Surgical Management of UES Procedures

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Questions and Answers

What is the main purpose of performing a cricopharyngeal myotomy?

To improve bolus flow by removing UES outlet obstruction (correct)

To attach tissue from the pharynx to the soft palate

To secure the airway and reduce aspiration

To completely remove the larynx

What is a common result of a total laryngectomy?

Improvement in glottic closure

Reduction in velopharyngeal insufficiency

Increased ability to perform vocal fold medialization

Potential prevention of aspiration (correct)

Which surgical procedure involves injecting Botox into the UES?

UES dilatation

UES botox injection (correct)

Pharyngeal flap surgery

Cricopharyngeal myotomy

What is the intended effect of pharyngeal flap surgery?

To reduce velopharyngeal insufficiency Signup and view all the answers

What surgical management would be appropriate for improving glottic closure?

Vocal fold medialization Signup and view all the answers

What is the primary goal of a cricopharyngeal myotomy?

To improve bolus flow by removing UES outlet obstruction Signup and view all the answers

Which procedure involves making an incision below the vocal folds?

Tracheostomy Signup and view all the answers

What is the intended effect of a botox injection in the UES?

To remove UES outlet obstruction Signup and view all the answers

What is a likely outcome of performing a total laryngectomy?

Complete removal of the larynx Signup and view all the answers

Which surgical procedure is performed to reduce velopharyngeal insufficiency?

Pharyngeal Flap Surgery Signup and view all the answers

What is the primary aim of performing a UES dilatation procedure?

To increase the size of the UES to improve bolus flow Signup and view all the answers

Which of the following is a potential benefit of performing a tracheostomy?

Securing the airway and reducing aspiration risk Signup and view all the answers

In which procedure is tissue obtained from the pharynx to be attached to the soft palate?

Velopharyngeal flap surgery Signup and view all the answers

What effect do both UES botox injections and UES cricopharyngeal myotomy have in common?

Both aim to eliminate UES outlet obstruction Signup and view all the answers

What is a key distinction between total laryngectomy and vocal fold medialization?

Total laryngectomy prevents aspiration through elimination of the larynx, whereas vocal fold medialization focuses on approximating vocal folds. Signup and view all the answers

Which procedure primarily aims to secure the airway while reducing aspiration risk?

Tracheostomy Signup and view all the answers

What surgical technique is used to improve bolus flow by addressing an outlet obstruction in the UES?

UES dilatation Signup and view all the answers

Which surgical procedure involves complete removal of a structure with the aim of preventing aspiration?

Total laryngectomy Signup and view all the answers

What is the main purpose of performing a pharyngeal flap surgery?

To reduce velopharyngeal insufficiency Signup and view all the answers

Which technique focuses on improving the approximation of vocal folds?

Vocal fold medialization Signup and view all the answers

What is the purpose of using capsaicin in medical management?

To improve pharyngeal sensory functions Signup and view all the answers

Which of the following distinguishes the insertion process of a Nasogastric Tube (NGT) from a Percutaneous Endoscopic Gastrostomy (PEG)?

NGT insertion is quick and easy compared to PEG Signup and view all the answers

What is a significant difference between the tube life of NGT and PEG?

PEG is designed to last up to 9 months or more Signup and view all the answers

What is a common problem encountered with the use of a Nasogastric Tube?

Arytenoid swelling Signup and view all the answers

Which statement accurately describes the replacement frequency of NGT compared to PEG?

NGT requires frequent replacement, while PEG is infrequently replaced Signup and view all the answers

What effect do cholinesterase inhibitor drugs have on involuntary muscle function?

They decrease the breakdown of acetylcholine Signup and view all the answers

What is the primary medical use of capsaicin in the context of management?

To enhance pharyngeal sensory functions Signup and view all the answers

Which statement correctly differentiates the insertion processes for NGT and PEG?

