Defective closure of the laryngeal vestibule during deglutition

Two-hundred and fifty patients with dysphagia were studied with cineradiography of the pharyngeal stage of deglutition. In 103 a defective closure of the laryngeal vestibule was disclosed. In 58 patients the closing of the supraglottic space, i.e., the inferior portion of the laryngeal vestibule was normal while the subepiglottic space, i.e., the superior portion of the laryngeal vestibule, was defective. In 41 patients neither the supraglottic nor the subepiglottic space closed properly during the act of deglutition. In 29 of these the contrast medium reached into the trachea. The defective closure of the laryngeal vestibule could be distinguished into two principally different categories. The first category could be discerned as a delayed closure of the vestibule allowing contrast medium to enter. This contrast medium was later expressed back into the pharynx when the vestibule was closed. The second category could be discerned as an inability to close-the vestibule remained open during the whole time lapse of swallowing. The contrast medium remained in the vestibule until it was either aspirated or expelled by vigorous coughing.