Effect of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy for Severe Dysphagia Due to Brainstem Disease

2020 ◽  
Vol 129 (7) ◽  
pp. 689-694
Author(s):  
Seiko Shibata ◽  
Hitoshi Kagaya ◽  
Yasunori Ozeki ◽  
Eiichi Saitoh ◽  
Yoichiro Aoyagi ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Tube Feeding ◽  
Inpatient Rehabilitation ◽  
Upper Esophageal Sphincter ◽  
Severity Scale ◽  
Severe Dysphagia ◽  
Long Time ◽  
Esophageal Sphincter ◽  
Penetration Aspiration Scale

Objectives: Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease. Methods: Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up. Results: Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up. Conclusion: Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.

Conservative treatment and radiological follow-up in a case of pneumatosis intestinalis associated with enteral tube feeding

2021 ◽  
Vol 67 (2) ◽  
Author(s):  
Nicolò BRANDI ◽  
Anna PARMEGGIANI ◽  
Stefano BROCCHI ◽  
Caterina BALACCHI ◽  
Caterina GAUDIANO ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Tube Feeding ◽  
Pneumatosis Intestinalis ◽  
Enteral Tube Feeding

Is conservative treatment really the best option for all thoracolumbar injury patients with a thoracolumbar injury classification and severity scale score<4?

2020 ◽  
Author(s):  
Yang Xu ◽  
Zhiyuan Zeng ◽  
Fubiao Ye ◽  
Feiyue Lin ◽  
Chuncai Xu ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Burst Fracture ◽  
Treatment Recommendation ◽  
Thoracolumbar Fractures ◽  
Severity Scale ◽  
Thoracolumbar Injury ◽  
Significant Difference ◽  
Injury Classification ◽  
Surgical Group

Abstract Objectives: The conservative treatment recommendation for patients with thoracolumbar burst fractures with a TLICS score<4 has always been controversial. This retrospective review was conducted to investigate the reliability and validity of thoracolumbar injury classification and severity scale(TLICS) recommendations for thoracolumbar burst fracture patients with a score<4. Methods: A retrospective analysis was conducted from Jan. 2010 through Jun. 2018 for patients with thoracolumbar fractures in a single local institute; patients with a TLICS score <4 were enrolled and grouped according to the therapeutic strategy (surgical or nonsurgical). Imaging and clinical data were collected and compared between the two groups before and after treatment. Results: In total, 119 patients were enrolled (75 in the nonsurgical group and 44 in the surgical group). There was no significant difference between the two groups with regard to both the VAS and ODI values ( p =0.91 and 0.79, respectively) at the last follow-up. Importantly, despite no improvements in the local sagittal angle (LSA, α) of the spine( p =0.09),a worsened regional sagittal angle (RSA, β) ( p =0.03)was observed in the nonsurgical group, while significant improvements in the LSA and RAS were both observed in the surgical group( p <0.01). Conclusions: There were no clinical quantifiable benefits (VAS pain and ODI scores) between nonsurgical and surgical patients with comminuted thoracolumbar fractures (TLICS score<4). However, this type of patient deserves a very careful preoperative evaluation if a nonoperative decision is made; a close follow-up is mandatory due to the high likelihood of long-term kyphotic deformities.

Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report

2019 ◽  
Vol 28 (4) ◽  
pp. 1381-1387
Author(s):  
Ying Yuan ◽  
Jie Wang ◽  
Dongyu Wu ◽  
Dahua Zhang ◽  
Weiqun Song
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Rating Scale ◽  
Tube Feeding ◽  
Nasogastric Feeding ◽  
Lateral Medullary Infarction ◽  
Severe Dysphagia ◽  
Transcutaneous Vagus Nerve Stimulation ◽  
Medullary Infarction

Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438

Conservative Treatment of Vestibular Schwannomas: A Follow-Up Study on Clinical Outcomes

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
M. Sadadcharam ◽  
R. Wormald ◽  
M. Javadpour ◽  
D. Rawluk ◽  
R. McConn-Walsh
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Vestibular Schwannomas ◽  
Follow Up Study

A combined lateral-crestal approach of sinus floor elevation: A report on three cases

2020 ◽  
Author(s):  
Xin Zhang ◽  
Yuting Zhang ◽  
Jian Wang ◽  
Qianbing Wan ◽  
Lei Li
Keyword(s):  
Clinical Study ◽  
Conservative Treatment ◽  
Lateral Approach ◽  
Clinical Report ◽  
Sinus Lift ◽  
Sinus Floor Elevation ◽  
Long Term Follow Up ◽  
Sinus Floor

This clinical report describes a combined lateral-crestal approach to elevate the sinus floor when placing implants on a wide maxillary posterior ridge. The buccally enlarged osteotomy broadens vision of practitioners and facilitates access of instruments in the sinus. Compared to the traditional lateral approach of sinus lift, the proposed technique may offer a more conservative treatment modality. And a clinical study with sufficient subjects and long term follow up is needed to validate the potential and limitations of the proposed technique.

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