Effects of head rotation on pharyngeal function during normal swallow.

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

[A case of primary orbital chondrosarcoma].

The case of a twenty-year-old male with orbital chondrosarcoma is reported. He visited National Defense Medical College Hospital because of reduced vision in the right eye since two months previously. His corrected visual acuity was 8/20 in the right eye and 20/20 in the left eye. Fifteen degrees lateral displacement of the right globe and limitation of right ocular movement were recognized. Right fundus examination revealed optic disc edema and protuberant nasal fundus. Orbital computed tomography (CT) demonstrated a high density area between the inner part of the right orbit and the ethmoid sinus. Magnetic resonance imaging (MRI) showed a smoothly outlined and low intensity (T1) space occupying lesion. This lesion was irregularly enhanced by gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA). This orbital tumor was removed by an anterior approach. Histopathological examination revealed well-differentiated chondrosarcoma (grade 1) as determined by small prominent chondromatous cell projection into the collagen fibrous stroma, and existence of binucleate cells in the hypercellular region. After the operation the disc edema disappeared and his corrected right visual acuity improved to 20/20.

[Effect of posture strategies on preventing aspiration].

The purpose of this study was to determine the effect of postural change on preventing aspiration, and the types of swallowing disorder that were influenced by posture. Ninety-five patients that were examined by aspiration of barium during videofluoroscopic examination of oropharyngeal swallow assumed one of four postures (chin down, head rotation, chin down + head rotation, and head back to chin down). Postural strategies were successful in eliminating aspiration in 68(72%) of the 95 patients. Twenty five of the 68 patients, however, needed an additional change in bolus volume to eliminate aspiration. Effective postures eliminating aspiration were chin down for 43 patients, head rotation for 10 patients, chin down + head rotation for 12 patients, and head back to chin down for 3 patients. The successes rates of posture changes for each swallowing abnormality were 76% for reduced tongue base retraction, 74% for delay in triggering pharyngeal swallow, 74% for reduced laryngeal elevation, 73% for laryngeal paralysis, 68% for inefficient oral transit, and in 57% for cricopharyngeal dysfunction. Among individuals with cricopharyngeal dysfunction or with than three swallowing motility problems, the frequency of unsuccessful swallow despite postural change was significantly higher than that of successful swallow. These results indicated that the posture strategies in addition to control of bolus volume could prevent aspiration in more than 70% of patients, but the efficacy of posture techniques differed with the different types of swallowing disorder identified as causing the aspiration, and suggested that the posture strategies were less beneficial in individuals with cricopharyngeal dysfunction or exhibiting multiple swallowing disorders.

[Effects of transcutaneous silicon injection for aspiration caused by unilateral vocal cord paralysis].

The purpose of this study was to determine the effects of transcutaneous silicon injection on swallowing function in unilateral vocal cord paralysis with aspiration. The preoperative and postoperative swallowing function were evaluated by means of videofluoroscopy and pharyngeal manometry in eight patients who received injection of silicon into the laryngeal vestibule, ventricle and vocal cord. Data analysis compared 1) types of aspiration and pharyngeal clearance, 2) timing of laryngeal closure (complete closure between arytenoid and epiglottic base) that was correlated with the onset of cricopharyngeal (CP) opening as time zero, and 3) swallowing pressure in the pyriform sinus on the side of the paralyzed vocal cord. In seven of the 8 patients, a favorable clinical response was achieved and aspiration and/or penetration were not observed on the fluoroscopic images after the silicon injection. Timing of laryngeal closure could be quantified in six patients, and mean values of the times preceding the onset of CP opening were significantly earlier on the postoperative examinations than preoperative examinations. Pharyngeal clearance on the affected vocal cord side was improved in six of the 8 patients, and swallowing pressure in the pyriform sinus was significantly elevated in four patients following surgery. These results suggested that silicon injection therapy produced earlier laryngeal closure during the swallow and improvement of pharyngeal clearance on the affected side after the swallow, so that aspiration and/or penetration with vocal cord paralysis might be prevented.

Amelanotic melanoma metastatic to the epiglottis.

Metastasis of melanoma in the head and neck region is often reported but the report of amelanotic melanoma metastatic to the epiglottis is an extremely rare entity. This paper describes a patients previously treated for cutaneous amelanotic melanoma who developed metastatic tumour involving his epiglottis. This legion was successfully excised by a intra-oral approach combined with KTP/532 laser surgery. The paper also describes the diagnostic evaluation, management, operative technique and DNA analysis of this rare case.