The grade and the time onset of dysphagia can be predicted before a wide resection of oral and oropharyngeal cancer. The management of dysphagia can also be planned before the operation. After performing a wide resection of oropharyngeal cancer the swallowing function is affected depending on the site and the volume of the resection. This report describes the experience of this department in performing wide resections and Gehanno reconstruction for oropharyngeal cancer. The postoperative swallowing and speech functions were evaluated in twelve oropharyngeal cancer patients. The site and size of the defect affected the grade of the swallowing and speech dysfunction. However, the patients that underwent Gehano reconstruction maintained a satisfactory post-operative function. A videofluoroscopic evaluation and videoendoscopic evaluation revealed the functional reconstruction of the velo-pharyngeal closure to be successful. The indications for laryngeal suspension, a crico-pharyngeal myotomy, and laryngeal preservation were also discussed. Furthermore, the prevention of post-operative complications was also discussed.

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The aim of this study was to investigate the efficacy of a cricopharyngeal myotomy and laryngeal suspension following an oral or oropharyngeal resection. Beginning in 2006, a cricopharyngeal myotomy and laryngeal suspension have been performed following a radical oral or oropharyngeal resection. These patients have achieved better postoperative swallowing function in comparison to previous patients that underwent surgery without such procedures. In addition, no severe complications were observed due to the cricopharyngeal myotomy or laryngeal suspension. These procedures should therefore be considered at the time of a radical oral or oropharyngeal resection is performed.

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The long term follow-up for six post-operative dysphagic patients with head and neck cancer is herein reported. The patients consisted of three with oral cancer, one with epipharynx cancer, one with mesopharynx cancer and one with thyroid cancer. Two of the three patients with oral cancer were discharged in a state of complete oral food uptake, however, both died of recurrence. One of the three patients with oral cancer(gingiva) was discharged free from cancer, but requiring the use of a nasal feeding tube. He suffered from tongue cancer after being discharged. Due to the tongue cancer he continued to require nasal feeding. The patient with epipharynx caner was discharged free from cancer but requiring a nasal feeding tube. However, distant metastases(liver and bones) were discovered after being discharged. Combined treatment with radiation and chemotherapy to both his bones and liver proved to be very effective. He continues to have cancer and presently lives at home using a feeding tube. The patient with mesopharynx cancer was discharged free from cancer but requiring a nasal feeding tube. He lives at home and is free from cancer now. The patient with thyroid cancer was discharged free from cancer but requiring a nasal feeding tube. Since the rehabilitation this patient's dysphagia was very effective, she can now eat almost everything without any aspiration. However, she unfortunately hospitalized herself due to the onset of dementia.

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The present paper reports the effectiveness of postural changes and water-drinking therapy on the swallowing function in a severely dysphagic LMS patient one year after the onset. The posture that resulted in the minimum residue in the pyriform sinuses was identified using a videofluoroscope. Direct swallowing therapy was provided, starting from repetitive 2 ml water drinking and thereafter progressing in incremental steps. The posture, in which the patient's head was rotated to the intact side, which thus allowed for a maximum reduction of the neck tension and while also guiding the bolus flow to the intact side of the oral cavity and the damaged side of the pharynx. At the time of referral, the patient exhibited unilateral facial paralysis and hemiplegia due to a right pontine and cerebellar infarction. The position of the larynx was deviated to the damaged side and the laryngeal elevation and muscular tension in the neck area were both asymmetrical. After undergoing the swallowing therapy, the patient eventually achieved full oral intake. Subsequently, the position of the larynx shifted more medially, laryngeal elevation looked less asymmetrical and the bolus started to pass bilaterally in the pharynx.

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n patients with Wallenberg syndrome, swallowing disturbance remains a critical issue in terms of the prognosis and the quality of their lives. In this study, we conducted an evaluation of the swallowing functions and review the clinical backgrounds of the patients, while also discussing the prognostic factors for dysphagia. The patients consisted of 15 cases with a mean age of 59.8 years. 7 patients successfully received oral alimentation (rehabilitation group), while 8 patients required surgical intervention due to an insufficient recovery of their swallowing function (operation group). In the rehabilitation group, pharyngolaryngeal sensitivity and the provocation of the swallowing reflex were maintained, while videoendoscopy and videofluorography showed a significantly poor pharyngeal clearance and a delay in the laryngeal elevation of the operation group. The self-walking ability and the absence of aspiration pneumonia were significantly frequent in the rehabilitation group. An improvement in the swallowing function was obtained about 4 months after onset in the rehabilitation group. These results indicated that the prognostic factors for dysphagia due to Wallenberg syndrome were; 1) the ability to maintain pahryngolaryngeal sensitivity and the provocation of the swallowing reflex, 2) the ability to maintain ADL, such as the ability for a patient to walk unassisted, and 3) an improvement in the swallowing function within 4 months after the onset of symptoms.

