Varun V. Varadarajan

Evaluation of the natural history of patients who aspirate

The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations, Penetration‐Aspiration Scale (PAS) score, and dysphagia etiology would be associated with changes in time to first pulmonary event and overall survival for patients with documented aspiration on radiologic testing. This study identified a cohort of patients with detectable unsensed penetration or aspiration on videofluoroscopic swallowing study (VFSS), and followed this cohort over time for development of pulmonary events and death. We then evaluated the association of aspiration severity and dietary modification recommendations on incidence of these endpoints.

Improving quality outcomes in head and neck free flap surgery with the use of a physician inpatient coordinator

Head and neck free flap patients require complex postoperative care. The quality of care for these patients often depends on their management from the time they leave the operating room. The purpose of this study was to investigate the impact of a postoperative inpatient coordinator (IC) for head and free flap patients on quality outcomes: length of stay (LOS), 30‐day unplanned return to the emergency department (30dRED), 30‐day unplanned readmissions (30dUR), and complication rates.

Head and neck free flap reconstruction: What is the appropriate post-operative level of care?

Patients undergoing head and neck reconstruction require complex, multidisciplinary postoperative care which may include wound care, flap monitoring, tracheostomy management, and management of comorbid conditions. Historically, patients undergoing major resection of a head and neck or aerodigestive tract malignancy with regional or free flap reconstruction were routinely admitted to the ICU. Although head and neck cancer patients may have multiple medical comorbidities that may require postoperative critical care, the current trend in many institutions is to transfer stable and less medically complex patients to non-intensive care-level units with specialty trained nursing staff. These units have been shown to decrease the total cost of care without compromising the quality of care, length of stay, or postoperative complications.

Surgical Management of Salivary Gland Disease

The study of salivary gland tissue and the surgical management of salivary gland pathology are fundamental to the practicing otolaryngologist-head and neck surgeon. Traditional surgical intervention for both neoplastic and nonneoplastic disease of the salivary glands includes sialadenectomy, superficial or complete parotidectomy, minor procedures involving the salivary ducts, and procedural interventions for xerostomia and sialorrhea. Recent surgical advances of the salivary glands and ducts such as minimally invasive, endoscopic, and robotic techniques have augmented the surgeon’s armamentarium for managing salivary gland disease. Novel techniques such as salivary gland transfer are also being pioneered. The mechanisms of salivary gland function remain an active research topic, and future applications may include regeneration of functional salivary gland tissue. This chapter briefly reviews the basic surgical anatomy and physiology of the major and minor salivary glands and describes traditional indications for surgical intervention. The recent advances in salivary gland surgery are described, and the chapter concludes by highlighting recent discoveries in the field of salivary gland regeneration. The implications of these advances for the head and neck surgeon and the potential future of surgical management of salivary gland pathology are discussed.