About

Dinesh K. Chhetri, MD, is a Professor and Interim Chair of the Department of Head and Neck Surgery at UCLA. He is a laryngologist specializing in voice, swallowing, and upper airway disorders. Dr. Chhetri graduated magna cum laude from Brown University with a degree in biochemistry and earned his MD from the David Geffen School of Medicine at UCLA, where he graduated with distinction for his thesis on vocal fold paralysis and laryngeal reinnervation. He completed his residency in otolaryngology–head and neck surgery and a fellowship in laryngology at UCLA. Recognized internationally as an academic laryngologist and head and neck surgeon, he has authored over 150 peer-reviewed publications on voice, swallowing, and airway disorders. His clinical expertise includes treatment of vocal cord lesions, professional voice disorders, vocal cord paralysis, laryngeal and tracheal stenosis, cricopharyngeal dysfunction, and Zenker’s diverticulum, along with advanced airway surgeries such as tracheal and cricotracheal resection, and minimally invasive endoscopic and laser procedures. Dr. Chhetri is a leading authority in swallowing disorders, authoring the book Dysphagia Evaluation and Management in Otolaryngology, and has delivered numerous invited lectures worldwide. His NIH-funded research focuses on the neuromuscular control of the larynx, contributing to advances in restoring voice and airway function. He is certified in transoral robotic surgery for head and neck cancer and serves as Director of the UCLA Voice Center, the Swallowing Disorders Program, the Head and Neck Cancer Survivorship Program, and the Laryngology Fellowship Program. He is actively involved in education, mentorship, and international surgeon training, and holds professional memberships including the American Academy of Otolaryngology – Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and the American Laryngological Association.

Research topics

• Medicine
• Artificial Intelligence
• Computer Science
• Political Science
• Internal medicine
• Natural Language Processing
• Oncology
• Audiology
• Pathology
• Speech recognition
• Intensive care medicine
• Medical emergency
• Psychology
• Surgery
• Cartography

Selected publications

• Role of Pediatric Otolaryngologist in Pediatric Tracheostomy Code Blue Cases: A New Safety Initiative

  The Laryngoscope · 2026-02-06

  articleOpen accessSenior author

  OBJECTIVE: A "Code Blue" is a term to activate an alarm for the resuscitation team for a patient who has a cardiopulmonary arrest. The role of a pediatric otolaryngologist in a tracheostomy-related code blue case is not clearly defined. We aim to describe the role of pediatric otolaryngologists in pediatric tracheostomy code blue (PTCB) cases. METHODS: This retrospective study analyzed pediatric code blue cases in a tertiary care hospital from January 2019 to December 2022, before and after the implementation of a standardized PTCB that includes a pediatric otolaryngologist in the resuscitation team. Primary outcome variables included response time and survival-to-discharge of patients. RESULTS: The most common reason for code activation was reduced oxygen saturation. The leading cause for the otolaryngology consultation was tube blockage. Tracheostomy tube change was the most common intervention performed. The mean time of otolaryngology arrival was significantly decreased from 14.0 min pre-implementation to 4.0 min post-implementation (p < 0.001). While including all 48 PTCB events, pediatric otolaryngologist involvement was significantly associated with higher survival-to-discharge (94.4% vs. 66.7%, p = 0.028). While comparing post-PTCB protocol implementation versus pre-implementation, mortality declined from 23.8% to 3.7% with increased discharge rates, although this did not reach statistical significance (p = 0.073). CONCLUSION: Inclusion of a pediatric otolaryngologist in the resuscitation team reduces time-to-arrival of the pediatric otolaryngologist to the code blue activation site. Reduced time to pediatric otolaryngologist arrival and completion of interventions by pediatric otolaryngologist are associated with reduced mortality in PTCB events.

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• Contributors

  Elsevier eBooks · 2025-12-17

  book-chapter
  PublisherDOI

• Impact of postoperative fluorodeoxyglucose positron emission tomography/computed tomography on adjuvant head and neck cancer treatment

