Phase Of Swallowing Research Articles

Implementing the International Dysphagia Diet Standardization Initiative: Opportunities for Change

Modified-texture foods and thickened liquids are commonly prescribed to minimize the risk of choking or aspirating for patients identified to have dysphagia. With improvements in health care resulting in increased survival of preterm infants and those with congenital anomalies, dysphagia prevalence is increasing in the pediatric population. Children may be prescribed texture-modified diets for various reasons because dysfunction can be present in any of the four phases of swallowing, which may manifest at different stages of development.

Hyoid kinematic features for poor swallowing prognosis in patients with post-stroke dysphagia

Identification of prognostic factors for swallowing recovery in patients with post-stroke dysphagia is crucial for determining therapeutic strategies. We aimed at exploring hyoid kinematic features of poor swallowing prognosis in patients with post-stroke dysphagia. Of 122 patients who experienced dysphagia following ischemic stroke, 18 with poor prognosis, and 18 age- and sex-matched patients with good prognosis were selected and retrospectively reviewed. Positional data of the hyoid bone during swallowing were obtained from the initial videofluoroscopic swallowing study after stroke onset. Normalized hyoid profiles of displacement/velocity and direction angle were analyzed using functional regression analysis, and maximal or mean values were compared between the good and poor prognosis patient groups. Kinematic analysis showed that maximal horizontal displacement (P = 0.031) and velocity (P = 0.034) in forward hyoid motions were significantly reduced in patients with poor prognosis compared to those with good prognosis. Mean direction angle for the initial swallowing phase was significantly lower in patients with poor prognosis than in those with good prognosis (P = 0.0498). Our study revealed that reduced horizontal forward and altered initial backward motions of the hyoid bone during swallowing can be novel kinematic features indicating poor swallowing prognosis in patients with post-stroke dysphagia.

Esophageal dysphagia in neuromuscular disorder patients with validity and reliability study of the brief esophageal dysphagia questionnaire.

Esophageal dysphagia (ED) is often underestimated in neuromuscular disorders (NMD) and it is important to evaluate the esophageal phase of swallowing with an easy and rapid screening test. We aimed both to assess the prevalence of ED in NMD and to perform validity and reliability study of the brief easophageal dysphagia questionnaire (BEDQ) screening test in NMD patients. This prospective cross-sectional clinical study was performed on NMD patients. Demographic features and disease characteristics were recorded. Endoscopic evaluation for oropharyngeal dysphagia (OD) and high-resolution esophageal manometry for ED were performed. In addition, the BEDQ and the 10-item eating assessment tool (EAT-10) were used to all subjects. Cronbach's α and principle components factor analysis (PFCA) with varimax rotation were used for reliability. The Chicago Classification version 3 (CCv3) level (high-resolution esophageal manometry) and EAT-10 was used for validity. A total of 50 patients were included in the study. Thirty-four (68%) patients were diagnosed with myasthenia gravis and 16 (32%) patients were diagnosed with myopathy. Esophageal dysphagia according to the CCv3 was found in 33 (66%) of patients. While the Cronbach's α was excellent as 0.937 for test overall the T-BEDQ scale. The PCFA included all scale items and resulted in a single factor (eigenvalue = 5.72, 71.5%). The all BEDQ scores were demonstrated good correlation with EAT-10 score and very good correlation with CCv3 level. Evaluation of swallowing in patients with NMD should include not only the oropharyngeal phase of swallowing, but also esophageal phase. For this purpose, the BEDQ can be used as a rapid, valid, and reliable test for the evaluation of ED.

