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Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop neurogenic dysphagia per year. Neurogenic dysphagia is typically occurring in patients with neurological disease of different etiologies. A correct and early diagnosis and an appropriate management of dysphagia could be useful for improving patient's quality of life and may help to prevent or delay death. In the present review, we discuss thoroughly the anatomy and physiology of swallowing and also the pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia. Assessment of neurogenic dysphagia includes medical history, physical exam, and instrumental examinations (fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, electromyography). Pharmacological treatment of these problems includes oral anticholinergic drugs. Surgical myotomy of the cricopharyngeal muscle showed an important improvement of oropharyngeal dysphagia associated to upper esophageal sphincter hyperactivity. Chemical myotomy of the upper esophageal sphincter by local injections of botulinum toxin type A into the cricopharyngeal muscle has been proposed as an alternative less invasive and less unsafe than surgical myotomy. [ABSTRACT FROM AUTHOR]

Objective:To discover the anatomist who first identified the upper oesophageal sphincter.Method:The authors searched dozens of antique anatomy textbooks kept in the old section of the ‘Vincenzo Pinali’ Medical Library of Padua University, looking for descriptions of the upper oesophageal sphincter.Results:The oesophageal sphincter was drawn correctly only in 1601, by Julius Casserius, in the book De vocis auditusque organis historia anatomica… (which translates as ‘An Anatomical History on the Organs of Voice and Hearing …’), and was properly described by Antonio Maria Valsalva in 1704 in the book De aure humana tractatus… (‘Treatise on the Human Ear …’).Conclusion:Anatomists Casserius and Valsalva can be considered the discoverers of the ‘oesophageal sphincter’. [ABSTRACT FROM PUBLISHER]

To evaluate the efficacy of botulinum neurotoxin type A (BoNT/A) for severe oro-pharyngeal dysphagia associated with multiple sclerosis (MS). BoNT/A was injected percutaneously into the hyperactive cricopharyngeal muscle of 14 dysphagic MS patients under electromyographic control. Patients were evaluated by videofluoroscopic and electromyographic examinations and by the Penetration/Aspiration Scale (PAS), at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. All patients showed a significant improvement in all the swallowing outcome measures. No specific treatment for oro-pharyngeal dysphagia related to MS has been described to date. Our preliminary findings suggest a potential benefit from BoNT/A treatment in MS patients with dysphagia associated with upper esophageal sphincter hyperactivity. [ABSTRACT FROM AUTHOR]

In recent decades, functional laryngeal surgery has become a widespread method of treating glottic and supraglottic neoplasms, since it ensures an oncological outcome comparable to that of radical surgery and functional results that are conducive to a good quality of life. The most common postoperative complaints for this type of surgery are swallowing disorders, which can thwart good surgical results, especially when severe. Five supracricoid laryngectomees with swallowing disorders unresolved by speech therapy were treated by percutaneous injection of botulinum toxin under electromyographic control. All patients presented marked improvement in their complaints. A single session of botulinum toxin type A treatment resolved the dysphagia in all cases. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented that provides information on the application of botulinum toxin treatment for oropharyngeal dysphalgia caused by tetanus.

Swallowing disorders are present in more than one-third of multiple sclerosis (MS) patients. Dysphagia in MS usually receives limited attention, maybe because of the unpredictability and variability of the disease among patients. Complications of dysphagia such as dehydration and aspiration pneumonia are a common cause of death and morbidity in late MS. For the effectiveness of swallowing rehabilitation in MS-related dysphagia we suggest that all MS patients should have a thorough evaluation of swallow ability. [ABSTRACT FROM AUTHOR]

Dysphagia can complicate multiple sclerosis (MS). Its real prevalence may be estimated to be around 30%–40%. Furthermore, dysphagia is life-threatening. In fact, its complications such as dehydration and aspiration pneumonia are a common cause of death and morbidity in late MS. The management of dysphagia should be focused on treatment of the specific dysphagic symptom and the underlying pathophysiology. The symptomatic management of dysphagia is based on two different types of approaches: the rehabilitative treatment and the pharmacological treatment. Botulinum toxin treatment may be a valid therapy in MS patients with oro-pharyngeal dysphagia associated with upper oesophageal sphincter hyperactivity. [ABSTRACT FROM AUTHOR]

