Alterations in hyolaryngeal elevation after esophageal anastomosis: A possible mechanism for airway aspiration

Numan Demir; Selen Serel Arslan; Sule Yalcin; Ayşe Karaduman; Feridun Cahit Tanyel; Tutku Soyer

doi:10.1016/j.jpedsurg.2017.04.001

Alterations in hyolaryngeal elevation after esophageal anastomosis: A possible mechanism for airway aspiration

J Pediatr Surg. 2017 Oct;52(10):1580-1582. doi: 10.1016/j.jpedsurg.2017.04.001. Epub 2017 Apr 5.

Authors

Numan Demir¹, Selen Serel Arslan¹, Sule Yalcin², Ayşe Karaduman¹, Feridun Cahit Tanyel², Tutku Soyer³

Affiliations

¹ Hacettepe University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
² Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
³ Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey. Electronic address: soyer.tutku@gmail.com.

PMID: 28412031
DOI: 10.1016/j.jpedsurg.2017.04.001

Abstract

Aim: A prospective study was performed to evaluate anatomical alterations and hyolaryngeal elevation (HE) by videofluoroscopic swallowing study (VFSS) in patients with esophageal atresia-tracheoesophageal fistula (EA-TEF).

Methods: Patients operated for EA-TEF were evaluated for age, sex, type of atresia and time to esophageal anastomosis. All patients were evaluated by videofluoroscopic swallowing study (VFSS). Penetration-Aspiration scale (PAS≥7 is considered as aspiration), distance between upper esophageal sphincter and 2nd cervical vertebrae (UES-C2) and hyolaryngeal elevation (HE) were evaluated by the same deglutitionist who was blind to the study. The results of EA-TEF patients were compared with healthy children.

Results: Eighteen patients with EA-TEF and 10 healthy controls were included. The median age was 16months (12-36m) in EA-TEF and 18months (13-51m) in controls. Male-to-female ratio was 5:4 and 4:1 respectively. 12 of cases were isolated-EA, 1 of them was EA-proximal TEF and 5 of the cases were EA-distal TEF. Half of the cases had primary EAN and others underwent delayed esophageal repair. Early oral feeding was also started in 9 patients (50%) whereas others had delayed oral feeding. VFSS showed aspiration in 27.7 (n=5) of cases (PAS≥7) in EA group. The median distance between UES-C2 was 3.04cm (min: 2.17-max: 3.94) in EA and 4.17cm (min: 3.45-max: 6.24cm) in controls. Median distance for HE was 0.37cm (min: 0.18-max: 1.1cm) in EA and 1.15 (min: 0.61-max: 1.06cm) in controls. The distance between UES-C2 was significantly lower than controls (p<0.05) and HE was decreased in EA-TEF without any statistical significance.

Conclusion: Children with EA-TEF had shortened distance between airway and upper esophagus. HE may be inefficient to protect airway during deglutition. Anatomical alterations after EAN suggest that airway problems may be related with decreased HE in children with EATEF.

Level of evidence: Level II (Development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard").

Keywords: Children; Esophageal atresia; Hyolaryngeal elevation; Respiratory; Tracheoesophageal fistula.

MeSH terms

Anastomosis, Surgical / adverse effects*
Child, Preschool
Deglutition
Deglutition Disorders / etiology*
Deglutition Disorders / prevention & control
Esophageal Atresia / surgery*
Esophageal Sphincter, Upper / surgery
Female
Humans
Hyoid Bone
Infant
Infant, Newborn
Male
Prospective Studies
Tracheoesophageal Fistula / surgery*

Supplementary concepts

Esophageal atresia with or without tracheoesophageal fistula