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PubMed1991

Approaches to management of disordered swallowing.

Management of disordered oropharyngeal swallowing begins with careful assessment of the patient's oropharyngeal anatomy and physiology, medical status and cognitive, language and behavioural characteristics. More often, videofluoroscopic studies are performed which enable observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. Treatment for oropharyngeal dysphagia may take the form of compensatory strategies, direct therapy or indirect therapy. Compensatory strategies include postural changes and modification of bolus volume and consistency as well as rate of food presentation. These strategies are designed to eliminate the symptoms of the swallowing problem but may not directly change swallow physiology. Direct therapy techniques are designed to change swallow physiology and consist of oral sensory stimulation techniques and swallow manoeuvres, as well as maxillofacial prosthetics, medication and surgical procedures. Indirect therapy procedures are designed to improve the neuromuscular controls necessary for the swallow without actually producing a swallow. Specific swallowing treatment strategies within each category are described. In addition to assessing the patient's swallow physiology, the videofluoroscopic study of the swallow can be used as a treatment efficacy trial in which selected compensatory strategies or direct therapy techniques are used by the patient to improve their swallow safety and efficiency. Factors to be considered in the design of an overall treatment plan for a patient with disordered swallowing are defined.

Deglutition Disorders↗
PubMed2000

The effects of the traditional chinese medicine, "Banxia Houpo Tang (Hange-Koboku To)" on the swallowing reflex in Parkinson's disease.

Swallowing disorder is common in Parkinson's disease (PD). We studied the swallowing disorder in PD, and tested the efficacy of Banxia Houpo Tang (BHT, a Chinese traditional medicine) in improving the swallowing reflex of PD patients. The Swallowing reflex test is a simple method used to detect swallowing disorders in patients with cerebrovascular disease. Because we observed previously that BHT significantly improved the swallowing reflex in cerebrovascular patients, we studied whether BHT was also effective in improving the swallowing disorder in patients with PD. 23 PD patients (13 males, 10 females, mean age 66.0+/-9.3, Hoehn & Yahr (H-Y) mean score = 2.8) were evaluated for swallowing reflex and the concentration of substance-P in their saliva before and after 4 weeks of BHT treatment. The swallowing reflex before treatment was significantly delayed, according to the H-Y score (Spearman's p = 0.014, R2 = 0.463). The swallowing reflex before BHT treatment was 3.66+/-0.98 sec, and after BHT treatment, it improved significantly, to 2.27+/-0.54 sec (p < 0.0001). Substance-P concentration in PD patients saliva before treatment was significantly lower than in healthy controls (p = 0.007), but showed no significant change after BHT treatment. Our research shows that the swallowing reflex is an effective method to evaluate the swallowing disorder in PD. BHT can significantly improved the swallowing reflex in PD patients, and therefore can be a hopeful candidate for preventing aspiration pneumonia in PD.

Aged↗
PubMed2003

Efficacy of swallowing training for residents following stroke.

BACKGROUND: The presence of dysphagia is associated with an increased risk of mortality, malnutrition, dehydration, compromised pulmonary function, and disability. Appropriate swallowing training can establish optimal nutritional status and eliminate or reduce the risk of developing medical complications associated with swallowing impairment. AIM(S) OF THE STUDY: The aim of this study was to examine the functional swallowing and nutritional outcomes of swallowing training in institutionalized stroke residents with dysphagia. DESIGN AND METHODS: A quasi-experimental parallel cluster design was used. Seven institutions with similar bed sizes were selected. All subjects in the experimental group received a structured swallowing training programme. The subjects in the experimental group (n = 40) received 30 minutes of swallowing training each day for 6 days per week for 8 weeks. The control group (n = 21) did not receive any training. RESULTS: After swallowing training, mean differences in volume per second, volume per swallow, mid-arm circumference and body weight between pre- and post-training of the experimental group were significantly higher than for the control group, while mean differences in neurological examination and choking frequency during meals for the experimental group were significantly lower than in the control group. CONCLUSION: This study used objective timed swallowing tests, a swallowing questionnaire, and a neurological examination to evaluate the effects of swallowing training. However, videofluroscopy is generally considered the best method for evaluating the pharyngeal and esophageal stages of swallowing, and introducing this technique is recommended for future studies. Furthermore, it is recommended that nursing professionals should conduct swallowing training protocols in stroke patients to help prevent aspiration from dysphagia.

Adult↗
PubMed1998

Thermal oral-pharyngeal stimulation and elicitation of swallowing.

