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PubMed1982

Cineradiography of the pharyngeal stage of deglutition in 150 individuals without dysphagia.

With the aid of cineradiography the pharyngeal stage of deglutition was examined at a speed of 50 and 100 frames per second among 150 individuals without dysphagia. In 124 (83%) the act of swallowing had a symmetrical and synchronous pattern. Different types of aberrations from this pattern were registered in 26 individuals (17%). In seven individuals the epiglottis did not tilt down properly but remained in a transverse position during deglutition. In eight individuals, contrast medium passed into the laryngeal vestibule. Seven individuals had a dysfunction of the cricopharyngeal muscle which did not relax properly. One individual had a web in the upper oesophagus. In all but two individuals the aberrations were isolated and not concomitant with other abnormalities of the act of swallowing.

Adult↗
PubMed1991

Videofluoroscopy in elderly patients with aspiration: importance of evaluating both oral and pharyngeal stages of deglutition.

Oropharyngeal functional impairment increases with age so that radiologists frequently are asked to determine the cause of aspiration in elderly patients. Neuromuscular and cognitive impairment often make it difficult to perform and interpret videofluoroscopic deglutition examinations in these patients. We retrospectively reviewed the barium swallow examinations in 50 elderly patients (mean age, 87 years) who were known to aspirate. We looked for specific patterns of oropharyngeal dysfunction that resulted in bolus misdirection. Analysis revealed that aspiration was due to abnormalities of the oral stage in 23, pharyngeal stage in 10, and both stages in 17. Dysfunction in the oral stage was due to ingestion of large volumes or rapid acquisition rates in nine, failure of containment during processing (bolus manipulation) in 18, and dissociation of lingual delivery and swallowing initiation in the transitional phase in 13. Dysfunction in the pharyngeal stage was due to incomplete transport (bolus retention) in 21 and defective closure of the laryngeal vestibule in 11. No significant relationship between conditions known to cause oropharyngeal dysfunction (dementia, stroke, Parkinson disease, disuse deconditioning) and the specific pattern of dysfunction was identified. These results indicate that an accurate and valid assessment of oropharyngeal dysfunction in elderly patients with aspiration is possible if specific patterns of dysfunction are sought. Our study indicates the importance of evaluating the oral and pharyngeal stages of deglutition in elderly patients who aspirate.

Aged↗
PubMed2006

Dynamic MRI evaluation of tongue posture and deglutitive movements in a surgically corrected open bite.

Tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.

Adult↗
PubMedDate not supplied

Closure of the laryngeal vestibule during deglutition.

With the aid of high-speed cineradiography (up to 100 frames per second) the closure of the laryngeal vestibule during deglutition was studied in 150 volunteers free from swallowing complaints. The closure was observed to be effected by a peristaltic-like wave from below. This was accomplished in two steps. First the caudal segment of the vestibule, the supraglottic space, was closed by an apposition of the side walls. Then the cranial segment of the vestibule, the supraglottic space, was closed by an apposition of the fixed part of the epiglottis to the arytenoid region. The subdivision of the vestibule was made by an imaginary plane between the interarytenoid incisure and incisure of the thyroid cartilage. This subdivision corresponds to the location of the thyroarytenoid muscles lateral to the supraglottic space and the thyroepiglottic muscles lateral to the subepiglottic space. In this way the two muscle pairs contribute indifferent and distinct ways to the closure of the vestibule during deglutition.

Adult↗
PubMed1982

Defective closure of the laryngeal vestibule during deglutition.

Two-hundred and fifty patients with dysphagia were studied with cineradiography of the pharyngeal stage of deglutition. In 103 a defective closure of the laryngeal vestibule was disclosed. In 58 patients the closing of the supraglottic space, i.e., the inferior portion of the laryngeal vestibule was normal while the subepiglottic space, i.e., the superior portion of the laryngeal vestibule, was defective. In 41 patients neither the supraglottic nor the subepiglottic space closed properly during the act of deglutition. In 29 of these the contrast medium reached into the trachea. The defective closure of the laryngeal vestibule could be distinguished into two principally different categories. The first category could be discerned as a delayed closure of the vestibule allowing contrast medium to enter. This contrast medium was later expressed back into the pharynx when the vestibule was closed. The second category could be discerned as an inability to close-the vestibule remained open during the whole time lapse of swallowing. The contrast medium remained in the vestibule until it was either aspirated or expelled by vigorous coughing.

