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Scientific Oral Presentations

Laryngology/Broncho-Esophagology

Session: Scientific Oral Presentations 4 - Laryngology/Broncho-Esophagology

Impact of Internal Lymphedema on Airway Difficulty Assessments in HNC Survivals With Dysphagia

Tuesday, October 1, 2024
10:00 AM – 10:06 AM EDT
Location: MBCC, 224
Disclosure(s):
Mohammad Bilal Alsavaf, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Andrew Tyler Peachman:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Akhil Katragadda, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Juhi Katta, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jack L. Birkenbeuel, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Zachary A. Wykoff, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jacqueline R. Tardif, CCC-SLP:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amy M. Compston, PT, DPT, MBA, CRT, CLT-LANA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Dysphagia remains a common complication in head and neck cancer (HNC) treatment. The management of esophageal dilation in this patient population poses a challenge for surgeons and anesthesiologists with an important part of it due to airway-related concerns. Despite the prevalence of lymphedema in HNC survivors, its role in contributing to airway difficulties has been inadequately reported. This study aims to investigate whether internal lymphedema (IL) impacts airway assessments in HNC patients undergoing esophageal dilations.

Methods: A retrospective analysis was conducted on 98 patients over the age of 18 who underwent esophageal dilation from 2020-2022. Data on American Society of Anesthesiologists classification, Mallampati score, Cormack-Lehane classification, oral opening, thyromental distance, cervical range of motion, and difficulty of airway were collected and analyzed. Internal lymphedema was assessed through fiberoptic endoscopy using a modified Patterson Score. Transnasal balloon dilations were performed in the OR under spontaneous breathing sedation at a tertiary center.

Results: The mean sum of IL severity was 9.5 ± 5.2. Severity significantly correlated with tumor site (p = 0.012), with highest risk in laryngeal cancer (13.8) followed by hypopharynx (11.5) and oropharynx (10). Age, gender, race, and treatment modalities were not identified as predisposing factors for increasing severity or affected areas of IL. The Mallampati III-IV group had worse mean IL (11) versus Mallampati I-II (8.5, p = 0.018). No correlation was found between airway difficulty and overall IL severity or severity of any measured areas among Patterson’s scores. Dilation outcomes were unaffected by IL severity.

Conclusions: Severe IL may increase anesthetic risk in HNC survivors due to higher Mallampati grades. Experienced airway teams are vital for treating dysphagia in this population. Esophageal dilation appears safe even with severe IL when performed in settings similar to the one described in our study.

    Presenting Author(s)

  • MA

    Mohammad Bilal Alsavaf, MD

    Research Fellow
    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Andrew Tyler Peachman

    Medical Student
    The Ohio State University College of Medicine
    Avon Lake, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • MS

    Mayuri Srikanth, BS

    Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

    Disclosure information not submitted.

  • Akhil Katragadda, BS

    Medical Student
    The Ohio State University College of Medicine
    Columbus, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Juhi Katta, MD

    Resident
    Albany Medical Center
    Farmington Hills, Michigan, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • TK

    Tae-Hee Kim

    The Ohio State University College of Medicine, United States

    Disclosure information not submitted.

  • JB

    Jack L. Birkenbeuel, MD

    PGY-3
    The Ohio State University Wexner Medical Center
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Zachary A. Wykoff, BS

    MS4
    The Ohio State University College of Medicine
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • VK

    Veena Kallambettu, CCC-SLP

    The Ohio State University Wexner Medical Center, United States

    Disclosure information not submitted.

  • Jacqueline R. Tardif, CCC-SLP

    Speech Language Pathologist
    The Ohio State University Wexner Medical Center
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • TP

    Tulsi Patel, CCC-SLP

    The Ohio State University Wexner Medical Center, United States

    Disclosure information not submitted.

  • AC

    Amy M. Compston, PT, DPT, MBA, CRT, CLT-LANA

    Rehab Team Lead
    The Ohio State University- James Cancer Hospital
    Worthington, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Apoorva T. Ramaswamy, MD

    Assistant Professor
    Ohio State University Hospital Program
    Columbus, OH, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Apoorva T. Ramaswamy, MD

    Assistant Professor
    Ohio State University Hospital Program
    Columbus, OH, United States

    Disclosure information not submitted.