  JNCI Cancer Spectrum · 2025-07-01 · 1 citations

  articleOpen access

  BACKGROUND: Residual or recurrent cancer after surgery but prior to adjuvant therapy occurs in a proportion of patients with head and neck cancer and may warrant treatment changes. 18-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) may help to identify residual or recurrent disease but is not routinely obtained. We evaluated the relevance of postoperative FDG-PET/CT in this clinical context. METHODS: This single-institution, retrospective study identified patients with head and neck cancer who underwent definitive surgery between January 1, 2013, and April 1, 2023, and received a postoperative FDG-PET/CT prior to adjuvant treatment. We measured the rates of management changes resulting from postoperative FDG-PET/CT findings and the association between having a postoperative FDG-PET/CT which resulted in a management change and oncologic outcomes with selected multivariable competing-risks and proportional hazards regressions. RESULTS: Of 150 patients, 66 (44.0%) had a management change because of the postoperative FDG-PET/CT findings; 62 (93.8%) had radiotherapy plan changes, 20 (30.3%) underwent additional diagnostic testing, 11 (16.7%) had systemic therapy added or changed, 3 (4.6%) underwent reresection, and 15 (10.0%) switched to palliative-intent treatment. Having a postoperative FDG-PET/CT that resulted in a management change was not significantly associated with cancer recurrence or overall survival (both P > .05). CONCLUSIONS: In patients with resected head and neck cancer, postoperative, pre-adjuvant therapy FDG-PET/CT can alter clinical management and may enable additional personalization of treatment. When practical to obtain without delaying treatment, postoperative FDG-PET/CT may have clinical utility though requires careful interpretation due to the risks of false positives.

  PublisherDOI

• Risk Analysis Index Versus Modified Frailty Index: Outcomes After Otolaryngologic Surgery

  The Laryngoscope · 2025-08-01 · 1 citations

  articleOpen accessSenior author

  OBJECTIVE: Patient frailty negatively impacts postsurgical outcomes across multiple specialties. Commonly used frailty scoring systems include the Modified 5-Item Frailty Index (MFI-5) and the Clinical Risk Analysis Index (RAI-C). We compared these frailty indices in predicting postsurgical outcomes in otolaryngology, a comparison that has never been completed to date. METHODS: Retrospective chart review of patients undergoing otolaryngologic surgery at a quaternary care medical center (2022-2024) with an RAI-C score available for analysis. Chi-square analysis and ROC curves were utilized to determine associations and predictive ability of each scoring system. RESULTS: Among 1209 patients, 21% met MFI-5 frailty criteria (MFI-5 score > 1), and 23% met RAI-C frailty criteria (RAI-C score > 30). The Pearson correlation coefficient between MFI-5 and RAI-C was 0.481 (95% CI [0.43, 0.53]), indicating a moderate correlation between the two metrics. Patients deemed frail by RAI-C had 5.7 times higher odds of experiencing a postoperative complication than non-frail counterparts (95% CI [3.51, 9.28], p < 0.0001), but MFI-5 frailty status was not associated with postoperative complications. Both RAI-C and MFI-5 demonstrated significant predictive ability for 30-day readmission (AUC 0.77, 95% CI [0.64, 0.89] vs. AUC 0.76, 95% CI [0.61, 0.88]), respectively. When compared to MFI-5, RAI-C had greater predictive performance for all other postoperative outcomes in this study. CONCLUSION: RAI-C outperformed MFI-5 in predicting postoperative outcomes in patients undergoing otolaryngologic surgeries. RAI-C assessment should be considered in frailty research, multidisciplinary treatment planning, and managing patient expectations and outcomes.

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• Radiation Fibrosis of the Epiglottis: Histopathology and Multiphoton Imaging of Collagen and Elastin

  The Laryngoscope · 2025-08-13

  articleSenior author

  OBJECTIVES: Dysphagia attributed to radiation-induced fibrosis (RIF) is common among patients treated with radiation for head and neck cancer. In this study, we characterize RIF in the epiglottis. This has not been previously described. METHODS: Our cohort included 26 patients who underwent partial epiglottidectomy for symptomatic dysphagia due to epiglottic dysfunction. Eighteen patients had a history of radiation therapy. Epiglottis tissue sections were stained with H&E, and the ratio of epiglottic cartilage thickness to total epiglottis thickness was measured. Imaging for elastin and collagen was performed with multiphoton microscopy, and the density of each in the lamina propria layer was quantified. RESULTS: Radiated epiglottis had a higher prevalence of dilated vasculature, chronic inflammation, focal hyalinization-like changes in the elastic cartilage, and atrophic seromucous glands. In addition, a lower ratio of elastic cartilage to total epiglottis thickness was found (0.36 in radiated versus 0.45 in non-radiated, p < 0.01), attributable to increased thickness of the lamina propria layer due to fibrosis. In the radiated samples, the density of collagen was higher, 46.51% versus 36.78% (p < 0.01), and the density of elastin was lower, 5.11% versus 8.27% (p < 0.01). Elastic fibers were straighter, shorter, and more fragmented in radiated samples. CONCLUSION: This first characterization of RIF and pilot use of multiphoton microscopy in the epiglottis identified key histopathologic characteristics associated with radiation, notably higher density of collagen, lower density of elastin, and fragmentation of elastic fibers. These findings provide a pathophysiologic explanation for the relationship between epiglottic dysfunction, dysphagia, and radiation. LEVEL OF EVIDENCE: Level 3.

