[Palatal myoclonus and dysphagia]. / Myoclonies vélo-pharyngées et dysphagie.

INTRODUCTION: Post brainstem lesion dysphagia is frequently associated with palatal myoclonus (PM) but the correlation between these two symptoms is still unclear. OBJECTIVE: The aim of this study was to verify the relationship between PM and dysphagia, and if PM could itself induce dysphagia. PATIENTS AND METHODS: Twelve patients suffering from post brainstem lesion PM and dysphagia; 10 male and two female, mean aged of 50.5 years, were assessed using clinical examination, radiological and endoscopic examination of deglutition. RESULTS: In three cases, PM were associated with pharyngeal area decreasing, laryngeal aspiration, and dysphagia. DISCUSSION: This study confirms the hypothesis of close relationship between PM and dysphagia. In these cases, specific dysphagia therapy should be recommended. CONCLUSION: Post brainstem lesion dysphagia is sometimes associated with PM and in some cases, there is probably a relationship between PM and swallowing disorders of these patients.

[A retrospective study of 91 injections of botulinus toxin into the upper sphincter of the oesophagus]. / Analyse rétrospective de 91 injections de toxine botulique dans le sphincter supérieur de l'oesophage.

OBJECTIVE: To evaluate the results of botulinus toxin in dysphagia arising in the upper sphincter of the oesophagus. MATERIALS AND METHODS: Since June 1995, 64 patients have had botulinus toxin injected into the upper sphincter of the oesophagus for major swallowing disorders. All cases were treated in the dysphagia service, and underwent clinical assessment, video-swallow screening, and swallowing therapy. The patient cohort included various pathological groups--neurological (vascular accident, head injury, cranial nerve disorders, degenerative diseases), postoperative (surgery for carcinoma of the laryngo-pharynx), and functional, whether purely idiopathic or attributable. RESULTS AND CONCLUSIONS: Global analysis of the results shows that botulinus toxin has good efficacy in relaxing the upper sphincter of the oesophagus; this does not always lead to recovery of normal swallowing, but can bring about improvement by assisting in the therapeutic management of the swallowing problem, and in improving the dietary intake.

[A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)]. / Etude prospective des complications ORL de la chirurgie du rachis cervical par voie antérieure (résultats préliminaires).

In order to evaluate complications due to cervical spine surgery using the anterior cervical approach a prospective study was conducted on 125 patients. ENT examination with the fibroscope was employed for all the patients before the procedure. The patients were operated on under general anesthesia and were intubated with an armoured tube, and then were placed in an intensive care unit for 24 hours. Assessment of deglutition and an ENT examination were performed the day after surgery. Before surgery, two cases of vocal cord paralysis were noted. 111 patients (88.8%) presented with subjective disorders: problems such as sore throat, odynophagia, dysphagia, dysphagia with overspill and hoarseness were respectively noted in 55 (44%), 34 (27.2%), 32 (25.6%), 11 (8.8%) and 13 (10.4%) cases. Dyspnoea was found in 2 cases (1.6%). 117 patients (93.6%) presented postoperative anomalies which were found on the posterolateral pharyngeal wall, on the arytenoids and on posterior third of the vocal cords. Inflammatory and/or swollen lesions were slight, moderate, significant or very significant in respectively 22.4%, 22.4%, 15.2% and 1.6% of cases. Very significant circumferential swelling of the pharyngeal wall and of the arytenoids was responsible for two cases of respiratory distress, and the patients required reintubation and return to theatre. Severe pharyngeal lesion correlated with duration of surgery (r = 0.20; p < 0.05), with the number levels of fusion (r = 0.02; p < 0.02) and with the age of the patient (p < 0.02). Six patients presented problems of mobility of the vocal cords: 3 had a right vocal cord paresis which was temporary and 3 had paralysis, also on the right but which persisted. There were no other complications. It is concluded that (i) ENT complications are frequently found in postoperative cervical spine surgery using the anterior cervical approach, some of them being severe. An ENT examination must be performed before the procedure for legal reasons. It is also recommended in the postoperative period in the case of discomfort; (ii) patients need to be placed in an intensive care unit during for the first 24 hours (iii). This study needs to be attended over more patients (iv) comparison with a control group of patients having non cervical surgery and intubated in the same way is needed to differentiate lesions related to surgery or intubation.

Effects of central dopaminergic stimulation by apomorphine on swallowing disorders in Parkinson's disease.

Swallowing disorders are common in Parkinson's disease but are of obscure and complex nature and pathophysiology. The effect of central dopaminergic stimulation on disordered swallowing is not well known. We studied the effects of apomorphine (in combination with domperidone) on buccolinguofacial motoricity and on various swallowing stages by using videofluoroscopy in eight patients with dysphagia. Swallowing abnormalities more frequently encountered were vallecular stasis (n = 7), fragmentation of the bolus (n = 7), and buccal stagnation of the bolus. Apomorphine improved vallecular stasis and fragmentation in about half the cases and improved buccal stagnation in all cases. Direct laryngeal penetration was found in three cases and improved in two of them. The total swallowing duration was improved by apomorphine in a subset of patients (n = 5). This improvement correlated with an improvement of the buccolinguofacial motoricity and was combined with an improvement of pharyngeal transit time. Thus central dopaminergic stimulation by apomorphine improved swallowing in a subgroup of patients, mainly in its early stages.

[Surgical rehabilitation of deglutition after partial surgery of the pharyngo-larynx]. / Réhabilitation chirurgicale de la déglutition après chirurgie partielle du pharyngo-larynx.

The authors report four cases of severe deglutition disorders after partial laryngectomy. Three had collagen injection and one had a plastic reconstruction. They propose to use dynamic imagery in order to have a better selection of the patients.

[Problems of deglutition disorders]. / Problématique des troubles de la déglutition.

Disorders associated with swallowing often appear with difficulty in swallowing or with a cough when food goes down the wrong way. However, a detailed analysis of such disorders shows some distinctive characteristics based on neurological or surgical etiologies. Identification of the physiopathological mechanisms of the different types of deglutition allows for the elaboration of the appropriate rehabilitation strategies.