Videofluoroscopic Evaluation of Oropharyngeal Swallowing

Goldsmith, Tessa; Holman, Allison; Nunn, Danny

doi:10.1016/b978-0-323-05355-6.00033-1

Cited by 8 publications

(16 citation statements)

References 116 publications

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“…It adequately characterizes pharyngeal bolus residue, particularly in the AP view. 7,8 Our results demonstrated that pharyngeal residue in patients with idiopathic UVFP and short-term paralysis was increased significantly, especially on the affected PS. In contrast, patients with RLNP showed no significant differences in residue on the affected PS and vallecula as compared with the respective nonaffected sides.…”

Section: Discussionmentioning

confidence: 56%

“…Execution of a safe and efficient pharyngeal swallow requires simultaneous airway protection with upper esophageal segment (UES) opening and pharyngeal clearance as the bolus is propelled down the esophagus . Residue in the vallecula or pyriform sinus (PS) indicates incomplete pharyngeal clearance, which is well characterized during videofluoroscopic swallow studies (VFSSs) . The actions of the pharyngeal constrictors and suspensory muscles are crucial in clearing barium from the pharynx as the sphincter is mechanically pulled open by distracting forces from the suspensory muscles through attachments to the hyoid after UES relaxation .…”

Section: Introductionmentioning

confidence: 99%

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Postdeglutitive residue in idiopathic unilateral vocal fold paralysis

et al. 2013

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Postdeglutitive residue in idiopathic unilateral vocal fold paralysis

et al. 2013

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“…2 Despite the fact that postoperative dysphagia is generally transient (< 6 months), it can result in malnutrition, aspiration, dehydra tion, and pneumonia, as well as social isolation, depres sion, and anxiety. 11 Although there may be many overlap ping factors, including postoperative edema, preoperative debility, and neuromuscular injury, evaluating how the surgical anatomy of each approach relates to the neuro muscular anatomy and associated physiology of swallow ing is imperative to understanding the risk of postopera tive dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Transnasal odontoid resection: is there an anatomic explanation for differing swallowing outcomes?

Abel

Mallory

Kasperbauer³

et al. 2014

FOC

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Object Swallowing dysfunction is common following transoral (TO) odontoidectomy. Preliminary experience with newer endoscopic transnasal (TN) approaches suggests that dysphagia may be reduced with this alternative. However, the reasons for this are unclear. The authors hypothesized that the TN approach results in less disruption of the pharyngeal plexus and anatomical structures associated with swallowing. The authors investigate the histological and gross surgical anatomical relationship between pharyngeal plexus innervation of the upper aerodigestive tract and the surgical approaches used (TN and TO). They also review the TN literature to evaluate swallowing outcomes following this approach. Methods Seven cadaveric specimens were used for histological (n = 3) and gross anatomical (n = 4) examination of the pharyngeal plexus with the TO and TN surgical approaches. Particular attention was given to identifying the location of cranial nerves (CNs) IX and X and the sympathetic chain and their contributions to the pharyngeal plexus. S100 staining was performed to assess for the presence of neural tissue in proximity to the midline, and fiber density counts were performed within 1 cm of midline. The relationship between the pharyngeal plexus, clivus, and upper cervical spine (C1-3) was defined. Results Histological analysis revealed the presence of pharyngeal plexus fibers in the midline and a significant reduction in paramedian fiber density from C-2 to the lower clivus (p < 0.001). None of these paramedian fibers, however, could be visualized with gross inspection or layer-by-layer dissection. Laterally based primary pharyngeal plexus nerves were identified by tracing their origins from CNs IX and X and the sympathetic chain at the skull base and following them to the pharyngeal musculature. In addition, the authors found 15 studies presenting 52 patients undergoing TN odontoidectomy. Of these patients, only 48 had been swallowing preoperatively. When looking only at this population, 83% (40 of 48) were swallowing by Day 3 and 92% (44 of 48) were swallowing by Day 7. Conclusions Despite the midline approach, both TO and TN approaches may injure a portion of the pharyngeal plexus. By limiting the TN incision to above the palatal plane, the surgeon avoids the high-density neural plexus found in the oropharyngeal wall and limits injury to oropharyngeal musculature involved in swallowing. This may explain the decreased incidence of postoperative dysphagia seen in TN approaches. However, further clinical investigation is warranted.

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“…Incomplete pharyngeal clearance is indicated by the presence of residue in the vallecula or pyriform sinus, which is well characterized in videofluoroscopic swallow studies (VFSS) [7,8]. The actions of the pharyngeal constrictors and suspensory muscles are crucial for clearing barium from the pharynx.…”

Section: Introductionmentioning

confidence: 99%

Postdeglutitive residue in vagus nerve paralysis and its association with feeding style

Kumai

Samejima

Yumoto

2016

Eur Arch Otorhinolaryngol

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The objective of this study is to compare the postdeglutitive pharyngeal residues between Xth cranial nerve paralysis (XNP) and isolated recurrent laryngeal nerve paralysis (RLNP) to elucidate the association with feeding style. This study enrolled 15 XNP patients with injuries at the brainstem level (Group I) and 26 patients with RLNP (Group II). All subjects underwent videofluoroscopic swallowing studies (VFSS). The pyriform sinus (PS) and vallecula residues were quantified. The symmetry of the affected versus non-affected sides was compared in both groups. Feeding style at the time of VFSS was also examined. The intra-rater correlation coefficients for all of the data, including the areas of both the vallecula and pyriform sinus on the affected and non-affected sides, were 0.88-0.92 (p < 0.001), reflecting high consistency of the evaluation. In Group I, there was significantly (p < 0.01) more residue in the PS, but not vallecula, compared to the respective non-affected sides, while in Group II there were no significant differences in residue between the affected and non-affected sides for either the vallecula or PS. Comparing Groups I and II, there was significant (p < 0.01) residue on the affected side in the PS but not the vallecula. There was a significant correlation between dependency on a feeding tube and XNP (p < 0.01, Chi-square test). XNP at the brainstem level may cause significantly increased residue in the PS compared to RLNP. This might increase the dependency on a feeding tube with XNP.

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Videofluoroscopic Evaluation of Oropharyngeal Swallowing

Cited by 8 publications

References 116 publications

Postdeglutitive residue in idiopathic unilateral vocal fold paralysis

Postdeglutitive residue in idiopathic unilateral vocal fold paralysis

Transnasal odontoid resection: is there an anatomic explanation for differing swallowing outcomes?

Postdeglutitive residue in vagus nerve paralysis and its association with feeding style

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