Orofacial motricity and use of mixed techniques in a cranio-facial trauma: a case report

ABSTRACT No reports about treatments applied by orofacial motricity experts, in craniofacial trauma, were found in the specialized literature. However, their knowledge, added to that of the aesthetic area, would be useful in the rehabilitation of scars. The aim of this work is to describe the mixed use of orofacial motor skills, muscle balance massage and scar management in a patient with soft tissues facial trauma. During the initial evaluation, a decrease in the vertical and horizontal oral opening and in the mimic movements, facial asymmetry and marked scars that affected the oral phase of swallowing, chewing (bolus formation), lip mobility, compromising speech intelligibility and, significantly, aesthetics, were observed. Myofunctional therapy lasted 12 months, during which the patient underwent three surgeries. The process was divided into an intensive phase (six months, two weekly sessions) and a follow-up phase (six months, one weekly session), which ended when the indicators evaluated at the beginning were stable, showing improvements in scars condition and appearance, as well as in orofacial functions, including pre-post therapy self-perception and greater muscular mobility, reflecting a management with an integrative approach.

Swallowing in behavioral variant frontotemporal dementia.

Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases of swallowing. To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features. Consecutive outpatients with bvFTD in mild, moderate and severe dementia stages were recruited along with their caregivers. Patients and caregivers were screened with the following scales: "Mini-Mental State Examination", "Severe Mini-Mental State Examination", "FTLD-modified Clinical Dementia Rating", "Neuropsychiatric Inventory", "Frontal Assessment Battery", "Index of Independence in Activities of Daily Living", "Swallowing Rating Scale" and "Assessment of Feeding and Swallowing Difficulties in Dementia". Overall, thirty patients with bvFTD were included along with their caregivers. Patients with bvFTD showed feeding and swallowing difficulties such as: messy to eat, passivity, coughing and choking, difficulty with some food consistencies and with specific food. Swallowing problems in bvFTD correlated with impaired functionality (p<0.05) and cognition (p<0.05), executive dysfunction (p<0.01) and behavioral features (p<0.01). Caregivers had great difficulty in managing the feeding situation during mealtime, with different characteristics in each dementia stage. Patients with bvFTD had inappropriate speed eating, passivity, coughing and choking starting in the mild dementia stage, and these problems worsen in the severe stage. Such difficulties affected caregiver performance during mealtime. The correlations indicated that swallowing difficulties tend to follow cognitive and behavioral decline in patients with bvFTD.

Eating and swallowing disorders in children with cerebral palsy

Introduction. Cerebral palsy is characterized by abnormalities of muscle tone, movement and motor abilities caused by disorders in brain development. Many children with cerebral palsy have severe swallowing problems. Cerebral Palsy. Cerebral palsy is a neurodevelopmental disorder characterized by abnormalities in brain development. Swallowing is a process by which a bolus that is formed within the oral cavity is transported through the pharynx into the esophagus and stomach. It has four phases: preparatory oral, oral, pharyngeal and esophageal. Swallowing disorders in children with cerebral palsy. Swallowing disorders vary depending on the type of cerebral palsy. Children with spastic paralysis have a more pronounced disorder of the voluntary phases of swallowing, while children with athetoid paralysis are expected to have a disorder at the oral-motor level. Neurological lesions may affect the muscle function of the jaw, cheeks, lips, tongue, palate and pharynx, which is manifested by difficulties in controlling saliva and swallowing. Diagnosis and treatment of dysphagia in cerebral palsy. Diagnosis and treatment of dysphagia is best accomplished by a team of experts including a pediatrician, neurologist, otorhinolaryngologist, gastroenterologist, radiologist, dental specialist, speech therapist, nutritionist, and a specialist in physical medicine and rehabilitation. Conclusion. Dysphagia is a common comorbidity in children with cerebral palsy. Although swallowing disorders often correlate with the type of cerebral palsy, the most prevalent signs of dysphagia include: coughing, prolonged feeding time, laryngotracheal penetration and aspiration, suffocation, which leads to dehydration, malnutrition, but also to the need for alternative feeding methods. It is important to emphasize the importance of early treatment by a team of experts, with a speech therapist as a team leader.

