PMC9366393_01
Magnetic resonance imaging (MRI) of the patient and the swallowing evaluation results (A) and (B) show the transverse and sagittal plane of the patient's brain MRI scan. The yellow arrows indicate the abnormal lesions in the medulla oblongata. (C) and (D) show the videofluoroscopic swallowing study (VFSS) imaging of this patient (captured as she ate 3 ml of extremely thick food). Her upper esophageal sphincter (UES) was completely not open with aspiration in (C), while (D) shows that her UES was completely open with no aspiration after treatment. (E) is the high-resolution pharyngeal manometry (HRPM) space-time diagram of the patient (analyzed as the patient ate 3 ml of extremely thick food) and (F) shows the specific statistics of HRPM. The four diagrams in (E) and the colors from dark to light in (F) represent the timeline of the patients' treatment process: before the injection, and after the first, second, and third injections, respectively. In figure (E), The x-axis represents time (the arrow indicates 1 s), the y-axis represents the structure from the velopharynx (VP) to the esophagus, and the color represents the pressure (mmHg) (the warmer the color, the higher the pressure). It can be observed that her UES residue pressure gradually declined. Her VP peak pressure was always in the normal range (>100 mmHg). Considering the dispersal of BTX to the hypopharynx (HP), her HP peak pressure dropped after the first and second injections. Therefore, her speech-language pathologist conducted pharyngeal balloon pressure training, then her HP peak pressure got back to normal.
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F1
Brain MRI demonstrated abnormal lesions in the medulla oblongata, bilateral hypothalamus, and white matter of the cerebral hemispheres (Figures 1A,B). And the VFSS results showed that her UES were opening without aspiration (Figure 1D).