Dysphagia Final

Front 1

Greatest difficulty a laryngectomee may have with swallowing:

Back 1

The greatest difficulty a laryngectomee may have with swallowing is in propulsion of the bolus through the oral cavity and pharyngoesophagus.

Front 2

Why propulsion problems?

Back 2

 Loss of hyoid bone as the foundation for the tongue
 Some data indicate that there is increased pressure in the pharyngoesophagus after TL, which requires the tongue base to increase the pressure generated to propel the bolus.
 Effects of pre or post-operative XRT
 Pharyngoesophageal strictures
 Pseudoepiglottis

Front 3

Effects of pre or post-op radiation therapy

Back 3

 Xerostomia
 Tissue devascularization
 Fibrosis of the tongue, muscles of mastication and pharynx

Front 4

Xerostomia

Back 4

 Dry mouth or reduced saliva production
 Logemann, et al. 2003 - study done over 12 months found that reduced saliva does not correlate with slowed or inefficient swallow. Instead, it changed the patients’ perceptions of their swallowing ability and subsequently, their diet choices.
 Empirically, patient’s will not eat a wide variety of foods from a normal diet.

Front 5

Tissue Devascularization

Back 5

 Can make tissue more friable placing patient at risk for fistulization.

Front 6

Fibrosis

Back 6

 If fibrosis is in tongue and jaw, range of motion will be affected.
 Pharyngeal transit will be affected by pharyngeal fibrosis as well as reduced base of tongue retraction.

Front 7

Pharyngoesophageal Strictures

Back 7

 Narrows the food channel and can cause accumulation of food above the stricture
 Reflux back into mouth or nose with boluses of liquid
 Can affect voice in VP users

Front 8

Treatment for strictures

Back 8

 Alternate liquids and solids
 Multiple swallows
 Dilation of stricture
 Transcutaneous injection of botulinum toxin to PES if spasm is causing the stricture.
 Myotomy – less common

Front 9

Pseudoepiglottis

Back 9

 A fold of mucous membrane and sometimes scar tissue coming from the lateral pharyngeal wall at the tongue base
 At rest, it often collapses against the base of tongue which is misleading on mirror examination

Front 10

Treatment for pseudoepiglottis

Back 10

 Alternate liquids and solids
 Multiple swallows
 Crush pills or take in suspension
 Surgical removal

Front 11

Causes of pseudoepiglottis

Back 11

 Need longterm follow-up of swallowing in newly laryngectomized patients.
 Does base of tongue retraction push fold of mucous membrane to form pseudoepiglottis overtime?