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Dysphagia is an uncommon feature of thyrotoxic myopathy. This report describes a 56-year-old female who presented with severe dysphagia. A clinical examination and laboratory tests showed myopathy of thyrotoxicosis. The swallowing abnormality was assessed by videoendscopy and videofluorography. Her thyrotoxicosis improved after the dministration of antithyroid therapy and the balloon dilatation method was attempted to resolve the cricopharyngeal dysphagia at an early stage. Immediately after perfoeming the balloon method she was able to start oral intake. About one month later videofluorography showed the improvementof her dysphagia and 40 days thereafter, she was able to take all types of foods by mouth without tube feeding. The balloon dilatation method is therefore considered to be effective for the treatment of successful for thyrotoxic dysphagia.

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The pathological condition of dysphagia in Parkinson's disease patients is not yet clear. A video fluorogram of the pharynx was taken in 16 patients with Parkinson's disease to examine the swallowing motion of the oral stage and the pharyngeal stage. Smooth tongue movement and an influx to pharynx were significantly obstructed with respect to the stage and duration of the disease, resulting in a disturbance of synchronization between the oral and pharyngeal phases. A residue at the piriform sinus and a misdirection to the larynx increased with an extended duration of the disease.

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Introduction: A videoendoscopic swallowing study (VESS) is relatively less invasive and it has the advantages of portability and is also easy to perform in terms of bedside availability. However, some disadvantages are also associated with this modality, such as the inability to observe the pharynx during contraction. In the present study, we synchronized VESS with swallowing manometry (mano-videoendoscopy MVE), and then quantitatively evaluated the swallowing pressure during pharyngeal contraction. Subjects: Eight patients with dysphagia. Methods: All patients underwent both MVE and videofluorography (VF) for the evaluation of dysphagia. Informed consent was obtained from all subjects in the study. MVE was performed with a nasally inserted catheter, OD 2.3mm with 3 pressure sensors. The sensors were kept at the tongue base, hypopharynx, and upper esophageal sphincter (UES). The endoscopic view of the pharynx and pressure waveforms were simultaneously recorded in a computer. We compared the findings between MVE and VF regarding pharynegeal contraction and UES opening. Results: The findings of pharyngeal contraction and UES opening during swallowing showed a close correlation between both instrumental tests. Conclusion: MVE is considered to be a useful swallowing test, because we can observe the quantitative pharyngeal contraction and UES relaxationwhile we can also obtain an endoscopic view of the pharynx. The advantages of MVE in comparison to VF is no need to expose the patients to radiation and the possibility to obtain a detailed study of the swallowing functions with bedside availability.

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This report presents a case of persistent dysphagia which developed after anterior cervical spine surgery. A 75-year-old male with a past medical history of anterior cervical spine surgery to improve progressive dysphagia complained of his worsening symptoms. At the first consultation a laryngoscopic examination revealed saliva to be pooled in the bilateral piriform sinuses. Video-fluorography revealed the laryngeal elevation to be slightly disturbed and the cricopharyngeal opening was severely restricted. Lateral neck radiography showed no anterior osteophytes. Neither a gastrointestinal lesion nor any neurogenic/myogenic causeswere identified. He gradually failed to tolerate any peroral intake, although he was treated by a balloon catheter method. We therefore performed a cricopharyngeal myotomy and laryngeal suspension. An intensively scarred lesion was identified outside the cervical esophagus and the hypopharynx, while a histopathological examination disclosed fibrous scar tissue with inflammation. After surgery, the dysphagia was remarkably improved, as did the clinical findings based on video-fluorography and laryngoscopy. The patient thereafter was able to return to a general diet. It was therefore possible that the cervical osteophytes and the anterior cervical surgery synergistically induced cicatricial stenosis of the cricopharyngeal segment

