysphagia reached 88.5%.Conclusions: PIA could be used as a predictor for postoperative dysphagia in patients undergoing OCF. Adjusting a PIA level higher than the preoperative PIA level could avoid dysphagia. For those who inevitably had decreasing PIA, preserving intraoperative PIA over 90° would help avert postoperative dysphagia.Trial Registration: This trial has been registered in the Medical Ethics Committee of West China Hospital, Sichuan University. The registration number is 762 and the date of registration is Sep. 9 th, 2019. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the incidence and risk factors of postoperative dysphagia after anterior cervical decompression and fusion (ACDF) in terms of demographic, procedural and anaesthetic perspectives. Materials and methods: Medical records and radiologic data of patients who underwent anterior cervical surgery performed by two surgeons in a single centre between January 2012 and December 2015 were retrospectively analysed. Patients with spinal tumours, infective spondylitis and traumatic cervical pathologies were excluded. Patients with preoperative dysphagia and previous history of anterior cervical surgery were also excluded. Finally, 127 patients were enrolled. Bazaz dysphagia score was used for the diagnosis of postoperative dysphagia. Results: The incidence of postoperative dysphagia was 10.2% at six weeks after ACDF. Nine patients showed mild dysphagia that fully recovered at three months after ACDF. Four patients showed moderate dysphagia that also recovered fully at six months after surgery. The incidence of postoperative dysphagia increased significantly in cases of C4 or C5 level involvements. Age, sex, hypertension, body mass index, postoperative soft tissue swelling, intubation difficulty and intubation tools were not significant risk factors of ACDF. Diabetes mellitus, two surgical levels, the use of plate, long anaesthetic and operative time and large intubation tube size were causative factors of postoperative dysphagia in multivariable analysis (p < 0.05). Conclusions: The incidence of postoperative dysphagia after ACDF was relatively low, and the prognosis was good. [ABSTRACT FROM AUTHOR]