NGT insertion is performed without surgery, while PEG requires surgical placement. Signup and view all the answers

What is a significant side effect commonly encountered with the use of a Nasogastric Tube?

Mucosa scarring Signup and view all the answers

How do cholinesterase inhibitor drugs primarily affect involuntary muscle function?

They decrease the breakdown of acetylcholine. Signup and view all the answers

Which of the following represents a difference in the tube life between NGT and PEG?

PEG is designed to last up to 9 months. Signup and view all the answers

Why might enteral feeding via tube be necessary?

To provide nutrition when oral intake is impossible. Signup and view all the answers

What is the primary function of bolus modification in behavioral management?

To change the consistency or texture of foods and liquids Signup and view all the answers

Which of the following is NOT a characteristic of bolus modification?

It guarantees improvement in fluid intake Signup and view all the answers

How does bolus modification primarily affect aspiration events?

It reduces aspiration events like coughing Signup and view all the answers

What is a potential downside of bolus modification techniques according to current research?

They may not improve the odds of aspiration pneumonia Signup and view all the answers

Which aspect of behavioral management is addressed by compensatory techniques?

Improving patient postural adjustment Signup and view all the answers

What is a primary characteristic of compensatory strategies in dysphagia management?

They are considered quick fixes for swallowing issues. Signup and view all the answers

Which of the following compensatory strategies can be implemented to address anterior leakage during swallowing?

Use a straw for delivery Signup and view all the answers

What is an effective strategy for managing vallecular residue during swallowing?

Effortful swallow Signup and view all the answers

How is the efficacy of compensatory swallowing strategies typically evaluated?

Instrumental evaluation Signup and view all the answers

In the context of aspiration, which compensatory strategy is recommended?

Supraglottic swallow Signup and view all the answers

What strategy can help improve awareness of swallowing movement for individuals experiencing poor bolus awareness?

Verbal reminders Signup and view all the answers

What is the primary limitation of compensatory strategies for dysphagia?

They do not rehabilitate structure or physiology of swallow. Signup and view all the answers

Which strategy is effective for managing anterior leakage during swallowing?

Bolus placement more medial Signup and view all the answers

Which compensatory strategy is recommended for reducing vallecular residue?

Effortful swallow Signup and view all the answers

How is the efficacy of compensatory swallowing strategies typically evaluated?

Through instrumental evaluation. Signup and view all the answers

Which compensatory strategy is suitable for addressing aspiration?

Supraglottic swallow Signup and view all the answers

What adjustment can be made to help increase awareness towards swallowing movement for those with poor bolus awareness?

Verbal reminders regarding bolus quantity Signup and view all the answers

What is a common reason for prolonged mealtime in children?

The child may have a feeding disorder Signup and view all the answers

Which behavior might indicate a feeding problem in toddlers?

Refusal to eat unfamiliar foods Signup and view all the answers

What is a significant concern if a child has not gained weight in 2-3 months?

The child may be underweight or not building muscle Signup and view all the answers

Why should ages appropriate food choices be considered in feeding assessments?

To ensure nutritional adequacy for developmental stages Signup and view all the answers

What underlying factors should be evaluated when assessing pediatric feeding problems?

Motor skills, behavior, and sensory issues Signup and view all the answers

Which behavior should be considered when assessing potential trauma in feeding situations?

History of forced feeding Signup and view all the answers

What might limited food repertoire indicate in early childhood feeding assessments?

Potential oral motor difficulties Signup and view all the answers

What are two potential behavioral causes for a child's feeding problems?

Forced feeding practices and a history of trauma can contribute to feeding problems. Signup and view all the answers

How might a child's limited food repertoire affect their nutritional health?

A limited food repertoire can lead to inadequate nutrient intake and nutritional deficiencies. Signup and view all the answers

What factors should be considered when assessing a child's feeding issues?

Motor skills, behavioral history, and sensory processing need to be assessed. Signup and view all the answers

What is the recommended duration for a typical mealtime for children?

