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European Archives of Oto-Rhino-Laryngology

30-04-2024 | Neck Dissection | Head and Neck

Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection

Authors: Joo Hyun Park, Goeun Park, Kyu Hyeon Hwang, Hee Chun Cho, Junyoung Kim, Subi Oh, Han-Sin Jeong

Published in: European Archives of Oto-Rhino-Laryngology

Abstract

Purpose

Postoperative laryngeal edema (PLE) is a common complication in patients undergoing head and neck surgery, leading to symptoms such as odynophagia, dysphagia, or potential airway obstruction. However, the prevalence and risk factors of PLE in patients undergoing neck dissection (ND) have not been well investigated.

Methods

A retrospective analysis was conducted in three steps. Initially, a pilot study of 50 consecutive ND patients revealed a preliminary PLE prevalence of 0.34. Then, the medical records of an additional 295 ND patients were reviewed to estimate the prevalence of PLE with a total width of 95% confidence interval (CI) of ± 5%. Finally, multivariable logistic regression analyses were performed to identify risk factors for PLE (n = 343).

Results

PLE occurred in 29.4% [95%CI 24.4–34.4%] of patients undergoing any type of ND, with the most common symptoms of odynophagia (75.0%) and dyspnea (11.1%). Hospital stay was just one day longer in PLE patients, responding well with short-term steroid treatment (p = 0.0057). In multivariable analyses, no significant association was found between PLE occurrence and airway management. However, body mass index and the American Society of Anesthesiologists classification correlated with PLE. More importantly, surgery for oro-hypopharynx or supraglottis tumors (odds ratio, OR = 3.019, [95%CI 1.166–7.815]) and lymph node level 2(3) ND (OR = 4.214 to 5.279, [95%CI 1.160–20.529]) were significant risk factors for PLE.

Conclusions

PLE developed in approximately 30% of ND patients, causing uncomfortable symptoms. Early diagnosis and intervention of PLE in high-risk patients can improve patient care and outcomes.

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Pluijms WA, van Mook WN, Wittekamp BH, Bergmans DC (2015) Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Crit Care 19:295. https://doi.org/10.1186/s13054-015-1018-2CrossRefPubMedPubMedCentral

Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC (2009) Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 13:233. https://doi.org/10.1186/cc8142CrossRefPubMedPubMedCentral

Ak AK, Cascella M (2023) Post-Intubation Laryngeal Edema. In: StatPearls, Treasure Island (FL) ineligible companies. Disclosure: Marco Cascella declares no relevant financial relationships with ineligible companies.

Dark A, Armstrong T (1999) Severe postoperative laryngeal oedema causing total airway obstruction immediately on extubation. Br J Anaesth 82:644–646. https://doi.org/10.1093/bja/82.4.644CrossRefPubMed

Darmon JY, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, Schlemmer B, Tenaillon A, Brun-Buisson C, Huet Y (1992) Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology 77:245–251. https://doi.org/10.1097/00000542-199208000-00004CrossRefPubMed

Ho LI, Harn HJ, Lien TC, Hu PY, Wang JH (1996) Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Med 22:933–936. https://doi.org/10.1007/BF02044118CrossRefPubMed

Razack MS, Baffi R, Sako K (1981) Bilateral radical neck dissection. Cancer 47:197–199. https://doi.org/10.1002/1097-0142(19810101)47:1%3c197::aid-cncr2820470131%3e3.0.co;2-9CrossRefPubMed

Storper IS, Calcaterra TC (1992) Laryngeal edema induced by neck dissection and catheter thrombosis. Am J Otolaryngol 13:101–104. https://doi.org/10.1016/0196-0709(92)90006-fCrossRefPubMed

Martis C, Athanassiades S (1971) Post-thyroidectomy laryngeal edema. A survey of fifty-four cases. Am J Surg 122:58–60. https://doi.org/10.1016/0002-9610(71)90348-5CrossRefPubMed

10.

Iijima Y, Takaoka Y, Motono N, Uramoto H (2023) Temporary tracheotomy for post-intubation laryngeal edema after lung cancer surgery: a case report. J Cardiothorac Surg 18:88. https://doi.org/10.1186/s13019-023-02187-4CrossRefPubMedPubMedCentral

11.

Kim YS, Lee JJ, Chung YH, Kim ES, Chung IS (2011) Postoperative obstructing laryngeal edema in patients with diffuse idiopathic skeletal hyperostosis of cervical spine—a report of two cases. Korean J Anesthesiol 60:377–380. https://doi.org/10.4097/kjae.2011.60.5.377CrossRefPubMedPubMedCentral

12.

Matsushita H, Shirozu K, Umehara K, Uehara K, Takatori M, Yamaura K (2021) Association of an electromyographic tube for severe postoperative laryngeal edema and reintubation in neurosurgery: a retrospective study. J Anesth 35:611–616. https://doi.org/10.1007/s00540-021-02953-5CrossRefPubMed

13.

Koga Y, Mishima Y, Saho M, Ito A, Ito T, Hiraki T, Ushijima K (2011) A case of serious laryngeal edema unpredictably detected during laryngoscopy for orotracheal intubation following induction of anesthesia. J Anesth 25:589–591. https://doi.org/10.1007/s00540-011-1150-3CrossRefPubMedPubMedCentral

14.

Anene O, Meert KL, Uy H, Simpson P, Sarnaik AP (1996) Dexamethasone for the prevention of postextubation airway obstruction: a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med 24:1666–1669. https://doi.org/10.1097/00003246-199610000-00011CrossRefPubMed

15.

Cheng KC, Hou CC, Huang HC, Lin SC, Zhang H (2006) Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med 34:1345–1350. https://doi.org/10.1097/01.CCM.0000214678.92134.BDCrossRefPubMed

16.

Fan T, Wang G, Mao B, Xiong Z, Zhang Y, Liu X, Wang L, Yang S (2008) Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials. BMJ 337:a1841. https://doi.org/10.1136/bmj.a1841CrossRefPubMedPubMedCentral

17.

Francois B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, Brenet O, Preux PM, Vignon P, Association des Reanimateurs du C-O (2007) 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet 369:1083–1089. https://doi.org/10.1016/S0140-6736(07)60526-1CrossRefPubMed

18.

Kil HK, Kim WO, Koh SO (1995) Effects of dexamethasone on laryngeal edema following short-term intubation. Yonsei Med J 36:515–520. https://doi.org/10.3349/ymj.1995.36.6.515CrossRefPubMed

19.

Zhang W, Zhao G, Li L, Zhao P (2016) Prophylactic administration of corticosteroids for preventing postoperative complications related to tracheal intubation: a systematic review and meta-analysis of 18 randomized controlled trials. Clin Drug Investig 36:255–265. https://doi.org/10.1007/s40261-015-0369-4CrossRefPubMed

20.

Shinohara M, Iwashita M, Abe T, Takeuchi I (2020) Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting. J Int Med Res 48:300060520926367. https://doi.org/10.1177/0300060520926367CrossRefPubMed

21.

Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB (2013) Designing clinical research: an epidemiologic approach, 4th edn. Lippincott Williams & Wilkins, USA, p 80

22.

Greene AK, Grant FD, Slavin SA, Maclellan RA (2015) Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg 135:1715–1719. https://doi.org/10.1097/PRS.0000000000001271CrossRefPubMed

23.

Doyle DJ, Hendrix JM, Garmon EH (2023) American Society of Anesthesiologists Classification. In: StatPearls, Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441940/. Accessed 17 Aug 2023.

24.

Tu GY (1999) Upper neck (level II) dissection for N0 neck supraglottic carcinoma. Laryngoscope 109:467–470. https://doi.org/10.1097/00005537-199903000-00023CrossRefPubMed

25.

Ferlito A, Silver CE, Rinaldo A (2008) Selective neck dissection (IIA, III): a rational replacement for complete functional neck dissection in patients with N0 supraglottic and glottic squamous carcinoma. Laryngoscope 118:676–679. https://doi.org/10.1097/MLG.0b013e31815f6f25CrossRefPubMed

Title: Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection
Authors: Joo Hyun Park
Goeun Park
Kyu Hyeon Hwang
Hee Chun Cho
Junyoung Kim
Subi Oh
Han-Sin Jeong
Publication date: 30-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Neck Dissection
Edema
Published in: European Archives of Oto-Rhino-Laryngology
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-024-08671-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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