Recurrent Aspiration Research Articles

Tracheostomy weaning outcomes in relation to the site of acquired brain injury: A retrospective case series

ABSTRACTObjective: To analyse whether the outcome of tracheostomy weaning is influenced by the site of injury in acquired brain injury.Methods: A retrospective case review of all the consecutive admissions to an acute neurorehabilitation unit in a 2-year period was performed. Patients with a diagnosis of acquired brain injury and tracheostomy in situ were included in this study.Results: One hundred and six patients were included in the analysis. They were considered in two groups based on the site of brain injury: Group S, those with supratentorial brain injury only; and Group I, those with any injury with infratentorial involvement. Fifty-one (82%) patients in Group S were successfully weaned from the tracheostomy, compared to only 27 (61%) of patients in Group I. In other words, the proportion of unsuccessful weans (long-term tracheostomy) was 11 (18%) in Group S compared to 17 (39%) in Group I. The statistical significance of successful weans between the groups was p = 0.01 (Chi-square test). The common reasons for unsuccessful weaning were excessive secretion load and recurrent aspiration pneumonia.Conclusions: Patients with isolated supratentorial brain injury have a statistically significant higher chance of successful decannulation when compared to those patients with any infratentorial brain injury involvement.

Pulmonary outcome of esophageal atresia patients and its potential causes in early childhood

IntroductionThe aim of this study was to illustrate the pulmonary long term outcome of patients with repaired esophageal atresia and to further examine causes and correlations that might have led to this outcome. MethodsTwenty-seven of 62 possible patients (43%) aged 5–20years, with repaired esophageal atresia were recruited. Body plethysmography and spirometry were performed to evaluate lung function, and the Bruce protocol treadmill exercise test to assess physical fitness. Results were correlated to conditions such as interpouch distance, gastroesophageal reflux or duration of post-operative mechanical ventilation. ResultsSeventeen participants (63%) showed abnormal lung function at rest or after exercise. Restrictive ventilatory defects (solely restrictive or combined) were found in 11 participants (41%), and obstructive ventilatory defects (solely obstructive or combined) in 13 subjects (48%). Twenty-two participants (81%) performed the Bruce protocol treadmill exercise test to standard. The treadmill exercise results were expressed in z-score and revealed to be significantly below the standard population mean (z-score=−1.40). Moreover, significant correlations between restrictive ventilatory defects and the interpouch distance; duration of post-operative ventilation; gastroesophageal reflux disease; plus recurrent aspiration pneumonia during infancy; were described. ConclusionIt was shown that esophageal atresia and associated early complications have significant impact on pulmonary long term outcomes such as abnormal lung function and, in particular restrictive ventilatory defects. Long-running and regular follow-ups of patients with congenital esophageal atresia are necessary in order to detect and react to the development and progression of associated complications such as ventilation disorders or gastroesophageal reflux disease. Level of evidencePrognosis study, Level II.

Not Just Another Aspiration Pneumonia: Oculopharyngeal Muscular Dystrophy

Oculopharyngeal muscular dystrophy (OPMD) is a rare genetic myopathy of adulthood onset which presents as late-onset ptosis, dysphagia and family history of ptosis and dysphagia. It occurs due to the poly(A) binding nuclear protein 1 (PABPN1) gene mutation. A 75-year-old male presented with complaints of fever, cough and worsening dysphagia. His father and paternal grandfather both had a history of ptosis and dysphagia. He was febrile, tachypneic and bilateral ptosis was noticed. The chest CT revealed consolidation. A modified barium swallow showed frank tracheal aspiration. An acetylcholine receptor antibody test was negative. An electromyogram and nerve conduction study revealed a generalized myopathic process with the absence of myotonia. With a history of adult-onset bilateral ptosis and progressive dysphagia along with the positive family history of ptosis and dysphagia, there was a strong suspicion for OPMD. Genetic testing was performed, which was positive as it detected GCG expansion in the PABPN1 gene, which is associated with OPMD and thus the diagnosis of OPMD was established. Malnutrition and recurrent aspiration are potential and harmful complications that reduce the life expectancy of these patients. J Med Cases. 2017;8(12):378-380 doi: https://doi.org/10.14740/jmc2928w