A typical mealtime should last around 30 to 40 minutes. Signup and view all the answers

What might indicate a sensory issue in a child's feeding process?

Refusal to eat certain or unfamiliar foods could indicate sensory issues. Signup and view all the answers

Mealtime takes more than ______ mins on average.

30 Signup and view all the answers

Children who consistently refuse to eat certain foods may experience ______.

food refusal Signup and view all the answers

A key factor to consider in therapy intervention is the child's ______ activity related to feeding.

motor Signup and view all the answers

A child who has not gained weight in the past ______ months may require further evaluation.

2-3 Signup and view all the answers

A limited food repertoire indicates the child only eats ______ foods repetitively.

specific Signup and view all the answers

Study Notes

Surgical Management Overview

Surgical intervention is considered when therapy fails to yield satisfactory results.
Most surgeries target the larynx or upper esophageal sphincter (UES).

UES Surgical Procedures

Cricopharyngeal Myotomy:
- Involves cutting the cricopharyngeus muscle to remove obstruction at the UES.
- Aims to enhance bolus flow.
Botox Injection:
- Botulinum toxin is injected into the UES.
- Effectively alleviates outlet obstruction, improving bolus passage.
Dilatation:
- Mechanical widening of the UES to eliminate constriction.
- Facilitates better bolus flow by correcting strictures.

Velopharyngeal Surgery

Pharyngeal Flap Surgery:
- Tissue from the pharynx is surgically attached to the soft palate.
- Intent is to reduce velopharyngeal insufficiency, aiding in speech clarity.

Laryngeal Surgical Interventions

Total Laryngectomy:
- Complete surgical removal of the larynx.
- Primarily performed to prevent aspiration.
Tracheostomy:
- Surgical incision made below the vocal folds with a tube inserted.
- Procedure secures the airway and minimizes the risk of aspiration.
Vocal Fold Medialization:
- A surgery aimed at improving glottic closure by repositioning or augmenting the vocal folds.
- Enhances the approximation of vocal folds for better voice quality.

Surgical Management Overview

Surgical intervention is considered when therapy fails to yield satisfactory results.
Most surgeries target the larynx or upper esophageal sphincter (UES).

UES Surgical Procedures

Cricopharyngeal Myotomy:
- Involves cutting the cricopharyngeus muscle to remove obstruction at the UES.
- Aims to enhance bolus flow.
Botox Injection:
- Botulinum toxin is injected into the UES.
- Effectively alleviates outlet obstruction, improving bolus passage.
Dilatation:
- Mechanical widening of the UES to eliminate constriction.
- Facilitates better bolus flow by correcting strictures.

Velopharyngeal Surgery

Pharyngeal Flap Surgery:
- Tissue from the pharynx is surgically attached to the soft palate.
- Intent is to reduce velopharyngeal insufficiency, aiding in speech clarity.

Laryngeal Surgical Interventions

Total Laryngectomy:
- Complete surgical removal of the larynx.
- Primarily performed to prevent aspiration.
Tracheostomy:
- Surgical incision made below the vocal folds with a tube inserted.
- Procedure secures the airway and minimizes the risk of aspiration.
Vocal Fold Medialization:
- A surgery aimed at improving glottic closure by repositioning or augmenting the vocal folds.
- Enhances the approximation of vocal folds for better voice quality.

Surgical Management Overview

Surgical intervention is considered when therapy fails to yield satisfactory results.
Most surgeries target the larynx or upper esophageal sphincter (UES).

UES Surgical Procedures

Cricopharyngeal Myotomy:
- Involves cutting the cricopharyngeus muscle to remove obstruction at the UES.
- Aims to enhance bolus flow.
Botox Injection:
- Botulinum toxin is injected into the UES.
- Effectively alleviates outlet obstruction, improving bolus passage.
Dilatation:
- Mechanical widening of the UES to eliminate constriction.
- Facilitates better bolus flow by correcting strictures.

