Monday, January 23, 2012

anatomy lesson

People are capable of making lots of sounds because of a small thing called our larynx or voice box.  The larynx sits at the top of our trachea or windpipe.  If you were looking down at your larynx you'd see a sort of triangular opening.  It would be wider in the front and that's where your epiglottis is.  The epiglottis is kind of like a flap that guards the opening of the larynx.  It closes the opening when we swallow food or drink and prevents choking.  On the sides of the opening are the vocal cords or sometimes they're called vocal folds.  The vocal cords are what produce sound when they vibrate together.  They are also a sort of back up to the epiglottis.  At the back of the opening are two arytenoids (cartilage).

In Caelan those vocal cords were stuck together for the longest time.  It was only this past September that he underwent surgery to have them permanently pinned open.  During this surgery they made a point of not completely spreading the cords, but instead tried to keep about a third of the cords still close enough together to maintain a voice.  When that didn't seem to be enough of an airway for him they went back in and lasered off some of the arytenoid on one side.  Then at the end of November they put his trache back in.  The tracheotomy sits directly below the larynx in the trachea.

Prior to getting his tracheotomy back, with his vocal cords pinned open this is what Caelan's larynx looked like:

Looks like a decent airway, doesn't it?

Anyway, that's not where I was going with this...  What I wanted to explain is that Caelan is at a much greater risk for aspiration in his current situation than he was with his previous tracheotomy.

Caelan had a feeding study done a long time ago, at which time they concluded that he did have a good swallow.  This meant that his epiglottis worked and when he swallowed it protected his airway.  Variations of this feeding study was done in a less scientific way several times over the years.  For example, anytime we fed Caelan anything orally we were always watching closely for traces of it coming out his trache.  We attempted something similar after he got his trache back by putting a drop of blue food colouring in his mouth it instantly, INSTANTLY, came out his trache.  This is less than good.  I don't doubt that Caelan still has a good swallow, but unfortunately he probably has more secretions and saliva than he knows what to do with.  Not all of it is getting swallowed in a timely manner, resulting in some of it sliding down, past those pinned open vocal cords and into his trachea.

This also helps explain why Caelan seem so much 'juicier' this time around.  He's become the boy who can go through half a dozen shirts in a day as he soaks through them regularly.  Probably more.  Within minutes of a clean shirt it's all wet at the collar.  Needless to say, he's doing pretty good at clearing his trache on his own and we need to suction him less and less.

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