Modified Mondays: What looks bad can be ok
Any SLP completing an MBS study should know what normal anatomy looks like-otherwise how would we know when something is just…wrong? Anatomical anomalies are important to note, and often require a referral… and quite often can be the cause of all the problems in the first place. Knowing when we see something and what to do about it is part of doing a comprehensive evaluation.
Sometimes, though, it’s really important to be aware that not all anatomical anomalies impact the swallow function. This case from our Detroit, Michigan team is a great example of this. When the fluoro was first turned on, they immediately noted a pretty gnarly looking osteophyte-bridging over a few cervical vertebrae and quite large. Our immediate thought as an SLP might be “No WAY can this patient swallow with this thing in there”… but the thing about osteophytes is: they don’t grow overnight, and patients often have no difficulty with swallowing-even with one as large and involved as this one. In fact, the great majority of cervical osteophytes are completely asymptomatic. You can see in the clips here that the patient has a pretty timely and strong swallow, the osteophyte doesn’t have much impact that the patient can’t handle.
Osteophytes generally take time to develop, and don’t always affect the swallow. We as SLPs don’t usually get to see patients on fluoro with no swallowing problems-so we may have a slightly skewed perspective on the prevalence of dysphagia with osteophytes. Noting the osteophyte in this case was important (the Radiologist confirmed and the team notified the PCP), but it was equally important (perhaps even more so) to complete the full MBS study and see the whole picture of the patient-gnarliness and all.
Anterior cervical osteophytes causing dysphagia: Choice of the approach and surgical problems (nih.gov)