Case 1: Post-Chemoradiation Dysphagia

Initial Modified Barium Swallow Study (MBSS)

92611 Fluoroscopic Evaluation of Swallowing Function

FLUORO 1

MBSImP1  COMPONENTS

SCALE

SCORE

DESCRIPTION 

1. Lip Closure

(0 - 4)

0

No labial escape 

2. Tongue Control/Bolus Hold

(0 - 3)

Escape to lateral buccal cavity/
floor of mouth 

3. Bolus Prep/Mastication 

(0 - 3)

Solid not given

4. Bolus Transport/
Lingual Motion

(0 - 4)

Slowed tongue motion 

5. Oral Residue 

(0 - 4)

Residue collection on oral structures 

6. Initiation of Pharyngeal Swallow 

(0 - 4) 

Bolus head in pyriforms 

7. Soft Palate Elevation 

(0 - 4) 

0

No contrast between SP & PPW 

8. Laryngeal Elevation 

(0 - 3)

Partial superior movement of thyroid cartilage 

9. Anterior Hyoid Excursion 

(0 - 2) 

Partial anterior movement

10. Epiglottic Movement 

(0 - 2) 

No inversion

11. Laryngeal Vestibular Closure

(0 - 2) 

Incomplete; narrow column air/contrast in L. vestibule 

12. Phayrngeal Stripping Wave 

(0 - 2)

Present, complete 

13. Pharyngeal Contraction 

(0 - 3)

Unilateral bulging 

14. Pharyngoesophageal Segment Opening 

(0 - 3)

No distension; total obstruction of flow 

15. Tongue Base Retraction 

(0 - 4) 

Wide column contrast/air between BOT & PPW

16. Pharyngeal Residue

(0 - 4) 

Minimal to no pharyngeal clearance

17. Esophageal Clearance (upright )

(0 - 4)

N/A no bolus entry 

 


Penetration/Aspiration Scale2: Thin liquid entered airway below vocal fords; not ejected, despite effort (7);

No other consistencies administered.

Assessment: Suspected severe stenosis or stricture based on complete absence of PES distension/opening despite presence of partial laryngeal elevation and anterior hyoid excursion. Patient not responsive to compensatory PES opening maneuvers. Patient was able to improve valving of the laryngeal vestibule using the Supraglottic Swallow (pre- and sustained laryngeal vestibular valving via arytenoid to epiglottic base approximation).
*Note: subsequent direct visualization confirmed stricture