title: Digital cineradiographic study of swallowing in infants with neurologic disease. Our experience.
abstract: OBJECTIVE
  The study is aimed at proposing the use of digital cineradiography in the evaluation of swallowing disorders in children affected by severe neurological or developmental disability, in order to correctly identify these conditions and provide therapeutic approaches that could solve their feeding problem, improve their nutritional conditions and decrease the risk of infections.
  
  
  METHODS
  In the period between March 2001 and July 2003, 12 children (8 males and 4 females), aged between 9 months and 13 years, (average 6.2 years), affected by severe neurological or psychomotor disorders were evaluated with digital cineradiography. This investigation was requested for recurrent pulmonary infections and/or dysphagia with weight loss. All the examinations were performed with radio-controlled equipment provided with a digital C arm.
  
  
  RESULTS
  Using the above mentioned technique, in all 12 patients, it was possible to differentiate those with disorders of the oral and/or pharyngeal swallowing phase (9/12) from those without swallowing dysfunction (3/12). In 9/9 patients passage of contrast medium into the upper airways was observed during swallowing: in 2 of them this was limited to the laryngeal vestibule (sub-epiglottic penetration), while in 7/9 cases aspiration of contrast medium into the trachea (5/9) or into the right bronchus (1/9) or into both bronchi (1/9) was recorded. In one patient the aspiration decreased in the sequences acquired with hyperflexion of the head. In 3/9 patients we recorded the transition of contrast medium into the nasopharynx during swallowing caused by incomplete closing of the oropharyngeal isthmus by the soft palate. In 3/9 patients there was incomplete clearing of the pharynx with contrast medium deposition in glosso-epiglottic vallecules and in the pyriform sinuses; only in one case did this stagnation result in post-swallowing aspiration. More than one disorder was found in 5/9 patients, and one only in 4/9.
  
  
  CONCLUSIONS
  On the basis of our preliminary data it is possible to conclude that the dynamic swallowing study with digital technique allows a clear-cut evaluation of the swallowing process with minimum discomfort for the patient. On the other hand, the technique exposes to the risk of ionizing radiation; however, in consideration of the important clinical and therapeutic implications and in agreement with the literature, we believe that the importance of the information provided by the technique outweighs the risks linked to radiations.
authors.affiliation: Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Policlinico, Università degli Studi, Palermo. barbiera@inwind.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Barbiera
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iacono
authors.forename: Antonio
authors.initials: A
authors.lastname: Carroccio
authors.forename: Eugenio
authors.initials: E
authors.lastname: Fiorentino
authors.forename: Maria
authors.initials: M
authors.lastname: Bellia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Runza
authors.forename: Maria
authors.initials: M
authors.lastname: Lo Sciuto
authors.forename: Tiziana
authors.initials: T
authors.lastname: D'Agostino
authors.forename: Roberto
authors.initials: R
authors.lastname: Lagalla
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002933:Cineradiography; D003679:Deglutition; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011596:Psychomotor Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology*