Upper Gastrointestinal Surgery
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
Odynophagia➢ Painful swallowing➢ Causes of Odynophagia: Trauma: Radiation, oesophageal burn, oesophageal ruptureForeign Body: Oropharyngeal or oesophagealGORD: Oesophagitis, oesophageal ulcerationInfective: Pharyngitis, tonsillitis, oesophagitis (HSV/Candida), abscessNeoplasia: Pharyngeal/Laryngeal/Oesophageal carcinomaMotility-related: Achalasia, oesophageal dysmotlity disordersOther: Scleroderma
Causes and Assessment of Dysphagia and Aspiration
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
In the oral cavity, most tumours are malignant and of these 95% are squamous cell carcinomas (SCCs). The patient may present with a lump in the mouth or with an ulcer that may result in odynophagia. Dysphagia can be caused by tongue fixation. In the oropharynx, most malignant tumours are squamous cell in origin. Dysphagia is often due to pain but involvement of the tongue base and/or soft palate can result in problems with tongue fixation and regurgitation respectively. The tumour is often seen on examination. In the hypopharynx, rare benign tumours such as leiomyomas, lipomas and fibrolipomas can be found which cause dysphagia. The majority of tumours, however, are SCCs, with 60% occurring in the piriform fossa. Large tumours can cause significant swallowing problems with alteration of diet to softer textures. Weight loss is not uncommon and symptoms of aspiration such as cough associated with swallow and recurrent chest infections should be asked about. Small tumours and tumours of the postcricoid region or the cervical oesophagus can be more difficult to diagnose. The patient may only complain of a feeling of ‘something in the throat’, like a crumb being stuck. At examination it is important to look for pooling of saliva and any localized oedema, which might raise suspicion. In cases where there is a high index of suspicion or an obvious tumour, an assessment of the upper aerodigestive tract (UADT) and staging of the tumour is made, usually under general anaesthetic. Cross-sectional imaging MRI or CT is also helpful.
Esophageal Burns
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Pill induced esophageal burn injury ‘pill esophagitis’ is an under-reported problem and seems to occur most commonly in young women including adolescents. Over a hundred different medications have been implicated with the most common being nonsteroidal anti-inflammatory drugs, acne medicine (tetra- or doxycyclines), and potassium chloride tablets. Esophageal injury occurs when a caustic medicinal pill becomes lodged in the esophagus and releases a concentrated amount of irritant content. Risk factors for developing this injury include taking a pill with little or no fluid, reclining while ingesting a medication, underlying anatomic abnormalities (i.e. esophageal stricture, atrial enlargement), and esophageal motility abnormalities. Patients will usually present with odynophagia with or without dysphagia. A localized, circular area of ulceration characterizes a typical injury (10.11) and most often involves the junction of the proximal and middle esophagus. Diffuse erythema may surround the ulcer(s) with normal appearance of the mucosa in the rest of esophagus. Usually the injury heals without sequela but rare cases of mediastinitis and penetration of the great vessels have been reported.
Swallowing and communication outcomes following primary transoral robotic surgery for advanced or recurrent oropharyngeal cancer: Case series
Published in International Journal of Speech-Language Pathology, 2022
Emma Charters, Hans Bogaardt, Amy Freeman-Sanderson, Kirrie Ballard, Sarah Davies, Justine Oates, Jonathan Clark
In the interpretation of outcomes, it is important to note that all patients had changed their diet slightly prior to surgery. This was primarily due to xerostomia in the recurrent cases, and odynophagia in the advanced cases. In each case, this affected their ability to consume solids, rather than liquids, and none were reliant on a feeding tube prior to their TORS procedure. The post-TORS impairments in swallowing identified on FEES are consistent with previous literature demonstrating that TORS procedures result in a swallowing pattern characterised by (a) reduced base of tongue propulsion, (b) incomplete pharyngeal contraction and shortening and c) reduced or absent white out, suggesting absent epiglottic retroflexion and restricted hyolaryngeal elevation and excursion (Charters et al., 2020). The severity, however, in the cases of larger deficits or salvage cases appeared to be more severe.
Forget-me-not: Lemierre’s syndrome, a case report
Published in Journal of American College Health, 2023
Benjamin Silverberg, Melinda J Sharon, Devan Makati, Mariah Mott, William D Rose
Symptoms are somewhat nonspecific and include fever, rigors, odynophagia, difficulty swallowing, trismus, neck pain, and/or oropharyngeal swelling. (Of these, rigors and unilateral neck swelling represent red flags that may necessitate admission to the intensive care unit [ICU] and antibiotic coverage for anaerobes.) The tonsils do not necessarily appear exudative or ulcerated.17 Unilateral neck swelling and tenderness from thrombophlebitis of the IJV is often mistaken for cervical lymphadenopathy.16,17 The so-called "cord sign" is actually induration of the IJV under the anterior border of the SCM muscle.14,31 Evidence of thrombophlebitis can also be found with advanced imaging; a CT scan of the neck with contrast is the gold standard, but MRI or even ultrasound may be utilized.4,10,11,16,17,26,27,33 Workup does usually start with a plain chest X-ray, but this can be normal in a minority of cases.32 Myalgias, arthralgias, productive cough, hemoptysis, dyspnea, pleuritic chest pain, and abdominal pain are also possible.23,32
Breakthrough cancer pain in the radiotherapy setting: a systematic and critical review
Published in Expert Review of Anticancer Therapy, 2023
Sebastiano Mercadante
In a retrospective analysis, 42 patients with oropharyngeal cancer at clinical stages I–IVA were treated with adjuvant RT or RT-CT or definite RT or RT-CT, oropharyngeal cancer. Changes of the analgesic regimen occurred throughout the 6–7 week period of RT administration, with a more frequent administration of strong opioids. BP was recorded in 10 (23.8%) patients, after about four weeks of RT or RT-CT. BT was treated with non-opioid drugs or oral morphine. However, data about efficacy was not reported. Oral morphine syrup was the more frequently prescribed among patients with odynophagia. This choice was probably dictated by the presence of an inflamed mucosa for swallowing tablets., Pain intensity decreased by continued to be a significant clinical issue. The analgesic treatment was maintained in about 3/4 of patients after RT or RT-CT completion [10].
Related Knowledge Centers
- Dysphagia
- Esophagitis
- Head & Neck Cancer
- Mouth Ulcer
- Oral Cancer
- Pharyngitis
- Upper Respiratory Tract Infection
- Tonsillitis
- Parapharyngeal Abscess
- Epiglottitis
- Head & Neck Cancer