Imaging of the oral cavity and oesophagus

Question 1

Best modality for imaging the oral cavity (excluding teeth)

Answer 1

Assessment limited on radiographs

CT used - in particular soft tissues

Prehension of food- with fluoroscopy

Question 2

Imaging the oesophagus

Answer 2

Normally not visible - left lateral fluid in oesophagus

Contrast useful for:
○ Radiolucent FB/masses
○ Strictures
○ VRA
perforation/fistula
○ Hernia/diverticulum
○ Oesophagitis
○ Functional evaluation/dysphagia

CT as an adjunct modality

Ultrasonography for accessible areas

Question 3

What to evaluate with fluoroscopy of the oesophagus

Answer 3

Bolus formation

Pharyngeal and tongue movement

Pharyngeal clearing of barium

Cricopharyngeal sphincter function

Primary and secondary waves

Lower gastro-oesophageal sphincter function

Question 4

Pathologies of the oesophagus that can be visualised with radiograph +/- fluroroscopy

Answer 4

Megaoesophagus
- ventral displacement of trachea
- wide oesophagus

Oesophageal stricture
- wide oesophagus cranially and then very narrow

Oesophageal FB
- can see it hopefully

Oesophageal dilation
- dilation or megaoesophagus?

Sliding hiatal hernia
- fundus slides through

Vascular ring anomaly
- similar to stricture
- vasculature constricting oesophagus

Oesophageal perforation
- may see pneumomediatinum and free fluid

Question 5

Indications for fluoroscopy of the oesophagus

Answer 5

• Dysphagia
  
  • Oesophageal dysmobiliy
  • Oesophagitis
  • Foreign bodies
  • Gastrooesophageal sphincter
    ○ Hernias
    ○ Reflux
    ○ Dysphagia