  PublisherDOI

• Contemporary Surgical Approaches in Managing Laryngeal Chondrosarcoma: A Scoping Review

  The Laryngoscope · 2025-02-19 · 4 citations

  reviewOpen access

  OBJECTIVE: The aim of this scoping review is to describe and evaluate current surgical management options for chondrosarcoma of the larynx, and to summarize these techniques with respect to the laryngeal subsite affected. DATA SOURCES: PubMed/MEDLINE and EMBASE databases. REVIEW METHODS: The review was conducted according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. RESULTS: Forty-one articles met eligibility criteria for inclusion in the final analysis, which included a total of 149 unique surgical cases that were analyzed based on affected laryngeal subsites of cricoid, thyroid, arytenoid, and epiglottis. Management of cricoid chondrosarcoma favored transoral endoscopic resection (TER) or transcervical laryngeal preservation surgery (TPLS), which ranged from limited tumor debulking via laryngofissure to larger operations like subtotal to total cricoidectomy with laryngeal reconstruction. Nearly all cases of arytenoid and epiglottic chondrosarcoma were successfully managed with TER techniques. Thyroid chondrosarcoma primarily affected the outer cortex of the cartilage and very rarely involved the endolaryngeal mucosa, making it very amenable to transcervical approaches to remove part of or the entire affected thyroid lamina. CONCLUSION: Overall trends in the articles reviewed for this study suggest that more aggressive surgery and R0 resection did not lead to better overall survival, which aligns with the broader philosophical shift in treatment goals to prioritize preservation of the larynx and laryngeal function over complete oncologic resection. LEVEL OF EVIDENCE: NA.

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• Heterogeneous Presentations and Serologies in Myasthenia Gravis Patients Presenting with Dysphagia

  The Laryngoscope · 2024-07-01 · 1 citations

  articleOpen accessSenior author

  INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. MG patients may present de novo with primary otolaryngology complaints, including swallowing dysfunction. This study describes a range of unique presentations and rare diagnostic serologies, which have not previously been fully described. METHODS: A retrospective review was performed of all patients presenting with primary symptom of dysphagia and subsequently diagnosed with MG. Data collected included demographics, clinical presentation, swallow studies, serology, imaging, treatment, and response. RESULTS: Five patients met the inclusion criteria. Four endorsed dysphagia as primary complaint and one endorsed dysphagia and dysphonia. All patients underwent in-office swallow evaluations that showed vallecular or pyriform sinus residue. Three patients completed modified barium swallow studies that showed pharyngeal weakness and epiglottic dysfunction in all, and upper esophageal sphincter dysfunction in two. One patient with additional symptom of dyspnea was admitted and found to be in myasthenic crisis. Upon serologic evaluation, three patients were positive for acetylcholine receptor (AChR) antibodies only, one for muscle-specific-kinase (MuSK) antibodies only, and one for low density lipoprotein receptor-related protein 4 (LRP4) antibodies only. All patients received neurology evaluation and were treated with steroids, pyridostigmine, plasma exchange, or rituximab. In three patients with over 1 year follow-up, symptoms were significantly improved or resolved. CONCLUSION: MG is an important differential diagnosis in patients with unexplained pharyngeal dysphagia. While workup can include AChR antibody screening, in seronegative patients with persistent symptoms, additional testing for MuSK and LRP4 may lead to diagnosis and effective treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:4903-4910, 2024.

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• Prospective Outcomes After Serial Platelet‐Rich Plasma (<scp>PRP</scp>) Injection in Vocal Fold Scar and Sulcus

  The Laryngoscope · 2024-08-08 · 7 citations

  articleOpen access

  OBJECTIVE: Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function. METHODS: In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated. RESULTS: In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar. There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p = 0.007). The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases. CONCLUSIONS: PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs. LEVEL OF EVIDENCE: 3: Prospective cohort study, with blinded analysis Laryngoscope, 134:5021-5027, 2024.

