69-Year Old Man With Dysphagia and Nasal Regurgitation

Abstract Purpose The soft palate (SP) has a complex anatomy and physiology. Reconstruction after tumour resection is a challenge, and procedures that only restore bulk don’t give good results. We aim to present a new technique for the in-setting and the functional outcomes. Methods We retrospectively included in a monocentric retrospective cohort study every patient with a first diagnosis of a soft palate squamous cell carcinoma (SPSCC), who underwent a tumoral resection with a free flap reconstruction, from February 2013 to July 2017. For the in-setting, a special care is given for the flap in-setting: we suture the flap more caudally than usual under the tongue base, creating a neo-posterior pilar. The primary outcome was the deglutition function, assessed by the M. D Anderson Dysphagia Inventory (MDADI). We also analyzed the patient’s quality of life with the FOSS score and the occurrence of nasal regurgitation or larynx aspiration. Results We included twenty patients, with a median follow-up of 26.5 months. The median MDADI score was 89, and the mode was 93. A Fisher test shows a significant improvement of MDADI scores for unilateral vs bilateral reconstructions (p = 0.03). The median FOSS score was 2, and the mode was 2. Seven (35%) patients complained of nasal regurgitation, three (15%) reported episodic laryngeal aspiration.

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Velopharyngeal dysfunction

10.1093/med/9780199682874.003.0192 ◽

2021 ◽

pp. 777-786

Author(s):

David C.G. Sainsbury ◽

Caroline C. Williams ◽

Felicity V. Mehendale

Keyword(s):

Management Strategies ◽

Speech Sound ◽

Well Being ◽

Surgical Interventions ◽

Speech Evaluation ◽

Oral Speech ◽

Neuromotor Function ◽

Velopharyngeal Function ◽

Speech Learning ◽

Nasal Regurgitation

This chapter explores velopharyngeal dysfunction (VPD), its impact, aetiology, assessment, and management. VPD may cause hypernasal, weak, and unintelligible speech, facial grimacing, nasal turbulence and nasal regurgitation, middle ear problems, and sinusitis. Such manifestations may be distressing for the patient, be associated with poor academic outcomes, be negatively perceived by others, lead to bullying and withdrawal, and result in relationship and employment difficulties. Like the effect of a visible difference on psychosocial confidence and self-esteem, the manifestations of VPD on emotional well-being and social interaction do not necessarily correlate with the amount of speech, language, or communication dysfunction. Normal anatomy, neuromotor function, and speech learning are prerequisites for effective velopharyngeal function. A problem with any of these components may result in a velopharyngeal mechanism that fails to efficiently and fully close throughout oral speech sound formation leading to VPD and an ensuing speech disorder. Perceptual speech evaluation is used to diagnose VPD. Lateral videofluoroscopy and nasoendoscopy are commonly deployed to assess velopharyngeal function and determine management strategies. Surgical interventions include pharyngoplasty, pharyngeal flaps, and velopharyngeal augmentation. Non-surgical interventions include speech prostheses and nasal obturators for speech improvement.

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Airway protective and abdominal expulsive mechanisms in infantile regurgitation

Journal of Applied Physiology ◽

10.1152/jappl.1985.59.3.716 ◽

1985 ◽

Vol 59 (3) ◽

pp. 716-721 ◽

Cited By ~ 17

Author(s):

A. P. Menon ◽

G. L. Schefft ◽

B. T. Thach

Keyword(s):

