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Hu X, Ma YN, Karako K, Tang W, Song P, Xia Y. Comprehensive assessment and treatment strategies for dysphagia in the elderly population: Current status and prospects. Biosci Trends 2024; 18:116-126. [PMID: 38658363 DOI: 10.5582/bst.2024.01100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
As the population ages, the prevalence of dysphagia among older adults is a growing concern. Age-related declines in physiological function, coupled with neurological disorders and structural changes in the pharynx associated with aging, can result in weakened tongue propulsion, a prolonged reaction time of the submental muscles, delayed closure of the laryngeal vestibule, and delayed opening of the upper esophageal sphincter (UES), increasing the risk of dysphagia. Dysphagia impacts the physical health of the elderly, leading to serious complications such as dehydration, aspiration pneumonia, malnutrition, and even life-threatening conditions, and it also detrimentally affects their psychological and social well-being. There is a significant correlation between frailty, sarcopenia, and dysphagia in the elderly population. Therefore, older adults should be screened for dysphagia to identify both frailty and sarcopenia. A reasonable diagnostic approach for dysphagia involves screening, clinical assessment, and instrumental diagnosis. In terms of treatment, multidisciplinary collaboration, rehabilitation training, and the utilization of new technologies are essential. Future research will continue to concentrate on these areas to enhance the diagnosis and treatment of dysphagia, with the ultimate aim of enhancing the quality of life of the elderly population.
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Affiliation(s)
- Xiqi Hu
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Ya-Nan Ma
- Department of Gastroenterology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Kenji Karako
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wei Tang
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Peipei Song
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Ying Xia
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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Koyama M, Ueha R, Sato T, Goto T, Yamauchi A, Kaneoka A, Suzuki S, Nito T, Yamasoba T. Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency. Otolaryngol Head Neck Surg 2023; 168:1146-1155. [PMID: 36939382 DOI: 10.1002/ohn.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In recent years, the use of aspiration prevention surgery (APS) for the treatment of severe dysphagia has been on the rise. However, relevant clinical studies have included small samples, and the frequency of, and risk factors for postoperative complications have not been clarified. We investigated the clinical features of patients undergoing APS and whether oral-intake status and suction frequency could be reduced. STUDY DESIGN A case series. SETTING Single-institution academic center. METHODS We retrospectively evaluated medical charts generated from 2010 to 2021. The clinical characteristics of patients undergoing APS, changes in the oral-intake status (Functional Oral Intake Scale, FOIS), suction frequency before and after surgery, risk factors for postoperative complications, and factors contributing to improvements in postoperative oral-intake status were retrieved. RESULTS We included the data of 100 patients (median age: 65 years, 72 men). Amyotrophic lateral sclerosis was the most common primary disease (28%), and glottis closure was the most common APS (69%). Postoperatively, 78% of patients showed improvements in the FOIS score, and suction frequency decreased in 85% of cases. Postoperative complications were observed in 10 patients (10%), wound infection in 6, and bleeding in 4; all improved. Higher preoperative FOIS scores were significantly associated with postoperative complications (p = 0.02). CONCLUSION APS contributed to improving the FOIS score and helped reduce the suction frequency in most cases. APS can be performed safely with proper perioperative management, even in patients with poor preoperative general conditions and nutritional status.