The influence of thermal stimulation of the oral and pharyngeal mucosa on the elicitation of swallowing was studied in 14 healthy volunteers. The Repeated Dry Swallowing Test was used to study the ability to elicit swallows. The test consists of 11 manometrically recorded dry swallows performed at maximum speed. The time between swallows 1 and 11 (Swallowing Test Time) is considered a measure of the ease of eliciting the swallowing reflex. The study includes two controlled experiments, each consisting of an active test done immediately after a cold stimulus and a control done after a stimulus at body temperature. In one experiment the stimulus consisted of stimulation of the fauces with a laryngeal mirror and in the other of swallowing water. Each subject served as his or her own control. The order of the tests was randomized and the results read blindly. In the mirror experiment, the swallowing test times obtained after application of a cold laryngeal mirror did not differ significantly from those obtained after stimulation at body temperature. In the water experiment, swallowing test times were shorter after swallowing cold water compared to those after swallowing water at body temperature in 11 of the 14 volunteers (n.s.). The concept that swallowing is significantly facilitated by cold applied to the oral-pharyngeal mucosa was thus not supported by the present study. The importance of these findings is discussed.

Adult↗
PubMed1999

Role of sensation in swallowing function.

OBJECTIVES: Sensation in the oral cavity and laryngopharynx has long been believed to be crucial for normal swallowing. One illustration of this belief has been intense interest in reconstruction after cancer resection using sensate tissue transfer as a means of improving swallowing function. A contrarian view is that mucosal sensation, by itself, is, in fact, relatively unimportant to swallowing function. STUDY DESIGN: A prospective study was designed to test the hypothesis that normal swallow function can occur with anesthesia of the upper aerodigestive tract mucosa. METHODS: Baseline (sensate) swallowing function of 13 healthy adults was assessed via video endoscopic swallow studies (VESS). Each subject was then topically anesthetized with lidocaine applied to the oral cavity, oropharynx, hypopharynx, and larynx. Swallowing was then reassessed via VESS and compared to the baseline examination to look for differences in function. RESULTS: There was little difference in swallowing ability between sensate and anesthetized states, even though all the subjects felt that their swallowing had been profoundly disrupted after lidocaine was applied. The main difference was a small increase in the time from food administration to swallowing. A few experienced trace aspiration, which was instantly eliminated on subsequent swallows with simple coaching. CONCLUSION: Normal swallowing can occur spontaneously or with simple coaching even with complete anesthesia of the upper aerodigestive tract mucosa. Current beliefs about the value of sensate free flaps and the importance of sensation in swallowing in general may need refinement.

Adult↗
PubMed1992

A timed test of swallowing capacity for neurological patients.

A timed test of swallowing capacity has been designed for use in patients with neurogenic dysphagia. Swallowing speed (ml/s) has been demonstrated to have high intra- and inter- rater and test- retest reliability, and to be essentially independent of flavour or temperature. "Guideline" normal values were established in individuals without a swallowing disorder: swallowing speed was less in females than males and declined in both groups with age. The validity of a swallowing speed less than 10 ml/s as an index of abnormal swallowing was tested by comparison with the complaint of abnormal swallowing in a group of 81 neurological patients. Swallowing speed had a sensitivity of 96% and specificity of 69%: some apparent false positive responses were found in patients with disordered swallowing, mainly due to multiple sclerosis. Using a standard questionnaire and examination a similar pattern of symptoms and signs were statistically associated with both the clinical complaint of abnormal swallowing and swallowing speed. It is concluded that swallowing speed is a reliable and valid index for assessing disordered swallowing in neurological patients and may be of value in monitoring response to therapy.

Adult↗
PubMed1992

Coordination of respiration and swallowing: effect of bolus volume in normal adults.

The coordination of swallowing and respiration, as measured by nasal airflow, and the effect of changes in the volume of the swallow bolus (0-20 ml) were investigated in 12 normal subjects. Both nonbolus and bolus swallows were usually preceded and followed by expiratory airflow. Swallows followed by inspiratory airflow accounted for 20% of nonbolus swallows but decreased further in frequency in the presence of a bolus. Swallowing was associated with an apneic period lasting 1.90 +/- 0.26 s for nonbolus swallows. Based on the apneic period response to bolus volume, the subjects were divided into two groups. The apneic period decreased by 60% in seven of the subjects regardless of bolus volume. The remaining five subjects gradually increased swallow apnea as bolus volume was increased. At larger bolus volumes, the latter group also exhibited an earlier onset of the swallow apnea and an increase in the number of swallows preceded by inspiration. The duration of the swallow-associated respiratory cycle was similarly prolonged by an increase in bolus volume in both groups. The results indicate that the respiratory pattern associated with swallowing is modulated by the volume of the swallow bolus. Within the normal population, at least two different patterns of response to bolus volume are identified.