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A 37-year-old male suddenly developed hearing loss in his right ear. He was treated with corticosteroids based on a diagnosis of sudden deafness. The deafness improved and thereafter the steroids were tapered off. He next presented right III, bilateral V, IX, X palsies soon after the steroids were withdrawn. The cell counts and the protein levels were elevated in the cerebrospinal fluid. The MRI findings of the brain were normal. He therefore was diagnosed to have Guillain-Barre syndrome; specifically, acute oropharyngeal palsy based on the rapid course of progression. He was placed on a high dose of intravenous immunoglobulins. However, the symptoms were aggravated and steroid therapy was again started. The multiple cranial palsies improved with steroid treatment. After further investigation with a tuberculin reaction, chest CT, 67Ga scintigraphy and bronchoalveolar lavage, a final diagnosis of multiple cranial neuropathies associated with sarcoidosis was made. The initial deafness was thought to be a part of sarcoid neuropathy. The present case suggests that multiple cranial neuropathies with sarcoidosis may present with rapid progression like Guillain-Barre syndrome.

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A 69-year-old female with dural arteriovenous fistula presented with brain stem symptoms including rapidly progressive dysphagia. At first she complained of left tinnitus, vertigo and nausea in March 2007 and was admitted. Diplopia, left blepharoptosis, hoarseness and left-sided ataxia appeared on May 11. T2-weighted head MRI revealed hyperintense areas in the left medulla oblongata and pons, where DWI showed a slight degree of hyperintensity. It was therefore difficult to diagnose the patient's condition. Dysphagia appeared on May 15. A videoendoscopic examination of swallowing (VE) revealed features of left-sided pharyngo-laryngeal palsy, which thereafter rapidly deteriorated over the next 2 days. Therefore, she was treated by drip infusion and nasogastric tube feeding. The amount of sputum expectorated decreased on May 23 and she became able to swallow saliva. As a result, she then received food swallowing training. During the patient's course, the left sigmoid sinus was poorly visualized on contrast-enhanced MRI and DSA led to the diagnosis of a dural arteriovenous fistula of the left sigmoid sinus. On July 19, an embolization was performed, followed by rehabilitation. The left-sided ataxia, the loss of temperature and pain sensation on the right side of the body and left bulbar palsy remained, but the dysphagia markedly improved. She thereafter became able to ingest food orally, attained a T-cane gait indoors and achieved an independent ADL and was finally discharged to home.

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[Objective] The aim of this study is to investigate the association between obedience to commands concerning motion in the upper-aero-digestive tract and swallowing ability.[Subjects and methods]The subjects included 201 (61 male and 140 female) hospitalized patients. The obedience abilities were estimated using a score to indicate the degree of the response to each direction of 1) phonation, 2) throat clearing, 3) tongue thrust and 4) moving the tongue to the right and left(Obedience Score:OS), Swallowing abilities were estimated using Fujishima's swallowing function Grade (FSFG) and another score to indicate the type of foods that could be swallowed without complications (Food Form Score:FFS).[Results]There was an extremely high correlation(r=0.91,p<0.0001) between the FSFG and FFS. Significant correlations were also found between the OS and FSFG (r=0.66, p<0.0001)and between the OS and FFS(r=0.83,p<0.0001).[Conclusion]These data demonstrate associations between the obedience to the directions in the oral and laryngeal region and swallowing abilities and suggests cause-result relationships between these abilities and the possibility that the OS could be used as a predictor of swallowing ability.

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A supraglottic laryngectomy is a surgical procedure for treating laryngeal cancer; however, this procedure may damage the swallowing function, thereby increasing the risk of aspiration. The post operative position of the glottis is superior to the preoperative position, thus reducing the distance between the traveling bolus and the airway. This surgical alteration results in patient dependence on voluntary airway protection measures while both eating and drinking. We herein report two laryngeal cancer cases who underwent a supraglottic laryngectomy. One was a 70-year-old female with recurrent laryngeal cancer, while the other case was a 43-year-old patient who had undergone both a neck dissection and radiation. Posture variations, maneuvers to improve supraglottic swallowing and cough training were carried out as swallowing rehabilitation. There are some reports that patients who have undergone a supraglottic laryngectomy were able to resume oral intake by about 20 days after surgery. In contrast, our patients were able to resume their normal preoperative diet by about two months after surgery. The reason for the delay in the resumption of a normal diet in comparison to other reports is considerd to be due to the fact that our patients underwent radiation and enteral feeding dependence may thus show a correlation with radiation and chemotherapy. Swallowing rehabilitation for the patients who have undergone a supraglottic laryngectomy improved the swallowing function, but these results also depended on the various conditions of the patients. Therefore, it is important to accurately estimate the function of each patient and also to perform the optimal rehabilitation of such patients.