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Affiliation(s)
- Misaki Koyama
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asako Kaneoka
- Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan.,Rehabilitation Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Sayaka Suzuki
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Ueha R, Magdayao RB, Koyama M, Sato T, Goto T, Yamasoba T. Aspiration prevention surgeries: a review. Respir Res 2023; 24:43. [PMID: 36747240 PMCID: PMC9901145 DOI: 10.1186/s12931-023-02354-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration. MAIN BODY Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50-80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency. CONCLUSIONS In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan. .,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Redentor B. Magdayao
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan ,Department of Otorhinolaryngology-Head and Neck Surgery, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Misaki Koyama
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Ohara K, Katada A, Kumai T, Ominato H, Hirata-Nozaki Y, Sabusawa T, Yamaki H, Kono M, Komatsuda H, Wakisaka R, Takahara M, Hayashi T, Harabuchi Y. Central-part laryngectomy after laryngotracheal separation to manage pharyngocutaneous fistula: A case report and retrospective analysis of 12 cases. Auris Nasus Larynx 2022:S0385-8146(22)00124-9. [PMID: 35568581 DOI: 10.1016/j.anl.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
A 15-year-old girl presented with a 3-year-history of continuous outflow of saliva from a pharyngocutaneous fistula, located at 5 mm superior to her tracheal stoma. She was diagnosed with Miller-Dieker syndrome at birth. At 2 years of age, pediatric surgeons at our institution carried out laryngotracheal separation to prevent aspiration pneumonia. At the age of 12 years, she developed continuous saliva discharge from the fistula. We performed central-part laryngectomy and resection of the pharyngocutaneous fistula, which relieved her from the continuous saliva discharge. Central-part laryngectomy is less invasive and easier to perform than total laryngectomy. We hereby present a case and retrospective analysis of 12 patients, who underwent central-part laryngectomy.
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Affiliation(s)
- Kenzo Ohara
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan.
| | - Akihiro Katada
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Takumi Kumai
- Department of Innovative Head & Neck Cancer Research and Treatment (IHNCRT), Asahikawa Medical University, Asahikawa, Japan
| | - Hisataka Ominato
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Yui Hirata-Nozaki
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Tomoaki Sabusawa
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Hidekiyo Yamaki
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Michihisa Kono
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Hiroki Komatsuda
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Risa Wakisaka
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Miki Takahara
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
| | - Tatsuya Hayashi
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan; Department of Innovative Head & Neck Cancer Research and Treatment (IHNCRT), Asahikawa Medical University, Asahikawa, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan
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5
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Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis. BMC Neurol 2022; 22:94. [PMID: 35296264 PMCID: PMC8925201 DOI: 10.1186/s12883-022-02619-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons selectively. In particular, weakness in respiratory and swallowing muscles occasionally causes aspiration pneumonia and choking, which can be lethal. Surgery to prevent aspiration, which separates the trachea and esophagus, can reduce the associated risks. Central-part laryngectomy (CPL) is a relatively minimally invasive surgery to prevent aspiration. No studies have been conducted on the long-term outcomes of surgery to prevent aspiration in patients with ALS. This case series aimed to determine the long-term outcomes of surgery to prevent aspiration and the use of a continuous low-pressure aspirator in patients with ALS by evaluating the frequency of intratracheal sputum suctions performed per day, intra- and postoperative complications, oral intake data, and satisfaction of patients and their primary caregiver to predict improvement in patients’ quality of life (QOL). Methods We report a case series of six patients with ALS who underwent CPL along with tracheostomy to prevent aspiration between January 2015 and November 2018. We evaluated their pre- and postoperative status and administered questionnaires at the time of last admission to the patients and their primary caregivers. Results The mean follow-up period after CPL was 33.5 months. Aerophagia was a common postoperative complication. The use of a continuous low-pressure aspirator resulted in reduced frequency of intratracheal sputum suctions. All cases avoided aspiration pneumonia. Oral intake was continued for 2–4 years after the tracheostomy and CPL. The satisfaction levels of the patient and primary caregiver were high. Conclusion Our case series suggests that the use of a continuous low-pressure aspirator in patients undergoing CPL improves oral intake and reduces the frequency of intratracheal sputum suctions, which improves the QOL of patients with ALS and their families and caregivers. CPL and continuous low-pressure aspiration should be considered as a management option for ALS with significant bulbar and respiratory muscle weakness/dysfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02619-z.
