Normal and Abnormal Swallowing: Imaging in Diagnosis and Therapy

244 Pages·1991·12.34 MB·English

by  Thomas J. Beck

Normal and Abnormal Swallowing
Bronwyn Jones Martin W. Donner
Editors
Normal and
Abnormal Swallowing
Imaging in Diagnosis
and Therapy
With 130 lllustrations in 256 Parts
Springer Science+Business Media, LLC
Bronwyn Jones, ER.A.C.P., ER.C.R. Martin W. Donner, M.D.
Associate Professor of Radiology Professor of Radiology
The Johns Hopkins Medical Institutions The Johns Hopkins Medical Institutions
Director Director Emeritus
The Johns Hopkins Swallowing Center The Russell H. Morgan Department
Baltimore, Maryland 21205 of Radiology and Radiological Science
USA Founder, The Johns Hopkins Swallowing Center
Baltimore, Maryland 21205
USA
Cover illustrations:
On the left side: a single spot fIlm in the frontal projection shows the shape of the normal pharynx and
cervical esophagus during a swallow of barium and air.
On the right side: a stop-frame print from a cinepharyngogram in the lateral position shows decompen
sation with incomplete laryngeal closure during swallowing with laryngeal penetration and aspiration
down into the trachea. The bolus is passing through the open cricopharyngeus into the cervical
esophagus.
Library of Congress Cataloging-in-Publication Data
Normal and abnormal swallowing: imaging in diagnosis and therapy /
Bronwyn Jones, Martin Donner, editors
p. cm.
Includes bibliographical references.
Includes index.
1. Deglutition disorders-Imaging. 2. Swallowing. 3. Pharynx
-Imaging. 1. Jones, Bronwyn. II. Donner, Martin w., 1920-
[DNLM: 1. Deglutition. 2. Deglutition Disorders-diagnosis.
3. Deglutition Disorders-therapy. 4. Diagnostic Imaging.
5. Pharyngeal Diseases-diagnosis. 6. Pharyngeal Diseases-therapy.
7. Pharynx-surgery. WV 400 N842].
RC815.2.N67 1990
616.3'I-dc20
DNLMIDLC
for Library of Congress 90-9913
CIP
Printed on acid-free paper.
© 1991 by Springer Science+Business Media New York
Originally published by Springer-Verlag New York Inc. in 1991.
Softcover reprint of the hardcover 1s t edition 1991
All rights reserved. This work may not be translated or copied in whole or in part without the
written permission of the publisher Springer Science+Business Media, LLC
except for brief excerpts in connection with reviews or scholarly analysis. Use in con
nection with any form of information storage and retrieval, electronic adaptation, computer
software, or by similar or dissimilar methodology not known or hereafter developed is for
bidden.
The use of general descriptive names, trade names, trademarks, etc. in this publication, even
if the former are not especially identified, is not to be taken as a sign that such names, as
understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely
by anyone.
While the advice and information in this book are believed to be true and accurate at the date
of going to press, neither the authors nor the editors nor the publisher can accept any legal
responsibility for any errors or omissions that may be made. The publisher makes no warranty,
express or implied, with respect to the material contained herein.
Typeset by David E. Seham Associates, Inc.
9 8 7 6 5 4 3 2 1
ISBN 978-1-4757-4152-0 ISBN 978-1-4757-4150-6 (eBook)
DOI 10.1007/978-1-4757-4150-6
To the patients
of The J ohns Hopkins Swallowing Center.
Preface
Despite the high and increasing incidence of dysphagia, many physicians
and allied health professionals are unfamiliar with the anatomy and physiol
ogy of the pharynx, nor are they trained in the techniques available to exam
ine such patients. An upper GI series, for example, usually examines only
the thoracic esophagus, neglecting the pharynx, unless symptoms suggest
oropharyngeal involvement. Even then, only spot films may l5e taken with
out analysis of the dynamic action of the muscles.
lt is the intention of this book to familiarize the reader with imaging of the
pharynx and the spectrum of swallowing disorders. We do not mean this
text to be encyclopedic or exhaustive, but more to present a practical ap
proach to the role of imaging in the diagnosis and treatment of the patient
with dysphagia. We have tried to define the role of the newer modalities
such as ultrasound, computed tomography, and magnetic resonance imaging
in perspective, indicating what each modality has to offer. We have not dis
cussed scintigraphy in depth, but have referred to it briefly in the section on
the tailored exam.
We have illustrated the various motility abnormalities to the best of our
ability; it is, however, difficult to illustrate a dynamic event using static im
ages. The reader is reminded also, that as most of the illustrations are stilI
frames from 16-mm movie films, there will be some graininess.
This text will concentrate on pharyngeal disease, but will also emphasize
the interrelationships between pharynx and esophagus which result in the
safe, efficient transport of ingested food and liquid from mouth to stornach.
