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20 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Pharyngeal Stage Problems
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delayed or mistimed swallow
reduced airway protection/incomplete valving incomplete bolus through pharynx (--> residue) |
3
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Disorders of Oral Prep
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Reduced lip closure (ant leakage)
reduced tongue shaping/coordination reduced ROM reduced labial tension/tone reduced tongue control for bolus hold |
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Disorders of Oral Transit
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1. Delayed Oral onset of swallow (swallow apraxia, red oral sensation, lack of recognition)
2. Searching tongue movements (apraxia, red organization) 3. Tongue Thrust 4. Reduced labial tension/time (residue in anterior sulcus) 5. Reduced Buccal tension/tone (resid in lateral sulcus) 6. Reduced tongue shaping 7. Tongue scarring s/p oral surgery 8. reduced tongue ROM or strength 9. Lingual Incoordination 10. Reduced tongue elevation 11. Piecemeal deglutition |
11
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Disorders of Pharyngeal stage
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1. delayed pharyngeal swallow
2. Reduced velopharyngeal closure 3. Reduced tongue base retraction (vallecular residue, p/asp after swallow) 4. reduced pharyngeal contraction (vallecular residue, penetration/aspiration after swallow) 5. Cervical osteophytes 6. Reduced laryngeal elevation/superior and anterior movement (reduced epiglottic inversion, red UES opening --> pyriform sinus residue) 7. Reduced laryngeal closure (--> reduced vf adduction, p/asp during swallow, coating of aryepiglottic folds) |
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Laryngeal Elevation/anterior motion
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w/mandible closed, suprahyoid muscles contract
superior and anterior movement of hyoid and larynx elevation of thyroid and cricoid cartilages due to thyrohyoid contraction results in pharyngeal shortening and UES opening larynx moves ~2 - 2.5 seconds |
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Disorders of cervical esophageal phase
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1. reduced esophageal persistalsis
2. esophageal pharyngeal backflow (may cause p/asp). -- symptom of achalasia, reflux, tumor, stenosis 3. Tracheoesophageal fistula (fistula in soft tissue common wall between trach and eso.) asp after swallow 4. Zenker's Diverticulum (side pocket from muscle herniation that forms from area of CP region |
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Esophageal inflammatory diseases
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GER
Laryngopharyngeal Reflux |
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Laryngopharyngeal Reflux (LPR)
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inflammatory disease
orginates in stomach acid rises to laryngopharynx and causes dysphagia, odynophagia, hoarseness and coughing |
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Gastrointestinal reflux
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backflow of gastric contents into esophagus bc of LES dysfunction
-heartburn GERD is a disorder - chronic and frequent GERD related asthma has no family hystory and reflux symptoms prior to onset, wheezing worsened by meals and nocturnal cough |
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Benefits of MBS A-P view
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1. oral prep
2. rotary jaw movement 3. mandibular movement: alignment of teeth 4. symmetry of oral and pharyngeal swallow 5. symmetry of bolus transport 6. Vocal fold adduction |
6
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Cause of aspiration before the swallow
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Premature spillage or swallow delay
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CAuse of penetration/aspiration during swallow
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reduced laryngeal closure/valving
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Cause of penetration/aspiration after the swallow
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d/t pharyngeal swallow
GERD TF fistula Zenker's backflow |
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Manipulations during MBS
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manipulation of bolus volume and viscosity
change in delivery postural changes (tuck, rotation) compensations/maneuvers |
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Things to consider in H&Neck Cancer patients
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1. cause of dysphagia
2. site of lesion 3. extent or surgery 4. structures involved in surgery 5. type of surgery (replace or flap?) 6. radiation 7. Chemo? |
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Purpose for TMB staging system
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to compare across patients the efficacy of treatment
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TMN = ____
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tumor size
nodal status mestasis |
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Types of resections of oral cavity
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Mandibullectomy
Glossectomy (partial, hemi, total) floor of mouth salivary gland maxillectomy palatectomy |
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Aspiration in H&N cancer pts
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s/p oral cavity surgery, but before radiation may demonstrate pen, but no aspi
pts s/p partial laryngeal resection may aspirate depending on extent of surg. common after chemo |
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Dysphagia: s/p resection
Structural changes |
Decreased: ROM, sensation, awareness
Impaired alignment |
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