stuff mr. fix said

2 comorbidities that may result in pediatric/infant dysphagia

1) prematurity (before 37 weeks)

2) cerebral palsy ("stroke during childbirth" - brain damage via lack of brain to oxygen, resulting in neurological motor/muscular issues)

what kinds of dysphagia signs & symptoms might infants have (drinking milk)?

- lack of bolus control (spillage out of mouth, inability to create a seal)

- coughing, crying, turning head away from food

- longer duration of feeding times

- splaying of fingers, arching of back

what signs & symptoms of aspiration specifically might infants have (drinking milk)?

- coughing

- splaying of fingers

- arching of back

transitioning from formula/milk to solid foods for the first time helps develop what 3 skills?

1) mastication / rotary chew

2) jaw strengthening

3) managing different bolus sizes/textures

what's the engine of the swallow

brainstem

are CNs in the brain?

heck no

part of PNS

(not CNS)

should always do ___________ assessment first (like ________), before ________ assessment

clinical, like bedside

before instrumental

list instrumental assessments

MBS

FEES

(also manometry used by ENTs ab pressures)

limitations of FEES

- cannot see during swallow bc of white out (via reflection into camera) so we can only see before & after swallow

(but MBS can)

- cannot measure how much hyolaryngeal complex moves during swallow (but MBS can)

pros of FEES

- longer duration so can see entire meal

- can see how fatigue impacts swallow function & at what length of meal (e.g., for MG)

- mobile/portable

- less expensive

erythema = _________

might indicate __________

redness

acid reflux

most common type of stroke & artery

ischemic, MCA

hemorrhagic vs. ischemic

hemorrhagic = burst, spillage of excess blood into skull leads to lack of oxygen in a v squished brain

ischemic = blockage, lack of oxygen

in both types of strokes there's not enough _______

oxygen to certain parts of brain

Generally, ischemic strokes are typically more _________ damage & hemorrhagic strokes are typically more _________ damage.

ischemic = focal

hemorrhagic = diffuse

** what are the 2 variables that help predict outcomes of strokes? **

(1) site

and

(2) extent

of lesion

stroke symptoms are commonly ____________.

one-sided (hemiparesis, etc.)

Generally, dysphagia can be summed up as either a (1)__________, (2)___________, or (3)____________ problem.

1) motor

2) sensory

3) coordination

hemilaryngectomy

removal of one vertical half of the larynx, including 1 of each of the following:

- false VF

- true VF

- ventricle (between TVF and FVF)

- portion of thyroid cartilage

usually excludes hyoid & epiglottis

can be extended to include portion of anterior commissure & opposite arytenoids (puts patient at greater risk for aspiration)

reconstructed with tissue bulk on operated side against which the unoperated side can achieve closure for airway protection & voice

supraglottic laryngectomy

usually part or all of hyoid & epiglottis, aryepiglottic folds, & false VFs (removal of structures that contribute to airway protection)

BOT, arytenoids, & TVCs remain to protecc

can extend inferiorly to include part of one TVC & arytenoids

sometimes requires permanent trach; may need to convert to TL if permanent trach &/or chronic aspiration

reconstruction usually elevates remaining larynx & tucks under tongue base (laryngeal suspension)

pt must learn to protect airway during swallow

total laryngectomy

removal of:

- entire cricoid cartilage

- thyroid cartilage

- epiglottis

- hyoid

- arytenoids

- TVFs

- FVFs

what are potential complications of supraglottic laryngectomy?

what might be done bc of these complications?

permanent trach

chronic aspiration

convert to total laryngectomy

following a supraglottic laryngectomy, the pt must learn to _______________ during swallowing.

protect the airway

In a supraglottic laryngectomy, reconstruction usually _________ remaining larynx & __________________. (this is ____________________)

elevates remaining larynx & tucks under BOT

laryngeal suspension

In a hemilaryngectomy, the operated side is reconstructed with tissue in order to.....

allow the remaining/unoperated side to still achieve closure for airway protection & voicing

A supraglottic laryngectomy compromises what?

airway protection

(it removes structures that airway protecc)

list what's removed in a hemilaryngectomy

what remains?

vertical half of larynx is outta here:

- 1 TVF

- 1 FVF

- 1 ventricle

- portion of thyroid cartilage on that side

hyoid & epiglottis r here 2 stay 😌

list what's removed in a supraglottic laryngectomy

what remains?

structures that protecc airway r gone 😔

part or all of:

- hyoid

- epiglottis

- aryepiglottic folds

- false VFs

BOT, arytenoids, & TVCs r here 2 stay 😌

(but the removal can extend inferiorly to include part of 1 TVC & arytenoids, & can extend superiorly to include part of BOT)