[DYSPHAGIA] epiglottic inversion

[eripley@yahoo.com (Irene Campbell-Taylor)]

I am assuming that the failure of the epiglottis was
bilateral. Movement of the epiglottis is dependent on
movement of the hyoid which, in turn, is essential for
opening of the upper esophageal sphincter, without
which, of course, aspiration is inevitable.
After the hyoid moves a certain distance anteriorly
and superiorly, the epiglottis is pulled by this
action, into a horizontal position. It descends by
being pulled inferiorly by the contraction of the
aryepiglottic and thyroepiglottic muscles on either
side. In order for all this to occur, there must be
intact motor function of Cr V, VII, XII and the
inferior laryngeal branch of the vagus.
In this gentleman, the Parkinson disease alone makes
it highly unlikely that any of the above will be able
to function normally and will, in fact, become
progressively worse. The increase in aspiration with
chin tuck makes this clear (See Bulow et al,
Dysphagia, 1999) in that it reduces the possible
movement of the hyoid, thus reducing the possibility
of UES opening.
The usual approach is to try various types of modified
diet with the chin horizontal, as the lack of hyoid
movement is the major problem. It has been established
that larger, heavier boluses increase hyoid movement,
thereby increasing duration of UES opening.
It is also important to keep in mind that what one
sees on MBS does not reflect what happens during a
meal.
Irene
--- denise gabel-comeau <denisecomeau@hotmail.com>
wrote:
> I am in need of your opinions and any treatment
> strategies for this complex 
> patient.
> 
> This 77 y/o male was admitted S/P acute MI, right
> occipital lobe infarct 
> 11/14/01, CABG 11/7/01 and GI bleed 11/16/01.  Pt
> has been 
> intubated/extubated x2 during this hospitalization.
> Bronchoscopy revealed a 
> paralyzed vocal fold(did not indicate which side).
> PMH includes 
> Parkinsons-moderately advanced. MBS completed
> 12/7/01 indicated frank silent 
> aspiration with puree consistency, use of chin tuck
> increased amount of 
> bolus aspirated, continued aspiration after the
> swallow secondary to 
> pharyngeal residue, cued cough ineffective to clear
> aspiration, decreased 
> laryngeal elevation and minimal to absent epiglottic
> inversion.
> Are there any specific exercises to improve
> epiglottic inversion? Any 
> suggestions for treatment would be appreciated.
> Thank you,
> Denise
> 
>
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