“Oooh Mom, we are learning about electromagnetism and magnetic fields in wire currents in Physics 2, so we have to think and calculate in 3D now, it’s pretty cool.” -my 18 year old daughter (who is clearly smarter than me, and YES she KNOWS it). Which then of course prompted me to think about how much I have to think in 3D when watching MBS studies. The MBS image, as delightful and as helpful as it can be when evaluating swallow physiology, shows a flat view of multiple, very complex, three dimensional structures (4 dimensional if you think about time and movement of all those complex structures). This clip is an excellent example of how we must think in 3D to make a proper assessment.
This patient has what appears to be a mysterious layer of something crossing over the pharynx. It happens to be a fair amount of plaque (possibly calcified) in the carotid arteries. This occurs in about 10% of the population age 50 and over and is important to note on your report and/or get the Radiologist to note it. If you watch carefully, you can see it pulse. It’s important to be familiar with all structures in the head and neck, even the ones that don’t necessarily relate to swallowing. An easy way to differentiate the carotid arteries from other structures within the pharynx is the have the patient turn their head from side to side-you will then see the arteries move anteriorly and posteriorly.
PS I told my daughter about how I do this and she was not impressed.