POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References

ECR 2024 / C-12541

Interpreting the Videofluoroscopic Swallow Study (VFSS): The gold standard for evaluating dysphagia

Congress:

ECR 2024

Poster Number:

C-12541

Type:

Educational Exhibit

Keywords:

Ear / Nose / Throat, Fluoroscopy, Diagnostic procedure, Education and training

Authors:

J. Janwar, H. L. Soh, F. A.-Z. Haji Johan, S. S. Chok, H. W. Khoo, A. Y. Q. Soon, A. Karandikar, J. Goh

DOI:

10.26044/ecr2024/C-12541

DOI-Link:

https://dx.doi.org/10.26044/ecr2024/C-12541

Learning objectives

Highlight the importance of the videofluoroscopy swallow study (VFSS) in the evaluation of patients with dysphagia. Recognise different components of normal swallow physiology Identify common functional and anatomic abnormalities of swallowing to guide rehabilitative management of dysphagia.

Background

Dysphagia is a debilitating condition that can lead to severe complications such as malnutrition, dehydration, aspiration pneumonia, and even death. The prevalence of dysphagia increases with age and is commonly a result of various medical conditions and their associated treatment complications.The current gold standard investigation for diagnosing dysphagia is the Videofluoroscopic Swallow Study(VFSS), a dynamic fluoroscopic study often performed in collaboration between speech therapists and radiologists.The use of fluoroscopy makes it possible to visualise bolus flow through the aerodigestive tract in relation to structural changes,...

Findings and procedure details

Normal swallow physiologyIn order to identify abnormal swallow, one needs to recognise the normal phases of swallowing. Normal swallow physiology can be divided into 3 phases: Oral Phase Pharyngeal Oesophageal The detailed components of each phase are shown below:[Fig 1][Fig 2][Fig 3][Fig 4][Fig 5][Fig 6][Fig 7]Common swallowing abnormalities can be classified based on which phase of swallowing they occur in.Oral phase Anterior loss Contrast is seen spilling out anteriorly from the mouth. Suggests weakness of orbicularis oris resulting in inadequate lip closure. Causes inclue: facial...

Conclusion

The VFSS allows comprehensive assessment of oropharyngeal dysphagia and risk of aspiration. VFSS is useful in providing a preliminary evaluation of oesophageal motility. A good understanding of swallow physiology is important to correlate signs seen on VFSS to the underlying cause. VFSS is essential to provide guidance for dysphagia rehabilitation and management.

Personal information and conflict of interest

J. Janwar: Nothing to disclose H. L. Soh: Nothing to disclose F. A-Z. Haji Johan: Nothing to disclose S. S. Chok: Nothing to disclose H. W. Khoo: Nothing to disclose A. Y. Q. Soon: Nothing to disclose A. Karandikar: Nothing to disclose J. Goh: Nothing to disclose

References

[Fig 27]

Fig 1: Phases of normal swallowing.

Fig 2: Annotated diagrams of normal oral phase. Reference: Tan Tock Seng Hospital,...

Fig 3: Normal oral phase (annotated). Reference: Tan Tock Seng Hospital, Singapore

Fig 4: Annotated normal pharyngeal phases. Reference: Tan Tock Seng Hospital,...

Fig 5: Normal pharyngeal phase (annotated). Reference: Tan Tock Seng Hospital,...

Fig 6: Annotated normal oesophageal phases. Reference: Tan Tock Seng Hospital,...

Fig 7: Normal oesophageal phase (annotated). Reference: Tan Tock Seng Hospital,...

Fig 8: Anterior loss: contrast leaks out anteriorly from the mouth. Reference: Tan...

Fig 9: Bolus held between tongue and palate in a patient with normal orolingual...

Fig 10: Containment of food bolus between tongue and palate with a normal palatoglossal...

Fig 11: Demonstration of sublingual loss and premature spillage, both a result of...

Fig 12: The hyoid bone remains in the resting position (green arrow) despite contrast...

Fig 13: Demonstration of reduced Bot-PPW and vallecular residue (yellow arrow)....

Fig 14: Reduced hyolaryngeal excursion in a patient with tracheostomy seen in-situ,...

Fig 15: Reduced cricopharyngeus opening and pyriform sinus residue (orange...

Fig 16: Pathophysiology of pyriform residue.

Fig 17: Normal oesophageal transit of food bolus. Reference: Tan Tock Seng Hospital,...

Fig 18: Delayed oesophageal transit of food bolus. Reference: Tan Tock Seng Hospital,...

Fig 19: Clearance of oesophageal hold-up with cyclic ingestion. (same patient as in...

Fig 20: Zenker's diverticulum (orange outline) seen on fluoroscopy and CT...

Fig 21: Esophageal diverticulum seen on fluoroscopy and CT Imaging. Reference: Tan...

Fig 22: Patient with proven adenocarcinoma in bilateral thyroid cartilage laminae...

Fig 23: Patient with proven adenocarcinoma in bilateral thyroid cartilage laminae (same...

Fig 24: Oropharyngeal dysphagia showing (1) premature spillage (2) delayed pharyngeal...

Fig 25: Oropharyngeal dysphagia showing (1) premature spillage (2) reduced tongue base...

Fig 26: Oropharyngeal dysphagia showing (1) vallecular and pyriform sinus retention (2)...

Fig 27: References.