Selective embolization of lingual artery in transoral robotic surgery for the management of recurrent base of tongue carcinomas

The incidence of oropharyngeal carcinoma has been on the rise in recent decades. About 30% of patients who undergo definitive chemoradiation as the initial treatment present with residual/recurrent disease. In such a situation, surgical salvage either in the form of traditional open surgery or transoral robotic surgery (TORS) remains a viable treatment option. However, the extensive vascular supply of the posterior tongue and tonsillar bed increases the risk of perioperative bleeding, which is a key concern. The article describes the technique of selective pre-operative embolization to reduce the risk of perioperative bleeding and enumerate its advantages in providing a bloodless field during surgery. Prospective study of 5 patients with recurrent or residual midline BOT tumours who underwent TORS after selective lingual artery embolization at our centre. None of the patients had any major perioperative bleeding or post procedural complications. All the patients after TORS had their tongue vascularity preserved with adequate recovery of tongue functions. Selective embolization of the feeder vessels provides a favorable bloodless surgical field without affecting the vascular integrity of the remnant tongue. This added advantage helps restoring the normal oral phase of swallowing.

Are there any differences between the tongue and posterior pharyngeal wall movement patterns during normal and Masako swallow?—An ultrasound analysis

Parkinson's disease (PD) is a neurodegenerative movement disorder affecting volitional movement due to Dopamine-producing neuron death in the substantia nigra. Impaired swallow function is highly prevalent with nearly 100% involvement in PD during the disease course and involves all three phases of swallowing. The oral stage of swallowing is impaired first. Reduced bolus control and reduced interior-to-posterior movement of the bolus transfer lead to delayed swallowing response, premature spillage, decreased base of tongue (BOT) retraction and strength, decreased hyolaryngeal elevation and excursion, and reduced action of pharyngeal constrictors. Together, these result in bolus retention, residue throughout the pharynx, and reduced airway protection leading to significant aspiration. To target these deficits we have designed an exercise regime to teach early to mid-stage PD patients to do the Masako swallow maneuver of saliva (swallow with tongue-tip held between teeth), with high intensity and frequency (i.e., 120 repetitions per day) in one month. The preliminary results are very promising. All participants demonstrated positive changes. To understand the underlying mechanism, we used Ultrasound and recorded 20 normal subjects while they did three normal swallows and 3 Masako swallow maneuvers. The initial observations indicated the tongue and pharyngeal movement patterns differ between the two maneuvers.

Predictors of Pharyngeal Dysphagia in Patients with Parkinson's Disease.

Diagnosis of pharyngeal dysphagia in patients with Parkinson's disease is often difficult as reliable screening methods are lacking so far and clinical examination fails to adequately assess the pharyngeal phase of swallowing. To identify clinical predictors indicating the presence of pharyngeal dysphagia in patients at risk. We examined pharyngeal dysphagia in a large cohort of patients with Parkinson's disease (n = 200) divided in three clinical subtypes (tremor-dominant (TD), mainly bradykinetic (BK) and early postural instability and gait difficulty PIGD)) by using flexible endoscopic evaluation of swallowing. ANOVA-multivariance analysis and following t-tests as well as binary logistic regression analysis were performed to detect group differences and to identify clinical predictors for dysphagia. Statistically significant differences were found in the dysphagic group: age, male gender, disease duration, stage of the disease, Levodopa equivalent dose and higher scores on the Unified Parkinson's disease rating scale III and II, item 7. The PIGD subtype was affected more frequently than the TD and BK subtype. In a logistic regression model higher age (>63.5 years p < 0.05) and Levodopa equivalent dose (>475 mg, p < 0.01) were identified to be independent predictors for the presence of pharyngeal dysphagia. Particularly patients with an age > 63.5 years and a daily Levodopa equivalent dose >475 mg show an increased risk for pharyngeal dysphagia. These findings may partly be influenced by presbyphagia but are likely to represent disease progression. The PIGD subtype seems to be a risk factor due to more pronounced dyscoordination of oropharyngeal muscle movements.

Swallowing in individuals with disorders of consciousness: A cohort study.

After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated. We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC.

Dysphagia in Lateral Medullary Syndrome: A Narrative Review.

Dysphagia is a common clinical feature of lateral medullary syndrome (LMS) and is clinically relevant because it is related to aspiration pneumonia, malnutrition, increased mortality, and prolonged hospital stay. Herein, the pathophysiology, prognosis, and treatment of dysphagia in LMS are reviewed. The pathophysiology, prognosis, and treatment of dysphagia in LMS are closely interconnected. Although the pathophysiology of dysphagia in LMS has not been fully elucidated, previous studies have suggested that the medullary central pattern generators coordinate the pharyngeal phases of swallowing. Investigation of the extensive neural connections of the medulla oblongata is important in understanding the pathophysiologic mechanism of dysphagia in LMS. Previous studies have reported that most patients with dysphagia in LMS have a relatively good prognosis. However, some patients require tube feeding for several months, even years, due to severe dysphagia, and little has been reported about conditions associated with a poor prognosis of dysphagia in LMS. Concerning specific therapeutic modalities for dysphagia in LMS, in addition to general modalities used for dysphagia treatment in stroke patients, non-invasive modalities, including repetitive transcranial magnetic stimulation and transcranial direct current stimulation, as well as invasive modalities, such as botulinum toxin injection, balloon catheter dilatation, and myotomy for relaxation of the cricopharyngeal muscle, have been applied. For the appropriate application of therapeutic modalities, clinicians should be aware of the recovery mechanisms and prognosis of dysphagia in LMS. Further studies on this topic, as well as studies involving large numbers of subjects on specific therapeutic modalities, should be encouraged.

Barium aspiration - Accident or complication?

Aspiration of barium sulfate is possible during radiographic contrast procedures and is potentially life‐threatening in severe cases. In patients with dysphagia or suspected tracheoesophageal fistula, barium compounds may be used, considering lateral projection fluoroscopy of the pharyngeal phase of swallowing, but iso‐osmotic agents should also be considered.

Imaging and Clinical Data on Swallowing Function of Individuals with Huntington's Disease and Dysphagia.

Dysphagia is common in Huntington's disease (HD) affecting all phases of swallowing. Correlations exist between non-instrumental measures of dysphagia and clinical features of HD, including age, disease duration and degree of motor impairment. Lack of instrumental data limits our ability to wholly characterize HD-related dysphagia and prognosticate swallowing changes over time. To retrospectively describe a relatively large database of videofluoroscopic studies (VFSSs) and determine the relationships between dysphagia and HD clinical parameters, including disease duration and burden of pathology score. Medical and swallowing data of 49 individuals with HD and dysphagia were examined. VFSS data were interpreted using the Bethlehem Assessment Scale and Penetration-Aspiration Scale. Data from clinical bedside examination and social information were collated to describe the impact of dysphagia in HD. Repeated VFSS data were available for seven individuals. Swallowing was characterized by lingual dysfunction, reduced soft palate elevation, delayed pharyngeal swallow initiation, and inability to clear matter from the pharynx. Two-thirds of cases presented with compromised airway protection with both liquid and solid consistencies. Tachyphagia and difficulty self-feeding were common. Dysphagia correlated with disease severity and duration. Longitudinal analysis revealed a mixed pattern of progression with some individuals presenting with worsening dysphagia whilst others appeared to remain stable or improved in function. Dysphagia in HD is exacerbated by difficulties with self-feeding and monitoring feeding rate. Burden of pathology relates to pharyngeal swallow initiation and penetration and aspiration of fluid. Dysphagia did not appear to worsen in a systematic way in a subset of participants.

Dysphagia in Myositis: A Study of the Structural and Physiologic Changes Resulting in Disordered Swallowing.