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Objective: To evaluate the preservation of eating and swallowing function following the use of superselective intra-arterial chemoradiotherapy for advanced head and neck cancers. Materials and Methods: Among the 96 Patients receiving concomitant radiation and intra-arterial docetaxel, systemic cisplatin and 5-FU chemotherapy, the videofluoroscopic and videoendoscopy findings and results of a questionnaire were evaluated. Results A Videofluoroscopic examination revealed an improved swallow function in 2 of 13, no change in 4, slightly worse in 5 and worse in 2 patients. Following treatment, the incidence of aspiration increased in four patients. Videoendoscopy revealed a residual of vallecula in few cases. Most of the patients were able to swallow after chemoradiation. The questionnaire results showed that the eating and swallowing functions were well preserved in almost 80% of the patients. Conclusion: The new chemoradiation protocol is thus considered to be equivalent to the other treatment modalities for maintaining the functions of eating and swallowing.

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This study was performed to analyze the postoperative function of velopharyngeal closure, feeding, and swallowing in 12 patients with squamous cell carcinoma originating from the lateral oropharyngeal wall, which was ablated and reconstructed by microvascular surgery. The defects extended to the soft palate in 11 cases (over half of the entire area of the soft palate in 8 cases) and to the base of the tongue in all cases. Adjuvant radiotherapy was performed in 8 cases. Reconstruction was performed with anterolateral thigh flaps in 10 patients and with rectus abdominis musculocutaneous flaps in the remaining 2 patients by the Gehanno method (11 cases) and the suturing of the posterior pharyngeal wall to the base of the tongue (8 cases). Postoperatively, the average blowing ratio was 88. 3% (30.0-100%). The average MTF score was 12.3 points (9-15 points) and all patients were able to ingest food orally. This reconstructive technique can easily narrow the nasopharyngeal space and the involved side of the inferior oropharyngeal space without the need to use bulky flaps in order to prevent the loss of swallowing pressure, thus probably leading to bolus passage on the normal side of the pharyngeal cavity, while also reducing the exposure of insensate flaps, thereby resulting in a good postoperative swallowing function.

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Doctors, nurses and a speech therapist formed a rehabilitation team of for swallowing dysfunction in April, 2007. The outcomes of rehabilitation were compared with those before the formation of this team from April, 2004 to March, 2007. The subject included 6 tongue carcinoma cases which all underwent the same therapy. The patients receiving rehabilitation performed by doctors, nurses and a speech therapist was termed the DNS group and that done by doctors and nurses, the DN group. Both groups contained 3 patients. The level of swallowing dysfunction was classified as none, slight and serious. The difference and utility of the rehabilitation was compared. Both of the slight cases in the DNS and the DN recovered within the same time period (average 16.5 days). The serious case in the DNS group recovered earlier than those in the DN group. There was no aspiration pneumonia in the DNS group, but there was in the DN group. These results indicate that the rehabilitation by the DNS group was better than by the DN grout).

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Due to the relatively severe swallowing difficulty which frequently occurs after the installation of percutaneous endoscopic gastrostomy(PEG) tube, a swallowing improvement operation is therefore often required. Although a cricopharyngeal myotomy is one of the most widely performed swallowing improvement operations, the gastroesophageal reflux sometimes becomes a problem in many cases. Gastroesophageal reflux often occurs after a cricopharyngeal myotomy to the throat due to an insufficient UES function. These complications can lead to serious illnesss, such as pneumonia, suffocation, and these are especially dangerous developments in PEG patients, and both the postoperative rehabilitation and swallowing functional recovery may be prolonged as a result. Advanced gastroesophageal reflux arose after a swallowing improvement operation consisting of a cricopharyngeal myotomy, and two cases in which it was difficult to administer appropriate medical treatment and thereby also making rehabilitation more difficult. We tried to solve this problem by extending the insertion tube from PEG to near the Treitz ligament, and thus provided nutrition to the patients using this tube. The degree of gastroesophageal reflux thereafter dramatically decreased, and the swallowing function was thereafter able to recover in these patients. Both patients are now able to orally take regular foods in an almost normal manner. Whether postoperative swallowing rehabilitation will be successful or not in such PEG cases depends on the control of gastroesophageal reflux.

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