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epiglottic deflection

  • Subject: epiglottic deflection
  • From: r.thacker@utoronto.ca (r.thacker)
  • Date: Fri, 28 Nov 1997 02:23:08 -0500

It would be useful to have the radiologist look at the 
original MBS again to rule out impingement of the epiglottis 
on a cervical vertebrae which could cause compromised 
deflection during the swallow.

Ron Thacker

On Thu, 27 Nov 1997 17:57:12 -0500 josh wilkins wrote:

> From: josh wilkins <ewilkins@julian.uwo.ca>
> Date: Thu, 27 Nov 1997 17:57:12 -0500
> Subject: epiglottic deflection
> To: dysphagia@cyberport.com
> This is a question about anatomy and innervation.  All 
responses welcome.
> I have recently seen an acquired brain injury patient 
(automobile accident)
> who also had a c-1 c-2 fusion (posterior approach).  When 
she first came to
> us from acute care,  she was on tube feed and not 
tolerating it
> well--nausea, vomitting. there was also bilateral vocal 
fold paralysis. We
> had to send her back because of the G-I problems.  When 
she returned to us
> she was tolerating the tube feed with the aid of 
medication,  she was alert
> and cognitively in good condition.  Recent ENT report 
indicated unilateral L
> vocal fold paralysis but gave minimal detail.  MBS at 
acute care had
> indicated gross aspiration of all consistancies with 
absence of epiglottic
> deflection and apparently good hyolaryngeal excursion. No 
A-P view was done.
> She also held her neck in extension with extremely tense 
muscles and
> reported tingling in her hands when she tried to flex her 
neck.  EMG
> indicated injury to the L spinal accessory nerve. Because 
of the fusion and
> nerve damage, ability to rotate the neck was severely 
limited. ENT was
> following her with consideration of teflon injection or 
surgery for the
> paralysed fold.
> Articulation was clear but when I approached her mouth 
with a tongue
> depressor, her tongue bunched upward and backward not 
under volitional
> control.  With effort there was some very rough,  hoarse, 
vocalizing.  With
> PT we worked with her to bring her neck to, at least, a 
neutral position.
> She had no difficulty with secretions and had a moderately 
strong cough.
> A month after the first MBS we went back to x-ray and 
found she had a rapid
> effective swallow for all consistancies.  A-P view showed 
no assymetry.  She
> was intentionally controlling the oral phase of the 
swallow, but the
> pharyngeal phase looked normal!
> Not having seen that first MBS,  I am questioning what was 
happening with
> the epiglottis.  My understanding is that epiglottic 
movement is largely
> passive and dependent on the adequacy of the upward and 
forward movement of
> the larynx--can anyone elaborate on that.
> Also, where was the damage that caused the vocal fold 
paralyis--I am
> assuming lower motor neuron (I don't think the palate was 
affected) and that
> the problem was most likely related to the neck injury.  
Is it possible the
> upward excursion was adequate but not the forward 
movement--and what nerve
> would be damaged in that case.  Could the G-I difficulties 
be related to the
> pharyngeal problems?
> All responses apppreciated.
> Carol

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