Cricopharyngeal myotomy is the most common treatment used to restore normal swallowing in patients with persistent (>6 months) cricopharyngeal muscle dysfunction post-stroke. We describe 2 patients whose dysphagia was due to cricopharyngeal muscle over-activity and who significantly improved after a percutaneous botulinum toxin injection in the cricopharyngeal muscle in combination with a rehabilitation treatment (dietary modifications, postural techniques, airflow protection manoeuvres). Swallowing was assessed clinically and by fibreoptic endoscopic evaluation of swallowing and videofluoroscopy; the degree of dysphagia was scored using the penetration-aspiration scale. Two months after the botulinum toxin injection the patients, who were previously fed via percutaneous endoscopic gastrostomy, returned to independent oral feeding and at 6, 12 and 24 months follow-up, both were still able to maintain an adequate oral intake with no signs of aspiration (by videofluoroscopy) or clinical complications. No further botulinum toxin injections or rehabilitation treatments were required. Our findings strongly suggest that even long-standing dysphagia can improve dramatically in selected patients. To the best of our knowledge, there are no other reports with such a long follow-up. [ABSTRACT FROM AUTHOR]

Objectives Olfaction is based on the function of the nasal olfactory receptors. Children can well detect and respond to odors in order to have information about food and environment. Rapid maxillary expansion seems to improve dental class and increase nasal patency correcting oral respiration in children. Nevertheless, there are no studies demonstrating that expansion in pediatric patients could influence olfactory sensitivity. The aim of this study was to evaluate olfactory threshold and nasal patency in children aged from 6 to 12 years before and after rapid maxillary expansion. Method N-butanol olfactory thresholds, anterior active rhinomanometry, and peak nasal inspiratory flow were measured in 12 children (6–12 years) before (T0), 20 days (T1), and 6 months after rapid maxillary expansion application (T2). Results A significant lower olfactory threshold was found comparing T2 and T0 N-butanol olfactory threshold values ( p = 0.038). Peak nasal inspiratory flow showed a significant improvement both at T1 and T2, with respect to T0 values ( p = 0.043 and p = 0.0001, respectively). T2 nasal resistances showed a trend towards a significant reduction when compared with T1 values ( p = 0.15). Conclusion This pilot study suggested that rapid maxillary expansion may lead to improved N-butanol olfactory thresholds, at least 6 months after palatal expansion. Furthermore, rapid maxillary expansion seems to improve peak nasal inspiratory flow values, and finally although with lower sensitivity, reduce nasal resistances as measured by rhinomanometry. [ABSTRACT FROM AUTHOR]

Conclusions. Diagnostic work-up should include contrast-enhanced computed tomography (CT) and mandible orthopantogram. When a dental origin of deep neck infection is suspected, the intravenous antibiotic regimen has to be active against gram-positive bacteria, both aerobes and anaerobes. Surgical exploration and drainage may be mandatory at presentation, or in cases not responding to medical therapy within the first 24 h. Objectives. Deep neck infections are still associated with significant morbidity and mortality rates when complications occur. Despite worldwide improvement in dental care and oral hygiene, a significant prevalence of deep neck infections caused by dental infections has been described recently (>40%). Patients and methods. We analysed retrospectively 85 cases of deep neck infection with dental origin out of 206 consecutive cases of deep neck infection diagnosed in our institution between 2000 and 2006. Results. The most frequent dental source was a periapical infection of the first mandibular molar, followed by second and third molar, respectively. Submandibular space infection involvement was diagnosed in 73 of 85 patients (85.9%), masticatory space infection in 28 (32.9%); in 56 patients (65.9%) the infection involved more than one space. Twenty-four patients (28.2%) were treated only with intravenous antibiotic therapy; 61 patients (71.8%) required both medical and surgical procedures. [ABSTRACT FROM AUTHOR]

The article studies the nasal microbiology of patients with sinonasal polyposis and chronic sinusitis treated with functional endoscopic sinus surgery (FESS). The isolation rate of Burkholderia cepacia complex (Bcc), a gram-negative bacteria, in sinonasal polyposis patients without cystic fibrosis is examined. The pre-operative and post-operative cultures of the species including Staphylococcus aureus, Bcc, Pseudomonas aeruginosa and others are also studied.