The patient has had a brainstem CVA and has 2 problems:  difficulty / slow initiation of the swallow and a very weak swallow, more so on the left. Incomplete airway closure.  She aspirates the barium liquid.

In this movie of a patient who has had surgery and CRT for HNC, we see VPI (velopharyngeal incompetence), excess secretions, and a weak swallow. He takes juice and it helps clear the secretions.

This FEES examination was done in the ICU on a patient who had his epiglottis resected due to cancer.  He is given an ice chip to determine whether he is ready to take anything orally.  He aspirates the ice chip and then swallows.  He has no response to the aspiration (ie., no cough). This exam made it clear that the patient was not ready to take anything to eat or drink orally

This patient has had a pharyngeal cancer with reconstruction of her pharyngeal wall with a free flap.  She has also had radiation therapy.  Her anatomy has been altered, leaving her no lateral channels to funnel liquid or food around the larynx.  These channels become very important for patients who have reduced ability to clear the bolus when they swallow.

A simultaneous view of normal swallows as visualized via fluoroscopy and with endoscopy.

Movie Clips: FEES Examinations

This is a FEES visualization of consecutive sips of water. Healthy normal subject.

Fiberoptic Endoscopic Evaluation of Swallowing

Langmore FEES