2019 AMI Online Salon

Disruption of Irradiated Cervical Esophageal Mucosa During Bougie Dilation

Project Details

  • Entrant Name: Carolina Hrejsa
  • Membership Type: Professional Submission
  • Other Contributors: Dr. Andrew Lerrick                     
  • Address: Arlington Heights, IL
  • Client: United Health Services Hospitals
  • Medium/software used: Adobe Photoshop CC, Adobe InDesign CC
  • Final presentation format: 22′ x 29” on a conference poster at American Academy of Otolaryngology-Head and Neck Surgery annual conference Fall 2018
  • Primary Audience: Attendees at AAO-HNS conference poster session, ie current practicing head and neck surgeons.

Project Description

These illustrations demonstrate to the medical professional the mechanism by which a squilgee effect occurs when performing bougie dilation of the cricopharyngeus muscle (CPM).  The loss of elasticity of the CPM following radiation treatment causes the lubricant applied to the bougie to accumulate proximal to the muscle and blood caused by disruption of the esophageal mucosal to remain distal to it. To maintain mucosal integrity in the vicinity of the upper esophageal sphincter when passing the bougies the practitioner should administer a water soluble lubricant through a rigid esophagoscope proximal and distal to the CPM at the outset of the procedure. Application of lubricant to the cervical esophagus as the esophagoscope is being withdrawn can reduce mucosal damage during subsequent bougie dilation.