Adult↗
PubMed1999

Study of mandibular movements in mandibulectomy patients--border movements and functional movements during mastication, deglutition and speech.

In mandibulectomy patients who have not undergone surgical reconstruction, the remaining mandibular segment is unstable and often deviated. Its movements have low reproducibility during mastication, deglutition and speech. The purpose of this study was to clarify three-dimensionally the differences in mandibular movements for each of these oral functions in mandibulectomy patients with and without mandibular continuity. Four mandibulectomy subjects (Group I) without mandibular continuity and three subjects (Group II) with mandibular continuity were selected. Their mandibular movements were recorded using a jaw movement tracking device with six degrees of freedom. Each movement was assessed graphically at the virtual incisor point and the rotational angles of the mandible in the frontal, sagittal and horizontal plane were analyzed. The findings were as follows; 1. In Group I, the border movements at the virtual incisor point exhibited an irregular and asymmetric envelope deviated to the resected side in the frontal plane, whereas Group II exhibited a smooth and symmetric envelope. 2. In Group I, the rotational angles in the frontal plane during border movements and mastication, in all planes during speech, and in the frontal and horizontal plane during deglutition were significantly larger than in Group II. A comparison among border and all functional movements in mandibulectomy patients revealed characteristic movements in the rotation of the mandible in the frontal plane. It is suggested that the rotational angle of the mandible is a useful parameter for assessment of mandibular movements in mandibulectomy patients.

Aged↗
PubMed2001

[Deglutition disorders in the elderly. Epidemiological aspects].

THE PREVALENCE: The exact prevalence of deglutition disorders in the elderly is not known. It appears frequent in very old patients and in those suffering from polypathological symptoms, affecting 50% of the populations in long-term care units. THE EFFECTS OF AGING: Physiological aging alters various parameters of swallowing, however it seems that these modifications related to age have little effect on healthy subjects. However, they may increase vulnerability in those presenting with intercurrent pathologies. CONCOMITANT DISORDERS: Other than the decrease in efficient mastication and the existence of xerostomia, frequently observed contributing factors, many diseases may be responsible for dysphagia in the elderly. Neurological disorders, particularly cerebral vascular diseases, central nervous system degenerative disorders and neuro-motor diseases predominate. In the aging, muscular disorders and after effects of various diseases can set-in. Modifications in oropharyngeal anatomy generally results from cancerous lesions of the aero-digestive junction, but also, occasionally from extrinsic compression that does not necessarily reflect a neoplastic etiology. Zenker's diverticulitis represents a cause of dysphagia specific to the elderly. Problems in swallowing of iatrogenic origin are also frequent, following cervical radiotherapy or after oropharyngeal surgery, during tracheal intubation or when using feeding tubes and also during various medical treatments. UNDERRATED CONSEQUENCES: Dysphagia leads to multiple morbid after effects, primarily alteration in quality of life, dehydration, undernutrition, asphyxia and congestion and recurrent infections of the respiratory tract. The responsibility of deglutition disorders in the occurrence of these complications is difficult to assess in weak elderly subjects because of the frequent concomitance with multiple deficiencies and incapacities.

Age Factors↗
PubMed1975

[Pharyngeal constrictors and deglutition (apropos of 4 cases].

The authors describe four cases of deglutition disorders, even resulting in aphagia in two cases, in which the constrictor muscles of the pharynx were quite clearly entirely responsible. Electromanometry made diagnosis possibe for these patients and it is the only method capable of distinguishing crico-pharyngeal achalasis from paralysis of the constrictor muscles. The authors draw attention to the fundamental importance of this method of investigation in the pathology of deglutition. The propellent role of the constrictors, emphasized by some authors, rather than the upthrust of the tongues seems to be the borne theory out by these cases. Despite surgical ablation as recommended by most authors, or the spontaneous pathological disappearance of the crico-pharyngeal, the condition of the patients described was not improved; therefore it would seem wise, if a decision is taken to operate, not to make any promises to the patients about improvement of function insofar as aphagia is due to paralysis of the constrictors. Diagnosis, it should be remembered, can only be made after electromanometric investigation which is an essential preliminary to any therapeutic decision.

Adult↗
PubMed1992

[Quantitative evaluation of deglutition in the upper esophagus by scintigraphy].

