[Neurologic and neuromuscular functional disorders of the pharynx and esophagus].

Neurologic swallowing disorders are an increasing diagnostic problem in our overaged population. Undiagnosed chronic aspiration pneumonia is the cause of death in 20-40% of all inhabitants of nursing homes. In neurologic diseases of the pharynx, the physiologic interaction of pharyngeal contraction, closure of the pharynx, and esophageal motility are frequently disturbed.

[Esophageal motility disorders].

For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility.

[Deglutition disorders in neurological patients. A prospective study of diagnosis, pattern of impairment, therapy and outcome].

We performed a prospective study on 208 patients with neurogenic dysphagia who were consecutively admitted for swallowing therapy over a 3-year period. The most frequent etiology was stroke (48%). Videofluoroscopic and/or fiber optic endoscopic evaluation of swallowing were performed in 204 patients.

Social and psychological burden of dysphagia: its impact on diagnosis and treatment.

The social and psychological impact of dysphagia has not been routinely reported in large studies. We sought to determine the effects of dysphagia on broad measures of the quality of life of patients and to explore the relationship between the psychological handicaps of the condition and the frequency of diagnosis and treatment. A total of 360 patients selected on the basis of known subjective dysphagia complaints, regardless of origin, in nursing homes and clinics in Germany, France, Spain, and the United Kingdom were interviewed using an established questionnaire.

Topographic evaluation of lateral hypopharyngeal pouches using electron beam tomography.

Background: To evaluate the exact topography of lateral hypopharyngeal pouches using electron beam tomography.

Methods: Seventeen patients, nine female, eight male, aged 28-72 years, who showed lateral hypopharyngeal pouches in the videofluorographic swallowing examination were studied using electron beam tomography. Upon swallowing a 20-ml bolus of water, the region of the thyrohyoid membrane was scanned 20 times per level.

Functional imaging of the pharynx using electron beam tomography.

Due to long scan times it was impossible to make dynamic swallowing imaging using computer tomography (CT) of the third or fourth generation. This study evaluates whether electron beam tomography with scan times of 100 ms enables a more detailed dynamic imaging of swallowing disorders. Examination using electron beam tomography was done in three planes: (1) Passavant's cushion (n = 6), (2) thyrohyoid membrane (n = 9), and (3) upper esophageal sphincter (n = 5).

Intramural pseudodiverticulosis of the esophagus: a case series.

Intramural pseudodiverticulosis of the esophagus is a rare benign disease of the esophageal wall, with dilation of the submucosal glands, and the predominant symptom is dysphagia. In the literature, 191 cases have been described so far. Along with a short review of the literature, the present report describes six cases of this disorder, including a patient in whom intramural pseudodiverticulosis of the esophagus was secondary to laser therapy and endoluminal afterloading of an esophageal squamous-cell carcinoma.

[Analysis and radiologic staging of the type and severity of aspiration].

The estimated number of the incidence of undiagnosed chronic aspiration pneumonia after cerebral or cerebrovascular injury seems very high. According to American statistics, at least 6% of these patients die from aspiration pneumonia within the first year. The high temporal resolution of cineradiography with frame rates of the complex process of pharyngeal swallowing lasting 0.

[Videocinematography and pre- and postoperative diagnosis of lip-maxillary-palatal clefts].

Videocinematography is a valuable tool in the diagnostic workup and planning of functional surgery in cleft patients. The high resolution and depiction of the finest mucosal structures in motion allow objective and dynamic assessment of the individual velopharyngeal function. A total of 170 cleft patients were examined by videocinematography, and the results were compared to nasoendoscopy and to the clinical examination.

[The physiology of swallowing].

This article reviews the sensory and the motor coordination during the oro-pharyngeal and pharyngo-esophageal stage of deglutition including laryngeal dynamics. The performance of swallowing takes less than one second. In this short period the well-coordinated action of five cranial nerves and 26 muscle-groups has to be accomplished.

[Radiological diagnosis of benign dysphagia].

