抄録
We introduce here our diagnostic approaches for pharyngeal dysphagia and briefly discuss the results of surgical treatments. In dysphagia, we routinely use fluorography, manometry, electromyography and endoscopy. Fluorography in conjunction with manometry particularly provides valuable information for understanding the function of pharyngeal swallowing.
Fluorography is the most important diagnostic means of studying the function of swallowing. We utilize the double contrast pharyngogram using Computed Radiography as the screening method for detecting clinical and subclinical dysphagia, since barium coating or remaining on the pharyngeal mucosa is always observed in patients with organic or functional dysphagia. Moreover, we devised a new system of pharyngo-esophagography using a video tape recorder, digital fluorography and a multiformat camera, because a contrast medium rapidly passes through the pharyngeal phase of swallowing. The video signal from the fluoroscopic unit is fed into the video tape recorder, and recorded images are transferred through the digital fluorography to the multiformat camera. Sequential images of barium swallowing in one deglutition are copied on sheet film at the rate of 30 frames per second. By this method, qualitative and quantitative assessments of pharyngeal swallowing can be carried out easily.
Manometric study indicates the constricting power of pharyngeal muscles for propulsion of a bolus into the esophagus and timing of relaxation of the esophageal orifice during swallowing. The relaxation of the esophageal orifice cannot be detected by fluorography. Only a manometric approach indicates the timing, duration and degree of relaxation.
We also describe our experience with surgical treatment of 19 patients with pharyngeal dysphagia caused by cerebro-vascular accidents, degenerative diseases of the neuromuscular system and myositis, and we discuss briefly the use of cricopharyngeal myotomy, section of the infrahyoidal muscles and a laryngeal elevation technique in these diseases.
Finally, we emphasize the importance of multidimensional diagnostic approaches to pharyngeal dysphagia, on the basis of which the most suitable method of treatment can be selected.