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• A Novel Hybrid Procedure Combining Resection and Tracheoplasty for Complex Laryngotracheal Stenosis

  The Laryngoscope · 2024-07-30

  articleSenior authorCorresponding

  Adult airway stenosis is a common condition treated in the otolaryngology clinic. Patients with high-grade, long-segment stenosis often fail endoscopic management. We describe the successful use of a hybrid resection and laryngotracheoplasty procedure that maximizes airway luminal patency in adults with successful decannulation. Laryngoscope, 2024 Open surgical treatments for laryngotracheal stenosis in adults commonly include primary resection with anastomosis, such as cricotracheal resection (CTR)/tracheal resection (TR) or staged laryngotracheoplasty (LTP).1 The indications, techniques, advantages, and disadvantages for these two approaches differ. Airway resection with primary anastomosis is optimal for shorter-segment (<3 cm) high-grade (Grade 3–4) stenosis and has maximum potential for creating normal luminal diameter. Additional benefits include single-stage procedure not requiring stent placement. However, a tension-free anastomosis is challenging in long-segment stenosis (>4 cm). High anastomotic tension may lead to anastomotic dehiscence, which is a serious and possibly fatal complication. Other risks include glottic airway edema or vocal fold paralysis due to proximity of anastomosis to the vocal folds or injury to the recurrent laryngeal nerves (RLN), respectively. LTP is an alternate technique for open airway management when the stenosis is not amenable to primary resection and anastomosis.2 LTP is preferred in cases of long-segment or multilevel stenosis, infraglottic involvement, or when primary resection is not possible due to excessive anastomotic tension. LTP does not require dissection lateral or posterior to the trachea, thus decreasing the risks of RLN or esophageal injury. However, LTP is a multistage surgery with often the need to maintain a stent such as a T-tube between stages. Additional limitations include decreased efficacy in addressing high-grade stenoses, risk for persistent anterior wall collapse, and poor mucociliary clearance. In this report, we highlight a unique hybrid surgery technique combining the respective benefits of both primary resection with anastomosis and LTP. The hybrid procedure is best suited for the management of complex long-segment or multilevel airway stenosis that is not optimally treated with either procedure alone. In the proposed technique, high-grade subglottic or proximal tracheal stenosis is treated with resection and anastomosis, and the remaining tracheal stenosis, the tracheostoma site, or tracheomalacia are treated with the LTP technique. This leads to better results than using either surgical approach individually and successful long-term decannulation of the tracheostomy-dependent patient. The hybrid procedure commences with airway assessment using suspension direct laryngoscopy and bronchoscopy under general anesthesia. The patient is ventilated via a flexible endotracheal tube through the existing tracheostomy site. The length and severity of stenosis are determined to plan for resection and anastomosis. The neck is prepared and draped in standard fashion for open airway surgery. A horizontal cervical incision incorporating the existing tracheostomy is made. Subplatysmal flaps are raised from the thyroid cartilage to clavicle. Dissection is performed in the midline to divide and lateralize the strap muscles. The thyroid gland is divided in the midline and the laryngotracheal complex is skeletonized from the thyroid cartilage to the sternal notch. Substernal pre-tracheal dissection is performed bluntly with finger dissection, or mediastinoscopy when needed, to mobilize the trachea. Intraoperative flexible bronchoscopy is performed to identify the superior level for airway resection. Ideally, the airway stenosis is managed by primary resection and anastomosis. The decision to perform a hybrid procedure depends on the surgeon's comfort and experience with long-segment resection and mobility of the trachea for tension-free anastomosis. If tension-free anastomosis cannot be achieved after tracheal mobilization and other release maneuvers, hybrid procedure is performed. The high-grade stenosis is resected and anastomosed, and the remaining stenotic tracheal segment is treated with tracheoplasty (Video 1). The tracheoplasty is a staged procedure that incorporates the existing tracheostomy site. The involved anterior tracheal stenosis is incised vertically. Then, the superior and inferior skin flaps are advanced and approximated to the tracheal edges using interrupted 3-0 polyglactin (Vicryl®) half-mattress sutures. The patient is admitted for postoperative airway management for one week to allow anastomosis maturation. A secondary procedure may be performed to place a T-tube stent spanning the LTP stoma and extending superiorly to the subglottis, which allows for phonation as the airway matures during the healing phase. The anterior wall is reconstructed in multiple layers about 3–6 months when the stoma has matured (Figs. 1 and 2). Two illustrative cases are presented below. A 56-year-old female with a complex medical history, including kidney transplantation, coronary artery disease, type 2 diabetes mellitus, and obesity was referred for airway management. She had required prolonged intubation followed by tracheostomy