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Published in Henry J. Woodford, Essential Geriatrics, 2022
A range of cognitive, motor and sensory components are required for safe swallowing. The process of swallowing can be divided into phases.Oral phase: chewing and mixing with saliva. The bolus of food is moved backwards in the mouth by the tongue.Pharyngeal phase: there is closure of the velopharynx (to block off the nasal cavity) and the larynx (by an upward and anterior movement). The epiglottis prevents food from entering the airway. There is pharyngeal peristalsis to aid the transit. The food passes the cricopharyngeal muscle to enter the oesophagus.Oesophageal phase: transport to the stomach by peristalsis.
Airway Management
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Inserted correctly, an OP airway should not cause problems but loose or damaged teeth can be dislodged and potentially become foreign bodies in the airway. If the airway is too large, the tip can lie close to or against the epiglottis causing gagging, vomiting, coughing or laryngospasm. If any of these occur, the airway should be removed.
Rhinolaryngoscopy for the Allergist
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jerald W Koepke, William K Dolen
The lingual tonsils are located on either side of the dorsum of the tongue anterior to the epiglottis (Fig. 11.6). The median glossoepiglottic fold and the two lateral glossoepiglottic folds attach the epiglottis to the base of the tongue.
Acute epiglottitis due to Pasteurella multocida after contact with a feral cat
Published in Baylor University Medical Center Proceedings, 2019
Lauren Sisco, Lizbeth Cahuayme-Zuniga
On arrival the patient appeared acutely ill. He was febrile and dyspneic with a muffled voice. His temperature was 101.1°F; heart rate, 113 beats per minute; blood pressure, 180/115 mm Hg; and respiratory rate, 25 breaths per minute. Scratches and erythema were visible on both hands and forearms. The skin over the neck and chest was flushed. Cervical lymphadenopathy was present. Lung auscultation revealed rhonchi in the left lower lobe. He had no stridor but developed worsening shortness of breath and difficulty swallowing. Racemic epinephrine and dexamethasone were administered due to concern for airway edema, but his respiratory distress progressed. Laryngoscopy was then performed. This revealed an erythematous and edematous epiglottis with leftward deviation, edema, and erythema of the supraglottic tissues with purulent drainage in the oropharynx. Endotracheal intubation was unsuccessful due to severe oropharyngeal edema. An emergent cricothyrotomy was performed.
Comparison of postoperative pain scores and dysphagia between anterior palatoplasty and uvulopalatal flap surgeries
Published in Acta Oto-Laryngologica, 2018
Elvan Yüksel, Murad Mutlu, Ömer Bayır, Melike Yüceege, İstemihan Akın, Güleser Saylam, Ali Özdek, Hikmet Fırat, Mehmet Hakan Korkmaz
Surgery is one of the options in OSAS treatment. Obstruction may be located in any part of the upper airway from nose to the epiglottis. It is a well-known fact that retropalatal region is the most common place of obstruction in patients with OSAS [3]. In order to create scar tissue in soft palate, various surgical techniques were implemented, which led to fibrosis and stiffening of the palate. Numerous surgical procedures directed to the soft palate may be performed alone or together with some other surgical interventions. Anterior palatoplasty (AP) is one of the recent surgical procedures performed with this purpose. In our center, AP is performed as defined by Pang and Terris [4]. Uvulopalatal flap (UPF) is another surgical procedure directed to the soft palate and this procedure is performed as defined by Powell et al. [5] in our clinic. Oropharyngeal and nasopharyngeal airway openings are enlarged with those operations.
Prognostic factors and importance of recognition of adult croup
Published in Acta Oto-Laryngologica, 2018
Tomoyasu Tachibana, Yorihisa Orita, Takuma Makino, Yasutoshi Komatsubara, Yuko Matsuyama, Yuto Naoi, Michihiro Nakada, Yasuharu Sato, Kazunori Nishizaki
Epiglottitis is an acute life-threatening inflammatory condition involving the epiglottis and other supraglottic structures [16]. Unlike AC, antibiotics play an important role in the initial treatment of epiglottitis [16,17]. Although, the vast majority (70–90%) of adult patients with epiglottitis can be managed medically with close observation [17]. Epiglottitis and croup are often confused, especially in early phase of disorders, due to similarities in symptoms and signs, including stridor [18]. Coughing is a hallmark of croup, and 15 of 18 AC patients in this study had cough symptoms. However, the presence or absence of coughing in epiglottitis has been uncertain [18]. Although treatments differ between croup and epiglottitis, differentiation on presentation is difficult [19]. We speculate that the small number of manuscripts about AC may be partially attributable to misdiagnosis by physicians who cure AC patients using empirical treatments. Direct visualization of the larynx by laryngoscopic examination is indispensable to avoid misdiagnoses of diseases like severe epiglottitis or croup as common cold or pharyngitis. In particular, we should pay special attention to female, young age (<60 years), the symptom of cough, or high serum levels of CRP.