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PubMed1988

Laryngeal reflex mechanism during deglutition--observation of subglottal pressure and afferent discharge.

In this investigation, particular attention was paid to elucidate the laryngeal reflex mechanism of protective closure and the sensory function of the larynx during deglutition. For this purpose, three different experimental procedures were adopted: (1) subglottal pressure of felines was measured during deglutition using a pressure transducer; (2) subglottal pressure of human beings was measured during deglutition using a pressure transducer; and (3) afferent discharges from superior and recurrent laryngeal nerves of felines were recorded. The following conclusions appear justified. (1) Feline and human subglottal pressure during deglutition showed the following pattern. The pressure rises with onset of deglutition, temporarily drops during laryngeal elevation, rises again during the downward movement of the larynx, and drops again at the end of the glutition. This pattern was not affected by the resection of the unilateral recurrent laryngeal nerve. (2) The superior laryngeal nerve is involved in the sensory function of the pharynx, larynx, and trachea. At least two types of afferent discharges from superficial and internal sensory nerves are suspected. Afferent discharges from the recurrent laryngeal nerves in the larynx and trachea are not as distinct as those of the superior laryngeal nerve, and this seems to correspond with various changes in the thorax. During deglutition, afferent discharges were recorded from superior to recurrent laryngeal nerves.

Animals↗
PubMed1993

Shape, volume, and content of the deglutitive pharyngeal chamber imaged by ultrafast computerized tomography.

BACKGROUND: Conventional radiographic techniques image only the silhouettes of the deglutitive pharyngeal chamber. This study aimed to accurately image the horizontal plane shape and content of the pharynx during swallowing. METHODS: Dynamic computerized tomography images of the pharynx were obtained at the rate of 17 per second during swallowing. Multiple adjacent levels were imaged in eight subjects and a single level was scanned in four subjects during swallows of varied volume. Images were analyzed for area, volume, and the bolus fraction of the deglutitive pharyngeal chamber. RESULTS: The deglutitive chamber enlarged to approximately 24 mL (during tongue loading) compared with a preswallow pharyngeal volume averaging 15 mL. Throughout the 10 mL swallows, the bolus occupied less than 30% of the lumen regardless of axial level. The bolus fraction of the deglutitive chamber increased with swallow volume, as did the dimensions of the upper esophageal sphincter and the bolus velocity through the upper esophageal sphincter. CONCLUSIONS: The deglutitive pharyngeal chamber was typically approximately 15 mL > the bolus volume, implying that an obligatory 15 mL of air was swallowed under these test conditions. Most swallowed air originated as air trapped within the pharynx and larynx as the oropharynx was sealed from above and below.

Adult↗
PubMed1995

Dynamic magnetic resonance imaging of vocal cord closure during deglutition.

BACKGROUND & AIMS: Vocal cord closure is instrumental in airway protection during deglutition. Conventional imaging of vocal cord closure and reopening during deglutition requires invasive and nonphysiological methods. The aim of this study was to characterize the biomechanical properties of normal vocal cord adduction/abduction during deglutition using echoplanar magnetic resonance imaging, a technique that has the capability of imaging soft-tissue motion with real-time temporal resolution. METHODS: The movements of laryngeal and vocal cord structures during swallowing were determined in 11 normal volunteers by single slice and axially reformatted multislice coronal echoplanar images. RESULTS: During swallowing, the larynx ascended to peak elevation, maintained peak elevation for a discrete interval, and descended to its resting position. Vocal cord adduction occurred with a symmetric tent-like configuration at the midpoint of maximal laryngeal elevation, whereas vocal cord abduction occurred at the midpoint of laryngeal descent. Spatial analysis of vocal cord configuration during adduction determined that the vocal cords attained an initial parallel configuration during ascent, followed by closure at peak laryngeal elevation. CONCLUSIONS: These results show that the vocal cords adduct and abduct synchronously with laryngeal ascent and descent, respectively, during deglutition. Echoplanar magnetic resonance imaging constitutes a novel tool used to assess clinical abnormalities of deglutitive laryngeal function.

Adult↗
PubMed2004

Relationship between maxillofacial morphology and deglutitive tongue movement in patients with anterior open bite.