Adult↗
PubMed1994

Ventilatory sparing strategies and swallowing pattern during bottle feeding in human infants.

During feeding, infants have been found to decrease ventilation in proportion to increasing swallowing frequency, presumably as a consequence of neural inhibition of breathing and airway closure during swallowing. To what extent infants decrease ventilatory compromise during feeding by modifying feeding behavior is unknown. We increased swallowing frequency in infants by facilitating formula flow to study potential ventilatory sparing mechanisms. We studied seven full-term healthy infants 5-12 days of age. Nasal air flow and tidal volume were recorded with a nasal flowmeter. Soft fluid-filled catheters in the oropharynx and bottle recorded swallowing and sucking activity, and volume changes in the bottle were continuously measured. Bottle pressure was increased to facilitate formula flow. Low- and high-pressure trials were then compared. With the change from low to high pressure, consumption rate increased, as did sucking and swallowing frequencies. This change reversed on return to low pressure. Under high-pressure conditions, we saw a decrease in minute ventilation as expected. With onset of high pressure, sucking and swallowing volumes increased, whereas duration of airway closure during swallows remained constant. Therefore, increased formula consumption was associated with reduced ventilation, a predictable consequence of increased swallowing frequency. However, when consumption rate was high, the infant also increased swallowing volume, a tactic that is potentially ventilatory sparing as a lower swallowing frequency is required to achieve the increased consumption rate. As well, when consumption rate is low, the sucking-to-swallowing ratio increases, again potentially conserving ventilation by decreasing swallowing frequency much more than if the sucking-to-swallowing ratio was constant.

Bottle Feeding↗
PubMed2006

The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing.

Surface electrical stimulation is currently used in therapy for swallowing problems, although little is known about its physiological effects on neck muscles or swallowing. Previously, when one surface electrode placement was used in dysphagic patients at rest, it lowered the hyolaryngeal complex. Here we examined the effects of nine other placements in normal volunteers to determine 1) whether movements induced by surface stimulation using other placements differ, and 2) whether lowering the hyolaryngeal complex by surface electrical stimulation interfered with swallowing in healthy adults. Ten bipolar surface electrode placements overlying the submental and laryngeal regions were tested. Maximum tolerated stimulation levels were applied at rest while participants held their mouths closed. Videofluoroscopic recordings were used to measure hyoid bone and subglottic air column (laryngeal) movements from resting position and while swallowing 5 ml of liquid barium, with and without stimulation. Videofluoroscopic recordings of swallows were rated blind to condition using the National Institutes of Health-Swallowing Safety Scale. Significant (P < 0.0001) laryngeal and hyoid descent occurred with stimulation at rest. During swallowing, significant (P <or= 0.01) reductions in both the larynx and hyoid bone peak elevation occurred during stimulated swallows. The stimulated swallows were also judged less safe than nonstimulated swallows using the National Institutes of Health-Swallowing Safety Scale (P = 0.0275). Because surface electrical stimulation reduced hyolaryngeal elevation during swallowing in normal volunteers, our findings suggest that surface electrical stimulation will reduce elevation during swallowing therapy for dysphagia.

Adult↗
PubMed2006

Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation.

RATIONALE: Malnutrition and aspiration are major problems in patients with neuromuscular disease. Because impaired swallowing contributes to malnutrition, means of improving swallowing are needed. OBJECTIVES: To investigate interactions between breathing and swallowing in neuromuscular disorders and to evaluate the impact of mechanical ventilation (MV) on swallowing in tracheostomized patients. METHODS: We studied 10 healthy individuals and 29 patients with neuromuscular disease and chronic respiratory failure (including 19 with tracheostomy). The tracheostomized patients who could breathe spontaneously were recorded during spontaneous breathing (SB) and with MV, in random order. MEASUREMENTS AND MAIN RESULTS: Breathing-swallowing interactions were investigated by chin electromyography and inductive respiratory plethysmography, using three water-bolus sizes (5, 10, and 15 ml) in random order. In contrast to healthy individuals, neuromuscular patients showed piecemeal deglutition with several swallows over several breathing cycles for each bolus. The percentage of swallows followed by expiration was about 50% in the patients compared with nearly 100% in the control subjects. The number of swallows and total swallowing time per bolus correlated significantly to maximal inspiratory pressure. In the 10 tracheostomized patients who were recorded both in SB and MV, the number of swallows and total swallowing time per bolus were significantly reduced during MV compared with SB. CONCLUSION: Neuromuscular patients showed abnormal breathing-swallowing interactions, which correlated to maximal inspiratory pressure. Moreover, MV improved the swallowing parameters in tracheostomized patients who were able to breathe spontaneously.

