1/26. tooth wear and loss: symptomatological and rehabilitating treatments.The authors report a clinical case that presented tooth wear and absence, with painful muscular and articular symptomatology, and also alteration in deglutition, mastication and speech. The clinical procedures used were re-establishment of vertical dimension of occlusion, mandibular centric relations, and occlusal contacts through therapeutic removable partial dentures. The condyle position was analyzed in habitual occlusion and in occlusion with dentures, through transcranial radiographs of the temporomandibular joints. Oral rehabilitation was achieved with dental restoration and removable partial dentures.- - - - - - - - - - ranking = 1keywords = deglutition (Clic here for more details about this article) |
2/26. Spindle cell lipoma of the hypopharynx.larynx and hypopharynx lipomas are reported to account for approximately 0.6% of benign laryngeal neoplasms. Spindle cell lipoma is a histologically distinct variant characterized by mature adipocytes mixed with collagen-forming spindle cells; only one case of spindle cell lipoma of the larynx has been previously reported. We here describe a new case of spindle cell lipoma of the pyriform sinus successfully treated by means of endoscopic surgical excision. A 77-year-old woman with a 40-year history of dysphagia reported that the condition had markedly worsened over the three years before she came to us. She had difficulty swallowing even semisolid food and she experienced occasional nasal regurgitation of liquid or solid food. Flexible videolaryngoscopy showed a very large mass, covered by normal mucosa that almost totally occupied the right pyriform sinus and was apparently attached to the right arytenoid. Functional endoscopic study and videofluoroscopy of swallowing showed that the bolus progressed exclusively in the left pyriform sinus, with postdeglutitory pooling in the right pyriform sinus and a reflux toward the valleculae during consecutive deglutitions. Computed tomography demonstrated that the hypopharyngeal mass had low attenuation values and negative densitometry. The entire mass was surgically removed during suspension microlaryngoscopy. The histological sections showed mature adipocytes mixed with small and slender spindle cells. Postoperative endoscopic and videofluorosocpic deglutition studies revealed the recovery of normal swallowing. This case indicates that hypopharyngeal lipomas should be included in the differential diagnosis of slowly occurring swallowing impairments.- - - - - - - - - - ranking = 2keywords = deglutition (Clic here for more details about this article) |
3/26. Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing.BACKGROUND & AIMS: Central control of swallowing is regulated by a central pattern generator (CPG) positioned dorsally in the solitary tract nucleus and neighboring medullary reticular formation. The CPG serially activates the cranial nerve motor neurons, including the nucleus ambiguus and vagal dorsal motor nucleus, which then innervate the muscles of deglutition. This case provides insight into the central control of swallowing. methods: A 65-year-old man with a right superior lateral medullary syndrome presented with a constellation of symptoms, including dysphagia. The swallow was characterized using videofluoroscopy and esophageal motility and the results were compared with magnetic resonance imaging (MRI) findings. RESULTS: Videofluoroscopy showed intact lingual propulsion and volitional movements of the larynx. Distal pharyngeal peristalsis was absent, and the bolus did not pass the upper esophageal sphincter. manometry showed proximal pharyngeal contraction and normal peristaltic activity in the lower esophagus (smooth muscle), but motor activity of the upper esophageal sphincter and proximal esophagus (striated muscle) was absent. MRI showed a lesion of the dorsal medulla. CONCLUSIONS: These findings are compatible with a specific lesion of the connections from a programming CPG in the solitary tract nucleus to nucleus ambiguus neurons, which supply the distal pharynx, upper esophageal sphincter, and proximal esophagus. There is functional preservation of the CPG control center in the solitary tract nucleus and of the vagal dorsal motor nucleus neurons innervating the smooth muscle esophagus.- - - - - - - - - - ranking = 1keywords = deglutition (Clic here for more details about this article) |
4/26. Cricopharyngeal muscle hypertrophy associated with florid myositis.hypertrophy of the cricopharyngeal muscle is a serious clinical condition that can cause severe dysphagic symptoms, including prolonged deglutition and postdeglutitive aspiration. Although the therapeutical concepts are well established, the pathogenic mechanism of cricopharyngeal hypertrophy remains unclear. We present a patient with a ten-year history of progressive dysphagia. The neurological and MRI findings were normal. However, videocineradiography showed severe hypertrophy of the cricopharyngeal muscle. This condition was first treated by injections of botulinum toxin, which did not alleviate the symptoms. Next, myotomy and muscle biopsy were performed. Histological evaluation disclosed lymphoplasmacellular florid myositis, single-fiber atrophy, and muscle fiber necrosis with phagocytosis. There were no signs of inclusion body myositis or oculopharyngeal muscular dystrophy. Our finding of severe cricopharyngeal muscle hypertrophy associated with myositis has been published previously (n = 34). The study presented here shows cricopharyngeal dysphagia associated with various systemic diseases, including motor neuron disease, general granulomatous disease, dermatomyositis, or inclusion body myositis. Isolated changes of the cricopharyngeal muscle were described in 65% of the cases.- - - - - - - - - - ranking = 1keywords = deglutition (Clic here for more details about this article) |
