Oropharyngeal dysphagias in the dog: A cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders

Cinefluorography and videofluorography were used to record and analyze functional swallowing deficits of 12 dogs with spontaneously occurring oropharyngeal dysphagias and six experimental dogs with selected neurectomies. Ten of the 12 dogs had dysphagias affecting the cricopharyngeal stage of the oropharyngeal phase of swallowing. Two dogs had mixed oropharyngeal dysphagias. Clinical signs of cricopharyngeal dysphagia could not be differentiated from those of dysphagias due to pharyngeal or mixed oropharyngeal deficits. Signs of cricopharyngeal dysphagia consisted of: 1) repeated attempts to swallow; 2) excessive head movement; 3) dropping food from the mouth after unsuccessful swallowing attempts; 4) reingestion of dropped food. Nine of these dogs had cinefluorographic evidence of asynchrony between the normal pharyngeal contraction and relaxation, and subsequent cricopharyngeal relaxation and contraction. Only one dog demonstrated a consistent cricopharyngeal non-opening (achalasia). Seven of the dogs responded dramatically to cricopharyngeal myotomy. Two dogs with mixed oropharyngeal dysphagias had poor contractility of the pharyngeal muscles in addition to cricopharyngeal dysphagia. Clinical and cinefluorographic evaluation following cricopharyngeal myotomy of one dog verified exacerbation of functional deficits due to the iatrogenic cricopharyngeal chalasia. Esophagopharyngeal reflux accentuated the contrast medium retention in the pharynx and laryngotracheal aspiration. The need was stressed for careful differentiation between cricopharyngeal dysphagia and dysphagias involving the pharyngeal stage. Four experimental dogs with selective bilateral neurectomies of branches of the glossopharyngeal (IX) and vagus (X) nerves were evaluated clinically and cinefluorographically in an attempt to identify the pathogenesis of cricopharyngeal dysphagia. The variable results in the four dogs and the observed recovery in two dogs suggested that peripheral motor nerve deficits are not a major cause of cricopharyngeal dysphagia. Glossopharyngeal neurectomy in two dogs induced a profound functional disorder involving the pharyngeal and cricopharyngeal stages and the esophageal phase of swallowing. This would support a new hypothesis that the glossopharyngeal nerve is sensory to the esophagus as well as the pharynx, and may play a major role in disorders of the pharynx, upper esophageal sphincter, and esophagus, including congenital or acquired megaesophagus.     

针刺治疗脑卒中后吞咽障碍临床疗效的系统评价

目的 采用Meta分析评价针刺与其他常规方法治疗脑卒中后吞咽障碍的临床疗效。方法 计算机检索建库至2018年12月中国期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库、PubMed数据库中针刺治疗脑卒中后吞咽障碍的临床随机对照研究,并辅以人工检索湖南中医药大学图书馆的过刊资料库,制定文献纳入及排除标准,提取资料,评价纳入文献的质量,利用Revman 5.3软件进行Meta分析。结果 共纳入28篇文献,病例数2 557例。Meta分析结果提示治疗组对吞咽障碍的总有效率优于对照组（Z=12.51,P<0.000 01）,且治疗组在改善MBI评分、SWAL-QOL评分方面优于对照组,差异有统计学意义（P<0.05）;但治疗组在改善患者肺部感染情况上无明显优势,与治疗组差异无统计学意义（P>0.05）。结论 针刺治疗脑卒中后吞咽障碍可提高现代康复治疗的临床疗效,有助于改善患者日常生活活动能力和生活质量,但由于本研究纳入的文献数量和质量存在不足,仍需进一步研究予以证实。     

Penetrating injury at the thoracic inlet in a Paint‐Arab mare

A 12‐year‐old Paint‐Arab mare was admitted for evaluation of a penetrating chest laceration at the thoracic inlet. The left brachiocephalic muscle was transected and the recurrent laryngeal nerve was traumatised. Subsequent to the injury, the horse developed Horner's syndrome on the left side of the neck and face, Grade IV left laryngeal hemiplegia, dysphagia, cough and subcutaneous emphysema. The defect was closed in multiple layers. Antimicrobial and antiinflammatory therapy was instituted along with local wound care. The mare remained bright and responsive and the wound healed normally. The mare showed no signs of respiratory distress. Dysphagia and ptosis persisted at 30 days post trauma.     

EFFECT OF BOLUS SIZE ON DEGLUTITION AND ESOPHAGEAL TRANSIT IN HEALTHY DOGS

Contrast videofluoroscopy is the gold standard procedure for evaluating dysphagia in humans, but quantitative measures vary depending on bolus size and consistency. We hypothesized that quantitative measures made during videofluoroscopy of swallowing in dogs would differ between bolus sizes and consistencies. Ten healthy adult dogs were enrolled a prospective, crossover experimental study and underwent contrast videofluoroscopy while swallowing liquid (5, 10, and 15 ml) and canned food (3, 8, and 12 g) boluses. Maximum pharyngeal contraction occurred significantly later with medium solid boluses than with medium liquid boluses, with a mean difference of 0.021 s (adjusted P = 0.042). Upper esophageal sphincter opening occurred significantly earlier with large solid boluses than with medium solid boluses, with a mean difference of 0.018 s (adjusted P = 0.025). Thoracic esophageal transit time was significantly longer with small solid boluses than with small liquid boluses, with a mean difference of 0.68 s (adjusted P = 0.004). Odds of primary esophageal peristalsis occurring were significantly (18.5 times) higher with large solid vs. large liquid boluses (adjusted P = 0.031). No other statistical comparisons reached significance. Based on these results, we recommend a standardized approach to videofluoscopy in dogs with determination of quantitative measures using medium liquid and soft food boluses to minimize effects of size. Furthermore, we conclude that measurements made on liquid swallows should not be directly compared to measurements made on soft food boluses.     