Upper Airway ◽

Airway Closure ◽

Protective Mechanisms ◽

Abdominal Girth ◽

Airway Reopening ◽

Pharyngeal Pressure ◽

Gastric Pressure ◽

Gastric Contents ◽

Respiratory Movements ◽

Nasal Regurgitation

To define the expulsive and airway protective mechanisms involved in infantile regurgitation, we studied 15 infants (9 premature and 6 mature infants) with histories of frequent postfeeding regurgitation. In 13 infants we recorded pharyngeal pressure, pH, nasal and oral airflow, and abdominal respiratory movements. In two additional infants we recorded gastric pressure. In eight infants observations were made without intrapharyngeal recording devices. Distinctive abdominal regurgitation movements (RMs) immediately preceded 84% of regurgitation episodes. These RMs were characterized by one or more large brief increases in abdominal girth. In the two infants with gastric pressure recordings, large increases in gastric pressure, with duration and frequency characteristics similar to the RMs, immediately preceded regurgitation episodes. Thus, in contrast to the generally accepted concept that flow of gastric contents out of the stomach is passive during infantile regurgitation, we documented an active expulsive mechanism similar to that of vomiting in the adult. In all regurgitation episodes, upper airway closure occurred at the onset of the regurgitation movement. One or more swallows occurred immediately following RMs and prior to airway reopening in 97% of regurgitation episodes. Brief respiratory pauses occurred during regurgitation in all premature infants and occasionally in mature infants. Nasal regurgitation, coughing, and sneezing occasionally accompanied regurgitation episodes. Thus upper airway closure and swallowing prior to airway reopening were the most frequently observed airway protective mechanisms during regurgitation. Brief respiratory pauses, sneezing, and coughing may be secondary airway protective mechanisms. Nasal regurgitation likely represents immaturity of airway protective mechanisms.

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Fulminant Guillain Barre syndrome with recurrent lung collapse

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20205551 ◽

2020 ◽

Vol 10 (1) ◽

pp. 127

Author(s):

Hasif Kolleri ◽

Mohammed Fardan ◽

A. Priya ◽

K. Arun Chander

Keyword(s):

Muscle Power ◽

Lower Limbs ◽

Guillain Barre Syndrome ◽

Mechanically Ventilated ◽

Guillain Barré Syndrome ◽

Brainstem Function ◽

Upper Respiratory ◽

Guillain Barré ◽

Minimal Resistance ◽

Nasal Regurgitation

Fulminant Guillain-Barré syndrome (GBS) is a rapidly progressive form of polyneuropathy in which patients demonstrate eventual flaccid quadriplegia and an absence of brainstem function. Most patients present initially with a mild upper respiratory or gastrointestinal illness and have non-diagnostic cerebral imaging studies. Here we report the case of child aged 7 who was admitted initially with complaints of weakness of lower limbs lasting for 4-5 hours. He had difficulty in standing and walking, associated with pain in both lower limbs. Flaccid weakness rapidly progressed over 12 hours to involve both upper limbs along with difficulty in swallowing and nasal regurgitation of feeds. He was intubated and mechanically ventilated for respiratory failure. Over the period of time, after confirmation with all the test reports and symptoms, other differential diagnoses were ruled out and fulminant GBS was considered and hence plasmapheresis was started. Over the period of 3 months his muscle power slowly improved. During discharge, he was able to lift limbs against minimal resistance, turn sideways on bed, sit up with minimal support and likewise stand with support.

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Surgical Management of Velopharyngeal Insufficiency Due to Unilateral Oropharyngeal Agenesis in a Patient With Stickler Syndrome

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620977414 ◽

2020 ◽

pp. 105566562097741

Author(s):

Bronson Wessinger ◽

Kyle Kimura ◽

James Phillips ◽

Ryan H. Belcher

Keyword(s):

Surgical Management ◽

Soft Palate ◽

Surgical Correction ◽

Velopharyngeal Insufficiency ◽

Patient Specific ◽

Stickler Syndrome ◽

Pharyngeal Flap ◽

Nasal Regurgitation

Velopharyngeal insufficiency (VPI) results from defects interfering with closure of the velopharyngeal port. It can lead to many issues ranging from nasal regurgitation to severe speech abnormalities. Treatment is tailored to patient-specific etiology and severity, often involving surgical correction. A rare, and therefore seldom, described cause of VPI is isolated unilateral agenesis of the soft palate. We describe the case of a 2-year-old patient with Stickler syndrome possessing a unique anatomic presentation of this pathology, managed successfully with a unilateral pharyngeal flap.

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Miller Fisher syndrome: a diagnosis not to be missed

The Journal of Laryngology & Otology ◽

10.1017/s0022215107005889 ◽

2007 ◽

Vol 122 (1) ◽

pp. 82-85 ◽

Cited By ~ 4

Author(s):

S J Davis ◽

R Salib ◽

H Buchan ◽

E Nilssen

Keyword(s):

Early Diagnosis ◽

Campylobacter Jejuni ◽

Miller Fisher Syndrome ◽

Fisher Syndrome ◽

Favourable Prognosis ◽

Mode Of Presentation ◽

Nasal Regurgitation ◽

Management Issues

AbstractWe report a case of Miller Fisher syndrome presenting in an ENT setting. The referral was made on the basis of worsening nasal regurgitation following Campylobacter jejuni enteritis. The aim of this report is not to add to the recorded instances of Miller Fisher syndrome, but to help raise the level of its awareness amongst otolaryngologists. Emphasis is placed on the mode of presentation and management issues, as early diagnosis is crucial and confers a favourable prognosis. In that respect, we consider this case noteworthy and instructive.

