Chapter Sixteen Flashcards
Chapter 16
Videofluoroscopy
xxx
Imaging of the Velopharyngeal Valve
Imaging of the velopharyngeal valve is indicated to determine…
It is important to obtain this information so that
the cause, approximate size, and particularly the location of the velopharyngeal opening.
the best form of surgical intervention can be determined.
History of Radiography for VPI
Radiography—
History of radiography for evaluation of VPI:
1.
2.
3.
use of the roentgen ray (X-ray) to image internal body parts
- Lateral cephalometric X-rays
- Cineradiography
- Videofluoroscopy
Lateral Cephalometric X-rays
Lateral cephalometric X-ray (also called a lateral “ceph”) —
still radiographic images of the midsagittal plane of the head, showing the velum and posterior pharyngeal wall
Lateral Cephalometric X-rays
Taken during__________
Shows: 1. 2. 3. 4. 5.
phoneme prolongation
Hard palate
Velum at rest
Velar length and height during phonation
Posterior pharyngeal wall
Cervical spine and cranial base abnormalities that can affect position of the posterior pharyngeal wall
Disadvantages of LateralCeph X-rays
- A lateral ceph X-ray shows on the ______.
- It cannot see _______
- It’s a _____only.
a. Speech is dynamic, but X-ray can show _______ - Image is ______
a..
b.
midsagittal plane
lateral pharyngeal walls.
still picture
only structure, not function.
summation of all parts.
a. Beam travels through all tissues
b. Small or unilateral openings do not show.
Cineradiography
Cineradiography (also called cine study)—
a series of 16 to 24 frames of radiographs per second, which were recorded on motion picture film; incorporated several views so examiner could appreciate all aspects of the valve
Disadvantages of Cineradiography:
1.
2.
No way to simultaneously record sound
Relatively high radiation dosage
Videofluoroscopy—
Videofluoroscopic speech study—
an imaging technique used to obtain real-time moving images of internal structures; done through the use of a fluoroscope.
moving images of the velopharyngeal valve, along with simultaneous audio recordings, for the evaluation of velopharyngeal function during speech
Videofluoroscopy
__________assessment
Can see…
Allows…
Multiview radiographic
all structures of the VP valve in order to evaluate function during speech
simultaneous audio and video recording
Videofluoroscopy can be used to: 1. 2. 3. 4. 5.
Confirm the presence of a velopharyngeal opening and estimate the size.
Differentiate the cause of velopharyngeal dysfunction (e.g., a short velum versus poor velar movement).
Show the vertical movement of the velum during speech.
Provide a view of the entire length of the posterior pharyngeal wall.
Evaluate the effects of some surgical procedures.
Purpose of Multiple Views
Velopharyngeal port is…
Necessary to…
Most common views are as follows:
three-dimensional structure but fluoroscopic imaging is only two-dimensional
obtain three mutually perpendicular planes to fully evaluate all sides of the velopharyngeal port
- Lateral projection
- Frontal or anterior-posterior (AP) projection
- Base projection
Lateral View
Beam…
Shows…
Illustrates effective ______, _______, and ________, _______wall, _____movement, and patency of a _____when barium is in the nasal cavity.
enters side of the head
the velum and posterior pharyngeal wall in a midsagittal plane.
length of the velum; velar movement; height of the velum during speech
posterior pharyngeal; tongue; fistula
Lateral View
Position:
Patient sits upright or lays on the side.
Frontal (Also Called Anterior-Posterior, or AP) View
Beam…
The AP view shows…
Position:
enters the front of the nose.
the lateral pharyngeal walls at rest and during speech.
Patient sits upright or lays in a supine position.
Base (Also Called Enface) View
Beam…
The base view shows…
Position:
enters through the base of the chin and then up through the velopharyngeal port.
the perimeter of the VP port.
Patient lays in a prone “sphinx” position (by pulling the head up and placing the upper body weight on the arms and elbows).
Towne’s View
Beam enters..
Towne’s view shows…
Position:
through the top of the head and then down through the velopharyngeal port.
the perimeter of VP port (similarly to the base view).
Patient is seated upright with the chin tucked and the head hyperflexed.
Oblique View
Beam…
The oblique view shows…
Position:
enters through the front of the face
the relationship between movements of structures seen on the lateral view to those seen on the frontal view.
Patient is seated upright and rotates head and body to 45º on one side, back to midline, and then 45º to the other side.
Contrast Material (AP and Base)
Patient placed in ______
Barium instilled into…
Head rotated to coat pharynx
supine position
nasopharynx thru catheter, dropper or pipette
to coat pharynx
Speech Sample Patient is asked to: 1. 2. 3.
Repeat a combination of sentences loaded with pressure-sensitive phonemes.
Produce a repetition of pressure sensitive syllables.
Count from 60 to 70.
Interpretation
Interpretation should be done by both a ____and ______.
See interpretation guidelines for each view in the text.
radiologist and SLP
Advantages of Videofluoroscopy
It provides ….
It shows ….
It’s possible to …
a view of entire length of the posterior pharyngeal wall (PPW).
the point at which the velum contacts the PPW during speech.
identify a short velum versus poor velar movement.
Limitations of Videofluoroscopy
There is radiation exposure to the patient.
It requires multiple views.
There is relatively poor resolution, when compared to nasopharyngoscopy.
It is not possible to see very small gaps
Barium is squirted through the nose and then into the pharynx, which is uncomfortable.
Summary
Videofluoroscopy evaluates the _______of the VP valve and helps to determine the cause of VP dysfunction and the location of the opening.
Information obtained is used to determine the type of _____.
Since the introduction of ______, videofluoroscopy is used less frequently.
structure and function
intervention
nasopharyngoscopy