Velopharyngeal Surgery

Pharyngeal Flap Surgery:
- Tissue from the pharynx is surgically attached to the soft palate.
- Intent is to reduce velopharyngeal insufficiency, aiding in speech clarity.

Laryngeal Surgical Interventions

Total Laryngectomy:
- Complete surgical removal of the larynx.
- Primarily performed to prevent aspiration.
Tracheostomy:
- Surgical incision made below the vocal folds with a tube inserted.
- Procedure secures the airway and minimizes the risk of aspiration.
Vocal Fold Medialization:
- A surgery aimed at improving glottic closure by repositioning or augmenting the vocal folds.
- Enhances the approximation of vocal folds for better voice quality.

Surgical Management Overview

Surgical intervention is considered when therapy fails to yield satisfactory results.
Most surgeries target the larynx or upper esophageal sphincter (UES).

UES Surgical Procedures

Cricopharyngeal Myotomy:
- Involves cutting the cricopharyngeus muscle to remove obstruction at the UES.
- Aims to enhance bolus flow.
Botox Injection:
- Botulinum toxin is injected into the UES.
- Effectively alleviates outlet obstruction, improving bolus passage.
Dilatation:
- Mechanical widening of the UES to eliminate constriction.
- Facilitates better bolus flow by correcting strictures.

Velopharyngeal Surgery

Pharyngeal Flap Surgery:
- Tissue from the pharynx is surgically attached to the soft palate.
- Intent is to reduce velopharyngeal insufficiency, aiding in speech clarity.

Laryngeal Surgical Interventions

Total Laryngectomy:
- Complete surgical removal of the larynx.
- Primarily performed to prevent aspiration.
Tracheostomy:
- Surgical incision made below the vocal folds with a tube inserted.
- Procedure secures the airway and minimizes the risk of aspiration.
Vocal Fold Medialization:
- A surgery aimed at improving glottic closure by repositioning or augmenting the vocal folds.
- Enhances the approximation of vocal folds for better voice quality.

Pharmacological Management

Capsaicin: Ingredient derived from hot peppers; enhances the release of substance P, leading to improved pharyngeal sensory functions.
Cholinesterase Inhibitors: Commonly found in medications for Alzheimer’s disease and Myasthenia Gravis; these drugs inhibit the breakdown of acetylcholine, thereby enhancing involuntary muscle function from the pharynx to the larynx.

Enteral Feeding/Tubefeed Management

Indications for Tube Feeding: Used when there is an inability to obtain adequate nutrition orally and when airway protection is compromised during swallowing.
Types of Feeding Tubes:
- Nasogastric Tube (NGT):
  - Insertion is easy and quick.
  - Typically lasts around 1 month.
  - Requires infrequent replacements.
  - Higher patient discomfort due to invasiveness.
  - Common issues include mucosa scarring, arytenoid swelling, infections, tube obstruction, and displacement.
- Percutaneous Endoscopic Gastrostomy (PEG):
  - Requires a surgical procedure for insertion; more invasive.
  - Designed for longer-term use, functioning for up to 9 months or more.
  - Patient discomfort is lower compared to NGT.
Therapeutic Interventions: Aimed at enhancing tolerance for various food and liquid consistencies until tube feeding is no longer necessary.

Pharmacological Management

Capsaicin: Ingredient derived from hot peppers; enhances the release of substance P, leading to improved pharyngeal sensory functions.
Cholinesterase Inhibitors: Commonly found in medications for Alzheimer’s disease and Myasthenia Gravis; these drugs inhibit the breakdown of acetylcholine, thereby enhancing involuntary muscle function from the pharynx to the larynx.

