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42 Cards in this Set

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Types of medical procedures used in swallowing management include
-pr. to improve anatomy/physiology
-pr. to eliminate/control aspiration
-pr. to provide nutrition/hydration non-orally
-medications
p. 345
What are potential drawbacks to surgical reduction of ostephyes?
-entering the neck can create scar tissue, damage nerves leading to dysphagia
p. 346
How does substance injection work to improve vocal fold closure? Who is this used for in general?
inert substance injected into dysfunctional vocal fold to improve contact with other vf. Generally used with patients whose laryngeal addduction has not improved with exercise
p. 346
How much of aspiration is caused by poor vf closure?
about 10 % or less
p. 347
How does laryngeal suspension work?
Suture placed from middle of mandible to laryngeal cartilage, so larynx raised and tilted under tongue base
p. 347
How does dilatation work?
Passage of mercury-filled soft rubber tubes with increasing diameter to gradually stretch cricopharyngeal region, tear scar tissue.
p. 347
Is dilatation permanent or temporary?
Effects are temporary (1 to 3 months)
p. 347
Does dilatation help neurologically caused dysphagia?
No
p. 347
How does myotomy work?
External incision through side of neck into CP muscle. Permanent opening of sphincter. Patient can eat about 1 week afterwards.
p. 347
WHat are the ideal criteria for CP myotomy candidates?
1) CP dysfunction predominant problem
2) intact oral and pharygeal stages of swallow
3) patient can close airway voluntarily
p. 348
Who should this NOT be used with?
Patients with insufficient laryngeal up and forward mvt to open CP. Also, don't use ealy on with patients w/ srtoke, TBI, spinal cord injury, becaue most of them recover. Also people with damaged oral and pharyngeal stages.
p. 348
What are potential negative results of CP myotomy?
Hemorrhage, recurrent laryngeal nerve damage, inherent surgery complications
p. 349
How does Botox injection work?
Botox is injected into CP muscle. Hard to do b/c CP muscle hidden behind cricoid cartilage. May result in paralysis of other muscles.
p. 349
What are some procedures for unremitting aspiration?
-epiglottic pull-down
-suturing vf
-suturing false vf's
-laryngeal bypass
-tracheostomy
-total laryngectomy
p. 349
How does epiglottic pull-down work?
Suture epiglottis to arytenoids. This is reversible sometimes. But often epiglottis gets "dis-attached".
p. 349
How does suturing vf's work?
Strip epithelium from vf's, suture them toegether. Usually irreversible, often unsuccessful b/c they tear apart
p. 350
Suturing false vf's?
Same as true vf's except this is reversible and they're less likely to tear apart
p. 350
Laryngeal bypass?
Separate air and food pasage by cutting trachea at 3/4 tracheal ring, suture one end to esophagus, other end to skin. Permanent
p. 350
Tracheostomy?
See previous chapter.
n/a
Why does cuff in a tracheostomy not always prevent aspiration?
B/c there is often leakage around cuff
p. 350
What's another term for laryngeal bypass?
Tracheo-esophageal diversion
p. 350
Total laryngectomy
Removal of entire larynx plus hyoid. Complete separation of food and air passages.
p. 350
What are techniques for non-oral feeding?
-nasogastric feeding
-pharyngostomy
-esophagostomy
-percutaneous/surgical gastrostomy
-percutaneous/surgical jejunostomy
p. 350
All nonoral feeding procedures lead to higher risk of reflux -- T or F?
True
p. 350
All of these procedures are temporary
True
p. 350
How does NG feeding work?
Tube placed through nose, pharynx, esophagus into stomach.
p. 350
With an NG tube, what usually follows each feeding?
120-240 cc of water to cleanse feeding tube, provide hydration. Also, patients kept upright for 1 hour afterwards to reduce risk of reflux
p. 351
How does pharyngostomy work?
Create hole from skin into pharynx. Tube is then placed there into esophagus and stomach.
p. 351
What's an advantage of pharyngostomy?
Eliminates tube through nose
p. 351
How does esophagostomy work?
Hole from skin into cervical esophagus. Feeding tube passed through esophagus into stomach
p. 351
What are two types of gastrostomy?
1) General surgical procedure w/ general anaesthetic
2) Percutaneously w/ local anesthetic
p. 352
How is the second procedure called?
Percutaneous endoscopic gastrostomy
p. 352
When is gastrostomy usually done?
It's a long-term solution to severe dysphagia. But can be reversed if patient recovers from dysphagia.
p. 353
What are some disadvatnages of gastrostomy?
Stoma site can leak or become infected/sore/uncomfortable
p. 353
WHat is jejunostomy?
External opening on abdominal wall into jejunum. Can also be done with local or general anesthetic
p. 353
What does jejunostomy require?
Prepared foods, because it bypasses stomach
p. 353
Jejunostomy is often placed to reduce ___, although patients with jejunostomy can still have it.
reflux
p. 353
WHat is fundoplication?
General surgical procedure; twist top of stomach around LES to reinforce LES
p. 354
When is fundoplication done? What is a possible complication?
In kids who get gastrostomy or jejunostomy, or in adults with history of reflux who get non-oral feeding. May be wrapped too tightly, preventing food from getting into stomach
p. 354
A patient who is aspirating ____ despite therapy or who takes ___ to swallow _, is candidate for non-oral feeding.
1) more than 10% of all consistencies
2) longer than 10 seconds
3) all food types
p. 354
If dysphagia is short-term, ___ is usually done.
NG tube
p. 354
There are medications to improve___of swallow
Esophageal disorders
p. 354