1/42. Laparoscopic removal of an Angelchik prosthesis.The use of Angelchik prosthetic rings for the surgical treatment of gastroesophageal reflux disease has been associated with frequent complications, including dysphagia and migration, erosion, or disruption of the ring. Although reports of the laparoscopic insertion of Angelchik rings have been published, there have been no descriptions of the laparoscopic removal of rings inserted at open laparotomy. Our group recently removed an Angelchik ring laparoscopically in an 80-year-old woman with progressive, refractory dysphagia and esophageal narrowing due to an Angelchik ring originally placed in 1981 via an upper midline incision at open operation. Upper endoscopy and dilatation had failed to provide symptom relief. An extensive adhesiolysis was performed laparoscopically, and the Angelchik ring was dissected free from the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule enclosing the ring was divided, and the prosthesis was removed from around the esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative complications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of her dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/42. CT study of closure of the hemipharynx with head rotation in a case of lateral medullary syndrome.In a patient with unilateral pharyngeal paralysis, rotation of the head to the paralyzed side can effectively close the hemipharynx on that side. However, the exact level or place of closure is unknown. Serial computed tomography of the pharynx in a patient with lateral medullary syndrome showed that hemipharyngeal closing occurred at the level of the hyoid bone, or the hypopharyngeal cavity above the pyriform sinus, and that the entire space of the bilateral pyriform sinuses remained open despite the head rotation.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
3/42. technetium tin colloid test detecting symptomless dysphagia and ACE inhibitor prevented occurrence of aspiration pneumonia.Symptomless dysphagia and swallowing disorders play a very important role in the pathogenesis of aspiration pneumonia. A videofluoroscopic examination and a simple two-step swallowing provocation test (STS-SPT) could be useful for detection of swallowing disorders in elderly patients with stroke, however, there is no report on such a test for detection of symptomless dysphagia. We administered 1 ml technetium Tin Colloid (99mTC) to the patient during sleep via a nasal catheter placed in the mouth. At 09:00 h the next day, symptomless dysphagia was checked for by imaging. Improvement of the symptomless dysphagia was observed, and thus we could prevent the occurrence of aspiration pneumonia. The 99mTC test was particularly useful in detecting symptomless dysphagia in elderly patients with stroke.- - - - - - - - - - ranking = 14.326396046347keywords = mouth (Clic here for more details about this article) |
4/42. Dysphagia caused by a fetus-in-fetu in a 27-year-old man.Mechanical obstruction of the distal esophagus by a fetus-in-fetu is an extremely rare condition that has not been previously reported. We present the case of a 27-year-old man who presented with dysphagia caused by fetus-in-fetu contained within a retroperitoneal cystic cavity. The tumor, noticed since childhood, did not cause any symptoms until a year before presentation when symptoms of dysphagia developed. We propose including this entity in the differential diagnosis of a retroperitoneal mass.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/42. Treating aerophagia with contingent physical guidance.Contingent physical guidance was used to treat chronic aerophagia. This consisted of guiding the participant's hand over her mouth following each attempt to engage in aerophagia. A wristwatch was then correlated with the contingent physical guidance procedure. Responding remained low in the presence of the wristwatch, even after contingent physical guidance was withdrawn.- - - - - - - - - - ranking = 14.326396046347keywords = mouth (Clic here for more details about this article) |
6/42. Lower lip-lifting brace for bilateral facial nerve palsy: a case report.A 55-year-old man suffered from pontine hemorrhage 5 years before he visited our outpatient clinic with complaints of gait disturbance and dysphagia. At the first examination, his inability to close his mouth, eyes, and lower lip led to the diagnosis of facial diplegia. He was instructed to wear a gauze surgical mask and to use artificial saliva for his xerostomia. A videofluorogram of his swallowing excluded aspiration but revealed dysphagia attributable to neck hyperextension arising from efforts to prevent food spilling from his mouth. We prescribed a brace to lift his lower lip as a treatment of his dysphagia. This brace covered his chin to support his lower lip. Our brace resulted in improved function; liquids no longer leaked from his mouth and because the lip elevation eliminated his xerostomia, he no longer required artificial saliva or the gauze mask.- - - - - - - - - - ranking = 42.97918813904keywords = mouth (Clic here for more details about this article) |
7/42. Abnormal elevation of resting pressure at the upper esophageal sphincter of Parkinson's disease patients.We investigated the oral and pharyngeal swallowing function in seven Parkinson's disease (PD) patients, using videomanofluorometry, which is videofluorographic and manometric evaluation conducted simultaneously. Abnormal elevations of resting pressure were found at the upper esophageal sphincter (UES) in three of the seven cases, when they were asked to hold a bolus in the mouth and initiate swallowing. One of these three cases showed an abnormal elevation of resting pressure, intermingled with a normal pressure pattern. Since the UES showed complete relaxation in these three cases, it is inappropriate to suppose that irreversible pathophysiological changes at the level of peripheral nerves had occurred. Our results suggested that altered resting pressure resulted from dysfunction at a more central level, such as a lack of dopaminergic stimulation at the supramedullary level causing skeletal muscle rigidity. Since a tonic abnormality of the UES cannot be measured by only videofluorography, both videofluorographic and manometric evaluation will be necessary to assess the pharyngeal phase of swallowing in PD patients.- - - - - - - - - - ranking = 14.326396046347keywords = mouth (Clic here for more details about this article) |
8/42. multiple sclerosis and oral care.multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Common early symptoms include visual disturbances, facial pain or trigeminal neuralgia and paraesthesia or numbness of feet, legs, hands and arms. These, plus symptoms of spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The dental team plays an essential role in ensuring that oral health impacts positively on general health.- - - - - - - - - - ranking = 14.326396046347keywords = mouth (Clic here for more details about this article) |
9/42. Prosthetic management of a total glossectomy defect after free flap reconstruction in an edentulous patient: a clinical report.Total glossectomy with surgical reconstruction can result in a significantly altered mandibular arch anatomy. In edentulous patients, lingual vestibules along with the mandibular alveolar ridge can be obliterated. With the absence of lower anterior dentition, support of the lower lip is lost and traction from surgical closure can cause the lower lip to collapse into the oral cavity. This report describes the prosthetic treatment of an edentulous total glossectomy patient with an unconventional custom impression procedure to develop and record proper lower lip and cheek support. It also discusses some issues involved in the prosthetic management of the total glossectomy patient.- - - - - - - - - - ranking = 32.299293448657keywords = oral cavity, cavity (Clic here for more details about this article) |
10/42. Oral administration of (131)I by semiautomatic pipette to a patient with severe swallowing difficulties: a case report.As an alternative method of oral administration of (131)I to a patient with quadriplegia and severe swallowing difficulties, we introduced, into the back of the patient's mouth, a 200- micro L laboratory pipette containing 74 MBq (2 mCi) of (131)I-sodium iodide in a 76- micro L aqueous solution and delivered its contents. The procedure was repeated a few days later with a 1,000- micro L laboratory pipette to administer 1.48 GBq (40 mCi) of (131)I-sodium iodide in a 270- micro L aqueous solution. The patient tolerated both procedures well. The pipette permitted accurate measurement of both dosages and complete (greater than 99.9%) delivery of the tracer in a small volume to the back of the patient's mouth, as documented by assay of the empty pipette after use. In patients with swallowing difficulties, use of the pipette constitutes a safe and efficient means to deliver (131)I-sodium iodide by the oral route.- - - - - - - - - - ranking = 28.652792092693keywords = mouth (Clic here for more details about this article) |
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