Dysphagia in patients with myositis is associated with an increased risk of aspiration pneumonia. However, the pathophysiology of dysphagia is poorly understood. The aim of this study was to understand how myositis affects swallowing physiology on videofluoroscopic swallow study. This is a retrospective review of video fluoroscopic swallowing studies on 23 myositis patients with dysphagia from 2011 to 2016. Swallow studies were analyzed by timing of swallowing events and duration of swallowing events, diameter of upper esophageal sphincter opening, Modified Barium Swallow Impairment Profile, and Penetration-Aspiration Scale. The outcome measures for patients were compared with an archived videofluoroscopic swallow study from healthy, age-matched participants by Wilcoxon rank-sum tests. Patients with myositis had a shorter duration of upper esophageal sphincter opening (P < 0.0001) and laryngeal vestibule closure (P < 0.0001) than healthy subjects. The diameter of upper esophageal sphincter opening did not differ between groups. Patients with myositis presented with higher scores on the MBSIMP than healthy subjects, indicating great impairment particularly during the pharyngeal phase of swallowing, and a higher frequency of penetration and aspiration. Dysphagia in patients with myositis may be attributed to reduced endurance of swallowing musculature rather than mechanical obstruction of the upper esophageal sphincter.

Swallow Motor Pattern Is Modulated by Fixed or Stochastic Alterations in Afferent Feedback.

Afferent feedback can appreciably alter the pharyngeal phase of swallow. In order to measure the stability of the swallow motor pattern during several types of alterations in afferent feedback, we assessed swallow during a conventional water challenge in four anesthetized cats, and compared that to swallows induced by fixed (20 Hz) and stochastic (1-20Hz) electrical stimulation applied to the superior laryngeal nerve. The swallow motor patterns were evaluated by electromyographic activity (EMG) of eight muscles, based on their functional significance: laryngeal elevators (mylohyoid, geniohyoid, and thyrohyoid); laryngeal adductor (thyroarytenoid); inferior pharyngeal constrictor (thyropharyngeus); upper esophageal sphincter (cricopharyngeus); and inspiratory activity (parasternal and costal diaphragm). Both the fixed and stochastic electrical stimulation paradigms increased activity of the laryngeal elevators, produced short-term facilitation evidenced by increasing swallow durations over the stimulus period, and conversely inhibited swallow-related diaphragm activity. Both the fixed and stochastic stimulus conditions also increased specific EMG amplitudes, which never occurred with the water challenges. Stochastic stimulation increased swallow excitability, as measured by an increase in the number of swallows produced. Consistent with our previous results, changes in the swallow motor pattern for pairs of muscles were only sometimes correlated with each other. We conclude that alterations in afferent feedback produced particular variations of the swallow motor pattern. We hypothesize that specific SLN feedback might modulate the swallow central pattern generator during aberrant feeding conditions (food/liquid entering the airway), which may protect the airway and serve as potentially important clinical diagnostic indicators.

Optogenetic stimulation of respiratory related neurons modulates swallow and swallow‐breathing coordination