In the diagnostic work-up of the benign dysphagia modern radiology must not only describe morphologic alterations but also has to keep in mind the great importance of motility disorders. Dysfunction of the esophagus can be assessed by fluoroscopy alone. The superior method to analyze the motility disorders of the oropharyngeal and pharyngo-esophageal transport is high-speed cineradiography at a frame-rate of 50 frames/sec on 35-mm film because of the very fast and complex patterns of motion during oropharyngeal deglutition, which occurs within only 0.

Dysphagia of the treated laryngeal cancer--detection of functional and morphological changes by cineradiography.

After treatment of laryngeal cancer 35 patients with dysphagia have been examined by high speed cineradiography. When compared to normal swallowing patterns, the following abnormalities were observed: Excursion of the posterior pharyngeal wall during swallowing is twice as intensive as normal. The function of the base of the tongue becomes more important for pharyngeal emptying--a fact that surgeons should take into consideration when planning laryngeal resection.

[The feasibility of pretherapeutic diagnosis of malignant pharyngeal processes using high-frequency cineradiography].

The differentiation between stage T3 and stage T4 pharyngeal tumors is of crucial importance for the proper therapeutic approach (surgery, surgery with consecutive radio- or radiochemotherapy, chemotherapy). The clinical relevance of the additional information provided by cineradiography was evaluated in combination with the endoscopic and computed tomographic results. We performed static and dynamic pharyngography with mono- and double-contrast-methods in four planes, including pharyngeal distension (Valsalva's and Müller's maneuver) and phonation.

[Cinematography, a new diagnostic procedure in evaluation of the injured painful wrist joint].

By the X-ray Cineradiografie we are able to examine and to judge the dynamic of the wrist bones by 50 pictures/sec. in comparison to one another and also depending on their ligaments. We did an investigation of 170 patients with painful wrist.

[Functional and morphological changes in the pharynx in achalasia and diffuse esophageal spasm].

Since the pharynx and the esophagus are a functional unit, functional radiodiagnosis has to be directed at pharyngo-esophageal interaction. Among our collective of 73 patients suffering from achalasia or diffuse esophageal spasm, we were able to recognize a substantially increased incidence of morphological or functional pharyngeal disorders by means of cineradiography. The functional alterations in particular were often not revealed by conventional fluoroscopy.

[Cinematographic study of the pathologic mechanisms of aspiration pneumonia].

6% of all patients suffering from a cerebrovascular injury die from aspiration pneumonia within the first year. The high temporal resolution of high-speed cineradiography (HFK) (50 frames/sec.) allows the recording of the 0.

[Roentgen cinematographic studies in patients who snore].

A radiocinematographic procedure of the pharyngeal examination of snorers is presented. By swallowing, by the production of pharyngeal sounds and by the forced inspiration which produces snoring sounds a dysfunction or an obstruction in the upper respiration tract can be located. This method is a useful diagnostic aid in snoring disease which should precede surgical interventions in the pharynx.

[Oropharyngeal dysphagia in neuromuscular diseases--differential diagnosis, examination procedure and therapy].

After a synopsis of brain stem structures participating in swallowing, the main neurologic diseases are presented as a part of which swallowing disorders may occur: central and peripheral nervous system, motor end-plates and muscles can be involved. The sequence of clinical examination is described with special reference to findings in mouth, pharynx and larynx as well as to findings in high-frequency cinematography. After description of normal swallowing pre-, intra- and postdeglutitive mechanisms of aspiration are shown.

[Detection of a higher incidence of pathologic somatic findings in globus sensation by use of high frequency cinematography].

Since December 1984 303 patients have undergone examination in our Multidisciplinary Consultation Service for Swallowing Disorders; 117 of them were suffering from typical globus symptoms. We were able to increase the yield of detection of organic lesions by use of the technique of 35 mm film cineradiography with a rate of 50 frames/s. Frame-by-frame analysis and computer-assisted evaluation showed that 80% of the patients with globus symptoms suffered from one or more underlying organic diseases, which could often be treated later with success.