Resolution of life-threatening dysphagia caused by caudal occipital malformation syndrome following foramen magnum decompressive surgery

A Cavalier King Charles Spaniel was presented with acute onset, life-threatening dysphagia suspected to be secondary to medulla oblongata compression caused by caudal occipital malformation syndrome. The patient required urgent tracheostomy tube placement to remain stable and was subsequently cured of the presenting neurological deficits by foramen magnum decompressive surgery. Neurogenic dysphagia is a relatively common presenting sign in human Chiari malformation syndromes, but has not been described as a major clinical sign in veterinary patients. Caudal occipital malformation syndrome should be included in the differential diagnosis list for susceptible breeds presenting with dysphagia. Early recognition favours expeditious surgical intervention and a positive outcome in human patients, and this may also be the case in veterinary patients.     

OROPHARYNGEAE DYSPHAGIAS IN THE DOG: A CINEFLUOROGRAPHIC ANALYSIS OF EXPERIMENTALLY INDUCED AND SPONTANEOUSLY OCCURRING SWALLOWING DISORDERS

Cinefluorography and videoflurography were used to record and analyze the functional swallowing deficits of nine dogs with spontaneous oropharyngeal swallowing problems. Based on the clinical and radiographic signs observed in one dog with experimentally induced bilateral hypoglossal palsy and comparison with cinefluorograms of normal dogs, the nine spontaneous dysphagias were divided into five oral dysphagias and four pharyngeal dysphagias. Dogs with oral dysphagias had problems with tongue control and in prehending and transporting food and fluid to the oropharynx. On cinefluorograms, a poor closure of the oral egress led to the loss of contrast medium from the mouth, and a weak tongue-thrust action caused retention of contrast medium in the oropharynx. The clinical and radiographic signs could be duplicated by hypoglossal neurectomy. In contrast to the pharyngeal dysphagias, aspiration pneumonia was noticeably absent in oral dysphagias. The dogs with pharyngeal dysphagia had severe difficulties in transporting the food from the oropharynx to the laryngopharynx owing to a poor contractility of the pharyngeal muscles. The latter resulted in contrast medium retention in the pharynx and laryngotracheal aspiration. The need was stressed for a careful differentiation between oral and pharyngeal dysphagias on one hand, and cricopharyngeal dysphagias on the other hand. In oral dysphagias, cricopharyngeal myotomy appeared of no use. In pharyngeal dysphagias, cricopharyngeal myotomy severely aggravated the clinical signs by causing a cricopharyngeal chalasia.     

Upper respiratory signs associated with Anaplasma phagocytophilum infection in two horses

An adult Quarter Horse gelding (Case 1) was evaluated for tachypnoea and acute dysphagia. A 20-year-old Quarter Horse gelding (Case 2) was evaluated for respiratory stertor and severe, acute swelling of the head in the submandibular region. A physical examination, complete blood count, blood chemistry, upper airway endoscopy, and peripheral blood Anaplasma phagocytophilum polymerase chain reaction were completed for both horses. Both horses tested positive for A. phagocytophilum. The upper airway endoscopy for Case 1 revealed a feed contaminated pharynx, absent swallowing reflex, and left laryngeal hemiplagia. The upper airway endoscopy for Case 2 revealed severe diffuse pharyngeal swelling occluding the airway. Due to increased respiratory effort in Case 2, a tracheotomy was performed. In both horses, treatment consisted of intravenous oxytetracycline 6.6 mg/kg bwt i.v. q. 24 h for 2–3 days followed by minocycline 4 mg/kg bwt per os q. 12 h for 10–14 days. Both horses made full recoveries.     

针药结合治疗风痰阻络证中风后吞咽障碍患者75例临床观察

目的 观察化痰通咽汤结合针灸治疗中风后风痰瘀阻证吞咽障碍的临床疗效。方法 选取在武汉市第一医院康复医学科住院的证属风痰瘀阻证中风后吞咽障碍患者150例,随机分为对照组和治疗组各75例。治疗组采用针刺结合化痰通咽汤进行治疗,对照组采用针刺治疗,两组均给予神经内科基本治疗和康复治疗,疗程4周,对比临床疗效。结果 治疗后两组洼田饮水试验评分,吞咽功能障碍中医评价量表评分,电视X线透视吞咽功能检查,吞咽困难生活质量测量比较差异均有统计学意义,治疗组优于对照组（P<0.05）。结论 在神经内科基本治疗和康复治疗基础上综合运用化痰通咽汤结合针灸治疗中风后风痰瘀阻证吞咽障碍患者,能提高疗效,值得推广应用。