Swallowing dynamics status post caustic ingestion in a pediatric patient: A multidisciplinary case report.

A case report of a 10 year old male illustrates the effect of damage to the tongue base, hypopharynx, cricopharyngeus, and esophagus on the sensory and motor components of the swallowing mechanism. The characteristics of the dysphagia were manifested clinically, radiographically, and endoscopically. A myectomy was required to restore functional swallowing as scar tissue formation in the cricopharyngeus severely interfered with the dynamic components of swallowing. A collaborative approach facilitated communication and effective treatment planning; the multidisciplinary components in the management of this case are discussed.

Oesophageal complication from button battery ingestion in an infant.

The substantial risks of button battery ingestion in children have been known to clinicians for some time. Modern button batteries are twice as large (20 mm rather than 10 mm) and twice as powerful (3 V rather than 1.5 V) as older batteries. Ingestion of modern batteries causes earlier and more severe tissue injury, as these larger batteries are more likely to impact at areas of physiological narrowing. A high index of suspicion for ingestion, use of appropriate imaging and early removal of batteries is necessary to prevent complications.

Incidence of secretory otitis media following maxillectomy.

OBJECTIVE: The purpose of this investigation was to determine the incidence and characteristics of secretory otitis media after maxillectomy procedures. STUDY DESIGN: Retrospective chart analysis was performed with the cases of 49 patients who underwent maxillectomy for tumor in the Departments of Otolaryngology-Head and Neck Surgery and Oral and Maxillofacial Surgery between the years 1990 and 1996. RESULTS: In 10 patients (20%), secretory otitis media manifested itself from 1 week to 6 months after surgery; 1 patient developed a central perforation with chronic otitis media. Nearly one third of patients who underwent total maxillectomy had secretory otitis media. Six patients (8 ears) required insertion of ventilation tubes. CONCLUSIONS: Patients undergoing total and partial maxillectomies are prone to occurrences of secretory otitis media. Insertion of ventilation tubes easily resolves the problem. Preoperative and routine postoperative patient follow-up should always include otoscopy and audiometry, and tympanometry should be performed when warranted.

Does upper airway muscle injury trigger a vicious cycle in obstructive sleep apnea? A hypothesis.

Recent studies have indicated that the level of neural activation of upper airway dilator muscles is abnormally elevated in patients with obstructive sleep apnea (OSA). This is presumed to represent an adaptive mechanism that partially compensates for the anatomically small upper airway found in individuals with OSA. We have reviewed evidence that pharyngeal dilator muscles undergo secondary changes in structure as a direct consequence of their increased activity level in OSA. These alterations have the potential to be both beneficial and harmful with respect to the maintenance of upper airway patency. We propose a model outlining the possible role of activity-induced upper airway muscle remodeling and injury in the pathogenesis of OSA, and discuss potential implications for treatment of the disease.

Caustic ingestion injuries of the upper aerodigestive tract.

Few reports have described in detail the injuries that occur to the oral cavity, pharynx, and larynx following caustic ingestion. The role of dynamic radiographic studies to delineate the extent of damage has been minimized. In-depth radiographic analysis of such cases has not, to our knowledge, been previously reported. In order to examine the injuries and functional abnormalities of these sites following caustic ingestion, the records of The Johns Hopkins Swallowing Center were reviewed. Five patients were identified as having significant upper aerodigestive tract caustic injuries. All patients had dysphagia, epiglottis injuries, and incomplete laryngeal protection with aspiration. Four of five had sustained some degree of esophageal stenosis. Also noted were pharyngeal muscle dysfunction, nasopharyngeal regurgitation, tongue fixation, and hypopharyngeal stenosis. Roentgenographic findings are described and illustrated. The multidisciplinary approach to the management and rehabilitation of these patients is discussed.

Hyoid bone syndrome: a degenerative injury of the middle pharyngeal constrictor muscle with photomicroscopic evidence of insertion tendinosis.

This article describes the condition known as hyoid bone syndrome, its diagnosis by exclusion, and the histopathologic evidence of focal, degenerative muscle injury. The injury involves the origin fibers of the middle pharyngeal constrictor muscle on the greater cornu of the hyoid bone. The importance of the dentist and physician in recognizing the condition is emphasized, because dental and nondental pain reference sites make up the syndrome.

Muscle spindles in the human levator veli palatini and palatoglossus muscles.

Muscle spindles are present in many muscles of the speech mechanism including those of the jaw, tongue, larynx, and respiratory system. Past investigations that have examined muscles of the velopharynx for the presence of muscle spindles have reported their existence only in the tensor veli palatini and palatoglossus muscles. The present investigation has demonstrated the existence of muscle spindles in two muscles of the human velopharynx--the levator veli palatini (LVP) and palatoglossus muscles. Seven LVP and two palatoglossus muscles were embedded in paraffin blocks, serially sectioned at 8 microns, and selected slides were stained by a modified Gomori trichrome technique. Scanning by light microscopy at 40x revealed spindles in all of the muscles examined. This positive finding likely reflects the use of a more chromatically distinctive staining procedure and a higher scanning magnification than were used in prior investigations. The potential roles of muscle spindles in velopharyngeal function are addressed.