Re-insertion of Gastric Feeding Tube via Previous Surgical Gastrostomy in Elderly Sick Patient with Reflux Oesophagitis Secondary to Gastrointestinal Motility Disorder: Case Report

Background: Reflux oesophagitis is an esophageal mucosal injury that occurs secondary to retrograde flux of gastric contents into the esophagus. Here, we reported a case of re-insertion of gastric feeding tube (RIGFT) to an old man who underwent gastrostomy due to progressive Dysphagia secondary to reflux oesophagitis. Methods: We report the case of re-insertion of gastric feeding tube in an elderly man who could not undergo PEG and open surgical gastrostomy. Case presentation: An 85-year-old man with advanced Parkinson dementia, presented with progressive Dysphagia, fever, disorientation and recurrent aspiration pneumonia. He had a history of open abdominal surgical gastrostomy which was performed under spinal anesthesia and gastric tube was inserted successfully. Three months later the patient pulled out the tube and was referred to our teaching hospital and the next day re-insertion was performed. Conclusion: For elderly patients who cannot undergo the percutaneous endoscopic gastrostomy and open surgical gastrostomy under general anesthesia should be recommended for re-insertion of gastric feeding tube via previous surgical orifice under local anesthesia. Therefore, percutaneous re-insertion should be considered as option to all patients who are contraindicated to surgery.

Newer insights into the management of interstitial lung disease in systemic sclerosis

Interstitial lung disease (ILD) is a debilitating complication of systemic sclerosis (SSc) and now the leading cause of death in SSc patients, largely from progressive respiratory failure or advanced pulmonary hypertension. Despite significant advances in our understanding of the epidemiology and pathogenesis of SSc-ILD, there are significant uncertainties in the approach to managing these patients given the heterogeneity of presentation, substantial variability in progression, and presence of comorbid cardiopulmonary conditions, particularly pulmonary hypertension and esophageal dilation with recurrent aspiration pneumonitis that portend poor prognosis. Early detection of progressive lung involvement based on worsening pulmonary physiology and quantification of fibrosing alveolitis severity on high-resolution computed tomography is critical as response to immunomodulatory agents is usually best when initiated earlier in the disease course. A selected group of patients may benefit from early referral for hematopoietic stem cell transplantation or lung/heart–lung transplant. The last decade has seen a significant advance in evidence-based approaches to treatment of SSc-ILD with immune suppressants, and there are several ongoing treatment trials with recent advances in understanding of the role of pro-inflammatory and profibrotic cytokines in SSc-ILD. The efficacy of antifibrotic agents in idiopathic pulmonary fibrosis has also provided another promising avenue for utilization in these patients. In this review, we will provide an up-to-date review of the treatment options for SSc-ILD, the ongoing studies moving this field forward, emerging treatments for SSc-ILD, and propose a management algorithm for SSc-ILD, based on the available evidence in the literature and our experience.

The Efficacy of Intervention for the Prevention of Aspiration Pneumonitis in Recipients of Non-oral Nutrition

Objective: We provided continuous training targeting the oral cavity and neck region to elderly, bedridden recipients of non-oral nutrition in addition to conventional physical interventions, with the aim of investigating changes in feeding and swallowing function. Method: Bedridden (and caregiver’s extensive care-requiring), non-tracheotomized patients with a conscious level of 1 or 2 on the Japan Coma Scale (three inclusion criteria) were eligible. We enrolled 13 patients (5 men, 8 women; mean age: 85.2 ± 6.4 years) meeting the three criteria specified in the Setting, who had been receiving nutrition nasogastrically, via a gastrostomy tube, or by central venous hyperalimentation. Intervention was provided three times weekly, as additional interventions to conventional physical function training. The interventions were 1) neck stretching, 2) facilitation of swallowing response, 3) stimulation of the oral cavity, and 4) positioning into an anti-gravity posture (in a position with the back elevated 60° from the bed). Comparative assessments covered 1) intraoral saliva volume, 2) swallowing response time, 3) neck muscle hardness, 4) lip opening width, and 5) aspiration pneumonitis status at the initiation of training and the completion of training three months later. Results: All assessments showed significant changes in a beneficial direction post-training relative to pretraining. Additionally, no participant experienced recurrent aspiration pneumonitis. Conclusion: Selection of suitable training for the target function site, and continuous implementation of that training, are important for achieving efficacy.

Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes.

Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment. Multicentre retrospective study. We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients. This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.

Physiology of respiratory disturbances in muscular dystrophies.

Muscular dystrophy is a group of inherited myopathies characterised by progressive skeletal muscle wasting, including of the respiratory muscles. Respiratory failure, i.e. when the respiratory system fails in its gas exchange functions, is a common feature in muscular dystrophy, being the main cause of death, and it is a consequence of lung failure, pump failure or a combination of the two. The former is due to recurrent aspiration, the latter to progressive weakness of respiratory muscles and an increase in the load against which they must contract. In fact, both the resistive and elastic components of the work of breathing increase due to airway obstruction and chest wall and lung stiffening, respectively.The respiratory disturbances in muscular dystrophy are restrictive pulmonary function, hypoventilation, altered thoracoabdominal pattern, hypercapnia, dyspnoea, impaired regulation of breathing, inefficient cough and sleep disordered breathing. They can be present at different rates according to the type of muscular dystrophy and its progression, leading to different onset of each symptom, prognosis and degree of respiratory involvement.Key pointsA common feature of muscular dystrophy is respiratory failure, i.e. the inability of the respiratory system to provide proper oxygenation and carbon dioxide elimination.In the lung, respiratory failure is caused by recurrent aspiration, and leads to hypoxaemia and hypercarbia.Ventilatory failure in muscular dystrophy is caused by increased respiratory load and respiratory muscles weakness.Respiratory load increases in muscular dystrophy because scoliosis makes chest wall compliance decrease, atelectasis and fibrosis make lung compliance decrease, and airway obstruction makes airway resistance increase.The consequences of respiratory pump failure are restrictive pulmonary function, hypoventilation, altered thoracoabdominal pattern, hypercapnia, dyspnoea, impaired regulation of breathing, inefficient cough and sleep disordered breathing.Educational aimsTo understand the mechanisms leading to respiratory disturbances in patients with muscular dystrophy.To understand the impact of respiratory disturbances in patients with muscular dystrophy.To provide a brief description of the main forms of muscular dystrophy with their respiratory implications.

Total esophagogastric dissociation: single center experience

AimFundoplication fails in approximately 20% of children with severe neurodisability. We aimed to evaluate total esophagogastric dissociation (TOGD) as a primary procedure and as a ‘rescue’ procedure for severely neurologically impaired children with significant swallowing discoordination and gastroesophageal reflux disease. MethodsCasenotes of 40 children with severe neurodisability who underwent TOGD between 2005 and 2015 were retrospectively reviewed. Of these, 33 were primary procedures and 7 were ‘rescue’ procedures following failed fundoplication. ResultsMedian age at surgery was 3years 7months (range 1month to 13years 11months). Preoperatively, all children had symptoms of regurgitation, retching or vomiting and 70% of children had an unsafe swallow. There were 5 early complications related to surgery in 4 children requiring surgical intervention. One child died following relaparotomy for esophagojejunal anastomotic breakdown because of multiorgan failure. Gastrostomy feeding was established by a median of 6days (range 2 to 25days) and median hospital stay was 10days (range 4 to 280days). There were 5 late complications. Median follow-up was 13months (range 1month to 8years 4months). All children have had resolution of gastroesophageal reflux. Thirteen percent of children experience bloating or pain on feeding and 26% of children experience retching unrelated to gastroesophageal reflux. There were 8 late deaths unrelated to surgery. ConclusionTOGD should be considered as a primary and definitive procedure in selected severely neurodisabled children who are at higher risk of failure of fundoplication, recurrent aspiration and a reduced quality of life. Level of EvidenceIV.

