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Videofluoroscopic Evaluation of Normal and Impaired Oropharyngeal Swallowing

2019; Radiological Society of North America; Volume: 39; Issue: 1 Linguagem: Inglês

10.1148/rg.2019180070

1527-1323

Javier Azpeitia Armán, Rosa M. Lorente‐Ramos, Pilar Gete García, Teresa Collazo Lorduy,

Esophageal and GI Pathology

HomeRadioGraphicsVol. 39, No. 1 PreviousNext Gastrointestinal ImagingFree AccessRadioGraphics Fundamentals | Online PresentationVideofluoroscopic Evaluation of Normal and Impaired Oropharyngeal SwallowingJavier Azpeitia Armán , Rosa M. Lorente-Ramos, Pilar Gete García, Teresa Collazo LorduyJavier Azpeitia Armán , Rosa M. Lorente-Ramos, Pilar Gete García, Teresa Collazo LorduyAuthor AffiliationsFrom the Central Radiology Unit of Madrid (J.A.A, R.M.L.R) and Department of Otorhinolaryngology (P.G.G., T.C.L), Infanta Leonor Hospital, Av Gran Vía del Este 80, 28031 Madrid, Spain.Address correspondence to J.A.A. (e-mail: [email protected]).Javier Azpeitia Armán Rosa M. Lorente-RamosPilar Gete GarcíaTeresa Collazo LorduyPublished Online:Jan 8 2019https://doi.org/10.1148/rg.2019180070MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.A videofluoroscopic swallow study (VFSS), also known as a modified barium swallow, is a dynamic x-ray examination of the oral cavity, pharynx, and cervical esophagus. VFSS permits evaluation of the patient’s swallowing function through the administration of liquids and solids of varying consistencies to assess swallowing fluoroscopically.Currently, VFSS is the standard imaging modality used for diagnosing and managing oropharyngeal dysphagia, allowing for evaluation of the oral, palatal, pharyngeal, and pharyngoesophageal segments of deglutition. It is also useful in identifying aspiration risk in patients with dysphagia. Not only does a VFSS assist the radiologist in diagnosing swallowing dysfunction, it also helps guide management recommendations for modifying bolus texture and evaluating the effectiveness of therapeutic strategies (eg, postures and maneuvers). The disadvantages of performing a VFSS include patient radiation exposure, potential difficulty in positioning the patient, and a potential influence on imaging owing to the patient’s reaction to the taste and texture of the contrast material.This online presentation summarizes the VFSS findings of normal and abnormal swallowing. A review of the normal anatomy of the oropharyngeal region and the mechanism of swallowing, with descriptions of the phases of deglutition, is presented. Indications, contraindications, techniques, and important anatomic landmarks are discussed, and the most prevalent pathologic disorders that contribute to swallowing dysfunction are reviewed.Various functional neuromuscular disorders may contribute to the wide variety of manifestations in dysphagia. A dysfunction may manifest in any of the physiologic swallowing components and can include impairments of the (a) lip seal, (b) oral transit, (c) tongue–soft palate seal, (d) soft palate–superior constrictor muscle seal (eg, nasopharyngeal regurgitation), (e) oral transport or propulsive phase (eg, laryngeal penetration), (f) hyoid and laryngeal movements, or (g) epiglottic tilt.The most frequent pathologic findings at VFSS are pharyngeal bolus residue, laryngeal penetration and/or aspiration, and cricopharyngeal bar. Pharyngeal bolus residue is a substantial predictor of postswallow aspiration. An impaired closure of the glottis leads to laryngeal penetration and aspiration (Fig 1). Laryngeal penetration refers to the presence of barium contrast material in the laryngeal vestibule, and aspiration consists