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6
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Olinde L, Evangelista L, Bewley AF. Functional laryngectomy for the dysfunctional larynx: indications and outcomes in setting of prior chemoradiotherapy. Curr Opin Otolaryngol Head Neck Surg 2021; 29:473-478. [PMID: 34535008 DOI: 10.1097/moo.0000000000000757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To review the recent literature on indications for and functional outcomes following laryngectomy for severe laryngeal dysfunction. RECENT FINDINGS The use of functional laryngectomy as a definitive treatment for severe laryngeal dysfunction is increasing as more patients with head and neck cancer are treated with definitive chemoradiotherapy. Data are emerging on the efficacy of this technique as measured by aspiration, recurrent pneumonias, enteral tube feeding dependence, and surgical complication rates. Though most patients have marked improvement in aspiration and oral intake, difficulties in swallowing and voicing functions may persist. SUMMARY Functional laryngectomy is an effective treatment for end-stage laryngeal dysfunction. There is a clear benefit with regard to prevention of aspiration and alleviation of nothing by mouth status. However, qualitative speech and swallowing outcomes are less well studied, though available data suggest that many patients still suffer some degree of continued chronic impairment. More research is needed on these outcomes in order to appropriately counsel patients regarding long-term functional outcomes.
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Affiliation(s)
- Lindsay Olinde
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, USA
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7
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Ueha R, Sato T, Goto T, Koyama M, Yamauchi A, Mizukami A, Yamasoba T. Effects of Aspiration Prevention Surgery on the Dynamics of the Pharynx and Upper Esophageal Sphincter. OTO Open 2021; 5:2473974X211048505. [PMID: 34708180 PMCID: PMC8543729 DOI: 10.1177/2473974x211048505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Oral intake after aspiration prevention surgery (APS) is influenced by postoperative pharyngeal pressure and the dynamics of the upper esophageal sphincter (UES). We examined the effects of less invasive APS combined with UES relaxation techniques (laryngeal closure with cricopharyngeal myotomy [LC-CPM] and central-part laryngectomy [CPL]) on pharyngeal pressure and UES dynamics. Study Design Retrospective, observational study. Setting Single center. Methods We assessed the high-resolution pharyngeal manometric parameters of patients who underwent APS from 2018 to 2020. Then, we compared the effects of bilateral cricopharyngeal myotomy (combined with LC: LC-CPM group) and total cricoidectomy (CPL group) on both pharyngeal pressure and UES dynamics pre- and postoperatively. Results Eighteen patients (median age, 68 years; 17 men [94%]) were enrolled. Primary diseases associated with severe aspiration were neuromuscular disorders in 13, stroke in 3, and others in 2 patients. Pharyngeal swallowing pressure did not significantly change before and after APS. UES resting pressure and UES relaxation duration were significantly reduced (P < .001) and prolonged (P < .001), respectively, after APS. Only the CPL group (8 patients: median 62 years, all men) showed an increase in the velopharyngeal closure integral after APS (P < .05). More prolonged UES relaxation duration was recognized postoperatively in the CPL group (P < .01) than in the LC-CPM group. Conclusion Less invasive APS minimally affects pharyngeal swallowing pressure, decreases UES resting pressure, and prolongs UES relaxation duration. CPL may be more effective for postoperative UES relaxation in patients with a short UES relaxation time.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, University of Tokyo Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Aiko Mizukami
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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8
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Ku PKM, Vlantis AC, Yeung ZWC, Ho OYM, Cho RHW, Lee AKF, Hui TSC, So EPL, Law TKT, Abdullah V, van Hasselt A, Tong MCF. Perceptual Voice and Speech Analysis after Supraglottic Laryngeal Closure for Chronic Aspiration in Head and Neck Cancer. Laryngoscope 2020; 131:E1616-E1623. [PMID: 33264438 DOI: 10.1002/lary.29298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the voice and speech outcomes after tubed supraglottic laryngeal closure (TSLC) surgery to treat chronic aspiration after radiotherapy for head and neck cancer. STUDY DESIGN A retrospective case-control study. METHODS The data of patients who underwent radiotherapy for head and neck cancer and who later required total laryngectomy or TSLC for chronic aspiration between 2004 and 2017 were retrieved from a dysphagia clinic. Preoperative and postoperative voice and speech were assessed by the GRBAS and INFVo rating scales. Control subjects who underwent radiotherapy alone or total laryngectomy with a tracheoesophageal prosthesis for other indications were recruited for comparison. RESULTS Of 15 patients who underwent a TSLC with a mean age of 57.3 years (45-75 years), 13 were male and 2 female. All patients had a history of nasopharyngeal carcinoma. The success rate of speech production using their own larynx following an intact TSLC was 64%. There was no statistically significant difference in voice and speech ratings between preoperative and TSLC subjects on the GRBAS (P = .32) and INFVo scales (P = .57), although the quality of voice appeared to deteriorate after TSLC. However, the INFVo scale for impression, intelligibility and unsteadiness of the voice after TSLC was statistically significantly better than for laryngectomy with tracheoesophageal speech. CONCLUSIONS A tubed supraglottic laryngeal closure controls chronic aspiration while preserving the larynx for phonation, and results in a better voice and speech quality than a laryngectomy with a voice prosthesis. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1616-E1623, 2021.