due to COVID19 pneumonia. She was decannulated after 3 months but required urgent second tracheostomy several months later due to interval development of airway stenosis. She subsequently failed four endoscopic treatments (CO2 laser resection, balloon dilation, steroid injection, and mitomycin C application). Airway assessment under anesthesia revealed grade 4 subglottic stenosis and a long-segment tracheal stenosis to the tracheostomy site, with a total length of 5.5 cm. The anterior tracheal wall had poor structural integrity due to the two prior tracheotomies. Due to the history of COVID-19, there was significant scarring of the airway to the mediastinum, resulting in poor mobilization of the trachea despite mediastinoscopy and mediastinal release. As the trachea could not be adequately mobilized to allow resection of entire segment from subglottis to tracheostomy site for primary anastomosis, the hybrid procedure was utilized. A 2.5-cm section of subglottis and trachea was resected primarily and anastomosed and LTP was performed for the remaining 2-cm segment of stenotic cervical trachea. One week later, a No. 11 T-tube stent (Boston Medical Products, Boston, MA) was placed. The final stage, involving the closure of the LTP stoma, was performed 6 months later (Figure 3). A 40-year-old female with a 10-year history of shortness of breath presented with acute dyspnea and was diagnosed with critical grade 3 subglottic stenosis. She underwent endoscopic dilation, but a tracheostomy was also performed due to tissue friability and edema. Over the next 3 years, she underwent five more failed endoscopic airway procedures (CO2 laser excision, balloon dilation, steroid injection, and topical mitomycin C application). She was then referred for open airway surgery. Operative endoscopy revealed high subglottic and tracheal grade 3 stenosis spanning 5 cm and involving the tracheostomy stoma. CTR was performed to address 2.5 cm of proximal grade 3 stenosis. The distal 2.5-cm stenosis spanning the length of her tracheostomy site underwent tracheoplasty. A tracheostomy tube was replaced. A T-tube was not placed due to the proximity of the CTR anastomosis to the vocal folds and postoperative edema. CTR site was patent and healed at 3 months postoperatively (Figure 4) and LTP stoma closure was performed at 6 months (Figure 2). Complex long-segment and high-grade airway stenoses are challenging to treat successfully. Ching et al. suggested that CTR and LTP have equivalent rates of decannulation. However, only short-segment stenoses were managed with CTR in that study.3 Other methods of airway augmentation without stent placement have been trialed, such as laryngotracheoplasty with costal cartilage graft.4 While this technique has been well-established in pediatric airway surgery, costal cartilage grafts in adult airway stenosis have demonstrated poor results, with patients either requiring intraoperative tracheostomy due to glottal edema or postoperative poor functional voice outcomes.4 The hybrid procedure highlighted here is applicable to treating complex long-segment stenosis where primary resection with anastomosis is not possible. This increases the efficacy compared to either CTR/TR or LTP alone. The high-grade subglottic or proximal tracheal stenosis is managed with primary resection with anastomosis, and the more distal tracheal stenosis and tracheostoma are managed with LTP. Resection techniques are more effective than LTP for the areas of high-grade stenosis. LTP approach works best for long-segment stenosis with poor structural integrity of the anterior tracheal wall. Securing the tracheal edges to the skin at the tracheoplasty site has the secondary benefit of reducing anastomotic tension at the resection site, thus reducing the risks of postoperative dehiscence or future restenosis at the anastomosis. The hybrid procedure also allows anterior collapse to be addressed in the second stage of the procedure. The senior author has used the LTP closure technique described here for management of complex long-segment stenosis for over two decades.2 The hybrid procedure is a similar multistaged procedure, but the addition of primary resection with anastomosis ultimately results in a final airway lumen much superior to that achieved from LTP alone. The hybrid procedure is effective in maintaining near-normal airway patency, and allowing for decannulation of the tracheostomy-dependent patient with high-grade long- or multilevel stenosis and is a useful technique in the airway surgeon's armamentarium.

  PublisherDOI

• Selective Laryngeal Adductor Denervation and Reinnervation

  2024-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

Recent grants

• Neuromuscular control of the Larynx

  NIH · $6.0M · 2011–2024

Frequent coauthors

• Gerald S. Berke

  University of California, Los Angeles

  33 shared

• Zhaoyan Zhang

  27 shared

• Jennifer L. Long

  VA Greater Los Angeles Healthcare System

  23 shared

• Maie A. St. John

  University of California, Los Angeles

  17 shared

• David A. Berry

  University of California, Los Angeles

  16 shared

• Juergen Neubauer

  Mayo Clinic in Arizona

  16 shared

• Andrew Erman

  UCLA Health

  16 shared

• Patrick Schlegel

  University of California, Los Angeles

  15 shared

Awards & honors

• Kamal A. Batniji Chair in Laryngology and Humanitarian Care
• Casselberry Award, American Laryngological Association, 2022…
• Top Doctors, Los Angeles Magazine, 2021-2026