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ENT Foreign Bodies
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Coins, toys and small household objects including most dangerously ‘button batteries’ are easily swallowed especially by toddlers who are inclined to explore and very often put objects into their mouths. Many are innocuous and pass into the stomach and beyond with no ill-effects, but some may impact at the level of the vallecula, cricopharyngeus or midoesophagus. There may be a definite history, and the child will complain of difficulty with swallowing, but presentation can be delayed. Some objects such as a food bolus or a large coin can compress the trachea and cause acute airway obstruction. A sharp object, a pin or nail, can cause oesophageal perforation. An impacted pharyngeal or oesophageal foreign body will need to be removed under general anaesthesia, ideally within a few hours. Button batteries are especially destructive, with the capacity to erode the oesophageal mucosa and cause catastrophic bleeding in the mediastinal great vessels so need immediate removal, even if the child has a full stomach.
Paediatrics
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Paula Coyle, Eishaan Bhargava, Adnan Darr, Karan Jolly, Kate Stephenson, Michael Kuo
Investigations: Investigations in the immediate period are avoided as condition is time critical, UNLESS STABLEA chest radiograph may demonstrate thumbprinting (epiglottis ≥7 mm thick) as well as obliteration of vallecula (vallecula sign)Once the airway has been secured: Swab epiglottisIV access, IV antibiotics as per local protocol (usually third-generation cephalosporin)Blood cultures, FBC, CRP, U&Es, LFTs and clotting
Tumours of the oral cavity and pharynx
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Kunwar S S Bhatia, Ann D King, Robert Hermans
The oropharynx is divided into four regions: the posterior third of the tongue (or tongue base) and two valleculae, the soft palate, the posterior wall, and the two lateral walls. Posterior to the muscles of the tongue base, there is a variable amount of lymphoid tissue termed the lingual tonsil. The valleculae are shallow depressions behind the tongue base and anterior to the epiglottis, which are bordered medially and laterally by the median and lateral glossoepiglottic folds, respectively (Figure 1.2). The lateral walls of the oropharynx contain vertical ridges termed anterior and posterior tonsillar pillars, formed by palatoglossus and palatopharyngeus muscles, respectively. Between these pillars is lymphoid tissue termed the faucial or palatine tonsil.
Re-evaluation of the prognostic significance of oropharyngeal dysphagia in idiopathic inflammatory myopathies
Published in Scandinavian Journal of Rheumatology, 2022
JG Kim, Y Park, J Lee, JH Ju, W-U Kim, S-H Park, S-K Kwok
VFSS was performed by a skilled radiology technician and a physiatrist working as a team. VFSS was performed to evaluate the anatomy and motor function of four phases: the oral preparatory, oral, pharyngeal, and oesophageal phases. We focused on the aspiration risk of oropharyngeal dysphagia, and defined at least one of the following findings as abnormal: penetration of the bolus into the larynx, tracheobronchial aspiration, residue in the vallecula, residue in the pyriform sinuses, and delayed triggering of the pharyngeal swallow (26–28). To measure the severity of penetration and aspiration, the Penetration–Aspiration Scale (PAS) was used, which is the commonly used semi-quantitative index. The higher the PAS score, the more severe the aspiration tendency of the patient. A PAS score of 1 indicates no penetration and aspiration, and scores of 2–5 indicate the presence of penetration, meaning that materials enter the airway but do not pass the glottis. A score of 6–8 indicates aspiration, which is defined as materials passing the glottis (29). As well as the findings on the VFSS, the treatment modalities for dysphagia and symptomatic improvement were assessed.
Lymphatic malformation in larynx masquerading as respiratory papillomatosis
Published in Acta Oto-Laryngologica Case Reports, 2021
Contrast-Enhanced MRI was suggestive of the mixed cystic type of common (cystic) LM which demonstrated an ill-defined cystic mass in the region of the posterior wall of the hypopharynx measuring 3.8 × 2.5 cm. Mass was infiltrating the bilateral vallecula, epiglottis, and bilateral aryepiglottic folds. Bilateral pyriform fossa sinus was obliterated with severe narrowing of the supraglottic airway. The cystic mass was extending along the left lateral pharyngeal wall of the oropharynx, hypopharynx, left submandibular spaces displacing and encasing the gland. Inferiorly, it was extending along with the left anterior strap muscles into the thoracic inlet. Another 2.6 × 1.4 cm ill-defined cystic area was also noted in the left paratracheal region with mass effect and right lateral displacement of the trachea (Figures 3 and 4).
Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients
Published in Logopedics Phoniatrics Vocology, 2021
Chiara Mezzedimi, Enza Vinci, Fabio Giannini, Serena Cocca
FEES was performed with a fiberoptic rhinopharyngoscope for studying the physiology and physiopathology of certain stages of swallowing, particularly the pharyngeal stage. As far as concerns the static investigation, three main positions were performed for the tip of the endoscope: rhino-pharyngeal, upper position and lower position. In the upper position (with the endoscope next to the velum palati), it was possible to detect stagnation of secretion in the glosso-epiglottic valleculae, the pyriform recesses, the interarytenoid area and the laryngeal vestibule. The lower position (the endoscope is placed at the laryngeal aditus) was tested by simply inviting the patient to cough, swallow saliva and carry out a Valsalva maneuver. Static evaluation of the morphology and function of the upper airways and upper digestive tract was followed by a dynamic evaluation of swallowing, administering a bolus to the patient. At least four bolus types were administered: 5 ml of thin liquid from a spoon, thin liquid from a cup (self-administered), 5 ml of a semisolid from a spoon, and a cookie.