This is not meant to be an exhaustive text but to be a helpful guide to the
diagnosis and management of common problems that can result in dys
phagia.
To aid the reader unfamiliar with the terminology used in the discussion
of pharyngeal disease, we have appended a glossary of some words and
phrases commonly used when discussing pharyngeal structure or function.
vii
Glossary
Aspiration Entry of liquid or food into and/or through the larynx principally or partially
brought about by inspiration.
Dysphagia Difficulty in swallowing, often implying a sense of food or liquids sticking.
Can be further classified symptomatically into oral, oropharyngeal, and
esophageal.
Laryngeal Entry of swallowed material into the larynx during swallowing. This may be
penetration further categorized by whether it is extruded during laryngeal closure and
elevation.
Leakage Incompetence of faucial isthmus allowing spillage from the mouth into the
pharynx prior to swallow.
Pharyngoesophageal Junction of pharynx and esophagus, which includes the cricopharyngeal
(P-E) segment sphincter, the closed portion of the hypopharynx (superior to the crico
pharyngeal sphincter and adjacent to cricoid cartilage)' and the adjacent
esophagus. This corresponds in usage to the upper esophageal sphincter.
Reflux Gastroesophageal reflux, i.e., retrograde movement of gastric contents into
the esophagus.
Regurgitation Retrograde movement within the esophagus, the extreme of which is eso
phagopharyngeal regurgitation through P-E. segment into the pharynx,
mouth, and/or larynx.
Retention Residual bolus remaining in the valleculae and/or piriform sinuses after the
bolus has been stripped from the pharynx.
Upper esophageal Defined manometrically as a resting zone of high pressure between swallows
sphincter thought to result from the action of the cricopharyngeus, thryopha
ryngeus, and proximal circular muscle of the esophagus. The main contri
bution is thought to come from the cricopharyngeus, hence the term "cri
copharyngeal sphincter." Radiographically, an indentation posteriorly at
about the C5-C6 disc may indicate the level of the cricopharyngeus
muscle.
viii
Acknowledgments
Our deep appreciation and heartfelt thank you to Kathy Lee Erlandson, our
research assistant, for her thoughtful concern and untiring work. We are also
grateful to Fay R. Yates who was responsible for typing several of the chap
ters, to Diane Robertson, Tim Phelps, and Kathryn Born for the medical
illustrations and to Henri Hessels, our departmental photographer.
ix
Contents
Preface .... . . . . ... . . . . . . .... . . . . . ... . . . . . . . .... . . . . . . . . ... . . . . . . .... . . . . . .... . . . . . ... . . . . . VII
Glossary ................................................................................. VIII
Acknowledgments ..................................................................... ix
Contributors ............................................................................ XIII
Overview ................................................................................ XV
Radiation in Video-Recorded Fluoroscopy .............................. .
THOMAS J. BECK AND BOB W. GAYLER
2 Anatomical and Physiological Overview................................... 7
EMMETT T. CUNNINGHAM, JR., MARTIN W. DONNER,
BRONWYN JONES, AND STUART M. POINT
3 The Tailored Examination ..................................................... 33
BRONWYN JONES AND MARTIN W. DONNER
4 lnterpreting the Study........................................................... 51
BRONWYN JONES AND MARTIN W. DONNER
5 Adaptation, Compensation, ~nd Decompensation ...................... 77
BRONWYN JONES AND MARTIN W. DONNER
6 Pharyngoesophageal lnterrelationships .................................... 85
BRONWYN JONES AND MARTIN W. DONNER
7 Common Structural Lesions .................................................. 93
BRONWYN JONES AND MARTIN W. DONNER
8 Ultrasound lmaging and Swallowing........................................ 109
BARBARA C. SONIES
9 lntegrated Approach to Cross-Sectional Imaging and Dysphagia .. 119
STUART W. POINT, R. NICK BRYAN, S. JAMES ZINREICH, AND
EMMETT T. CUNNINGHAM, JR.
10 Imaging of the Pharynx after Surgical Therapy ......... ........ ......... 147
DENNIS M. BALFE
Xl
xii Contents
I I Swallowing in Children ......................................................... 173
SANDRA S. KRAMER
12 Aging and Neurological Disease ............ .......... ....................... 189
MARTIN W. DONNER AND BRONWYN JONES
13 Dysphagia in AIDS.............................................................. 203
SUSAN D. WALL
14 RoJe of Radiology in Rehabilitation of Swallowing .................. ... 215
JEFFREY B. PALMER, ANN S. DUCHANE, AND MARTIN W. DONNER
Conclusion: What Does the Future Hold? ........... ..................... .... 227
Index ..................................................................................... 229