of the presence of barium contrast material below the level of the true vocal folds. Cricopharyngeal bar appears as a smooth posterior bandlike protrusion into the lumen and the barium column at the junction of the hypopharynx and cervical esophagus, owing to a spasm of the cricopharyngeus muscle and/or tonic contraction inhibition failure (Fig 2). Several types of diverticula may be visible at VFSS, including pharyngeal diverticula and pouches, Zenker diverticulum, and Killian-Jamieson diverticulum.Figure 1. Lateral radiograph shows nasal regurgitation (arrow) of a bolus with the consistency of liquid into the nasopharynx caused by an impaired velopharyngeal closure. Note the aspiration of the barium (arrowhead), which enters the trachea, and the upper esophageal web (*).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Lateral VFSS image shows a cricopharyngeal bar (arrow), a prominent cricopharyngeal muscle, without aspiration.Figure 2.Download as PowerPointOpen in Image Viewer Recommendations regarding appropriate rehabilitative strategies are also determined at VFSS by evaluating the effectiveness of imaging postures and maneuvers and recommending bolus modifications to improve swallowing safety and efficiency.Performing and analyzing a VFSS should be a multidisciplinary activity. The radiologic report, which may be a multidisciplinary effort or written independently, should contain a clinical summary, the videofluoroscopic description and/or report, the diagnosis, and recommendations and/or comments.VFSS is the current standard imaging modality used for the diagnosis and management of oropharyngeal dysphagia and provides a comprehensive evaluation of the oral, pharyngeal, and pharyngoesophageal segments of deglutition. Careful attention to radiographic techniques used during VFSS, the movement of the structures, and the bolus transit can aid in the diagnosis of an abnormal swallow, which may allow for a diagnosis of the functional causes of dysphagia. VFSS findings can also help determine the appropriate rehabilitation strategies and postural maneuvers and the specific modifications needed for oral intake, including the volume, texture, and consistency of the bolus.Recipient of a Certificate of Merit award for an education exhibit at the 2017 RSNA Annual Meeting.All authors have disclosed no relevant relationships.Suggested ReadingsAmerican Speech Language Hearing Association (ASHA). Guidelines for speech-language pathologists performing videofluoroscopic swallowing studies. https://es.scribd.com/document/252202957/Videofluoroscopic-Swallowing-Studies-1. Published 2004. Accessed March 10, 2018. Google ScholarClavé P, Terré R, de Kraa M, Serra M. Approaching oropharyngeal dysphagia. Rev Esp Enferm Dig 2004;96(2):119–131. Crossref, Medline, Google ScholarDodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol 1990;154(5):953–963. Crossref, Medline, Google ScholarGore RM, Levine MS. Structural abnormalities of the pharynx. In: Gore RM, Levine MS, eds. Textbook of gastrointestinal radiology. 3rd ed. New York, NY: Saunders Elsevier, 2008. Google ScholarJaffer NM, Ng E, Au FW, Steele CM. Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors. AJR Am J Roentgenol 2015;204(1):49–58. Crossref, Medline, Google ScholarO’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia 1999;14(3):139–145. Crossref, Medline, Google ScholarOtt DJ, Pikna LA. Clinical and videofluoroscopic evaluation of swallowing disorders. AJR Am J Roentgenol 1993;161(3): 507–513. Crossref, Medline, Google ScholarRosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996;11(2):93–98. Crossref, Medline, Google ScholarRugiu MG. Role of videofluoroscopy in evaluation of neurologic dysphagia. Acta Otorhinolaryngol Ital 2007;27(6):306–316. Medline, Google ScholarArticle HistoryReceived: Mar 11 2018Revision requested: Apr 25 2018Revision received: May 18 2018Accepted: May 24 2018Published online: Jan 08 2019Published in print: Jan 2019 FiguresReferencesRelatedDetailsCited ByThe Biomechanical Characteristics of Swallowing in Tracheostomized Patients with Aspiration following Acquired Brain Injury: A Cross-Sectional StudyXiao-XiaoHan, JiaQiao, Zhan-AoMeng, Dong-MeiPan, KeZhang, Xiao-MeiWei, Zu-LinDou2023 | Brain Sciences, Vol. 13, No. 1The importance of shear and extensional rheology and tribology as the design tools for developing food thickeners for dysphagia managementChaiwutGamonpilas, AkapongKongjaroen, PawadeeMethacanon2023 | Food Hydrocolloids, Vol. 140The kinematic features of hyoid bone movement during swallowing in different disease populations: A narrative reviewKuo-ChangWei, Ming-YenHsiao, Tyng-GueyWang2022 | Journal of the Formosan Medical Association, Vol. 121, No. 10Speech and Swallowing Problems in Parkinson’s DiseaseNguyenDo, ShaneMitchell, LaurenSturgill, PravinKhemani, Mo-KyungSin2022 | The Journal for Nurse Practitioners, Vol. 18, No. 8Swallowing kinematic analysis might be helpful in predicting aspiration and pyriform sinus stasisKuo-ChangWei, Sheng-HaoCheng, Ming-YenHsiao, Yu-ChenWang, Chi-HungWeng, Jo-YuChen, Tyng-GueyWang2022 | Scientific Reports, Vol. 12, No. 1Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-AnalysisRaffaellaFranciotti, EricaDi Maria, MicheleD’Attilio, GiuseppeAprile, Federica GiuliaCosentino, VittoriaPerrotti2022 | Biomedicines, Vol. 10, No. 9Geriatric GastroenterologyCustonNyabanga, AbrahamKhan, Rita M.Knotts2021Automatic Hyoid Bone Tracking in Real-Time Ultrasound Swallowing Videos Using Deep Learning Based and Correlation Filter Based TrackersShuruiFeng, Queenie-Tsung-KwanShea, Kwok-YanNg, Cheuk-NingTang, ElaineKwong, YongpingZheng2021 | Sensors, Vol. 21, No. 11Communications in Computer and Information ScienceJuan PabloRestrepo-Uribe, SebastianRoldan-Vasco, EstefaniaPerez-Giraldo, Juan RafaelOrozco-Arroyave, AndresOrozco-Duque2020 | , Vol. 1274Geriatric GastroenterologyCustonNyabanga, AbrahamKhan, Rita MKnotts2020Radiopaedia.orgAndrewMurphy, MattMorgan2019Radiopaedia.orgMohammadNiknejad, HenryKnipe2014Accompanying This ArticleVideofluoroscopic Evaluation of Normal and Impaired Oropharyngeal SwallowingJan 8 2019Default Digital Object SeriesRecommended Articles Fluoroscopic Swallowing Examination: Radiologic Findings and Analysis of Their Causes and Pathophysiologic MechanismsRadioGraphics2021Volume: 41Issue: 6pp. 1733-1749Imaging Review of Gastrointestinal Motility DisordersRadioGraphics2022Volume: 42Issue: 7pp. 2014-2036Traumatic Neck and Skull Base InjuriesRadioGraphics2019Volume: 39Issue: 6pp. 1796-1807Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common PitfallsRadioGraphics2017Volume: 37Issue: 1pp. 323-345Multidetector CT of Laryngeal Injuries: Principles of Injury RecognitionRadioGraphics2019Volume: 39Issue: 3pp. 879-892See More RSNA Education Exhibits "There's Something in my Throat": Educational Review of Common and Not-So-Common Etiologies of DysphagiaDigital Posters2019Videofluoroscopic Swallow Study: Back to BasicsDigital Posters2020A Diagnosis Difficult to Swallow: Dysphagia RevisitedDigital Posters2019 RSNA Case Collection Right vocal cord palsyRSNA Case Collection2021Esophageal Pseudodiverticulosis RSNA Case Collection2021Esophageal Fibrovascular PolypRSNA Case Collection2022 Vol. 39, No. 1 Slide PresentationAbbreviations Abbreviation: VFSS videofluoroscopic swallow study Metrics Altmetric Score PDF download