[Swallowing defects determined by tracheostomy]

We have studied the interference on swallowing of the skin-tracheal fixation determined by tracheostomy. We have analyzed this interference by videofluoroscopy. One hundred and twelve patients with complain of dysphagia have been studied by videofluoroscopy at the Hospital Universitário "Clementino Fraga Filho", Rio de Janeiro, RJ. Four have undertaken tracheostomy. One (female, 52 years) had already a metal cannula in the trachea, three others (two females and one male/40 to 66 years) exhibited a longitudinal anterior depressed scar, for more than five years. Two patients had also a neurological disease. In the videofluoroscopic observation it was used liquid medium (barium solution) and also solid and soft contrast media made of barium powder mixed with a bread dough. We have found a correlation between skin-tracheal fixation and swallowing defects. The skin-tracheal fixation interference occurs basically by opposition to the hyo-larynx free displacement. This limited displacement determines a small amplification of the laryngo-pharyngeal space, a restrictive opening of the pharingo-esophageal segment and also determines that the laringeous aditus remains near the pharingo-esophageal limit. We have observed swallowing defects in all the four tracheostomized patients. The observed defects relative to tracheostomy was the penetration of contrast medium in the airway. This penetration was cleared by forced expiration. In three patients the swallowing defects was clearly linked to tracheostomy. We can admit that the skin-tracheal fixation, without any other pathology, can determine dysphagia. In association with other diseases this fixation can increase the disturbance: On the other hand it can run unnoticed due to more evident pathology. The consequence of skin-tracheal fixation is better determined by videofluroscopy.