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The effect of balloon dilation at the vallecular using videofluoroscopic swallowing study on patient who has a Dysphagia.

Kim YK, Kim MT, Kim SK - Ann Rehabil Med (2013)

Bottom Line: A 72-year-old male patient has been diagnosed with rectal cancer and have been treated with an ileocolostomy after the intubation.Foods and drinks could not be transmigrated into the esophagus due to the inability of the epiglottis to bend backward in the direction of posterior inferior on VFSS.After stretching and spreading the epiglottis in the direction of posterior inferior, the bolus remaining in the epiglottic vallecula was decreased.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.

ABSTRACT
Authors have previously experienced the effect of balloon dilation at the vallecular by utilizing the video-fluoroscopic swallowing study (VFSS) and the urethral catheter to physically stretch and spread in the direction of the posterior inferior towards the patients who have claimed for dysphagia symptoms due to epiglottic dysfunction. A 72-year-old male patient has been diagnosed with rectal cancer and have been treated with an ileocolostomy after the intubation. After the removal of tracheal intubation, the patient complained of dysphagia. Foods and drinks could not be transmigrated into the esophagus due to the inability of the epiglottis to bend backward in the direction of posterior inferior on VFSS. The epiglottis was physically stretched and spread in the direction of posterior inferior by utilizing the balloon attached to a urethral catheter. After stretching and spreading the epiglottis in the direction of posterior inferior, the bolus remaining in the epiglottic vallecula was decreased. For a patient who is experiencing dysphagia due to an epiglottis disorder, it seems that an epiglottis balloon dilation supported by VFSS and a urethral catheter may be appropriate for the treatment of dysphagia symptoms.

No MeSH data available.


Related in: MedlinePlus

Balloon dilatation at the vallecula.
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Figure 1: Balloon dilatation at the vallecula.

Mentions: The patient had received a continuous nutrition supply through total parenteral nutrition for more than 2 months since the first onset, and changed nutrition supply to tube feeding through nasogastric tubing after being hospitalized by the present hospital, followed by continued exercise promoting tongue's posterior movement and laryngeal elevation through occupational therapy. After that, VFSS was conducted to analyze the possibility of oral nutrition, during which, a large quantity of remnant epiglottis vallecula was observed without, however, a finding for aspiration so that nasogastric tubing was removed and oral nutrition was attempted through a compensation technique. Since then, however, there was a complaint of continued dysphagia during eating, and esophagogastroduodenoscope (EGD) examination was conducted through a consultation with the division of gastroenterology for a detailed cause analysis. From the EGD examination, no finding of mechanical closure of esophagus or stomach was observed. For a more accurate diagnosis, esophageal pressure manometry was conducted, which indicated normal findings for both the length of the upper and lower esophagus sphincter muscles or the resting pressure, as well as coordination of the esophagus during swallowing and fluid changes. Following that, VFSS was conducted again and a comparative analysis with the previous study images was made. The result of which led to a judgment that epiglottis was not bent back toward posterior inferior so that foods did not pass to the esophagus, Hence, an intervention was conducted where the epiglottis was physically stretched and spread in the direction of posterior inferior, using a urethral catheter. Intervention involved first implementation of the swallowing test, positioning a 16 F urethral catheter in the epiglottis vallecula, and subsequently expanding the balloon, as well as stretching and spreading of the epiglottis for 1 minute using about 5 mL of a contrast medium for balloon expansion; followed by rest for 10 seconds, which were repeated for a total of 3 times for the treatment (Fig. 1). Thereafter, swallowing test was again conducted to make judgment on the treatment effects (Figs. 2, 3).


The effect of balloon dilation at the vallecular using videofluoroscopic swallowing study on patient who has a Dysphagia.

Kim YK, Kim MT, Kim SK - Ann Rehabil Med (2013)

Balloon dilatation at the vallecula.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713301&req=5

Figure 1: Balloon dilatation at the vallecula.
Mentions: The patient had received a continuous nutrition supply through total parenteral nutrition for more than 2 months since the first onset, and changed nutrition supply to tube feeding through nasogastric tubing after being hospitalized by the present hospital, followed by continued exercise promoting tongue's posterior movement and laryngeal elevation through occupational therapy. After that, VFSS was conducted to analyze the possibility of oral nutrition, during which, a large quantity of remnant epiglottis vallecula was observed without, however, a finding for aspiration so that nasogastric tubing was removed and oral nutrition was attempted through a compensation technique. Since then, however, there was a complaint of continued dysphagia during eating, and esophagogastroduodenoscope (EGD) examination was conducted through a consultation with the division of gastroenterology for a detailed cause analysis. From the EGD examination, no finding of mechanical closure of esophagus or stomach was observed. For a more accurate diagnosis, esophageal pressure manometry was conducted, which indicated normal findings for both the length of the upper and lower esophagus sphincter muscles or the resting pressure, as well as coordination of the esophagus during swallowing and fluid changes. Following that, VFSS was conducted again and a comparative analysis with the previous study images was made. The result of which led to a judgment that epiglottis was not bent back toward posterior inferior so that foods did not pass to the esophagus, Hence, an intervention was conducted where the epiglottis was physically stretched and spread in the direction of posterior inferior, using a urethral catheter. Intervention involved first implementation of the swallowing test, positioning a 16 F urethral catheter in the epiglottis vallecula, and subsequently expanding the balloon, as well as stretching and spreading of the epiglottis for 1 minute using about 5 mL of a contrast medium for balloon expansion; followed by rest for 10 seconds, which were repeated for a total of 3 times for the treatment (Fig. 1). Thereafter, swallowing test was again conducted to make judgment on the treatment effects (Figs. 2, 3).

Bottom Line: A 72-year-old male patient has been diagnosed with rectal cancer and have been treated with an ileocolostomy after the intubation.Foods and drinks could not be transmigrated into the esophagus due to the inability of the epiglottis to bend backward in the direction of posterior inferior on VFSS.After stretching and spreading the epiglottis in the direction of posterior inferior, the bolus remaining in the epiglottic vallecula was decreased.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.

ABSTRACT
Authors have previously experienced the effect of balloon dilation at the vallecular by utilizing the video-fluoroscopic swallowing study (VFSS) and the urethral catheter to physically stretch and spread in the direction of the posterior inferior towards the patients who have claimed for dysphagia symptoms due to epiglottic dysfunction. A 72-year-old male patient has been diagnosed with rectal cancer and have been treated with an ileocolostomy after the intubation. After the removal of tracheal intubation, the patient complained of dysphagia. Foods and drinks could not be transmigrated into the esophagus due to the inability of the epiglottis to bend backward in the direction of posterior inferior on VFSS. The epiglottis was physically stretched and spread in the direction of posterior inferior by utilizing the balloon attached to a urethral catheter. After stretching and spreading the epiglottis in the direction of posterior inferior, the bolus remaining in the epiglottic vallecula was decreased. For a patient who is experiencing dysphagia due to an epiglottis disorder, it seems that an epiglottis balloon dilation supported by VFSS and a urethral catheter may be appropriate for the treatment of dysphagia symptoms.

No MeSH data available.


Related in: MedlinePlus