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