ASPO075 - Pediatric Swallowing Outcomes after Maxillectomy or Mandibulectomy with Free Tissue Transfer for Head and Neck Tumors
Sunday, May 1, 2022
8:55 AM – 9:55 AM CT
Location: Landmark C
Priyanka Velappan, BS Candidate1, Amy Dimachkieh, MD2, Edward Buchanan, MD3, W. Christopher Pederson, MD3, Christina Rappazzo, SLP4, Jean Hawney, SLP4, Michael Kupferman, MD, MBA5, Randal Weber, MD5, Daniel Chelius, MD2;
1Rice Univ., Houston, TX, 2Otolaryngology - Head and Neck Surgery, Texas Children's Hosp./Baylor Coll. of Med., Houston, TX, 3Plastic and Reconstructive Surgery, Texas Children's Hosp./Baylor Coll. of Med., Houston, TX, 4Speech and Language Pathology, Texas Children's Hosp., Houston, TX, 5Head and Neck Surgery, Univ. of Texas M.D. Anderson Cancer Ctr., Houston, TX.
Introduction: Pediatric maxillary and mandibular tumors require complex, multidisciplinary surgical care and rehabilitation to optimize function and cosmesis. Expectations for swallowing outcomes are critical both for patient/family counseling and for early detection of deviation from anticipated recovery. Our objective was to examine 5 years of pediatric mandibulectomy/maxillectomy with free-tissue reconstruction patient data to establish normative swallowing expectations within a multidisciplinary tumor program.
Methods: Retrospective analysis. All patients had preoperative counseling with Speech & Language Pathologist (SLP) from the head and neck tumor team and were followed closely postoperatively by the SLPs. Decisions to start/advance diet were made collaboratively between SLP and surgical team considering wound healing and swallowing abilities on bedside evaluation.
Results: 15 patients (9 mandibulectomy/6 maxillectomy) had a mean age of 11.3 years (range 1.6 -23.4). All patients achieved regular diet in mean 33.9 days (range 11 - 65), however there was a trend for longer time to full diet for mandibulectomy (41.8 v 22.2, p=0.06). The mean times for progression to full diet were: PO trial 7.3±1.6 days; clear liquids 7.8±1.9 days; full liquids 9.1±2.1 days; soft (dysphagia 1, 2, or 3) 11.5±4.2 days; and regular 33.9±16.1 days. Age had no significant effect on progress to regular diet. All patients were initially managed with tracheostomy and nasogastric tube (NGT) feeds with mean 11.9±3.9 days until NGT removal prior to decannulation and discharge on mean 13.0±2.8 days.
Conclusion: Herein we establish normative swallowing outcomes for pediatric patients undergoing free-tissue reconstruction after maxillectomy or mandibulectomy. Perioperative pathways based on institutional experience facilitate accurate preoperative counseling and safe, consistent postoperative therapy. Deviations from the expected recovery pathway may indicate developing complications. When confronted with difficult care decisions, accurate outcomes data will allow families to better understand postoperative function in the informed decision process and potentially alleviate anxiety.