We reported previously that patients with anterior open bite had tongue tip protrusion, slower movement of the rear part of the dorsal tongue, and earlier closure of the nasopharynx during deglutition. In the present study, the relationship between this characteristic tongue movement and maxillofacial morphology in patients with anterior open bite was investigated. The subjects were 10 female patients with anterior open bites and 10 women with normal overbites as controls. Maxillofacial morphology was measured by cephalometric radiography, and tongue movement during deglutition was analyzed by cineradiography. The relationship between each value obtained by cephalometric radiography and cineradiography was evaluated by simple correlation analysis. In the patients with anterior open bite, there were significant correlations between mandibular plane angle, ramus height of the mandible, or anteroposterior dimension of the maxilla and movement of the front part of the dorsal tongue during deglutition. Furthermore, there were also significant correlations in these patients between mandibular plane angle, gonial angle, or ramus height of the mandible and the change in the contact between tongue and palate during deglutition. The controls did not have the correlations like these. Our study suggests that characteristic tongue movements during deglutition in patients with anterior open bites are closely related to their morphological features.

Adolescent↗
PubMed1997

Deglutition apnoea as indicator of maturation of suckle feeding in bottle-fed preterm infants.

The maturation of deglutition apnoea time was investigated in 42 bottle-fed preterm infants, 28 to 37 weeks gestation, and in 29 normal term infants as a comparison group. Deglutition apnoea times reduced as infants matured, as did the number and length of episodes of multiple-swallow deglutition apnoea. The maturation appears related to developmental age (gestation) rather than feeding experience (postnatal age). Prolonged (> 4 seconds) episodes of deglutition apnoea remained significantly more frequent in preterm infants reaching term postconceptual age compared to term infants. However, multiple-swallow deglutition apnoeas also occurred in the term comparison group, showing that maturation of this aspect is not complete at term gestation. The establishment of normal data for maturation should be valuable in assessing infants with feeding difficulties as well as for evaluation of neurological maturity and functioning of ventilatory control during feeding.

Apnea↗
PubMed2006

[Relation between clinical evaluation of deglutition and the computed tomography in acute ischemic stroke patients].

Stroke is one of the main causes of permanent lesions in adults and can provoke global motor sequels, speech and language alterations, and swallowing. During the acute phase, the detection of aspiration risks is essential to prevent lung complications and to allow appropriate therapeutic interventions, making possible precocious oral feeding. In the literature, the correlations between the disturbance of the deglutition and the location of the lesion in patients with stroke are not specific. This way, the objective of the present study was to determine if correlation exists between the location of the vascular lesion and dysphagia in acute ischemic stroke patients. Bedside clinical evaluation of deglutition was made in 27 patients with acute ischemic stroke and the results were compared with the computed tomography findings. In the clinical evaluation, 48% patients were dysphagic and 52% had functional deglutition. In dysphagic patients, 84% had lesion in carotid territory, with 76% in the middle cerebral artery. In patients with functional deglutition, 57% had lesion in the middle cerebral artery and 22% in the posterior cerebral artery. In 50% of the patients with functional deglutition and in 46% of the dysphagics the lesion was in the left hemisphere. In conclusion, the hemispherical location is not associated with the presence or not of dysphagia, however most of the dysphagic patients presented alterations in the carotid territory, especially in the middle cerebral artery.

Acute Disease↗
PubMed2000

[Cricohyoidoepiglottopexy : deglutition in 44 cases].

The present work reviews the authors personal experience and applies a meta-analysis of the data in the literature (approximately 800 cases) to better focus on the opportunities and difficulties involved in the Majer-Piquet technique. Particular attention is focused on the problems involved in deglutition. The study involves 44 patients who underwent cricohyoidoepiglottopexy (CHEP) between 1989 and 1998. Given that surgical and rehabilitation techniques have been refined over the years, to better analyze the functional results, the data were separated into two subsequent periods. Of the 23 patients who underwent surgery between 1989 and 1992 (group I), 6 were benefited from bilateral preservation of the arytenoids while this was only possible in two of the 21 cases operated in the second period from 1993 to 1998 (group II). Functional rehabilitation was started earlier in the second group and was routinely monitored with digital viedeofluorography. The average recovery time was 34 days for group I and 27 days for group II. The tracheostomy closed in an average 91 days vs. the 13 days found by the meta-analysis of the literature. The authors normally leave the tracheostoma in place for a long time, even when closed with an easily removed plug, and only perform plastic surgery when the patient has shown stable deglutition for several weeks. The naso-gastric tube was removed from both groups of patients after an average 16 days while the review of the literature shows an average 21 days. On the whole the authors record good deglutition in 41 of the 44 cases (93.18%) with adequate deglutition in the remaining 3 cases. Likewise the literature reports good deglutition in 86.4% of the cases. The only difference found between the two groups of patients was a quicker recovery in the second group; there were no qualitative differences. The results are described and discussed. In conclusion, the present experience places CHEP in favorable light as long as the limits inherent to the method are recognized. However, these limitations relegate the technique to a "sporadic" role and the review of the literature appears to confirm this attitude.

