The fluoroscopy is carried out while this attempt is being made. The patient then closes his tracheostoma manually and tries to say “Aaah” with some force. The top edge of the tracheostoma is marked with an x-ray-proof marker (e.g. The attempt at speech is made in side projection. The mucous membrane of the pharynx is only colored for x-raying for a few minutes. A swallow of a barium contrasting agent is taken to rule out high-grade pharyngeal stenoses under frontal and lateral fluoroscopy (ill. In order to display the spastic pharyngeal segment precisely (the “spastic pharyngeal segment” is in fact a circular contractible section of the constrictor pharyngis muscle), video cinematography of the act of swallowing and the attempt to speak is carried out. Radiological presentation of the spastic pharyngeal segment NOTE: In the early days of speech therapy using voice prostheses, an insufflation test was usually carried out before secondary voice prosthesis insertion in order to rule out pharyngeal spasm. It needs to be deactivated for TE-speech to be possible, i.e. In laryngectomees this process is called a pharyngeal spasm, and it was originally a physiological reflex that prevented food from flowing back from the food pipe into the pharynx and mouth. The air that is needed for speaking is diverted through the voice prosthesis into the esophagus and prevented by a strong circulatory contraction of the constrictor pharyngis muscle (muscles of the pharynx) from flowing into the mouth. PathophysiologyĪ pharyngeal spasm occurs if no myotomy of the constrictor pharyngis muscle is made during the course of the laryngectomy, and no neurectomy of the pharyngeal plexus, or if they are functually ineffective. In some cases a very short sound may be produced, which is then quickly blocked. The voice prosthesis may flow well and be in the correct position, the pharynx wide and open, but the patient is unable to speak despite the greatest efforts to do so. Patients with pharyngeal spasm are usually diagnosed because they are unable to speak even though a voice prosthesis was inserted after their laryngectomy. It is misleading because it is not strictly speaking a spasm (cramp), but the retained physiological, circulatory contractibility of a part of the pharynx. It is imprecise because it does not affect the whole pharynx. The term pharyngeal spasm has become widespread in international literature thats why it is used here even though it is not really precise and is somewhat misleading. Structures pass through these gaps to the laryngopharynx (and larynx) from carotid triangle and root of neck, respectively.The term “pharyngeal spasm” is an abbreviation of the term “pharyngeal constrictor muscle spasm” used in the original English publications that wrote of the injection of Botulinum Toxin A for the treatment of this problem (see literature). The lower two gaps are between regions bordering neck and head. Structures pass through these gaps from deep styloid region to nasopharynx and oropharynx, respectively. The upper two gaps are between regions within the head.
The musculature of the pharynx consists of three overlapping constrictors (superior, middle and inferior) externally, with three smaller internal muscles (stylopharyngeus, palatopharyngeus and salpingopharyngeus) that run diagonally. Gaps in pharyngeal wall Gaps in pharyngeal wall
0 kommentar(er)