Enteral Feeding/Tubefeed Management

Indications for Tube Feeding: Used when there is an inability to obtain adequate nutrition orally and when airway protection is compromised during swallowing.
Types of Feeding Tubes:
- Nasogastric Tube (NGT):
  - Insertion is easy and quick.
  - Typically lasts around 1 month.
  - Requires infrequent replacements.
  - Higher patient discomfort due to invasiveness.
  - Common issues include mucosa scarring, arytenoid swelling, infections, tube obstruction, and displacement.
- Percutaneous Endoscopic Gastrostomy (PEG):
  - Requires a surgical procedure for insertion; more invasive.
  - Designed for longer-term use, functioning for up to 9 months or more.
  - Patient discomfort is lower compared to NGT.
Therapeutic Interventions: Aimed at enhancing tolerance for various food and liquid consistencies until tube feeding is no longer necessary.

Behavioral Management

Focuses on modifying various components to improve swallowing and reduce aspiration risks.
Four main areas of modification include diet, patient posture, swallowing techniques, and structure through rehabilitation exercises.

Bolus Modification

Involves changing the consistency or texture of foods and liquids to enhance safety during swallowing.
Follow International Dysphagia Diet Standardisation Initiative (IDDSI) levels to guide modifications.
Changes can include altering the size or taste of boluses to suit patient needs.
Aims to reduce aspiration events, such as coughing during eating and drinking.
Current research indicates limited benefits beyond aspiration reduction, showing little improvement in fluid intake or decreased risk of aspiration pneumonia.

Compensatory Strategies in Dysphagia

Compensatory strategies involve posture adjustments, swallowing maneuvers, and sensory enhancements.
These strategies serve as "quick fixes" but do not rehabilitate swallowing structure or physiology.
Effectiveness is evaluated through instrumental assessments.

Issues in Swallowing Phases and Corresponding Strategies

Poor Bolus Awareness
- Utilize verbal reminders to enhance awareness, such as announcing the food type and amount.
- Improve sensory input through enhanced taste or aroma.
Anterior Leakage
- Adjust bolus placement for better control, keeping it more medial in the mouth.
- Employ tools like straws or syringes for more effective delivery.
Oral Residue
- Perform finger sweeps or lingual sweeps to clear remaining food debris from the mouth.
Nasal Regurgitation
- Reduce the size of the bolus to minimize risk.
- Encourage effortful swallowing and cueing to increase awareness during the swallowing process.
Vallecular Residue
- Solutions include throat clearing, suctioning, and effortful or cued swallowing to clear residue.
Pyriform Sinus Residue (often seen with liquids)
- Encourage volitional coughing, effortful swallowing, and cued swallowing to eliminate residue.
Penetration
- Use techniques such as the supraglottic swallow and intentional coughing.
- Implement cued swallowing to ensure safe swallowing.
Aspiration
- Monitor vocal quality as a sign of aspiration risk.
- Utilize the supraglottic swallow and cued swallowing for safer swallowing.
Pharyngeal Regurgitation
- Decrease bolus size to lower the risk of regurgitation.
- Use cyclic ingestion strategy: alternate between solids and liquids during meals.

Compensatory Strategies in Dysphagia

Compensatory strategies involve posture adjustments, swallowing maneuvers, and sensory enhancements.
These strategies serve as "quick fixes" but do not rehabilitate swallowing structure or physiology.
Effectiveness is evaluated through instrumental assessments.

Issues in Swallowing Phases and Corresponding Strategies

Poor Bolus Awareness
- Utilize verbal reminders to enhance awareness, such as announcing the food type and amount.
- Improve sensory input through enhanced taste or aroma.
Anterior Leakage
- Adjust bolus placement for better control, keeping it more medial in the mouth.
- Employ tools like straws or syringes for more effective delivery.
Oral Residue
- Perform finger sweeps or lingual sweeps to clear remaining food debris from the mouth.
Nasal Regurgitation
- Reduce the size of the bolus to minimize risk.
- Encourage effortful swallowing and cueing to increase awareness during the swallowing process.
Vallecular Residue
- Solutions include throat clearing, suctioning, and effortful or cued swallowing to clear residue.
Pyriform Sinus Residue (often seen with liquids)
- Encourage volitional coughing, effortful swallowing, and cued swallowing to eliminate residue.
Penetration
- Use techniques such as the supraglottic swallow and intentional coughing.
- Implement cued swallowing to ensure safe swallowing.
Aspiration
- Monitor vocal quality as a sign of aspiration risk.
- Utilize the supraglottic swallow and cued swallowing for safer swallowing.
Pharyngeal Regurgitation
- Decrease bolus size to lower the risk of regurgitation.
- Use cyclic ingestion strategy: alternate between solids and liquids during meals.

