Abstract
The aim of this paper is to demonstrate the motion pattern in oral reflux, the backflow of the bolus from the vallecula or piriform sinus to the oral cavity, and compare it with swallowing in two patients with dysphagia using fluoroscopy.
Patients were a 67-year-old female suffering from oculopharyngeal muscular dystrophy and a 76-year-old male suffering from dermatomyositis. On examination, modified barium swallow procedures were observed and analysed with videofluorography. The changes of the thickness at three points (posterior pharyngeal wall at the level of inferior margin of the second, third and fourth vertebrae) and the movement of the laryngeal elevation at every frame of a radiograph during swallowing and oral reflux were measured.
The patient with oculopharyngeal muscular dystrophy showed aspiration during liquid swallowing, and reflux of bolus was observed from the vallecula and piriform sinuses to the oral cavity following attempts to swallow semisolid or solid food. Despite the fact that the upper and middle posterior pharyngeal wall contractions and laryngeal elevation occurred simultaneously during the oral reflux, a peristaltic wave like movement in the pharynx during swallowing was not observed. In the patients with dermatomyositis, barium was aspirated into the larynx and nasopharynx during liquid swallowing, and once semisolid and solid food was swallowed, the residue of the bolus was regurgitated from the vallecula to the oral cavity and then swallowed again. The pharyngeal contraction extended down to the lower pharynx, like the peristalsis observed during normal swallowing. Meanwhile, during the reflux, contractions of the upper and middle posterior pharyngeal walls and laryngeal elevation occurred.
The oral reflux was observed in swallowing semisolid and solid food, and, at the same time, the larynx moved upward. We concluded that the oral reflux occurred in the first patient to remove the bolus from the piriform sinus following insufficient deglutition, and in the second to coordinate the succeeding swallowing.