5/26. Diffuse idiopathic skeletal hyperostosis: a case of dysphagia.OBJECTIVE: To present and discuss the clinical manifestations, radiographic features, and treatment of a patient with diffuse idiopathic skeletal hyperostosis complicated by dysphagia. This case serves as an educational tool by bringing attention to an uncommon complication of a common disorder. An emphasis is placed on diagnostic imaging. CLINICAL FEATURES: A 63-year-old man had dysphagia after a fall from a ladder. Plain film radiographs revealed large flowing hyperostoses arising from the anterior aspect of C3-6. Advanced imaging, consisting of a computed tomography (CT) scan and a modified barium-swallow study were performed to provide additional anatomic and functional information. INTERVENTION AND OUTCOME: Treatment provided by a speech and language pathologist focused on the dysphagia and consisted of compensatory management for 2 weeks. The patient was able to successfully swallow pur ed food and was released with instructions to modify his diet as tolerated. CONCLUSION: Dysphagia is a common clinical presentation for many disorders of deglutition. Flowing spinal hyperostoses such as that seen in diffuse idiopathic skeletal hyperostosis may become large enough to physically encroach on the pharynx or esophagus or indirectly predispose the patient to swallowing problems from posttraumatic edema. Conservative care is the initial treatment of choice, whereas surgical excision of the hyperostoses is reserved for difficult cases.- - - - - - - - - - ranking = 1keywords = deglutition (Clic here for more details about this article) |
6/26. Prolonged effect of botulinum toxin injection in the treatment of cricopharyngeal dysphagia: case report and literature review.Cricopharyngeus (CP) muscle spasm can lead to severe dysphagia. Myotomy of the CP muscle was the treatment of choice. Recently, botulinum toxin type A (BtxA) has been used for CP spasm. It usually brings improvement in deglutition but most patients require reinjection in 3-5 months. We report a 35-year-old man who had an arteriovenous malformation hemorrhage in the brain stem resulting in CP spasm and consequently severe dysphagia. He received BtxA injection and deglutition and nutrition remained good one year after treatment. A literature review analyzing 28 patients and our patient showed negative correlations between age and BtxA dose and between age and duration. Efficacy was positively correlated with duration and BtxA dose was positively correlated with pretreatment severity. In conclusion, physicians would use higher doses on patients with more severe cases but use lower doses on older patients. Those who obtained better post-treatment results would enjoy longer effective duration. Thus, the effective duration of the BtxA is multifactorial.- - - - - - - - - - ranking = 2keywords = deglutition (Clic here for more details about this article) |
7/26. Premature closure of the upper esophageal sphincter as a cause of severe deglutition disorder in infancy.deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures.- - - - - - - - - - ranking = 5keywords = deglutition (Clic here for more details about this article) |
8/26. Preswallowing dystonia.A patient is described with some dystonic features related to the preswallowing period of oropharyngeal swallowing in the muscles of deglutition sequentially. This case may be called a "preswallowing dystonia."- - - - - - - - - - ranking = 1keywords = deglutition (Clic here for more details about this article) |
9/26. Swallow syncope in association with Schatzki ring and hypertensive esophageal peristalsis: report of three cases and review of the literature.syncope caused by swallowing-induced cardiac arrhythmia is an uncommon condition. The recognition of this syndrome is paramount but often difficult. We report three cases of deglutition syncope evaluated at our institution over a three-year period. Two patients had distal esophageal (Schatzki) ring and two had hypertensive peristaltic waves (commonly referred to as "nutcracker esophagus"), neither of which had been described before in association with deglutition syncope. Two patients underwent placement of a demand cardiac pacemaker with subsequent resolution of their syncopal symptoms, while the third patient refused any further intervention. Swallow syncope usually follows a benign course from a cardiac standpoint. Placement of a demand cardiac pacemaker can prevent recurrence of presyncopal and syncopal attacks and their untoward consequences.- - - - - - - - - - ranking = 2keywords = deglutition (Clic here for more details about this article) |
10/26. Use of a Mousseau-Barbin tube in the management of a tuberculous tracheo-oesophageal fistula.A case report of a tuberculous tracheo-oesophageal fistula is described. The patient was successfully treated by antituberculous chemotherapy and a Mousseau-Barbin tube to control dysphagia and choking on deglutition. After 3 months the Mousseau-Barbin tube became displaced and was removed. Closure of the fistula was demonstrated by radiology and endoscopy.- - - - - - - - - - ranking = 1keywords = deglutition (Clic here for more details about this article) |
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