Diseases of the Oropharynx

Question 1

What is the main clinical sign of disease in the oropharynx?

Answer 1

dysphagia (commonly mistaken for regurg

Question 2

What is the oropharynx bound by dorsally, ventrally and laterally?

Answer 2

Dorsal: soft palate
Ventral: root of tongue
Lateral: tonsillar fossae

Question 3

What are functional causes of dysphagia?

Answer 3

Functional causes of dysphagia are usually secondary to a neurologic or muscular disturbance

Question 4

If a patient is struggling to keep down solids, what is most likely the cause of the disease?

Answer 4

Structural disease
ex. neoplasia

Question 5

If a patient cannot keep down liquids, what is most likely the cause of the disease?

Answer 5

functional disease

Question 6

If a patient has difficulty seconds after eating, where should we suspect the problem to localize to?

Answer 6

oropharyngeal region

Question 7

If a patient appears to struggle 10-15 sec - hours after attempting to eat where should we suspect the problem to be localized to?

Answer 7

proximal esophagus if its a matter of seconds
distal esophagus if its closer to hours

Question 8

A patient with a history of what drugs may develop an esophageal stricture?

Answer 8

doxyxycline or clindamycin

(was the p recently intubated? can also lead to regurg then stricture)

Question 9

Describe oropharyngeal dysphagia

Answer 9

difficulty with prehension and abnormal transport through the upper esophageal sphincter

Question 10

What are some clinical signs of oropharyngeal dysphagia while eating?

Answer 10

retching
gagging
repeated swallowing
food coming out of nose - patients can’t swallow and move food into the esophagus
-exaggerated swallowing movements and food will usually drop from the mouth within seconds of prehension

Question 11

What must relax in order for the patient to swallow?

Answer 11

cricopharyngeal muscle

Question 12

What are clinical signs of neurogenic dysphagia?

Answer 12

Question 13

What are clinical signs of Cricopharyngeal dysphagia?

Answer 13

Patients struggle more with liquid - remember functional problem

Question 14

What functional disorder is caused by the failure of the UES to relax (achalasia) or a lack of coordination between the UES relaxation and pharyngeal contraction?

Answer 14

Cricopharyngeal dysphagia

Question 15

What species are predisposed to the congenital or aquired neuromusclar disorder of the upper esophageal sphincter?

Answer 15

Dachshunds and golden retrievers

Question 16

If I suspect cricopharyngeal dysphagia in my patient, what diagnostics should I perform?

Answer 16

I need to perform a swallow contrast videofluoroscopy

Question 17

If cricipharyngeal dysphagia is on my differnetial lsist, what conditions do I need to R/o?

Answer 17

myopathy or polyneuropathies
myasthenia gravis
Autoimmune myositis and muscular dystrophy
muscle biopsy
hypothyroidism

Question 18

Describe to your client the surgical treatment for cricopharyngeal dysphagia

Answer 18

we will conduct a surgical myotomy of the cricopharyngeal muscle i.e we will cut this muscle to allow for better passage of food

Question 19

If my client declines surgical repair for cricopharyngeal dysphagia, what are their other options?

Answer 19

gastrostomy tube or injection of botulinum toxin into the muscle- however this is temporary

Question 20

What is the only diagnostic test to evaluate functional dysphagias?

Answer 20

barium contrast videofluroscopy