To evaluate the function of deglutition quantitatively, radionuclide transit in the and upper esophagus was examined. Ten ml of water containing 185 MBq 99mTc pertechnetate was put into the mouth and isotopic counts were measured every 0.2 second in the oral cavity, upper and lower cervical esophagus, and upper mediastinum. The subjects were studied twice, once while sitting and once supine. Esophageal transit was evaluated with time-activity curves obtained in each region of interest. In twelve healthy volunteers transit of the radionuclide was significantly delayed in supine position compared with sitting position. Even while the subject was supine, the radionuclide was propelled into the lower cervical esophagus in 0.8 second and upper mediastinum in 1.4 second in the healthy volunteers. In the patient, who had reconstruction of the esophagus through posterior mediastinum, radionuclide transit was not different from that of healthy volunteers. Whereas in the patient, who had the reconstruction through retrosternal space, the transit was remarkably delayed. The esophageal scintigraphy was safe and sensitive enough to evaluated the function of deglutition quantitatively.

Adult↗
PubMedDate not supplied

[Respiratory and deglutition pathology in malocclusion].

The Authors, in this work, describe the ripercussions fixed by the pathology of the first respiratory organs and of the deglutition both at expense of maxillo-facial development and at systematic-level; by beginning from physiologic mechanisms, the most frequent causes of the oral respiration and the atypic deglutition are analysed.

Deglutition Disorders↗
PubMedDate not supplied

[Echography of the oral phase of deglutition].

Neither cineradiography nor videorecording are satisfactory techniques for the dynamic study of the oral phase of deglutition. Therefore, oral swallowing was studied by means of real-time sonography (US) in 20 asymptomatic patients. Both anatomy and motility of the muscles of the mouth and tongue were clearly demonstrated. Real-time US proved thus to allow an accurate and dynamic visualization of the oral phase of deglutition.

Adult↗
PubMed1989

[Relationships between dysgnathias, mode of formation of the sound S and abnormal deglutition].

In this study it is tried to clear how much there exist correlations between sigmatisms and abnormal deglutition of patients with dysgnathias. It was found of 535 patients of an orthodontic department that abnormal swallowing of patients with dysgnathias having a sigmatism with a probability of error of 1% appears highly significantly more often than of patients with dysgnathias without sigmatism. With nearly 50% of persons with sigmatism in the same time showing a dysgnathia may be expected an abnormal mode of deglutition. Relationship between abnormal swallowing and sigmatisms is with 76.47% especially high at "protruding of the lower jaw", followed by "open bite" with 75%, then "extendet overjet" with 47.78%, whereas at "lack of room" this relationship may be observed at 35.42% of the cases.

Deglutition Disorders↗
PubMed1986

[Neural control of deglutition and esophageal motility in mammals].

Swallowing is a complex motor sequence involving the coordinated contraction of many muscles of the buccopharyngeal cavity, the larynx and the oesophagus. Most of the muscles are striated except those of the distal oesophagus which, in human and some other species, are of the smooth type. During swallowing, usually divided into a buccopharyngeal and an oesophageal stage (peristalsis), the sequential activity of the muscles results from motor orders programmed by a rhombencephalic swallowing centre and conveyed to the periphery by efferent fibres belonging to various pairs of cranial nerves (Vth, VIIth, IXth, Xth). Apart from the motor nuclei of the cranial nerves, the swallowing centre contains an nuclei of the cranial nerves, the swallowing centre contains an interneurone network responsible for the programming of deglutition. During swallowing, these interneurones (INs) exhibit a sequential activity quite parallel to that of muscles, and persisting in the absence of sensory feedback. The "swallowing INs" are located in two medullary regions: a dorsal region including the nucleus of the solitary tract and the adjacent reticular formation, a ventral region corresponding to the reticular formation surrounding the nucleus ambigus. The dorsal INs are involved in the initiation and the programming of swallowing. The ventral INs receive their swallowing input from the dorsal neurones and are probably switching neurones that distribute the swallowing excitation to the various pools of motoneurones. The swallowing program can be triggered by inputs originating from either the peripheral reflexogenic areas or the supramedullary structures (cerebral cortex in particular). Under physiological circumstances, the swallowing program is continuously modified by peripheral afferents (especially muscular) that adjust the force and the timing of contractions to the size of the swallowed bolus. In addition, an important operating feature of the programming network consists of a functional polarization so that the activity of proximal portions of the swallowing tract inhibits that of distal portions. This polarization implies the existence of inhibitory connections between interneurones, that could constitute "time-lag lines" responsible for the series of delays typical of the swallowing contractile sequence. Lastly, although the smooth muscle oesophagus contains its own programming system (intramural nervous system), motility of this area during deglutition also depends on the medullary program that combines with the intramural program by ways not yet elucidated.