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Affiliation(s)
- Peter K M Ku
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.,Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Zenon W C Yeung
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Osan Y M Ho
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Ryan H W Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Alex K F Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Thomas S C Hui
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Erin P L So
- Department of Speech Therapy, Prince of Wales Hospital, Shatin, Hong Kong
| | - Thomas K T Law
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Victor Abdullah
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Andrew van Hasselt
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Michael C F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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9
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Sekiguchi Koyama M, Ueha R, Goto T, Sato T, Tachibana A, Mizumoto Y, Nito T, Yamasoba T. Aspiration Prevention Surgery under Local Anesthesia for Palliative Care in Patients with Head and Neck Cancer: A Report of Two Cases. ORL J Otorhinolaryngol Relat Spec 2020; 83:52-58. [PMID: 33075797 DOI: 10.1159/000510800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
Aspiration prevention (AP) surgery may improve the quality of life (QOL) of patients with severe dysphagia. However, not all patients can endure this type of surgery under general anesthesia because of their poor status. Herein, we describe the cases of 2 patients with head and neck cancer (HNC) who underwent AP surgery for palliative care. Although both patients had tracheostomy due to severe dysphagia and respiratory impairment and frequently needed suction, they were successfully managed with AP surgery under local anesthesia. A tracheostoma was reshaped to be sufficiently large for an airway to be secured without a cannula. Their respiratory failure gradually improved, and suction frequency markedly decreased after surgery; thus, they could receive medical treatment at home. When patients with HNC under palliative care have a tracheal cannula and cannot vocalize, AP surgery under local anesthesia is an option to improve their QOL.
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Affiliation(s)
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan,
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Akane Tachibana
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Yui Mizumoto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
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10
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Furukawa T, Tamagawa K, Fukui K, Iwaki S, Takahashi M, Iritani K, Shinomiya H, Teshima M, Otsuki N, Kano M, Nibu KI. Two cases of glottic closure for refractory aspiration pneumonia after vertical partial laryngectomy. Auris Nasus Larynx 2020; 48:1221-1225. [PMID: 32859443 DOI: 10.1016/j.anl.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
Vertical partial laryngectomy is a well-established surgical procedure for early glottic cancers with acceptable functional and oncological outcomes. However, on a long-term basis, aspiration might be a serious problem with aging. Here we presented two cases of refractory aspiration pneumonia after vertical laryngectomy. Case 1: A 76-year old gentleman with a past history of malignant lymphoma treated by chemotherapy and radiotherapy had glottic cancer, which was treated by repeated vertical partial laryngectomies. Although glottic caner had been well controlled, he started to suffer from refractory aspiration pneumonia. Since his cervical skin was very thin and hard and his general condition was poor, we employed modified Kano's method for glottic closure. Case 2: A 87-year old Japanese male had a past history of glottic cancer treated by radiotherapy and vertical partial laryngectomy. He was repeatedly hospitalized for severe aspiration pneumonia. At the age of 87, he had second primary oropharyngeal cancer. Kano's method was simultaneously performed at the time of resection of oropharyngeal cancer. Postoperative courses were uneventful without sign of leakage in both cases. The patients started oral intake 2 weeks after the surgery. They have been alive without aspiration pneumonia and takes normal diet.
