消化器としての食道・種々の神経疾患における誤嚥

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書誌事項

タイトル別名
  • Misswallowing in Neuromuscular Disorders
  • ショウカキ トシテノ ショクドウ シュジュ ノ シンケイ シッカン ニ オケル

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説明

A radiocinematographic study of deglutitory movements in patients with various neuromuscular disorders yielded the following findings:<br>1) In patients with hemiplegia due to encephalomalacia or brain tumor, there is no particular complaint of misswallowing. However, because the contractile force of the pharyngeal muscles ipsilateral to the paralysis is weak, barium meal passes through the pharynxalong the paralysed side above the epiglottis, which is pulled toward the healthy side, becoming asymmetric. Thus, hemiplegic patients are hemiplegic in deglutitory movements also and are ready to misswallow.<br>2) In patients with Wallenberg's syndrome in whom there is a paralysis of the pharyngeal muscles ipsilateral to the brain lesion, the bolus passes through the paralysed side of the pharynx, the epiglottis being asymmetric in configuration. Observed contractions of the cricopharyngeus muscle seem to suggest that this striated muscle is governed by the dorsal nucleus of vagus nerve.<br>3) In patients with amyotrophic lateral sclerosis the Passavant's bar is formed to a very modest extent by contraction of the palatopharyngeal sphincter. The barium which enters the vestibule of larynx is likely to be swallowed because of a weak action of the larynx to expel it out into the food passage.<br>4) In patients with myasthenia gravis elevation of the soft palatine becomes insufficient on repeating deglutitory movements, leading to an almost complete failure of the nasopharyngeal space to close.<br>5) In patients with cerebellar disorder, the contractile force of muscles involved in deglutition is kept normal but there is an impairment of co-ordination of their movements (ataxia), which is a possible cause of misswallowing.

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