Feeding Process and Pediatric Concerns

Mealtime duration exceeding 30 minutes is common, with typical meals taking 30 to 40 minutes.
Disruptive and stressful feeding environments can lead to behavioral issues such as crying or restlessness during meals.
Lack of weight gain over the past 2 to 3 months may indicate the child is underweight and not building muscle mass effectively.
A limited food repertoire is characterized by the child repetitively eating only select foods, indicating a lack of dietary variety.
Food refusal includes a child's rejection of certain or unfamiliar foods, potentially limiting nutritional intake.
Age-inappropriate food choices can occur, such as a 6-year-old child only consuming rice porridge (lugaw), raising concerns for developmental nutrition.

Primary Factors in Therapy Intervention

Motor skills are crucial in feeding, requiring coordination of multiple muscle groups involved in the process.
Behavioral aspects should be assessed, including any history of forced feeding or trauma that may impact a child's willingness to eat.
Sensory considerations play a role in feeding difficulties, necessitating an understanding of how sensory sensitivities may affect food acceptance.

Feeding Process and Pediatric Concerns

Mealtime duration exceeding 30 minutes is common, with typical meals taking 30 to 40 minutes.
Disruptive and stressful feeding environments can lead to behavioral issues such as crying or restlessness during meals.
Lack of weight gain over the past 2 to 3 months may indicate the child is underweight and not building muscle mass effectively.
A limited food repertoire is characterized by the child repetitively eating only select foods, indicating a lack of dietary variety.
Food refusal includes a child's rejection of certain or unfamiliar foods, potentially limiting nutritional intake.
Age-inappropriate food choices can occur, such as a 6-year-old child only consuming rice porridge (lugaw), raising concerns for developmental nutrition.

Primary Factors in Therapy Intervention

Motor skills are crucial in feeding, requiring coordination of multiple muscle groups involved in the process.
Behavioral aspects should be assessed, including any history of forced feeding or trauma that may impact a child's willingness to eat.
Sensory considerations play a role in feeding difficulties, necessitating an understanding of how sensory sensitivities may affect food acceptance.

Feeding Process and Pediatric Concerns

Mealtime duration exceeding 30 minutes is common, with typical meals taking 30 to 40 minutes.
Disruptive and stressful feeding environments can lead to behavioral issues such as crying or restlessness during meals.
Lack of weight gain over the past 2 to 3 months may indicate the child is underweight and not building muscle mass effectively.
A limited food repertoire is characterized by the child repetitively eating only select foods, indicating a lack of dietary variety.
Food refusal includes a child's rejection of certain or unfamiliar foods, potentially limiting nutritional intake.
Age-inappropriate food choices can occur, such as a 6-year-old child only consuming rice porridge (lugaw), raising concerns for developmental nutrition.

Primary Factors in Therapy Intervention

Motor skills are crucial in feeding, requiring coordination of multiple muscle groups involved in the process.
Behavioral aspects should be assessed, including any history of forced feeding or trauma that may impact a child's willingness to eat.
Sensory considerations play a role in feeding difficulties, necessitating an understanding of how sensory sensitivities may affect food acceptance.

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Description

This quiz covers the surgical management techniques for treating disorders of the upper esophageal sphincter (UES) and velopharynx, including procedures like myotomy, botox injections, and pharyngeal flap surgery. Understand the intended effects and implications of each surgical intervention.