ABSTRACT
While many patients who present with dysphagia have a clinically identifiable cause of dysphagia, the etiology of swallowing difficulty is oftentimes a diagnostic enigma. The aim of this article is to review possible etiologies of dysphagia when objective evidence of dysphagia is lacking. Included in this discussion are cricopharyngeal spasm, retrograde cricopharyngeal dysfunction, muscle tension dysphagia, dysphagia secondary to medications, and functional dysphagia.
Subject(s)
Deglutition Disorders , Humans , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Adult , Pharyngeal Muscles/physiopathology , Spasm/diagnosis , Deglutition/physiologyABSTRACT
BACKGROUND: Interscalene brachial plexus block (IBPB) has become a standard practice for perioperative analgesia for shoulder procedures. However, several side effects may occur owing to its anatomic location. We have chosen to evaluate vocal cord paresis and dysphonia following interscalene blocks. METHODS: After IRB approval, eight patients undergoing arthroscopic shoulder procedures were recruited into this prospective cohort study. Following informed consent, vocal cords were assessed by standardized fiberoptic evaluation. Subsequently, IBPB was performed under ultrasound (US) guidance. Patients were re-evaluated for vocal cord changes by a repeat fiberoptic assessment one hour following IBPB. Our primary outcome measure was incidence of vocal cord immobility. RESULTS: No patients had diminished vocal cord motion, dysphonia, or dysphagia. CONCLUSIONS: Although larger studies are required to determine the true incidence of vocal cord paresis following US-guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than that previously described.
Subject(s)
Arthroscopy/methods , Brachial Plexus Block/methods , Postoperative Complications/diagnostic imaging , Ultrasonography, Interventional/methods , Vocal Cord Paralysis/diagnostic imaging , Adult , Aged , Arthroscopy/adverse effects , Brachial Plexus Block/adverse effects , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/epidemiology , Prospective Studies , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Ultrasonography, Interventional/adverse effects , Vocal Cord Paralysis/epidemiologyABSTRACT
Reinke's edema (RE) is the polypoid degeneration of one or both vocal folds within Reinke's space. The viscoelastic properties of the mucosal folds are characteristically altered by the expansion of the subepithelial space. Most frequently, patients present with dysphonia, with women being more affected than men. The primary risk factor is tobacco use. Voice overuse and laryngopharyngeal reflux are also considered to be contributory. Although RE shares the same primary risk factor as malignancy, the risk of malignancy is low, and dysplasia is found only in 0% to 3% of cases. Treatment is focused on decrease of risk factors, such as implementation of smoking cessation, voice therapy, and reflux control. Surgical techniques aim to decrease redundant polypoid mucosa in order to improve voice and restore the glottic airway. Recurrence of RE is high.
Subject(s)
Laryngeal Edema/diagnosis , Laryngeal Edema/physiopathology , Smoking/adverse effects , Humans , Laryngeal Edema/surgery , Laryngopharyngeal Reflux/diagnosis , Laryngopharyngeal Reflux/therapy , Recurrence , Risk Factors , Sex Factors , Smoking/therapy , Stroboscopy , Vocal Cords/pathology , Vocal Cords/surgery , Voice TrainingABSTRACT
OBJECTIVE: This anatomic study considers the feasibility of a posterior endoscopic approach to the cricoarytenoid joint (CAJ) by describing relationships between readily identifiable anatomic landmarks and the posterior CAJ space in cadaver larynges. STUDY DESIGN: Anatomic study. METHODS: Six adult cadaver larynges (2 male, 4 female) were studied. Digital calipers were used for measurements, and Image J software was used for angle calculations. All cricoarytenoid joints were injected with colored gel via a posterior approach using a 27-gauge needle. RESULTS: The average age of the larynges studied was 78.7 ± 10 years. The average posterior CAJ space (pCAJs) length measured 4.95 ± 0.9 mm. The average distance from the superior aspect of the midline cricoid lamina (MCL) to the center of pCAJs and the corniculate cartilage (CC) to the center of the pCAJs were 8.35 ± 1.5 mm and 14.54 ± 1.9 mm, respectively. The average pCAJs angle of declination (AD) from the horizontal plane was 54° ± 6.2°. All 12 cricoarytenoid joints were successfully injected with colored gel via a posterior approach. CONCLUSIONS: The posterior CAJ space can be located surgically using readily identifiable anatomic landmarks. An understanding of this posterior CAJ anatomy may allow for more consistent intra-articular injection and support the development of other CAJ procedures for a range of disorders of vocal fold motion or malposition.
