Case 7

History

• 57 yr old male with right lateral brain stem CVA
• Cranial Nerve IX, X, XII involvement

Radiographic Findings

• Slow, weak, discoordinated lingual motility
  • Slow oral bolus transport
  • Oral residue
  • Delayed intiation of pharyngeal swallow
• Poor oropharyngeal sensation contributing
  • Delayed initiation of and diminished pharyngeal swallow
• Severely limited pharyngeal dynamics
  • Elevation and retraction of soft palate
  • Tongue base retraction
  • Hyolaryngeal excursion and laryngeal closure
  • PE Segment opening
    • Diminished propulsive forces with poor pharyngeal clearance

Treatment

• Bolus Texture
  • NPO with PEG
    • Prevent aspiration
• Tongue strengthening
  • Improves bolus containment and oral transport with improved initiation of pharyngeal swallow
• Hard swallow
  • Improves tongue base retraction
• Mendelson maneuver
  • Prolonged tongue base retraction and increased and prolonged hyolaryngeal excursion improving PE opening

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