Abstract
Aspiration and prolongation of the pharyngeal transit-time of a bolus become intractable problems in pharyngeal dysphagia caused by brain and/or brainstem stroke. Reconstruction of the swallowing function and the relief of aspiration are fundamental problems in the surgical management of pharyngeal dysphagia, the preservation of understandable speech and a normal airway without tracheostoma are also important. To date, several effective surgical procedures have been presented by many authors : cricopharyngeal myotomy, thyrohyoidpexia, laryngeal suspension, thyromandibular connection, laryngeal diversion and glottic closure. Indications for the respective surgical procedures are determined from videofluoroscopic and manometric examinations in which bolus transit-time, laryngeal closure, upward and forward motion of the larynx and the hyoid bone, opening of the pharyngoesophageal junction, relationship between aspiration and bolus transit (before, during and after swallowing) and swallowing pressure are measured and the patho-physiology of the dysphagia is evaluated.
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