摂食・嚥下障害における嚥下造影検査の役割

歯科放射線科の立場から

抄録

In recent years, adavances of rehabilitation technique for dysphagia has made it common to treat dysphagic patients in Japan. Since dentists will be frequently called upon to make home visits to patients who may not be able to walk or even stand up, dentists are in a position to screen many homebound patients for dysphagia. In cases where dysphagia is suspected, the dentist can consult with a dental hospital to make a thorough examination. The treatment options for dysphagia include rehabilitation for eating, surgery on the oropharynx and larynx, feeding via a nasal tube, and gastrostomy. Of all the problems associated with dysphagia, aspiration of food is the most important because it can lead to aspiration pneumonia. This is significant as pneumonia is the leading 4 th cause of death in the elderly in Japan. In determining a treatment strategy for dysphagic patients, extensive examination is necessary to understand not only the mechanism of aspiration but also the underlying etiology of the problem. Videofluorography allows the physician to examine the rapid motions involved in the act of swallowing. This technique will allow oral and maxillofacial radiologists to properly examine dysphagic patients. This article describes the equipment and procedure necessary to perform a videofluorographic examination of dysphagic patients. When aspiration is suspected, the recommended contrast media are iohexol or iopamidol, both of which are non-ionic low osmolar contrast media. High osmolar contrast media, such as amidotrizoic acid, are reportedly harmful to the lung when aspirated. For the examination of the act of swallowing foods containing contrast medium should be used, such as barium cookies or iopamidol-containing jelly. Dose measurement is also discussed in this article.