Structural Dysphagia

Question 1

Types/Causes of structural dysphagia:
endo?
...
.. surgeries or abnormality 
-carotid 
-...
-.. changes
-... CAs

Answer 1

endotracheal intubation 
tracheotomy 
cervical spinal surgeries 
endarterectomy 
infections 
esophageal changes
head and neck CAs

Question 2

Endotracheal intubation: 
used to ? 
prolonged ET intubation leads to or increases risk of: 
-... dysphagia 
-.... during intubation 
-...
-...
-... stenosis

Answer 2

ventilate pts in emergencies/during surgeries

post-extubation dysphagia 
vocal fold immobility 
aspiration 
granulomas 
subglottic tracheal stenosis

Question 3

Tracheostomy: 
inhale and exhale only through 
inflated cuff can? 
no airflow through ? 
lack of ? 
... located inferior to VCs 
vocal cords remain 
open system at ? 
reduced 
no natural ?

Answer 3

through tube 
tether larynx 
upper airway 
sensation in oropharynx 
baroreceptors 
open 
VCs and at trach tube 
sense of smell and taste 
PEEP leading to decreased oxygenation

Question 4

Physiological benefits of PMSSV
-first ? larynx not? 
inflated cuff does not ? 
PMV auto ? 
column of air after inhalation: 
PMV allows ? 
restored sense of ? 
VCs ?

Answer 4

deflate cuff of trach tube / tethered

prevent aspiration

closes causing closed system

prevents secretion backflow

airflow past vocal cords to allow phonation

smell and taste

close during swallow/restored pressure

Question 5

Physiological benefits continued: 
increased 
better 
swallow is both 
positive ? negative? 
restored 
improved 
exhaling through ?
pts transition to ?

Answer 5

sensation

cough

mechanical and pneumatic

pressure in trachea/pressure in esophagus

peep

upper airway aids in weaning

decanulation 3-5 days faster than capping

Question 6

Benefit highlights:
restored

deflated cuff allows

restored ? through ?

improved airflow through ?

restored ?

Answer 6

closed system

larynx to elevate and epiglottis to invert

airflow/upper airway improving sensation, taste, and smell

vocal cords allowing them to close and protect swallow

subglottic pressure allowing increased PEEP/oxygenation

Question 7

Cervical spine Sx:
anterior approach is most ?

-

Answer 7

risky

• denervation
• infection
• inflammatory response

Question 8

Osteophytes:
dependent on ?
-may impinge upon? and interfere with ?

Answer 8

location on cervical spine

hypopharynx/ bolus propulsion and or airway protection

Question 9

Head and Neck Cancers: 
dysphagias may be caused by? or by? 
-
-
-
-

Answer 9

cancer itself/ treatment used to cure/mitigate cancer

tumors
surgeries -resections
chemotherapy
radiation therapy

Question 10

Mandibulectomy:
removal of ? 
-
-
-
most expected is reduced ?

Answer 10

anterior portion of mandible

• drooling
• decreased oral manipulation of bolus
• reduced hyolaryngeal elevation

reduced efficacy of mastication of solids

Question 11

Glossectomy:
partial ?
hemi?
-usually does not cause

anterior ?
-more involved with

base of tongue ?
-… deficits

Answer 11

glossectomy
hemiglossectomy
-substantial dysphagia

resection with flap
-oral dysphagia

resection
-pharyngeal

Question 12

Hemilaryngectomy: 
removal of one ? including? 
usually excludes: 
can be extended to include ? 
-this puts pt at higher risk of 

reconstructed with ? on operated side against which the unoperated side can achieve?

Answer 12

vertical half of the larynx / one FVC, ventricle, TVC, portion of thyroid cartilage on involved side

hyoid and epiglottis

portion of anterior commissure and opposite arytenoids
-aspiration

tissue bulk/ closure for airway protection

Question 13

Supraglottic laryngectomy:
usually part or all of ?
-removal of structures that contribute to ?

BOT, arytenoids and TVCs remaining

can extend inferiorly to include

can extend superiorly to include

sometimes requires

may need to convert to ? if permanent trach or chronic aspiration

reconstruction usually elevates ?

patient must learn to ?

Answer 13

hyoid and epiglottis, aryepiglottic folds, and FVCs
-airway protection

protective mechanism

part of one TVF and aytenoids

part of tongue base

permanent trach

TL

remaining larynx and tucks under tongue base (laryngeal suspension)

protect airway during swallow

Question 14

Total laryngectomy: 
removal of 
entire 
... cartilage 
-
-
-
-
-

Answer 14

cricoid cartilage 
thyroid cartilage 
epiglottis 
hyoid 
arytenoids 
TVF 
FVF

Question 15

radiation/chemo therapy
may result in
-
-
-tissue 
-
-changes 
-
-

Answer 15

wight loss 
xerostomia 
tissue necrosis 
edema 
sensory changes 
fibrosis 
trismus