Cricoid Cartilage↗
PubMed1991

[The role of the hyoid bone in the act of deglutition after horizontal epiglottic laryngectomy].

Results of ++roentgeno-cinematographic studies of the deglutition act in patients after horizontal supraglottic laryngectomy are presented. The analysis of the material has been expected to provide an answer to what an extent the removal or the preservation of hyoid bone does influence the disorders that involve the swallowing. The entire elaborated material comprises 51 deglutition acts, having been divided into 3 groups. In the I group of studied subjects it was observed that there was a more sizable shortening of the pharynx, as well as a greater upward and forward movement of the remaining larynx. In the II group, the pharynx was longer by 1 cm, while the analogical movement of the spared larynx was by a half worse. The overall observations of other parameters facilitating efficient deglutition failed to reveal significant difference in I and II group of the studied. However, good deglutition we recorded in cases where the remaining larynx was maximally raised upwards to the hyoid bone or to the tongue base . These findings authorize us to ascertain that the preservation or the removal of the hyoid bone in the course of this procedure is without greater importance for the deglutition act rehabilitation. But, it is of more considerable significance to elevate the spared larynx upwards to the direct vicinity of the tongue base.

Aged↗
PubMed1994

[General review of deglutition. Anatomy, physiology and principal pathological disorders. Diagnostic and therapeutic contribution of imaging].

Disorders of deglutition are a relatively frequent, serious, sometimes fatal symptom, representing a major cost for society. Their frequency is currently increasing in parallel with aging of the general population, the increased incidence of pharyngolaryngeal operations and the prolonged survival of neurological patients. A good understanding of the nervous control and anatomical structures as well as the physiology of deglutition is therefore important to decide which investigations and treatments should be proposed. The radiological investigation of a patient presenting with a disorder of deglutition must include the pharynx and the entire oesophagus, regardless of the presenting symptom, which may be experienced at a distance from the cause. The examination must be dynamic and standardized to assess the time and circumstances of onset the disorder, as well as its possible postural corrections. Finally, any examination of deglutition must be performed in both the upright and supine positions.

Deglutition↗
PubMed1998

Functional reconstruction of the tongue and deglutition muscles following extensive resection of tongue cancer.

The authors describe their experience with functional restoration of tongue and deglutition muscles at the floor of the mouth after an extensive resection of tongue cancer. Five patients underwent immediate tongue reconstruction using a reinnervated rectus abdominis myocutaneous free flap in which the included tenth intercostal nerve was coapted to the remaining hypoglossal nerve. The rectus sheath strips attached on both cut ends of the muscle were used to create the firm tendinous insertions between the mandible and hyoid bone based on the anatomic findings of the extrinsic tongue and suprahyoid muscles. The postoperative course was uneventful in all patients. All patients presented with good tongue bulk without obvious atrophy. Three patients with subtotal glossectomy demonstrated good cooperative mobility of the reconstructed and remaining tongue and had solid or semisolid/soft diet. However, two patients with total glossectomy did not show satisfactory rehabilitation of the reconstructed tongue. Postoperative electromyographic assessment in two patients showed good functional recovery of the grafted muscle. The cine-magnetic resonance imaging deglutition study in one patient with 80-percent tongue resection demonstrated sufficient elevation of the dorsal base of the reconstructed tongue, contraction of the reconstructed deglutition muscles, complete glossopalatal closure, and elevation of the hyoid bone and larynx during the deglutition. This reconstructive technique is strongly recommended for the patients who have undergone subtotal glossectomy to provide physiological functional recovery of the reconstructed tongue synchronizing with the remaining tongue.

Adult↗
PubMed1998

[Pathologic swallowing pattern after tumor surgery of oro- and hypopharynx. Analysis with differentiated deglutition imaging].

Dysphagia is a common complaint following surgical intervention in the oral cavity and hypopharynx, often leading to prolonged postoperative recovery. Videofluoroscopy allows detailed visualization of deglutition, demonstrating the morphology as well as the functional aspects. Therefore, videofluoroscopy provides the basis for further therapeutic management. We discuss the pathology of deglutition in 19 patients recovering from tumor surgery of the oro- and hypopharynx. In most cases the results demonstrated severe impairment of both the oral and pharyngeal phase of deglutition. Our data emphasize the importance of the oral phase of deglutition for preparation and initiation of the following phases.