Swallow and breathing are tightly coordinated behaviors in which disruption of this coordination leads to aspiration pneumonia, the leading cause of death in many adult and pediatric diseases. Little is known about the neural coordination of these two behaviors. Previous work in the respiratory column has shown activity in swallow‐related and breathing‐related neurons, as well as neurons active during both swallow and breathing, suggesting coordination at a central network level. Evidence in the intermediate reticular nucleus (postinspiratory Complex, PiCo) suggest involvement in swallow behavior but not swallow‐breathing coordination. We hypothesize that swallow predominately occurs during the expiratory phase of breathing due to inspiratory related neurons suppressing swallow activity. Thus, inhibition of excitatory neurons within the Pre‐Bötzinger complex will increase swallow excitability, while exciting glutamatergic neurons within this network will have the opposite effect. To evaluate swallow circuitry and its coordination with respiratory related networks we use optogenetic approaches to manipulate the activity of inhibitory (Vgat‐Cre) and excitatory (Dbx1‐ERT2Cre, Vglut2‐Cre) neuron populations within the ventral respiratory centers as well as modulation of PiCo (ChAT‐Cre) in the presence of light stimulation. Optogenetic activation (blue laser, 447nm) of Dbx1 cells was performed in adult Dbx1‐ERT2Cre/Ai32(ChR2) mice after exposing the ventral surface of the brainstem in vivo, and placing bilateral glass fiber optics over the ventral surface in the region of the Pre‐Bötzinger complex. Swallow activity was measured by monopolar suction electrodes of the hypoglossal (XII) and vagus (X) nerves as well as cervical sympathetic nerve (cSNA). Phases of breathing was measured via monopolar electromyogram (EMG) of the diaphragm and swallow was stimulated orally by injection of 0.1cc of 2.5% citric acid water. Our preliminary data suggest that stimulating Dbx1 cells decreased the frequency and duration of swallows. Interestingly, we observed in the presence of light stimulation multiple swallow attempts (oral phase without the pharyngeal phase) resulting in hyoid elevation but failure to induce pharyngeal phase. The average swallow in the absence of light stimulation had a duration of 1025ms whereas swallow during light stimulation was 809ms. We believe that activation of Dbx1 neurons in the Pre‐Bötzinger complex suppresses swallow activity and decouples oral and pharyngeal phases of swallow.Support or Funding InformationNIH: P01 HL090554, R01 HL144801 and R01 HL126523

Dysphagia after chemo‐radiation for nasopharyngeal cancer: A scoping review

ObjectiveNasopharyngeal cancer (NPC) has distinct characteristics regarding its global prevalence, initial presentation, management and patient outcomes compared to other subtypes of head and neck cancer (HNC). The mainstay of NPC treatment is chemo-radiation (C/RT) and while dysphagia is a known early and late toxicity of C/RT treatment, the nature of dysphagia post NPC treatment has had limited investigation. The objective of this review is to summarise the existing evidence regarding dysphagia following NPC to inform the future research agenda for this population. Dysphagia incidence, characteristic deficits observed across the phases of swallowing, efficacy of current dysphagia interventions, and effect on quality of life will be explored.Data sourcesDatabases including MEDLINE, CINAHL, Embase, Scopus and Web of Science were included.MethodsA scoping review was conducted according to PRISMA-ScR guidelines. Two independent reviewers screened selected full text articles.ResultsOf the initial 2495 articles found, 28 articles were included. Reports of penetration and aspiration varied widely (0%–91.6%), with high rates of silent aspiration identified in 2 studies (42%, 66%). Oral, pharyngeal and upper esophageal phase impairments were reported. Of these, upper esophageal stasis and multiple pharyngeal stage deficits were most prevalent. The pharyngeal constrictors were found to have a significant dose–effect relationship and shielding to the anterior neck field was effective to preserve swallowing function. Six treatment studies were identified with limited evidence supporting the use of neuromuscular electrical stimulation, dilatation and swallowing exercises. Quality of life was adversely affected.ConclusionsDysphagia is a prevalent early and late problem post NPC treatment, with impairments across all phases of the swallow. Studies on preventing dysphagia and treatment efficacy remain limited. More systematic study of the nature of dysphagia and the efficacy of treatment in this population is warranted.

The role of extensional rheology in the oral phase of swallowing: an in vitro study.

