Formal swallowing evaluation and therapy after traumatic brain injury improves dysphagia outcomes.

BACKGROUND: The incidence of swallowing dysfunction after brain injury is unknown. The efficacy of dysphagia therapy is also unknown. We reviewed our experience to define the incidence of swallowing dysfunction and efficacy of therapeutic intervention. METHODS: Patients with brain injury sustained between January of 1996 and December of 1997 were reviewed. All were screened with trials of oral intake. Abnormal findings were confirmed with a videofluoroscopic swallow study. Standard therapies included diet, posture, and behavior modifications. RESULTS: A total of 47 patients were evaluated. Bedside evaluations were normal in 14 patients, 2 patients had overt aspiration and underwent gastrostomy, and 31 patients were referred for a videofluoroscopic swallow study (66%). The videofluoroscopic swallow study was abnormal in 22 of 31 patients (71%). Of these, 4 additional patients required gastrostomy, 13 patients had laryngeal penetration or minor aspiration responsive to dysphagia therapy and were fed. Five other patients had silent aspiration and were fed by means of nasogastric tube; these five patients responded to dysphagia therapy and were able to resume oral intake. CONCLUSION: Dysphagia is common after severe head injury. With formal swallowing service intervention, aspiration is avoided. Therapeutic interventions can be used to restore oral intake.

Axial temporomandibular joint morphology: a correlative study of radiographic and gross anatomic findings.

In degenerative diseases of the temporomandibular joint the mandibular condyle demonstrates changes in contour, including flattening and enlargement, resulting in an increased diameter of the articular surface. The purpose of this study was to determine if such alterations in the shape of the mandibular condyle can be visualized in submentovertex (axial) radiographs and correlated with pathologic changes of the temporomandibular joint. Submentovertex radiographs of 18 human cadaver specimens were made. The radiographic condylar dimensions, morphologic condylar outline, and angle of the condylar axis with respect to the transmeatal line were determined. The specimens were dissected and disarticulated, and radiographic findings were compared to anatomic structure. Osseous abnormalities were found in 21 of the 36 joints studied (58%). Perforations of the disk were found in nine of 31 joints (29%) investigated. No statistically significant differences between the normal condyles and condyles displaying osseous abnormalities were found in any of the radiographic parameters studied.