Barium Sulfate↗
PubMed1994

Failing deglutitive inhibition in primary esophageal motility disorders.

BACKGROUND/AIMS: Primary esophageal motility disorders (achalasia, diffuse esophageal spasm, and intermediate forms) are suggested to be caused by different degrees of inhibitory dysfunction; however, direct evidence for this hypothesis has never been presented in humans. The aim of this study was to measure the degree of inhibition that precedes deglutitive contractions in patients with primary motility disorders. METHODS: Deglutitive inhibition was examined in patients with primary motility disorders: 9 with achalasia, 6 with symptomatic diffuse esophageal spasm, and 5 with intermediate forms. An artificial high-pressure zone was created in the esophageal body by inflating a balloon to a critical level, and pressure changes were measured at the interface between the balloon and esophageal wall. Inhibition was visualized as a relaxation of the artificial high-pressure zone. RESULTS: An inverse relationship was found between the degree of inhibition and the propagation velocity of the deglutitive contraction (r = 0.75; P < 0.001). Normally propagated contractions were preceded by an inhibition of 84.2% +/- 3.6%; fast-propagating contractions were preceded by partial inhibition of 40.6% +/- 6.2%; and, in case of simultaneous contractions, inhibition was absent, i.e., 2.6% +/- 1.6%. CONCLUSIONS: The spectrum of primary motility disorders is an expression of a progressively failing deglutitive inhibition.

Adult↗
PubMed1989

Modulation of solitarial deglutitive N-methyl-D-aspartate receptors by dihydropyridines.

The ability of the dihydropyridine calcium channel activators, (-)-S-BAY K 8644 and (+)-S-202-791 and the calcium channel inhibitor, (+)-R-BAY K 8644, to modify the differential deglutitive actions of glutamate and muscarine at premotor loci in the nucleus tractus solitarii was investigated in urethane-anaesthetised rats. At subnuclei ventralis and intermedialis loci, pneumophoretic application (20-100 pl) from multibarrelled glass micropipettes (tip diameter 2-5 microns) of glutamate (10-20 pmol) evoked aminophosphonovaleric acid (APV)-insensitive pharyngeal swallows; at sites in the subnucleus centralis of the nucleus tractus solitarii glutamate evoked an APV-sensitive single-wave oesophageal response, whereas muscarine (5-10 pmol) evoked rhythmic oesophageal contractions. Both (-)-S-BAY K 8644 and (+)-S-202-791, applied in prepulses of 10-20 fmol and 100-200 fmol, respectively, either had no effect or selectively and reversibly enhanced or inhibited the glutamate-evoked responses. Identical results were obtained by intravenous administration of (-)-S-BAY K 8644 (10-50 micrograms/kg). Micropneumophoretic (20-50 fmol) or intravenous (10-50 micrograms/kg) administration of (+)-R-BAY K 8644 suppressed the N-methyl-D-aspartate (NMDA)-mediated oesophageal responses in a reversible and selective manner. The dihydropyridine vehicle produced a transient depression of all types of deglutitive responses. It is concluded that, within the deglutitive subnuclei of the nucleus tractus solitarii, "L"-type voltage-operated calcium channels are associated with NMDA-receptor-mediated deglutitive mechanisms. The inhibition or a lack of effect produced by the dihydropyridine calcium channel activators is explained in part by their actions at other sites e.g. release of inhibitory transmitters.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗
PubMed1996

Changes in deglutition following tonsillectomy in neurologically impaired children.

Tonsillectomy for improvement of dysphagia in children is well recognized, but its effects upon deglutition in the neurologically impaired child have not been described. A review was performed of pre- and post-operative oral-pharyngeal motility (OPM) studies obtained on 15 children (aged 1-10 years; mean 4.6 years) with neurologically-based dysphagia who underwent tonsillectomy for upper airway obstruction (13) or recurrent tonsillitis (2). Each OPM study was rated independently by two trained observers for the presence or absence of 13 features of deglutition. Subjects served as their own control in comparative analysis. There was a mean improvement of 4.33 features of deglutition (mode: 4, range: -1(-)+7) following tonsillectomy. Of 10 children with pre-existing laryngeal penetration or aspiration, two had partial resolution and five had complete resolution following surgery. Post-operatively, two children developed new laryngeal penetration with one also having aspiration. The inter-observer reliability for the OPM study interpretation was 0.90. We conclude that tonsillectomy has a role in the neurologically impaired child with dysphagia, but a pre-operative OPM study is indicated to identify silent aspiration and to aid in necessary counseling for the possibility of a deterioration of deglutition following surgery.

