Logemann J A
Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois.
Otolaryngol Clin North Am. 1988 Nov;21(4):613-23.
Many disturbances in oropharyngeal physiology can result in aspiration. Poor tongue movement in chewing or in the oral swallow can cause food to fall into the pharynx and into the open airway before swallowing. A delay in triggering the pharyngeal swallow can result in food falling into the airway during the delay when the airway is open. Reduced peristalsis in the pharynx, whether unilateral or bilateral, will cause residue in the pharynx after the swallow that can fall or be inhaled into the airway. Reduced laryngeal elevation causes food to catch at the top of the airway. This residual food is then easily aspirated during the inhalation after the swallow. Reduced laryngeal closure may result in food penetrating the larynx during the pharyngeal swallow. Cricopharyngeal dysfunction can result in material remaining in the pyriform sinus, with aspiration of material into the airway after the swallow. Aspiration may also occur because food returns or is refluxed from the stomach or esophagus back into the pharynx. Each of these causes of aspiration can occur in a variety of patients, including those with neurologic impairment or structural damage. Each of these causes of aspiration has a different treatment. Thus, accurate and in-depth evaluation of swallowing anatomy and physiology in the oral-pharyngeal region as well as in the esophagus is necessary in successful re-establishment of oral nutrition in the dysphagic patient. Currently, such thorough evaluation requires radiographic graphic techniques, that is, videofluoroscopy and often manometry as well.
口咽生理功能的许多紊乱都可能导致误吸。咀嚼或口腔吞咽时舌运动不佳可导致食物在吞咽前落入咽部并进入开放气道。触发咽吞咽延迟可导致在延迟期间气道开放时食物落入气道。咽部蠕动减弱，无论是单侧还是双侧，都会导致吞咽后咽部残留，这些残留物可能会掉落或被吸入气道。喉提升减弱会使食物卡在气道顶部。然后，这些残留食物在吞咽后的吸气过程中很容易被误吸。喉关闭减弱可能导致食物在咽吞咽时穿透喉部。环咽肌功能障碍可导致食物残留在梨状窦，吞咽后食物被误吸入气道。误吸也可能由于食物从胃或食管反流回咽部而发生。这些误吸原因中的每一种都可能发生在各种患者身上，包括有神经功能障碍或结构损伤的患者。这些误吸原因中的每一种都有不同的治疗方法。因此，为了成功地为吞咽困难的患者重新建立口服营养，对口咽区域以及食管的吞咽解剖结构和生理功能进行准确而深入的评估是必要的。目前，这种全面评估需要影像学技术，即电视透视吞咽功能检查，通常还需要测压检查。