Background Context: Dysphagia is a common postoperative complication in patients undergoing occipitocervical fusion (OCF). Previous studies had proposed the use of two measures-the occipital to C2 angle (O-C2a) and the occipital and external acoustic meatus to axis angle (O-EAa)-to predict postoperative dysphagia after OCF. However, these studies had small sample sizes and the predictive abilities of both measures are still not clear.Purpose: To evaluate the predictive ability of O-EAa and O-C2a for dysphagia after OCF.Study Design: A retrospective clinical study.Patient Sample: A total of 109 consecutive patients who had undergone OCF.Outcome Measures: Presence of postoperative dysphagia, O-C2a, C2 tilting angle (C2Ta), O-EAa, and the narrowest oropharyngeal airway space (nPAS).Methods: Between April 2010 and June 2018, 109 consecutive patients who had undergone OCF were reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic measurements, including O-C2a, C2Ta, O-EAa, and nPAS, were evaluated at preoperative and 1 month postoperative and the findings were compared. Simple linear regression was used to measure the correlations between the parameters and the presence of dysphagia, and the correlations within the parameters. Multiple regression analysis was used to examine the variables that affected the change of nPAS (dnPAS%). Sensitivity and specificity analyses were used to evaluate the effectiveness of the previously proposed measures ("O-C2a change≤-5°" and "postoperative O-EAa<100°") for prediction of post-OCF dysphagia.Results: The incidence of dysphagia after OCF was 26.6% (29/109). Preoperative values for the radiographic parameters were similar between patients with and without dysphagia. In the dysphagia group, both O-C2a and O-EAa values showed a dramatic decrease after surgery, which was accompanied by a decrease in nPAS. Postoperative O-C2a, O-EAa, and nPAS in the dysphagia group were significantly smaller than those in the nondysphagia group (p<.05). The changes in O-EAa, O-C2a, and nPAS showed a linear correlation with the presence of dysphagia (p<.05). In addition, linear correlations were found between two of the three parameters. Multiple regression showed the change of O-C2a and O-EAa were significant predictors for dnPAS% (β=0.200, p=.022 and β=0.549, p=.000). The sensitivity and specificity of "O-C2a change≤-5°" in predicting dysphagia were 75.9% and 80.0% respectively, and those of "postoperative O-EAa<100°" were 75.9% and 62.5%, respectively. However, the sensitivity of the combination of these two values in predicting postoperative dysphagia was as high as 96.6%.Conclusion: Both O-EAa and O-C2a could be critical predictors for postoperative dysphagia. During surgery, ensuring that the O-EAa exceeds 100° and simultaneously avoiding an O-C2a reduction greater than 5° could effectively avert postoperative dysphagia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis. At present, we can use a Zero-P lnterbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material. The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation. Besides, the Zero-P could avoid the risk of excessively long or poorly placed plate Injury to adjacent segmental Intervertebral discs. OBJECTIVE: To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage. METHODS: Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People's Hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into Zero-P group (Zero-P fusion, n=30) and plate group (anterior cervical plate fixation combined with cage Implantation, n=30). All patients In the two groups had Informed consent to the treatment plan. This study was approved by the hospital ethics committee. The Japanese orthopedic association score, neck disability index score and Bazaz swallowing function score ware used to evaluate the clinical efficacy. Cervical X-ray and cervical CT scans were performed to assess cervical curvature, observe bone graft fusion, and implant displacement, loosening and breakage. RESULTS AND CONCLUSION: (1) All surgeries were successfully completed in 60 patients. The wounds healed In stage I after operation. There were no serious complications such as nerve injury, esophageal fistula, and cerebrospinal fluid leakage. (2) During the follow-up, there was no significant difference in neck disability index, Japanese orthopedic association score and bone graft fusion rates between the two groups (P > 0.05). (3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation (all P < 0.05). (4) The overall curvature and operative segments curvature ware better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up (P < 0.05). (5) Two-level anterior cervical dlscectomy and fusion using Zero-P Is a safe and effective operative method. The operation time, bleeding volume, number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system, but It Is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine. Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic fundoplication (LF), even if performed in specialized centers, can be followed by long-term side effects such as dysphagia, gas bloating or inability to belch. Patients with an ineffective esophageal motility (IEM) and concurrent GERD are prone to postoperative dysphagia after LF. The aim of this study is to evaluate the safety and efficacy of electrical lower esophageal sphincter stimulation in patients with IEM and GERD.Methods: This is a prospective, open-label single center study. Patients with PPI-refractory GERD and ineffective esophageal motility were included for lower esophageal sphincter electrical stimulation (LES-EST). Patients underwent prospective follow-up including physical examination, interrogation of the device and were surveyed for changes in the health-related quality of life score.Results: According to power analysis, 17 patients were included in this study. Median distal contractile integral (DCI) was 64 mmHg s cm (quartiles 11.5-301). Median total % pH < 4 was 8.9 (quartiles 4-21.6). Twelve patients (70.6%) underwent additional hiatal repair. At 1-month follow-up, none of the patients showed any clinical or radiological signs of dysphagia. There were no procedure related severe adverse events. Mean total HQRL improved from baseline 37.53 (SD 15.07) to 10.93 (SD 9.18) at follow-up (FUP) (mean difference 24.0 CI 15.93-32.07) p < 0.001.Conclusions: LES-EST was introduced as a potential technique to avoid side effects of LF. LES-EST significantly improved health related quality of life and does not impair swallowing in patients with GERD and ineffective esophageal motility. [ABSTRACT FROM AUTHOR]

Dysphagia is a disease resulting from preparatory or transport disorder of the swallowing process and it is divided into oropharyngeal and esophageal phases according to the site of the lesion. The ear, nose and throat assessment focuses on the oropharyngeal phase, but differential diagnosis, investigation, and treatment of the cause of dysphagia is often a complex task requiring multidisciplinary approach and collaboration. The method of fiberoptic endoscopic evaluation of swallowing (FEES) has been introduced at the Department of Ear, Nose and Throat and Head-Neck Surgery, University of Szeged, enabling the examination of otorhinolaryngological and neurological disorders of swallowing as well as objective analysis of patients' swallowing quality. The fiberoptic endoscopic evaluation of swallowing is a minimally invasive procedure that allows visualization of the oropharyngeal phase of swallowing. It can identify anatomical abnormalities or neurological disorders causing dysphagia, thus playing a significant role in later patient rehabilitation. We hereby present our experiences in examinations of patients who underwent partial laryngectomy and/or pharyngectomy due to head and neck tumors as well as of those who underwent airway surgery duo to upper airway stenosis. Thanks to our collaboration with the Neurology Department, we also share our experiences gained during the examinations of patients struggling with oropharyngeal swallowing problems of various neurological origins. Orv Hetil. 2023; 164(46): 1817-1823.

