Speech language characteristics and intervention approaches in lockedin syndrome post snake envenomation

The present case study illustrates hypoxic-ischemic encephalopathy as a result of neuroparalytic snake envenomation in an 11 year old male patient. Detailed speech assessment was done which revealed diverged oral structures and language loss. The study aims to document speech and language characteristics as well as rehabilitation in terms of speech therapy. The study enlightens the role of speech language pathologist in assessment and intervention of locked in syndrome. Study shows the swapped roles of traditional therapy approaches and the importance of augmentative and alternative communication as compassion and a beneficial technique in an intricate incident like hypoxic-ischemic encephalopathy as a result of neuroparalytic snake envenomation.

Diagnosis and Management of Submandibular Sialolithiasis.

Submandibular gland is the most common site of stone formation among all the salivary glands, owing to its long duct, mucus rich saliva and antigravity flow. Swelling and pain on eating is its most common presentation. Most salivary stones are made up of calcium phosphates, and only a few contain pure organic material. Surgical removal is required, and the route of surgery is planned according to the site and size of the stone.METHODSWe conducted a cross sectional study on 25 consecutive patients with a clinical diagnosis of submandibular sialolithiasis. Thorough history taking and clinical examination was followed by ultrasound scan to confirm the diagnosis and establish the site and size of the stone. Stone procured after removal was analysed chemically in the biochemistry laboratory.RESULTSOut of 25 patients, calculi in 11 cases were found in the intraglandular part of the submandibular gland and in 14 cases in the intraductal part of the gland. Out of the 14 cases with stone in the intraductal part, in 4 cases the stone was removed with the help of sialagogues and milking due to the very small size of the stone; whereas, in 10 cases the stone was removed intraorally with marsupialisation of the duct under local anaesthesia. In 11 cases the gland had to be removed along with the stone. As per the biochemical analysis, calcium and phosphate stones were the commonest in our study followed by oxalate calculi. Obtained results showed that the studied salivary stones had almost 10% association with nephrolithiasis. The salivary pH was acidic in 10 cases and alkaline in 15 cases.CONCLUSIONSCharacteristic history, thorough clinical examination and ultrasonic examination help us in the diagnosis of sialolithiasis. The site and size of the calculus is the deciding factor for the surgical plan. Biochemically stones are invariably composed of calcium and phosphates. Simultaneous occurrence of sialoliths and renal calculi was purely by chance or as a comorbidity needs to be studied more in a larger study group.