Swallowing disorders deteriorate significantly the quality of life and can be life-threatening. Texture modification using shear thinning food thickeners has been proven to be effective in the management of dysphagia. Some studies have recently considered the positive role of cohesiveness, but there is still an insufficient understanding of the effect of the rheological properties of the liquid bolus on the dynamics of bolus transport, particularly when elasticity and extensional properties are combined with a shear thinning behaviour. This study combines steady shear, SAOS and capillary breakage extensional rheometry with an in vitro method to characterize the oral transport of viscoelastic liquids. Bolus velocity and bolus length were measured from exit in vitro experiments using image analysis and related to shear and extensional properties. A theory describing the bolus dynamics shows that the elastic and extensional properties do not influence significantly the oral transit dynamics. Conversely, in vitro results suggest that the extensional properties can affect the transition from the oral to the pharyngeal phase of swallowing, where thin, viscoelastic liquids lead to a fast transit, lower oral post-swallow residues and more compact bolus with a smoother surface, which may suggest a lower risk of fragmentation. This mechanistic explanation suggests that the benefit of the extensional properties of thin viscoelastic liquids in the management of dysphagia should be further evaluated in clinical trials.

Tongue function and swallowing in individuals with temporomandibular disorders.

The tongue participates in the oral phase of swallowing by pushing the food bolus toward the oropharynx. This relationship between tongue function and swallowing is little addressed addressed in individuals with temporomandibular dysfunction (TMD).Objective:To analyze the association of functional tongue conditions on swallowing in individuals with TMD.Methodology:After approval by the Institutional Review Board, the study was conducted on 30 individuals of both sexes, aged 18 to 28 years, with TMD, and not treated for the disorder. Tongue function was assessed as to the mobility, pressure, and oral motor control. Swallowing was analyzed by clinical assessment during ingestion of solid (wafer biscuit) and liquid (water). Data regarding mobility and swallowing were collected using the orofacial myofunctional evaluation protocol. Tongue pressure was measured by the Iowa Oral Performance Instrument, during elevation, protrusion, swallowing, and resistance test. The oral motor control was assessed by the oral diadochokinesis (DDK) test by rapid and repeated emissions of syllables “ta” and “ka”. Data were statistically analyzed by the Spearman correlation coefficient, at a significance level of 5%.Results:Relationships were found between tongue function and swallowing for the following aspects: mobility (r=0.741), pressure in protrusion (r=-0.366), swallowing of saliva (r=-0.499), mean DDK rate in emissions “ta” (r=-0.424) and “ka” (r=-0.446), and mean DDK period in emissions “ta” (r=0.424) and “ka” (r=0.446). Thus, the greater the change in tongue mobility, the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD.Conclusion:The functional conditions of the tongue regarding mobility, pressure, and oral DDK were associated with swallowing in individuals with TMD.

Effects of Habit-Breaking Appliances on Tongue Movements during Deglutition in Children with Tongue Thrust Swallowing using Ultrasonography - A Pilot Study.

Objective:The aim of this study is to evaluate and compare the duration and range of tongue movements in tongue thrust swallow patterns with and without habit-breaking appliances using computer-aided M-mode ultrasound images. Also to record the corresponding position of the tongue associated with normal and tongue thrust swallowing pattern using B-mode ultrasound images.Methodology:Ten patients with mature swallow pattern, ten subjects with anterior tongue thrust (ATT) and ten patients with lateral tongue thrust (LTT) swallowing habit were analyzed for the duration and range of tongue movement using two-dimensional ultrasound M-mode images before and after insertion of three habit-breaking appliances (anterior tongue crib [ATC], double oral screen [DOS] and DeLuke oral trainer [DOT]). Further, B-mode images were examined for the tongue positions in different swallow patterns with and without appliances.Results:Duration and range of tongue movement for the entire swallowing phase did not show a statistically significant difference for mature, ATT and LTT. Statistical significant difference existed in the duration between ATC and DOS with DOT for ATT patient (P ≤ 0.05). Furthermore, a significant difference existed in the range of tongue movement between DOS and DOT in LTT patients (P ≤ 0.05).Conclusion:Remarkable changes in the tongue position were observed postinsertion of DOT in both anterior and LTT swallow patterns where the tongue tip and anterior tongue dorsum shifted upward toward the anterior palate resembling that of a mature swallow pattern.