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Affiliation(s)
- Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
| | - Kotaro Tamagawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Kenta Fukui
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Shinobu Iwaki
- Division of Rehabilitation Medicine, Kobe University Hospital, 7-5-2 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Miki Takahashi
- Division of Rehabilitation Medicine, Kobe University Hospital, 7-5-2 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Keisuke Iritani
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Makoto Kano
- Department of Otorhinolaryngology-Head and Neck Surgery, Ohara General Hospital, 6-1 Uwamachi, Fukushima 960-8611, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
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11
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Osako M, Saigusa H, Takeuchi C, Minatogawa M, Mochizuki Y. [Effect of laryngeal closure on recurrent aspiration pneumonia in patients with neurodegenerative disease]. Rinsho Shinkeigaku 2020; 60:193-199. [PMID: 32101842 DOI: 10.5692/clinicalneurol.cn-001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Three patients with neurodegenerative diseases who had developed repeated aspiration pneumonia underwent laryngeal closure, a surgical procedure at the larynx to prevent aspiration. None of these patients have developed aspiration pneumonia since the procedure. One patient needed endoscopic suction and cough assist machine to clear thick sputum, because tracheostomy bypassed the upper airway and so prevented moisturization of inhaled air. While two patients achieved freedom from tracheal cannulation, one needed continued cannulation because of narrowing of the stoma due to improvements in the nutritional condition. One patient was able to resume oral intake. Although the right timing to perform the procedure and optimal care along with long-term observation are important, laryngeal closure is an effective option for patients with neurodegenerative diseases to prevent recurrent aspiration pneumonia.
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Affiliation(s)
- Miho Osako
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled
| | - Hideto Saigusa
- Department of Otolaryngology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled.,Department of Otorhinolaryngology and Pediatric Otorhinolaryngology, Tokyo Women's Medical University Yachiyo Medical Center
| | - Chisen Takeuchi
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled
| | - Mitsuko Minatogawa
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled
| | - Yoko Mochizuki
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled
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12
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Katoh M, Ueha R, Sato T, Sugasawa S, Goto T, Yamauchi A, Yamasoba T. Choice of Aspiration Prevention Surgery for Patients With Neuromuscular Disorders: Report of Three Cases. Front Surg 2019; 6:66. [PMID: 31824959 PMCID: PMC6881234 DOI: 10.3389/fsurg.2019.00066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Dysphagia, one of the major complications of neuromuscular diseases such as Parkinson's disease and amyotrophic lateral sclerosis (ALS), decreases quality of life and may lead to malnutrition or aspiration pneumonia. Although recent reports have suggested that surgical aspiration prevention improves quality of life and enables oral intake, the selection of appropriate aspiration prevention techniques has rarely been discussed. In this report, we present the cases of three patients with neuromuscular diseases who underwent surgical aspiration prevention; we selected the surgical techniques based on analysis of the dysphagia mechanisms, disease progression, and general condition in each case. Case 1 was a 55-year-old man with multiple system atrophy (MSA) and presented with dysphagia associated with insufficient upper esophageal sphincter (UES) relaxation. We performed central-part laryngectomy, which was able to improve UES relaxation. Case 2 was a 79-year-old man with progressive supranuclear palsy who presented with respiratory disorder and dysphagia. Glottic closure under local anesthesia was selected because he also had acute hepatobiliary dysfunction and methicillin-resistant Staphylococcus aureus pneumonia with pleural effusion. Case 3 was a 75-year-old man with ALS and presented with respiratory disorder and mild dysphagia. Subglottic closure with total cricoidectomy was selected because his dysphagia was expected to worsen due to tracheostomy and disease progression. We also summarize the characteristics of the aspiration prevention surgical techniques based on our cases and on literature review. The causes of dysphagia, including insufficient UES opening during swallowing, weak pharyngeal constriction, velopharyngeal insufficiency, and inadequate laryngeal elevation, should be assessed by detailed examination before surgery, and the type of aspiration prevention surgery should be selected based on patient swallowing function and general condition.