Study Design: A retrospective study., Objective: To investigate the potential risk factors of dysphagia after anterior cervical discectomy and fusion (ACDF) and to establish and validate a prediction model., Methods: The clinical data of 252 patients who underwent anterior cervical discectomy and fusion in our hospital from January 2018 to October 2020 were retrospectively analyzed and divided into the dysphagia group and the non-dysphagia group according to whether dysphagia occurred after surgery. Age, gender, body mass index, smoking and drinking history, hypertension history, diabetes history, disease duration, placement of Hemovac negative pressure drain, number of segments involved in surgery, whether C 4-5 /C 5-6 segment surgery, incision length, incision position, level of preoperative EAT-10 score, whether preoperative tracheal exercise, and changes in cervical curvature before and after surgery were recorded in both groups. Risk factors for postoperative dysphagia were identified and nomogram prediction models were developed., Results: A total of 252 patients were included in the study, 115 of whom presented with dysphagia within 1 week after anterior cervical fusion. The results of multivariate logistic regression analysis indicated that male gender (OR = .045, 95% CI .223-.889) and whether preoperative tracheal exercise (OR = .260, 95% CI .107-.633) were independent risk factors associated with reduced incidence of postoperative dysphagia., Conclusion: The incidence of dysphagia symptoms after anterior cervical decompression and fusion gradually decreased with the extension of follow-up time, and preoperative tracheal exercise and shortening the operation time may help to reduce the occurrence of postoperative dysphagia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Laparoscopic fundoplication is the gold standard operation for treatment of gastroesophageal reflux disease (GERD). It has been suggested that persistent postoperative dysphagia is increased following Nissen fundoplication compared to partial fundoplication. This study aimed to determine risk factors for persistent postoperative dysphagia, specifically examining the type of fundoplication. Methods Patients experiencing GERD symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication from 2009 to 2016 were identified from a single-institutional database. A dysphagia score was obtained as part of the GERD health-related quality of life questionnaire. Persistent dysphagia was defined as a difficulty swallowing score ≥1 (noticeable) on a scale from 0 to 5 at least 1 y postoperatively. Odds ratios of persistent dysphagia among those who underwent antireflux surgery were calculated in a multivariate logistic regression model adjusted for fundoplication type, sex, age, body mass index, and redo operation. Results Of the 441 patients who met inclusion criteria, 255 had ≥1 y of follow-up (57.8%). The median duration of follow-up was 3 y. In this cohort, 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n = 66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen versus partial) and the likelihood of postoperative dysphagia. Conclusions Persistent postoperative dysphagia after antireflux surgery occurred in approximately one-quarter of patients and did not differ by the type of fundoplication. These findings suggest that both Nissen and partial fundoplication are reasonable choices for an antireflux operation for properly selected patients. [ABSTRACT FROM AUTHOR]

Aim: Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs)., Methods: This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non-dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses., Results: The incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non-dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing-care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non-dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut-off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high-risk patients, the incidence of postoperative dysphagia was reduced by SSTs., Conclusions: The new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short-term outcomes., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.)

Gastroesophageal reflux is the most common benign disorder of the esophagus and laparoscopic Nissen fundoplication has become the standard surgical treatment for its treatment. In our area, where the use of bougie calibration is debatable, postoperative dysphagia is encountered often after this surgery although it is usually not permanent. The aim of this study was to investigate the effect of using a soft silicone tube 39 F in diameter for esophageal calibration during laparoscopic Nissen fundoplication on the incidence of postoperative dysphagia. We divided cases scheduled to undergo laparoscopic Nissen fundoplication between January 2009 and November 2010 into two groups, each consisting 25 patients. Esophageal calibration with a 39 F silicone orogastric tube was used for the first group while there was no operative calibration in the second group. The surgical duration was recorded; the presence and severity of the postoperative dysphagia was calculated by using a dysphagia severity scoring system during the 1-year postoperative follow-up. The dysphagia severity scores were significantly lower in group 1 than group 2 on the postoperative second day and at the end of the first week and first month. We did not find a significant difference at the end of the 6-month and first year. There was also no significant difference regarding surgery duration. The use of a soft orogastric tube 39 F in diameter for esophagus calibration during laparoscopic Nissen fundoplication has significantly decreased the incidence of postoperative transient dysphagia without affecting the duration of surgery. Although dysphagia gradually resolves in the majority of patients, a safe and easy calibration method for its prevention is worth developing, and we believe that the use of our method in larger series could be beneficial. [ABSTRACT FROM AUTHOR]