Professional Documents
Culture Documents
BRONCHOESOPHAGOLOGY
MANAGEMENT OF DYSPHAGIA
Include :
- Lips
- Buccal mucosa
- Upper and lower alveolar
ridges
- Retromolar trigone
- Anterior two-thirds of the
tongue
- Floor of the mouth
- Hard palate
3
The Pharynx
Nasopharynx
Oropharynx
Hypopharynx
4
Valve for Deglutition
1. Lips
2. Tongue
3. Velum to back of
tongue (the
glossopalatal valve)
4. Velopharynx
5. Larynx
6. Upper esophageal
(cricopharyngeal)
sphincter
5
The Esophagus
7
PHYSIOLOGY
8
SWALLOWING
9
10
Mechanisms of Oropharyngeal Dysphagia
16
History
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Imaging Studies
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Plain Film
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Manometry
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Bolus Scintigraphy
23
Ultrasound
Portable
Videofluoroscopic procedure
Also known as modified barium swallow
A radiographic study of a persons swallowing
mechanism that is recorded on videotape
Uses excellent to evaluate dynamic (e.g.
neuromuscular, aspiration) swallow disorders
(Logeman)
25
Videofluoroscopy
ADVANTAGES DISADVANTAGES
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Fiberoptic Endoscopic Evaluation of
Swallowing
Residue Penetration-Aspiration
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Indication of FEES
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Fiberoptic Endoscopic Evaluation of
Swallowing
ADVANTAGE DISADVANTAGE
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THERAPY
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Non Operative
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National Dysphagia Diet
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DESCRIPTION RATIONALE
Liquids :
Swallowing of liquids requires coordination and
control
Easily aspirated into the lungs
Liquids may need to be thickened for safe swallow
What are the benefits?
Delay the bolus transit through the pharynx
Extend the duration of pharyngeal peristalsis
Prolong the opening of the cricopharyngeal (upper
esophageal) sphincter
38
DIET POSITION
Chin - Tuck Narrows the opening to the
airway
Head Rotation to the weakness
rotation pharyngeal side, channels bolus to
strong side
Head Tilt Tilt to the stronger side direct the
bolus away from the side of
weakness
Side Lying May reduce hypopharyngeal
pooling for selected patients
39
Postural Techniques Succesful in Eliminating
Aspiration
Disorder Observed Posture Applied
Inefficient oral transit Head back
Delay in triggering the pharyngeal Chin down
swallow
Reduced posterior motion of Chin down
tongue base
Reduced laryngeal closure Chin down; head rotated
to damaged side
Unilateral pharyngeal paresis Head rotated to
damaged side
Reduced pharyngeal contraction Lying down on one side
Cricopharyngeal dysfunction Head rotated
40
41
Swallow Maneuvers
Problems for Which
Swallow Maneuvers Was Rationale
Maneuvers Designed
Supraglottic Reduced or late vocal Voluntary breath hold
swallow fold closure usually closed vocal
folds before and
during swallow
(Martin et al., 1993)
Delayed pharyngeal Closes vocal folds
swallow before and during
delay
Super Reduced closure of Effortful breath hold
supraglottic airway entrance tilts
Swallow arytenoid forward,
closing airway
42
entrance before and
Problems for Which
Swallow Maneuvers Was Rationale
Maneuvers Designed
44
PERHATI - KL
PEMERIKSAAN FISIK:
-Tanda Dehidrasi
-Tanda Malnutrisi
-Sumbatan jalan nafas
-Pneumonia Aspirasi
POSISI KEPALA
Disfagia Fase Oral/Fase
Faring (+)
-Head Back
-Chin Down
Konsul Gizi Konsul RM -Head
Rotation
-Head Tilt
Maneuvers Menelan
TERAPI KAUSAL:
THT
Neurologi
-Supraglotik
Geriatri
-Super-
Onkologi
Supraglotik
Pediatri
-Efforthful
Swallow
-Mendelson
Pipa Nasogaster
Gastrotomi
KESUKARAN MAKAN
KESUKARAN MAKAN
PADAT DAN CAIR
PADAT
Skleroder Akalasi
Sriktur Peptik Kanker
ma a
Spasme
Esofagus Difus
Striktur Esofagus
Bawah
Esofagoskopi
Esofagoskopi dan/atau Barium
Barium Esifagogram Esofagogram
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Dan/atau
Manometri
CONCLUSION
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