48 / Otolaryngology-Head and Neck Surgery : disease site, mucositis grade, and radiotherapy schedule with or without chemotherapy. Results.—Eighty-four percent of patients (27 of 32) referred for MBS studies after undergoing radiotherapy aspirated; 44% (12 of 27) did so silently. Silent aspiration was more prevalent during MBS studies con- ducted 1 or more years after radiotherapy. Pharyngeal phase disorders were observed more frequently than structural abnormalities (P < .01). Most patients required a feeding tube (78% [31 of 40]); however, 52% of the tubes (16) were eventually removed. We found no significant asso- ciation between the occurrence of aspiration and disease site, T classifica- tion, treatment regimen, or pretreatment variables (P > .05). Pretreatment and posttreatment levels of feeding tube dependency were significantly associated (P ¼ .03). Patient-reported dysphagia before treatment did not predict posttreatment swallowing outcomes (P > .05). Conclusions.—Dysphagia is a common outcome after laryngeal preser- vation with radiotherapy. Contrary to expectations, few parameters that we measured were significantly associated with swallowing outcomes in our study. Several articles in this year’s selection are dedicated to study swallowing function after radiotherapy or radio-chemotherapy for cancer of the larynx. For years we have known that radiotherapy and radio-chemotherapy (especially for cancer of the larynx) had a detrimental effect on deglutition. The nature of this impairment, however, was not well understood. Several recent studies have helped us to understand the nature of this impairment. This is a second article in this year’s selection to demonstrate that the main impairment in deglutition after organ preservation therapy for laryngeal cancer is a very high prevalence of aspiration (84% reported in this study). Furthermore, many patients aspirate silently (44% in this series). This article also lends support to the assumption that swallowing in irradiated patients may deteriorate with time because their data show that silent aspiration is more prevalent 1 or more years after radio- therapy. Clearly, those patients have to be followed very closely, and their diets have to be modified accordingly to minimize the risk of aspiration pneu- monia. M. Gapany, MD Surgical Technique A randomized controlled trial of minimally invasive thyroidectomy using the lateral direct approach versus conventional hemithyroidectomy Sywak MS, Yeh MW, McMullen T, et al (Univ of Sydney Endocrine Surgical Unit, St Leonards, Australia) Surgery 144:1016-1022, 2008 Background.—The role of minimally invasive thyroid surgery (MITS) is currently in evolution. The aim of this study is to compare the outcomes of MITS using the direct approach through a lateral incision with