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ENT
Esophagus and Swallowing
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
11 sections · 101 slides
Overview
- What this topic covers, and who treats it
Anatomy and Normal Function
How the esophagus is built and how it normally moves food
- Where the esophagus runs
- The wall, layer by layer
- The muscle changes character down the tube
- Three constrictions - the natural chokepoints
- Esophageal course, constrictions, and wall layers
- Blood supply and nerve supply
- Normal function - how the esophagus moves food
- Presbyesophagus - the aging swallow
Examining the Esophagus
Clinical exam, contrast imaging, endoscopy, and pressure/acid testing
- Clinical examination first
- Contrast swallow and cautions
- What a contrast swallow reveals
- Esophagoscopy - looking inside directly
- Rigid esophagoscopy instrument set
- A rigid esophagoscope passed into the esophagus
- A flexible fiberoptic esophagoscope
- Which scope for which job (from Table 7.1)
- Esophageal manometry - measuring the squeeze
- Impedance and pH testing
Trauma and Foreign Bodies
Swallowed batteries and caustics, injuries, impacted objects, and perforation
- Button battery ingestion - a true emergency
- Button battery - diagnosis and treatment
- Caustic ingestion - the clinical picture
- Caustic ingestion - acids versus alkalis
- Caustic ingestion - treatment and endoscopy timing
- Bougienage - stretching a scarred esophagus open
- Dilating an esophageal stricture with graduated bougies
- Bougienage guided over a swallowed thread
- Balloon dilation with the through-the-scope technique
- Blunt, penetrating, and iatrogenic injury
- Foreign bodies - who, and what they feel
- A swallowed coin at the upper constriction
- Foreign bodies - diagnosis and treatment
- Perforation and Boerhaave rupture
Esophageal and Swallowing Disorders
Diverticula, reflux, achalasia, Barrett, and other named conditions
- Esophageal diverticulum - a pouch in the wall
- Esophageal diverticula: locations and a contrast study
- Diverticulum - symptoms, diagnosis, treatment
- Gastroesophageal reflux disease (GERD) - what and why
- GERD - symptoms, diagnosis, treatment
- Hiatus hernia
- Achalasia (cardiospasm) - the gate that will not open
- Achalasia - treatment
- Barrett esophagus - a warning change in the lining
- Three more named disorders
- Esophageal infection
Neighbors and Congenital Anomalies
Outside compression, varices, and inborn malformations
- Outside compression, and esophageal varices
- Congenital stenosis and short esophagus
- Tracheoesophageal fistula
- Dysphagia from a congenital double aortic arch
Tumors of the Esophagus
The rare benign growths and the far more important carcinoma
- Benign tumors
- Esophageal carcinoma - epidemiology and risk factors
- Carcinoma - clinical features and diagnosis
- Carcinoma - treatment and palliation
- Percutaneous endoscopic gastrostomy (PEG) placement
How Swallowing Works
The apparatus, its central control, and the five phases
- The swallowing apparatus - a shared crossroads
- Eating, saliva, and the food bolus
- Central control - where the brain runs a swallow
- The four measured phases of a swallow (Table 7.2)
- Where the bolus sits during each phase of swallowing
- Phases one to three, in detail
- The pharyngeal and esophageal phases
Dysphagia - When Swallowing Fails
The vocabulary of failure, its causes, and how it is assessed
- The vocabulary of a failing swallow
- The typical patterns of swallowing failure
- What causes dysphagia - neurogenic versus structural
- Assessing dysphagia - the two radiological mainstays
- Flexible endoscopic evaluation of swallowing (FEES)
- What a FEES examination records
- Scoring severity - the PAS scale
- Residue, penetration, and aspiration
- Grading severity - the Munich Score (MUCSS)
Treating Swallowing Disorders
Retraining, maneuvers, adapting the diet, and surgery
- Functional (speech) therapy - the goal
- Strengthening maneuvers - Masako, Shaker, Mendelsohn
- Airway-protecting maneuvers
- Compensatory posture changes
- Adaptation methods - changing the food and the setup
- Facial-Oral Tract Therapy (F.O.T.T.)
- Surgery for the cricopharyngeal sphincter
- Medialization laryngoplasty (thyroplasty)
- Surgery for laryngeal incompetence
- Glottic closure
- Supraglottic laryngoplasty
- Laryngotracheal separation
- Laryngeal suspension
- Laryngohyoid suspension
- Separating airway and food path after laryngectomy
- Feeding tubes - PEG and the radiologic gastrostomy
Pulling It Together
The whole chapter in one pass
- The three threads of this chapter
- Key takeaways
- A child has 'swallowed a coin'. Why must you exclude a button battery, and why is it an emergency?
- Sources named in this chapter
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery