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5 results

  • Cricopharyngeal achalasia associated with laryngomalacia as a cause of failure to thrive

  • V Givens, K Brent, M Dunham, S P Kanotra
  • Journal:
    The Journal of Laryngology & Otology / Volume 132 / Issue 9 / September 2018
    Published online by Cambridge University Press:
    18 June 2018, pp. 852-855
    Print publication:
    September 2018
  • Objective

    To describe a case of concurrent cricopharyngeal achalasia with laryngomalacia as a cause of failure to thrive, and to review the literature and management options of cricopharyngeal achalasia in the paediatric population.

    Methods

    A chart review was performed on a four-month-old male, referred for failure to thrive, and diagnosed with cricopharyngeal achalasia and laryngomalacia. A PubMed and Embase search for ‘cricopharyngeal achalasia’ and ‘laryngomalacia’ was conducted. A review of reported paediatric cricopharyngeal achalasia patients, with emphasis on management options, was undertaken.

    Results

    A flexible laryngoscopic examination confirmed the laryngomalacia diagnosis, and videofluoroscopic evaluation of swallowing demonstrated cricopharyngeal achalasia via a cricopharyngeal bar. Supraglottoplasty was performed, with botulinum toxin injection into the cricopharyngeus muscle, with resultant improvement in oral intake and resolution of failure to thrive. The literature review revealed no reported case of the combined pathologies as a cause of failure to thrive.

    Conclusion

    Functional endoscopic evaluation of swallowing and videofluoroscopic evaluation of swallowing are complimentary in the evaluation of paediatric patients with failure to thrive and suspected oropharyngeal dysphagia. Both supraglottoplasty and botulinum toxin injection are effective for definitive management in cases of combined pathology, and can be safely performed in a single surgical setting.

  • The pathogenesis of proventricular dilatation disease

  • Ian Tizard, H. L. Shivaprasad, Jianhua Guo, Samer Hameed, Judith Ball, Susan Payne
  • Journal:
    Animal Health Research Reviews / Volume 17 / Issue 2 / December 2016
    Published online by Cambridge University Press:
    03 February 2017, pp. 110-126

  • Bornaviruses cause neurologic diseases in several species of birds, especially parrots, waterfowl and finches. The characteristic lesions observed in these birds include encephalitis and gross dilatation of the anterior stomach — the proventriculus. The disease is thus known as proventricular dilatation disease (PDD). PDD is characterized by extreme proventricular dilatation, blockage of the passage of digesta and consequent death by starvation. There are few clinical resemblances between this and the bornaviral encephalitides observed in mammals. Nevertheless, there are common virus-induced pathogenic pathways shared across this disease spectrum that are explored in this review. Additionally, a review of the literature relating to gastroparesis in humans and the control of gastric mobility in mammals and birds points to several plausible mechanisms by which bornaviral infection may result in extreme proventricular dilatation.

  • A rare case of paediatric stridor caused by achalasia

  • J G Barr, H Dean, G Morrison
  • Journal:
    The Journal of Laryngology & Otology / Volume 129 / Issue 7 / July 2015
    Published online by Cambridge University Press:
    15 June 2015, pp. 725-726
    Print publication:
    July 2015
  • Objective:

    This paper reports a case of achalasia in a 12-year-old girl who presented with stridor.

    Case report:

    An otherwise healthy 12-year-old girl presented to the ENT clinic with an 18-month history of dysphagia and noisy breathing on eating. Flexible fibre-optic examination showed a normal larynx with normal vocal fold movements. Fibre-optic endoscopic evaluation of swallowing was normal initially, but biphasic stridor occurred after several swallows. Microlaryngoscopy, bronchoscopy and upper oesophagoscopy showed a dilated oesophagus with normal mucosa. Bronchoscopy showed tracheomalacia of the distal trachea, which reduced the airway by approximately 75 per cent. This was caused by posterior compression from redundant oesophageal mucosa with dilatation as a result of retained fluids. Videofluoroscopy suggested achalasia, which was confirmed by oesophageal manometry. Her symptoms improved following a Heller's myotomy.

    Conclusion:

    This is the first paediatric case in the English literature of achalasia presenting with stridor. The condition was correctable with surgical intervention.