Recurrent Pneumonia: The Answer Is in the Esophagus

Laparoscopic adjustable gastric banding (LAGB) can impair esophageal peristalsis and relaxation of the lower esophageal sphincter, possibly leading to esophageal dilation. Stomach and esophagus dilation are rare; both are occasional complications of LAGB. Bronchoaspiration can occur as a late complication of gastric band placement, a serious complication that can be prevented by immediate deflation of the gastric band. We describe a case of a 44 year-old male patient who was treated for recurrent respiratory infections for several months and was subsequently found to have megaesophagus on further evaluation. A 44 year-old male with history of laparoscopic adjustable gastric band placement 4 years prior, presented to pulmonary clinic as a consultation for frequent respiratory infections requiring at least 7 courses of antibiotics over few months. He complained of persistent productive cough, exertional dyspnea and chest pain. Rest of review of systems was negative. His physical examination was normal. CT chest showed multiple tiny lung nodules representing a manifestation of recurrent and chronic aspiration and substantially dilated esophagus with fluid in the lumen (image 1). The patient was referred to GI clinic and after thorough evaluation, EGD was done that showed fluid in the lower third of the esophagus, dilated lumen of the lower third of the esophagus with no stenosis or stricture in the entire esophagus. It also showed a 4 cm gastric pouch in the stomach with fluid content proximal to the constriction from the lap band (EGD views are shown in images 2 and 3). Removal of the gastric band was performed with subsequent resolution of his symptoms. LAGB is approved for treatment of morbid obesity with successful outcomes by many bariatric surgeons worldwide. It is preferred due to ease of implementation and low rate of perioperative mortality. Megaesophagus with dysphagia can occur as a long term sequelae of LAGB. The preoperative manometry results cannot predict for its occurrence. The management of megaesophagus caused by LAGB requires band removal in most cases. Clinicians should be made aware of this rare entity when they encounter patients with frequent aspiration who had bariatric procedures. Inquiry about detailed relevant surgical history is also recommended.Figure 1Figure 2Figure 3

Acute lung injury induced by whole gastric fluid: hepatic acute phase response contributes to increase lung antiprotease protection.

BackgroundGastric contents aspiration in humans is a risk factor for severe respiratory failure with elevated mortality. Although aspiration-induced local lung inflammation has been studied in animal models, little is known about extrapulmonary effects of aspiration. We investigated whether a single orotracheal instillation of whole gastric fluid elicits a liver acute phase response and if this response contributes to enrich the alveolar spaces with proteins having antiprotease activity.MethodsIn anesthetized Sprague-Dawley rats receiving whole gastric fluid, we studied at different times after instillation (4 h −7 days): changes in blood cytokines and acute phase proteins (fibrinogen and the antiproteases alpha1-antitrypsin and alpha2-macroglobulin) as well as liver mRNA expression of the two antiproteases. The impact of the systemic changes on lung antiprotease defense was evaluated by measuring levels and bioactivity of antiproteases in broncho-alveolar lavage fluid (BALF). Markers of alveolar-capillary barrier derangement were also studied. Non-parametric ANOVA (Kruskall-Wallis) and linear regression analysis were used.ResultsSevere peribronchiolar injury involving edema, intra-alveolar proteinaceous debris, hemorrhage and PMNn cell infiltration was seen in the first 24 h and later resolved. Despite a large increase in several lung cytokines, only IL-6 was found elevated in blood, preceding increased liver expression and blood concentration of both antiproteases. These changes, with an acute phase response profile, were significantly larger for alpha2-macroglobulin (40-fold increment in expression with 12-fold elevation in blood protein concentration) than for alpha1-antitrypsin (2–3 fold increment in expression with 0.5-fold elevation in blood protein concentration). Both the increment in capillary-alveolar antiprotease concentration gradient due to increased antiprotease liver synthesis and a timely-associated derangement of the alveolar-capillary barrier induced by aspiration, contributed a 58-fold and a 190-fold increase in BALF alpha1-antitrypsin and alpha2-macroglobulin levels respectively (p < 0.001).ConclusionsGastric contents-induced acute lung injury elicits a liver acute phase response characterized by increased mRNA expression of antiproteases and elevation of blood antiprotease concentrations. Hepatic changes act in concert with derangement of the alveolar capillary barrier to enrich alveolar spaces with antiproteases. These findings may have significant implications decreasing protease burden, limiting injury in this and other models of acute lung injury and likely, in recurrent aspiration.