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Affiliation(s)
- Mitsuhiko Katoh
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | | | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
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13
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Furukawa T, Komatsu H, Fujio H, Kojima Y, Morita N, Teshima M, Shinomiya H, Morimoto K, Otsuki N, Kano M, Nibu KI. A laryngeal closure technique for the treatment of patients with head and neck cancer. Laryngoscope Investig Otolaryngol 2019; 4:246-249. [PMID: 31024995 PMCID: PMC6476292 DOI: 10.1002/lio2.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 11/30/2022] Open
Abstract
Background In 2008, Kano developed a new laryngeal closure technique (Kano's method) for the treatment of severe aspiration. The aim of this study was to evaluate the safety and efficacy of this technique in patients with head and neck cancer. Methods Since June 2014 until March 2018, six patients underwent Kano's method for management of severe aspiration after the treatment of head and neck cancers. The anterior parts of the thyroid and the cricoid cartilages were excised widely. The glottis was closed by suturing bilateral vocal folds and reinforced by the sternohyoid muscle. A tracheostoma was created with skin flaps, subglottic mucosal flaps, and stumps of cricoid and trachea cartilages. Results No severe complications were observed after the surgery. Oral intake improved without developing aspiration. Conclusions Kano's method can provide satisfactory functional results with minimal invasion for treating severe aspiration after advanced surgery, chemotherapy, and/or chemoradiotherapy, in patients with head and neck cancer. Level of Evidence 4
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Affiliation(s)
- Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Hirokazu Komatsu
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Hisami Fujio
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Yasutaka Kojima
- Department of Otorhinolaryngology-Head and Neck Surgery Nishi-Kobe Medical Center Kobe Japan
| | - Naruhiko Morita
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Koichi Morimoto
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
| | - Makoto Kano
- Department of Otorhinolaryngology-Head and Neck Surgery Ohara General Hospital Fukushima Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery Kobe University Hospital Kobe Japan
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14
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Kimura Y, Kishimoto S, Sumi T, Uchiyama M, Ohno K, Kobayashi H, Kano M. Improving the Quality of Life of Patients With Severe Dysphagia by Surgically Closing the Larynx. Ann Otol Rhinol Laryngol 2018; 128:96-103. [PMID: 30347994 DOI: 10.1177/0003489418808300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: The aim of this study was to elucidate the utility of the Kano method with surgical closure of the larynx by cricoid cartilage removal in improving quality of life in patients with severe dysphagia and their caregivers. METHODS: Nine patients with severe dysphagia who underwent the Kano method were evaluated for oral intake and activities of daily living using the functional oral intake scale and the Barthel index, respectively, as indices of quality of life. Additionally, nutritional status, inflammation, and postoperative complications were assessed. Furthermore, 7 family caregivers were queried regarding frequency of sputum suction, mood of family caregivers, and postoperative satisfaction. RESULTS: Functional oral intake scale and Barthel index scores as well as inflammation improved significantly after surgery ( P < .05). There were no severe complications or other complications requiring surgical intervention. The frequency of sputum suction was reduced postoperatively ( P < .05). The mood of family caregivers was significantly improved and satisfaction level was high postoperatively. CONCLUSIONS: Surgical closure of the larynx is an appropriate choice for patients with irreversible severe dysphagia and impaired articulation or vocal function because quality of life is improved for both patients and family caregivers and the satisfaction of family caregivers is sufficient.
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Affiliation(s)
- Yurika Kimura
- 1 Department of Otolaryngology, Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Ota-ku, Tokyo, Japan.,2 Department of Otolaryngology, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Seiji Kishimoto
- 3 Department of Head and Neck Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Takuro Sumi
- 4 Department of Head and Neck Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Mio Uchiyama
- 2 Department of Otolaryngology, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Keiko Ohno
- 5 Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan
| | - Hitome Kobayashi
- 2 Department of Otolaryngology, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Makoto Kano
- 6 Department of Otolaryngology and Head and Neck Surgery, Ohara General Hospital, Fukusima-shi, Fukushima, Japan
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15
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Abstract
Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies - focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.
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Affiliation(s)
- Rosemary Martino
- Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160-500 University Avenue, Ontario M5G 1V7, Canada.,Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11-331), Toronto, Ontario M5T 2S8, Canada
| | - Timothy McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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