Brain Diseases↗
PubMed2001

Rhombencephalic pathways and neurotransmitters controlling deglutition.

Information from neuronal pathway tracing and pharmacologic microstimulation studies, in conjunction with electrophysiological data, has begun to coalesce into a coherent, if still incomplete, picture of the brain stem circuitry responsible for generating the motor patterns underlying deglutition and esophageal peristalsis in the rat. The intermediate, interstitial, and ventral subnuclei of the solitarius complex appear to play a pivotal part, as evidenced by their viscerosensory inputs and extensive projections to the parvicellular intermediate reticular formation of the medulla, to the brain stem deglutitive motor neuron pools, and to general visceral efferent preganglionic neurons controlling the upper alimentary tract striated and smooth musculature, respectively. The dense projections of the solitarial central subnucleus form a separate subcircuit controlling esophageal, and also some aspects of gastric, motility. Although not extensive, direct connections between the latter subnucleus and interneurons coordinating the buccopharyngeal stage of swallowing appear to exist. In both subcircuits, fast information transfer uses excitatory amino acidergic transmission by means of several glutamate-receptor subtypes. Release from tonic GABAergic inhibition exerted by local solitarial interneurons may provide a mechanism for triggering deglutitive premotoneuronal activity. Local or reticular cholinergic neurons are implicated in pharyngoesophageal coupling and the generation of propulsive esophagomotor output. The solitary interneurons under investigation engage in complex local dendritic and axonal projections within the solitarius complex. Further analysis of these local circuits and their transmitters should yield essential clues regarding the mechanisms underlying deglutitive motor pattern generation.

Autonomic Nervous System↗
PubMed2001

Impairment of deglutition reflex by acid-induced esophageal mucosal injury.

Swallowing is an important defense mechanism against reflux esophagitis as it helps clear refluxed gastric contents from the esophagus, while bicarbonate in the saliva acts to neutralize acid. The purpose of the present study was to examine the effect of esophagitis on the deglutition reflex in anesthetized opossums. Animals perfused with either an acidified pepsin solution for 45 min or with 100 mM hydrochloric acid for 45 min on each of three consecutive days exhibited a significantly impaired deglutition reflex in comparison to baseline. Control animals perfused with 0.9% saline showed no impairment. Bilateral cervical vagotomy in animals perfused with acidified pepsin attenuated the impaired deglutition reflex. Taken together, these results suggest that esophagitis causes an impairment in the deglutition reflex that is mediated by vagal afferent pathways.

Animals↗
PubMed2000

A cineradiographic study of deglutitive tongue movement and nasopharyngeal closure in patients with anterior open bite.

The purpose of this study was to investigate the movement of the tip and the dorsal surface of the tongue during deglutition in patients with anterior open bite using cineradiography. The subjects were 10 female patients with anterior open bites and 10 female controls with normal overbites. By cineradiography we established 7 stages of tongue movement and bolus position during deglutition and analyzed the tongue position, tongue movement and the time. The tongue-tip position was more protrusive during deglutition in anterior open bite than in the controls. After the head of the bolus arrived at the opening of the esophagus, the rear part of the dorsal surface of the tongue demonstrated slower movement in patients with anterior open bite than in controls. The nasopharynx closed earlier in patients with anterior open bite than in controls. It is suggested that anterior open bite patients had compensatory coordination of tongue movement, soft palate movement and pharyngeal constrictor muscle activity during deglutition.

Adolescent↗
PubMed2000

Mandibular position at chin-point guided closure, intercuspation and final deglutition in asymptomatic and temporomandibular dysfunction subjects.

This study compared the mandibular position at chin-point guided jaw closure, intercuspation and final deglutition (position at the end of swallowing) in 159 asymptomatic subjects and 142 subjects with symptoms in the craniomandibular system. The symptomatic subjects were assigned to four groups showing an adapted centric posture, pain, luxation with reduction of the temporomandibular joint and pain with luxation and reduction. Computer equipment aided recording of hinge axis movements in three dimensions. While the three positions differed significantly in anterior-posterior direction on both sides and in inferior-superior direction on the right, a significant difference between asymptomatic and symptomatic subjects existed only in final deglutition on the left side and in the anterior-posterior location of the guided closure. Final deglutition did not coincide with the guided closure or the intercuspation in approximately 89%. A proportionally large standard deviation gave evidence against a strict relationship of the three positions in asymptomatic and symptomatic subjects. Because of this variability, final deglutition was not recommended for verification of centric relation or the intercuspal position.

Adolescent↗