2.2 VFSS
We improved VFSS properly (D2RS, STEPHANIX, France), using Iohexol Injection® (50ml: 17.5g, Yangtze River Pharmaceutical Co, China) instead of barium. The patient stood in an upright position, swallowed solid food (dry bread) about 1cm × 1cm × 0.5cm which injected Iohexol Injection, semisolid food manufactured by mixing Iohexol Injection and Resource Espesante®(Nestle, Germany) according to IDDSI level 4, and liquid food (Iohexol Injection) in sequence. During the examination, the possible compensatory position was chosen as same as modified GUSS. The procedures of all cases were executed by two trained ENT specialists and one experienced radiologist. Data were evaluated using a modified penetration aspiration scale (MPAS) (Table.1) for partial laryngectomy, already used and described in an earlier article, and the scores were assessed for all cases.2, 3, 13 Higher scores mean worse performance. In addition, Solid and semisolid food trails were also both assessed in all cases, but once the score of Solid or semisolid food trails was more than or equal to 5, the liquid food trail would be forbidden.