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Cleft Palate

Genetic Consultations in the Newborn ◽

10.1093/med/9780199990993.003.0012 ◽

2019 ◽

pp. 85-90

Author(s):

Robin D. Clark ◽

Cynthia J. Curry

Keyword(s):

Cleft Palate ◽

Maternal Diabetes ◽

Recurrence Risk ◽

Background Information ◽

Mendelian Disorders ◽

Organ Systems ◽

Common Causes ◽

Incidence Risk ◽

Pierre Robin ◽

Nasal Regurgitation

This chapter reviews background information about the incidence, risk factors, family history, sex ratio, genetics, recurrence risk, and epidemiology of isolated and syndromic cleft palate. Microforms of cleft palate including bifid uvula, submucous cleft palate, and nasal regurgitation are described. The discussion on the differential diagnosis of cleft palate summarizes its common causes, including teratogenic agents (alcohol, maternal diabetes, valproic acid), chromosome anomalies, and Mendelian disorders associated with malformations in other organ systems. The chapter provides recommendations for evaluation and management. A clinical case presentation features an infant with micrognathia, a cleft of the soft palate, and a retropositioned tongue and respiratory distress due to Pierre–Robin sequence.

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Longus Capitis Reconstruction of the Soft Palate

Otolaryngology ◽

10.1177/0194599819849031 ◽

2019 ◽

Vol 161 (3) ◽

pp. 536-538

Author(s):

Jennifer H. Gross ◽

Joseph Zenga ◽

Jeffrey D. Sharon ◽

Ryan S. Jackson ◽

Patrik Pipkorn

Keyword(s):

Soft Palate ◽

Muscle Function ◽

Donor Site ◽

Donor Site Morbidity ◽

Local Flap ◽

Velopharyngeal Insufficiency ◽

Single Institution ◽

Oral Diet ◽

Transoral Resection ◽

Nasal Regurgitation

Soft palate (SP) reconstruction remains a challenge for the head and neck reconstructive surgeon. One favorable local flap option is the longus capitis muscle (LCM), a deep neck flexor with redundant muscle function, appropriate bulk, and a relatively straightforward surgical harvest. A retrospective review of 3 patients with T2 to T4 tonsil squamous cell carcinoma requiring SP resection and LCM reconstruction at a single institution was performed. Three patients underwent primary transoral resection, all resulting in at least 50% full-thickness SP defects. Reconstruction comprised a superiorly based LCM local flap. Patients underwent adjuvant (chemo)radiation therapy as indicated. Within 3 to 8 months, each patient was tolerating a full oral diet with no dysphagia, nasal regurgitation, or velopharyngeal insufficiency. For select patients with SP defects, a superiorly based LCM flap may provide a functionally acceptable reconstruction with minimal donor site morbidity.

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An unusual nasopharyngeal foreign body with unusual presentation as nasal regurgitation and change in voice

BMJ Case Reports ◽

10.1136/bcr-2013-010005 ◽

2013 ◽

Vol 2013 (jul24 1) ◽

pp. bcr2013010005-bcr2013010005 ◽

Cited By ~ 1

Author(s):

S. Kumar ◽

D. B. Singh ◽

A. B. Singh

Keyword(s):

Foreign Body ◽

Unusual Presentation ◽

Nasal Regurgitation

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Uvulopalatopharyngoplasty: the Leicester experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215100127732 ◽

1994 ◽

Vol 108 (8) ◽

pp. 649-652 ◽

Cited By ~ 5

Author(s):

A. J. N. Prichard ◽

J. Marshall ◽

A. Ahmed ◽

R. S. A. Thomas ◽

C. D. Hanning

Keyword(s):

Postoperative Complications ◽

Speech Development ◽

Nasal Regurgitation

AbstractTwenty-nine patients undergoing uvulopalatopharyngoplasty (UPPP) for snoring are presented. Ninety per cent expressed an overall improvement in their symptoms: 21 per cent had complete abolition of snoring. Postoperative complications included nasal regurgitation of food/fluids and hyponasal speech development.

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