Dilatation of the hypopharynx leads to the accumulation of pharyngeal secretions which could overspill into the laryngeal inlet and cause aspiration pneumonia. Researchers in New York City sought to devise an operation that would reduce the dead space in the pyriform sinus allowing the accumulation of copious secretions causing dysphagia.
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Boca Raton, FL -- Swallowing is a complicated four stage process, where food undergoes oral preparation, then moves to the back of the mouth (oral stage), is passed through the pharynx, and finally through the esophagus. This series of coordinated movements requires the efficient operation of cranial nerves (trigeminal, facial, glosso-pharyngeal, vagal, and hypoglossal) all acting together.
The vagus nerve is the most complicated of the lower cranial nerves and is primarily involved in the swallowing at the upper end of the digestive tube, below the mouth and above the esophagus, known as the pharyngeal phase. When this nerve is paralyzed, aspiration and swallowing difficulties may occur. Dilatation of the hypopharynx leads to the accumulation of pharyngeal secretions which could overspill into the laryngeal inlet and cause aspiration pneumonia. These patients require prolonged periods of rehabilitation in which various swallowing maneuvers are attempted. In the meantime, the only option is to provide nourishment to the patient is with a nasogastric or percutaneous gastrostomy tube.
Researchers in New York City sought to devise an operation that would reduce the dead space in the pyriform sinus allowing the accumulation of copious secretions causing dysphagia. The authors of the study, "Hypopharyngeal Pharyngoplasty in the Management of Pharyngeal Paralysis: A New Procedure," are Paul Mok MD, Peak Woo MD, and Jacqueline Schaefer-Mojica MS-CCC, all from the The Grabscheid Voice Center, Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Medical Center, New York, NY. Their findings will be presented on May 12, 2002, at the Annual Meeting of the American Broncho-Esophagological Association (ABEA) http://www.abea.net/ to be held at the Boca Raton Resort and Club, Boca Raton, FL.
Methodology: A retrospective study was performed on patients with high vagal paralysis with dysphagia at Mt Sinai Hospital, New York between 1997 and 2001. Of these patients, eight (four females, four males) underwent hypopharyngeal pharyngoplasty. This operation is done under local anesthesia through an incision in the neck. Redundant and insensate pyriform sinus mucosa on the paralyzed side is removed and the inferior pharyngeal constrictor muscles are tightened.
Results: Postoperatively, seven of eight patients had subjective and objective improvements in their ability to swallow and progressed to oral, feeding.
Patients reported notably decreased secretions with improved pharyngeal transit after this surgery. They reported reduced secretions and food residue after initial swallow, which then required a second swallow. Their voices became less "wet" and hypophonic. Six patients progressed to an unrestricted diet without the need for compensatory head maneuvers. One patient continued to rely on compensatory head maneuvers and remained mildly dysphagic, having been previously G-tube dependent.
Conclusions: A new procedure is described which decreases the amount
of dead space in the hypopharynx thereby minimizing the risk of aspiration
in patients with high vagal neuropathies. Because of its technical simplicity
and low morbidity. Hypopharygeal pharyngoplasty may be a useful addition
to the existing armamentarium of surgical procedures to reduce aspiration.
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