Posterior Cricoid Region Fluoroscopic Findings: The Posterior Cricoid Plication

The region posterior to the cricoid cartilage is challenging to assess fluoroscopically. The purpose of this investigation is to critically evaluate the posterior cricoid (PC) region on fluoroscopy and describe patterns of common findings. This was a case control study. All fluoroscopic swallowing studies performed between June 16, 2009, and February 9, 2010, were reviewed for features seen in the PC region. These findings were categorized into distinct patterns and compared to fluoroscopic studies performed in a cohort of normal volunteers. Two hundred patient studies and 149 healthy volunteer studies were reviewed. The mean age of the referred patient cohort and the volunteer cohort was 57 years (±19) and 61 years (±16), respectively (p > 0.05). The patient cohort was 53% male and the control cohort was 56% female (p > 0.05). Four groups were identified. Pharyngoesophageal webs were seen in 7% (10/149) of controls and 14% (28/200) of patients (p = 0.03). A PC arch impression was seen in 16% of patients (32/200) and controls (24/149) (p = 1). A PC plication was demonstrated in 23% (34/149) of controls and 30% (60/200) of patients (p = 0.13). No distinctive PC region findings were seen in 54% (81/149) of controls and 42% (84/200) of referred patients (p = 0.02). Four patients (2%) had both a web and a PC plication. Four categories of PC region findings were identified (unremarkable PC region, web, PC arch impression, and PC plication). Both patients referred for swallowing studies and healthy volunteers demonstrated esophageal webs, PC arch impressions, and PC plications. Only webs were more common in patients than in control subjects (p = 0.03). The PC impression and PC plication are likely to represent normal variants that may be identified on fluoroscopic swallow studies.

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Dysphagia Development after Surgery Unrelated to Laryngeal and Pharyngeal Structures

Abstract The aim of this study was to retrospectively investigate swallowing capacity and dysphagia severity using VFSS and to determine their relationships to intra- and postoperative factors in long-lasting dysphagia patients who had undergone an operation unrelated to pharyngeal and laryngeal structures. Twenty-six patients without a definite cause of dysphagia were selected from among patients admitted to our hospital from January 2006 to December 2007. Videofluoroscopic dysphagia scale (VDS) and ASHA NOMS swallowing level (ASHA level) at 1 month postoperatively were used to determine dysphagia severity and swallowing capacity. Intraoperative factors (endotracheal tube size, intubation time, and total anesthetic time) and postoperative factors (tracheostomy history, vocal cord palsy, and postoperative delirium) were investigated to determine their relationhips with VDS and ASHA level. No significant relationship was found between these factors and VDS or ASHA level by Pearson’s or Spearman’s correlation testing. Further prospective studies are required to identify the causative factors of long-lasting dysphagia after surgical procedures unrelated to pharyngeal and laryngeal structures.

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