Soft Palate, Pharynx, Larynx

Question 1

Negative Nasopharyngography CM

Answer 1

Air

Question 2

Negative and Positive Nasopharyngography indication/s

Answer 2

Hypertrophy of the pharyngeal tonsil or adenoids

Question 3

Negative Nasopharyngography proj/ view

Answer 3

Lateral

Question 4

Negative Nasopharyngography pt/ strucure posn

Answer 4

Sitted laterally-front VGD; head- true lat posn

Question 5

Negative Nasopharyngography cxt and crd

Answer 5

8x10/ 10x12- longit- VCH/VGD;
3/4” (1.9cm) anterior to EAM

Question 6

Negative Nasopharyngography SN

Answer 6

Exposure–during intake deep breath through nose

Question 7

Positive Nasopharyngography CM

Answer 7

10-15cc iodized oil (dianosil oil) or finely ground barium sulfate

Question 8

Positive Nasopharyngography procedure

Answer 8

1. Orient pt regarding procedure
2. Ask pt to refrain from sneezing and inhibit CM swallowing during exam
3. Pt to follow instructions carefully

Question 9

Nasopharyngography projection/s

Answer 9

• Submentovertical (SMV)
• Lateral
• Chittinand, Patheja, and Wisenberg

Question 10

SMV Nasopharyngography pr posn

Answer 10

Supine: shoulders same transverse plane; OML- 40-45deg to a horizontal plane;
1st: no cm; 2nd: w/cm
keep head in this posn for entire exam

Question 11

SMV Nasopharyngography cxt and crd

Answer 11

10*12- longit- VCH/VGD;
15-20deg cephalad bn mandibular angles

Question 12

SMV Nasopharyngography SN

Answer 12

Position pt on RT after local anesthetization

Question 13

Nasopharyngography Lat Posn: Pt

Answer 13

Supine: shoulders same transverse plane; OML- 40-45deg to a horizontal plane

Question 14

Nasopharyngography Lat Posn CXT and CRD

Answer 14

10*12 vertical CW at lat L side of pt’s head- supported sandbag;
horizontally to 3/4” (1.9cm) anterior to EAM

Question 15

Nasopharyngography Lat Posn SN

Answer 15

After this phase, pt- sit up and blow nose to evacuate CM; remainder to be swallowed

Question 16

Chittinand, Patheja, and Wisenberg Pt Posn (nasopharyngo)

Answer 16

Sitted before VGD
1. prelim lat and SMV
2. Spray water–each nasal cavity
3. Spray micropaque powder- each nostril
4. 2 SMV proj; at rest and during modified valsalva (air blown w cheek puffed out)
5. 1 lat proj

Question 17

Chittinand, Patheja, and Wisenberg Nasopharyngography SN

Answer 17

• No anesthisia
• Use of standard spray bottle
• Have pt blow nose, rest is swallowed
• Immediate CXR should not reveal ba in lungs
• 24hr follow-up radiography should reveal complete cleaning of nasopharynx

Question 18

Palatography indications

Answer 18

Bloch and Quantrill: Tumors
Morgan et al: Chewing and swallowing abnormalities in children; Cleft palate

Question 19

Bloch and Quantrill CM used

Answer 19

Thick, creamy BaSO4 (Ba Sulfate) suspension

Question 20

Bloch and Quantrill pt posn/ procedure

Answer 20

Sitted lat in front VGD;
1st image: pt- swallow CM
2nd: 0.5ml injected into each nasal cavity

Question 21

Bloch and Quantrill CXT and CRD

Answer 21

810/ 1012 longit- VCH/VGD centered on the nasopharynx (3/4” or 1.9cm anterio to the EAM)

Question 22

Chewing and swallowing abnormalities in children CM

Answer 22

Ba-impregnated chocolate fudge

Question 23

Chewing and swallowing abnormalities in children Pt/ Structure Posn

Answer 23

Sitted lat in front VGD; child- chew- ba-impregnated choco fudge

Question 24

Chewing and swallowing abnormalities in children SN

Answer 24

w/ cineradiography

Question 25

Cleft palate studies are performed in the following manner:

Answer 25

pt- sitted laterally--in front VGD; IR centered at nasopharynx (3/1" or 1.9cm anterior to the EAM) *** for cleft palate studies: 1" below EAM *** make exposures during phonation (d-a-h, m-m-m, e-e-e)

Question 26

Why make exposure during phonation? (Palatography)

Answer 26

To deme range of soft Palate movement and tongue position

Question 27

Pharyngography CM

Answer 27

Thick, creamy mixture of water and barium Sulfate (50%-50%)

Question 28

Pharyngography SN

Answer 28

- usually carried out using fluoroscopy w/ spot-film images only - synchronized w a rapid exposure w the shortest exposure time - may use fluoroscopic equipment w spot radiography/ video tape/ cine film

Question 29

Pharyngography Procedure

Answer 29

1. Scout film- AP/ Lat 2. Pt- hold ba Sulfate w bolus in the mouth until signaled, and then swallow the bolus in one movement (full distention- tables spoon) 3. Expo during deglutition 4. If mucosal study- ask pt- refrain swalling again 5. Take mucosal study during modified valsalva maneiver for double-contrast delineation

Question 30

Pharyngography proj/s

Answer 30

1. AP 2. Lat

Question 31

AP Pharyngography pt posn

Answer 31

Conventional sitting/ standing in front VGD/ VCH- MSP of neck coincide MLL of CXT

Question 32

AP Pharyngography CXT and CRD

Answer 32

8*10- longit- VCH/VGD; MSP at laryngeal prominence (C3-C4)

Question 33

Lat Pharyngography pt posn

Answer 33

Conventional sitting/ standing laterally in front of VGD/ VCH- coronal plane just anterior TMJ to coincide w MLL of CXT; neck slightly exteded

Question 34

Lat Pharyngography CXT and CRD

Answer 34

horizontally 72" TMJ; coronal plane at laryngeal prom (C3-C4)

Question 35

Pharyngography Added Methods

Answer 35

1. Guns on Method 2. Templeton and Kredel

Question 36

Tie a dark-colored shoestring snugly around pt's throat above thyroid cartilage (displacement coincides w anterior and superior cartilage movement)

Answer 36

Gunson method

Question 37

Action of CM is so rapid that expo be made as soon as anterior movement is made

Answer 37

Templeton and Kredel