Explanation
In general evaluations of patients with suspected dysphagia, it is important to look for systemic symptoms such as fever, variability in blood pressure, tachycardia, dryness of the skin or mucous membranes, emaciation, and edema, and to check for signs of dehydration and undernutrition or malnutrition.
Explanation
In physical examinations of patients with suspected dysphagia, it is important to look for respiratory symptoms such as general malaise, fever, wet cough, dyspnea, and cyanosis, and to perform tests such as blood tests and chest X-rays if signs of aspiration pneumonia are present.
Explanation
In oral examinations of patients with suspected dysphagia, it is important to look for food residue, dental plaque, tongue coating, halitosis, dental caries, periodontitis, denture fit, and saliva quantity and perceived quality (composition).
Explanation
The first important point in neurological evaluations of patients with suspected dysphagia is to assess consciousness level and cognitive function in order to avoid overlooking mild impairment of consciousness or dementia.
Patients with impaired consciousness are prone to dysphagia associated with aspiration.
Cognitive impairment associated with dementia or cerebrovascular disease in elderly patients can cause problems with eating and swallowing. The problems observed include refusal of food due to loss of appetite, cessation of eating movements due to reduced attention span or decreased executive function, and reduced sensory recognition of food due to reduced comprehension or memory. If elderly patients with dementia develop dysphagia, they are at high risk of aspiration pneumonia regardless of the severity of the impairment causing the dysphagia.
Explanation
The second important point in neurological evaluations of patients with suspected dysphagia is to assess them for higher brain dysfunction. It is particularly difficult to reintroduce oral feeding in patients with loss of appetite caused by a mood disorder.
Explanation
The third important point in neurological evaluations of patients with suspected dysphagia is to conduct a cranial nerve exam of the main nerves involved in swallowing: the trigeminal nerve (V), facial nerve (VII), glossopharyngeal nerve (IX), vagus nerve (X), and hypoglossal nerve (XII).
Explanation
The important points about the trigeminal nerve (V) that relate to deglutition are that one of its branches, the mandibular nerve, is responsible for sensations in the teeth, mandible, lower lip, cheeks, chin, buccal mucosa, and the anterior two-thirds of the tongue, and it also controls movement of the muscles of mastication (masseter, temporal, lateral pterygoid, and medial pterygoid muscles), the mylohyoid muscle, and the anterior belly of the digastric muscle.
Explanation
The important points about the facial nerve (VII) that relate to to deglutition are that it is responsible for taste in the anterior two-thirds of the tongue, it controls movement of the muscles of facial expression, the platysma muscle, the buccinator muscle, the stapedius muscle, and the posterior belly of the digastric muscle, and it controls secretions from the nasal and oral mucosa as well as the secretory function of the submandibular and sublingual glands.
Explanation
The important points about the glossopharyngeal nerve (IX) that relate to to deglutition are that it is responsible for taste in the posterior third of the tongue and for sensation in the pharynx. Injury to the glossopharyngeal nerve causes problems with the pharyngeal reflex.
Explanation
The important points about the vagus nerve (X) that relate to to deglutition are as follows. One of its branches, the recurrent laryngeal nerve, is involved in autonomic functions and vocal cord movement. Hoarseness is seen with recurrent laryngeal nerve palsy.
The recurrent laryngeal nerve also branches into the external branch of the superior laryngeal nerve, which controls movement of the laryngopharyngeal muscles and the cricothyroid muscle, and the internal branch of the superior laryngeal nerve, which is responsible for sensation in the root of the tongue, the epiglottis, and the pharyngeal mucosa. Another recurrent laryngeal nerve branch called the inferior laryngeal nerve controls movement of the laryngeal muscles.
Explanation
The important points about the hypoglossal nerve (XII) that relate to deglutution are that it is distributed across all tongue muscles except the palatoglossus muscle, and it controls the movement of those muscles. In patients with hypoglossal nerve palsy, the tongue will protrude toward the affected side when they are asked to stick out their tongue.
Explanation
When evaluating articulation in patients with suspected dysphagia, it is important to evaluate the labial consonants (pa, ba, and ma), alveolar consonants (da, ra, and ta), velar consonants (ka and ga), and palatal sounds formed by lifting the soft palate ("ah") to determine if the patient has bulbar palsy or pseudobulbar palsy. Voice quality (wet hoarseness or weak voice) should also be evaluated at the same time.
Explanation
When evaluating motor function in a patient with suspected dysphagia, it is important to evaluate the motor function and sensory function of parts of the neck and trunk involved in sitting posture and eating movements.