Percutaneous Endoscopic Gastrostomy : A Review of Practice and Complications

Result: One hundred forty-eight patients underwent PEG insertion; 91 (61.5%) males and 57 (38.5%) females with a median age of 15 months (range 1-190 months). The procedure was abandoned in one patient due to unfavorable anatomy (failure rate 0.7%), and this patient is excluded from this report. PEG was indicated for feeding difficulties in 102 (68.9%) patients, recurrent aspiration pneumonia in 15 (10.1%) and failure to thrive in 32 (21.6%). No mortality was recorded; however, 15 (10.1%) patients developed stomal leakage and 3 (2%) of these required change of PEG. Nine (6%) patients developed a wound infection, 2 (1.4%) developed a gastrocolic fistula, 1 (0.7%) patient developed adhesive intestinal obstruction requiring laparotomy and adhesiolysis. Two (1.4%) patients had aspiration pneumonia, 3 (2%) had inadvertent tube removal, 4 (2.7%) had tube blockage, 3 (2%) had tube breakdown, 2 (1.4%) had tube migration, 5 (3.4%) had vomiting and 6 (4%) patients had excess granulation tissue. Conclusion: PEG tube feeding is an efficient, well-tolerated method for medium and long-term enteral feeding with excellent results and minimal overall morbidity.

重症心身障害児 (者) の誤嚥に対する声門閉鎖術の安全性と効果の検討

重症心身障害児 (者) の誤嚥に対する声門閉鎖術の安全性と効果の検討

Three Cases of a Rare Association: Double Aortic Arch

Background Vascular ring is less than 1% of congenital heart disease. Double aortic arch (DAA) is the most common form of it. Its detecting is important because of the effects of pressure on the esophagus and trachea. Case Report In this study, three children suffering from double aortic arch with symptoms of dysphagia and recurrent aspiration, which in two cases had led to cardiac arrest, were introduced. In all of these studies, computed tomography angiography and chest X-ray were used to diagnose the compression effect of double aortic arch on the esophagus and the surgery provided for treatment of the children. After the surgery, all three patients were monitored in the intensive care unit (ICU) for five days without showing any symptoms. Conclusion Totally, we found that three computed tomography angiography, as a non invasive, high quality method, would be suitable for the diagnosis of this abnormality.

Palliation of Malignant Esophageal Obstruction and Fistulas with Metallic Stents: A Tertiary Center Experience

Background: To determine the usefulness of metallic stent in advanced oesophageal malignancies. Methods: In a retrospective study conducted at the Endoscopy Unit of King Abdulaziz University Hospital, patients underwent stent placement, with or without palliative radiotherapy for inoperable esophageal cancer, during the period spanning January 2010 through December 2014. Ethical approval for this study was granted by the King Abdulaziz University Research Ethics Committee. Data were collected from the electronic database of the hospital. All patients underwent OGD before stenting to know site of tumor, length of tumor and degree of stricture. Barium meal and CT scan was also done in some cases to know exact characteristics of tumor. Stent was selected more than 2 cm longer than the length of tumor. Self expanding metallic stents were used in all cases. Confirmation of proper placement of stent was done using fluoroscopy. Complications post stenting were analysed. Results: A total of 15 cases were studied. Males were 53.3% while females were 46.7%. Youngest patient was 39 yr old and eldest was 79 years with mean 64.93 years. Mean height was 159.73 cm and mean weight 54.98 kilogram. Co-morbidities like DM was 20%, DM with HTN was 6.7%, bronchial asthma 13.3% and DM with HTN with IHD and Renal implant in 6.7%. Diagnosis at admission was esophageal squamous cell carcinoma in 33.3%, esophageal adeno-carcinoma in 53.3%, gastric cancer in 6.7%, tracho-esophageal fistula in 6.7%. Stage 3 was 13.3%, and stage 4 was 86.7%. Surgical resection and palliation was done in14.2%, and only palliation was done in 92.9% of cases. SEMS were used in all patients and majority had Niti-S stent placed in 73.3% and Wallflex in 13.3% and Ultraflex in 6.7% and Boston in 6.7% cases. Dysphagia was Indication of stenting in 100% of cases and stricture in 57.1% and stricture and recurrent aspiration in 42.9%. Post stenting complications were early in 20% and late in 40%. Tumor ingrowth was in 20%, GERD in 20%, Mild chest pain and discomfort in 10%, stent migration in 10%, fistula formation in 10%, chest pain and GERD in 10%, and aspiration and pneumonia in 20%. Conclusions: Self expanding metallic stents are invaluable in advanced oesophageal cancer for palliation and alleviation of symptoms and better quality of life. Patients prior to chemoradiotherapy may get benefit of stenting making oesophageal passage patent which may otherwise get occluded by edema caused by radiotherapy.

Intermittent At-Home Suctioning of Esophageal Content for Prevention of Recurrent Aspiration Pneumonia in 4 Dogs with Megaesophagus

Intermittent At-Home Suctioning of Esophageal Content for Prevention of Recurrent Aspiration Pneumonia in 4 Dogs with Megaesophagus

Non-Surgical Management of Critically Compromised Airway Due to Dilatation of Interposed Colon.

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.

Anaesthetic management of Mowat-Wilson syndrome.

Anaesthetic management of Mowat-Wilson syndrome.

Therapeutic Medical Thoracoscopy

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Compensatory Mechanisms in Patients After a Partial or Total Glossectomy due to Oral Cancer.

Excision of a part or the whole of tongue due to oral cancer disturbs swallowing and speech. Lower airways aspiration of the swallowed bolus in patients after such oral structures excision is a symptom of major swallowing disorder and may be the cause of aspiration pneumonia. Restoration of oral nutrition is possible after exclusion or reduction of aspiration threat in the patients. Video fluoroscopic evaluation of the swallowing performed at the beginning of the swallowing rehabilitation in 95 patients after a total or partial glossectomy due to oral cancer, who assessed their saliva swallowing as efficient on the day of examination, showed disturbances of all of the swallowing stages. The most common disturbances involved the oral stage: limited mobility of the oral tongue, impaired glossopalatal seal, and weak glossopharyngeal seal. The most serious among them involved pharyngeal stage of swallowing, as leakage into the larynx and aspiration. The patients used their own methods during barium suspension swallowing to facilitate the swallowing act. They used such methods as: changing the position of the head to the body, additional swallows, engaging the adjacent structures into sealing the oral fissure. We assumed that the compensatory mechanisms (CM) worked out by the patients before the swallowing examination will enable them efficient barium suspension swallowing. The CM were applied by 71 of 95 patients; 51 of the patients used more than one compensatory mechanism. Swallowing in 61 of the compensating patients was at least functional; swallowing in 10 of the compensating patients was non-efficient and caused recurrent aspiration. The results of our research negate the validity of multiple swallows (more than three) without apnea elongation because it may lead to aspiration. Aspiration was also recorded in patients with weak airways closure and immovable epiglottis, who complemented the impaired oral transport with gravitational oral transport by moving chin up during a swallow. The hypothesis that CM applied by the patients after oral cancer excision during saliva swallowing will be helpful in swallowing of the barium suspension was not proved. In 10 of all the patients recurring aspiration was found despite CM application. Determination of aspiration risk is the key to efficient swallowing rehabilitation. The assessment of CM applied spontaneously by the patients' maintenance validity is particularly important. Video fluoroscopic examination of swallowing allows to assess the aforementioned issue and is crucial for better comprehension of CM applied by the patients in creating a new swallowing pattern after oral cancer excision.