Animals↗
PubMed1987

Esophageal manometry in horses, cows, and sheep during deglutition.

Esophageal pressure events during deglutition were evaluated in healthy adult animals (6 horses, 6 cattle, and 5 sheep), using a 3-side hole catheter assembly perfused with water by use of a hydraulic-capillary infusion system. The peak postdeglutition pressure, contraction time, and contraction length were determined for the cranial and caudal esophageal sphincter regions and for each functionally different region within the body of the esophagus. The percentage of deglutitions in which relaxation developed at the sphincter regions and the propagation speed (velocity at which pressure waves traversed the esophagus) for the regions within the body of the esophagus also were determined. Mean (+/- SEM) resting pressures within the cranial and caudal esophageal sphincter regions in the horse were 84.8 +/- 4.39 and 12.7 +/- 0.61 mm of Hg, respectively, with postdeglutition peaks of 208.0 +/- 4.78 and 100.0 +/- 1.06 mm of Hg, respectively. Peak postdeglutition pressure was 92.3 +/- 1.59 mm of Hg in the cranial two thirds of the esophageal body and 100.9 +/- 1.31 mm of Hg in the caudal third. Mean resting pressure of the cranial esophageal sphincter region in the cow was 82.0 +/- 7.81 mm of Hg, whereas that of the caudal esophageal sphincter region was 20.5 +/- 0.36 mm of Hg. The peak postdeglutition pressures for the cranial esophageal sphincter region, proximal portion of the esophageal body, caudal portion of the esophageal body, and caudal esophageal sphincter region in the bovine esophagus were 238.1 +/- 2.93, 105.4 +/- 1.97, 114.5 +/- 1.49, and 112.0 +/- 1.20 mm of Hg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

[A deglutition stutterer. Contribution on psychogenic inability to swallow].

Description of a patient of 63 years who developed since the age of 50 years cloni of the tongue and a contraction of the hypopharyngeal muscles in the moment of deglutition. This leads to an inanition and exsiccosis. The patient becomes dependent from infusions. The psychical exploration discovers pharyngeal spasmes in the youth which reappeared in the higher age in stress situation. The patient learned the introduction of a nasal tube for liquids. The association of physio- and psychotherapy leads to a harmonization of the personality but the autonomic troubles of deglutition did not disappear completely.

Deglutition Disorders↗
PubMed1981

[The influence of the partial laryngectomy on the mechanism of deglutition (author's transl)].

Partial laryngectomy causes functional insufficiency on deglutition. 56 patients who had undergone partial laryngectomy were found to suffer from food aspiration into the respiratory tract during deglutition. Aspiration of food was mainly caused by: Narrowing of the inlet of the hypopharynx, due to edema in the region of the arytenoids; insufficiency of one of the two pyriform fossae; inadequate closure of the glottis. Eight out of 56 patients are suffering from aspiration of food, particularly of liquids. The age does not have any particular influence. Post-operative radiation therapy resulted to insufficiency because of persistent edema created in the region of the arytenoids.

Deglutition Disorders↗
PubMed1993

Successful treatment of deglutition syncope with oral beta-adrenergic blockade.

A case of deglutition syncope of 20 years' duration in a patient without cardiac or esophageal disease is presented. The therapeutic efficacy of beta-blockade is documented by symptomatic improvement, repeat esophageal balloon inflation and tilt-table testing. This suggests the Bezold-Jarisch reflex or sympathetic nervous system may be involved in the pathogenesis of deglutition syncope.

Administration, Oral↗
PubMed1976

Role of fetal deglutition and micturition in the production and turnover of amniotic fluid in the monkey.

In order to determine the precise role played by the absence of fetal swallowing or urine contribution in the disposal and production of amniotic fluid, we surgically occluded the fetal esophagus in 5 monkeys and the urethra in 2 monkeys. The amniotic fluid volume was then measured daily with an indicator dilution technic. Sham operations were performed on 3 monkeys of similar gestational age. It was found that in late pregnancy failure of fetal deglutition resulted in transient hydramnios which appeared to be followed by a readjustment in water exchange rates in other pathways by which the amniotic fluid volume returned to normal range. In midpregnancy fetal deglutition seems to have no appreciable effect upon the amniotic fluid volume. Diversion of fetal urine, however, appeared to result in a persistent decrease in the volume of the amniotic fluid.

Amniotic Fluid↗