Adolescent↗
PubMed2001

Mapping of brain stem neuronal circuitry active during swallowing.

A poorly understood neural circuit in the brain stem controls swallowing. This experiment studied the swallowing circuit in the rat brain stem by means of fos immunocytochemistry. The fos protein is a marker of activated neurons, and under experimental conditions, repetition of a behavior causes the fos protein to be produced in the neurons involved in that behavior. The fos technique has been successfully used to delineate neural circuits involved in reflex glottic closure, cough, and vocalization; however, the technique has not been used to map the swallowing circuit. Nine rats were used in this study. Swallows were evoked in anesthetized rats for 1 hour, then, after a 4-hour delay to allow maximum fos production, the rats were painlessly sacrificed by perfusion. The brain stems were removed and sectioned in the frontal plane, and every fourth section was immunoreacted for fos protein. All sections were examined by light microscopy, and cells positive for fos were marked on drawings of brain stem structures for different levels throughout the brain stem. Control animals underwent sham experiments. After subtraction of the areas of fos labeling seen in controls, all experimental rats showed fos-labeled neurons in very discrete and localized areas, including practically all regions implicated by prior neurophysiology studies of swallowing. The distribution of labeled neurons was more dispersed through the brain stem than current theories of swallowing would suggest. Specifically, recent studies of swallowing control have focused on the nucleus of the solitary tract (NST) and the region surrounding the nucleus ambiguus (periambigual area) just rostral to the obex. These areas contained fos-labeled neurons, but unexpectedly, heavy labeling was found in the same areas caudal to the obex. Areas containing the heaviest labeling were specific subnuclei of the NST and surrounding reticular formation; the periambigual area; and the intermediate reticular zone in the pons and caudal medulla. Interestingly, none of these anatomic structures had uniform fos labeling; this finding suggests that the unlabeled areas are involved in other oromotor behaviors, or that the specific protocol did not activate the full population of swallowing-related neurons. A notable finding of this study is a candidate for the central pattern generator (CPG) of swallowing. Careful lesioning studies in cats strongly suggest that a region in the rostral-medial medulla contains the CPG for swallowing, although the exact location of the CPG was never pinpointed. In the homologous region of the rat brain stem, fos labeling was only found in a small group of neurons within the gigantocellular reticular formation that may be a candidate for the CPG. In summary, correlation with prior physiology experiments suggests that this experiment appears to have delineated many, if not all, of the components of the swallowing circuit for the first time in any mammal. In addition, other areas were found that might also be swallowing-related. One notable example is a small group of fos-labeled cells that may be the CPG for swallowing. Further studies are required to clarify the specific roles of the fos-labeled neurons seen in this study.

Animals↗
PubMed1997

Characterizing swallowing abnormalities in progressive supranuclear palsy.

The dysphagia that occurs as an early sign of progressive supranuclear palsy (PSP), and which may predispose patients to aspiration pneumonia, has never been fully characterized. We evaluated 27 patients (mean +/- SEM: age, 64.9 +/- 1 years; symptom duration, 52 +/- 5 months) who met the clinical National Institute of Neurological Disorders and Stroke and Society for PSP (NINDS-SPSP) criteria for possible or probable PSP, with a swallowing questionnaire, an oral motor and speech examination, and either a modified barium swallow or ultrasound studies. Twenty-eight age- and sex-matched healthy controls (age, 65.6 +/- 1.5 years) were also evaluated with the questionnaire, oral examination, and the ultrasound study. We used ANOVA statistics to evaluate differences between groups; nonparametric correlations to assess associations between swallowing and motor and cognitive abnormalities; and logistic regression analysis to determine if the items of the questionnaire or oral examination predicted ultrasound or modified barium swallow abnormalities. While PSP patients had at least one complaint on the swallowing questionnaire (mean, 6.6), healthy controls had fewer and less relevant complaints (0.3). Patients with moderate-to-severe cognitive disabilities had significantly more complaints of dysphagia than those with mild or no impairment. PSP patients' oral motor skills and speech were mildly impaired but significantly different from those of controls. In the ultrasound studies, PSP patients had significantly fewer continuous swallows and required a longer duration to complete their swallows than did healthy controls. They also had mild-to-moderate abnormalities in the modified barium swallow study. The swallowing questionnaire, oral motor examination, and speech production examination accurately predicted the abnormalities detected with the swallowing studies. While 75% of patients had abnormal speech, all but one had abnormal swallowing studies. Thus, although dysphagia is associated with dysarthria, the two conditions are not always paired in the same patient. Our results suggest that the swallowing questionnaire and oral motor examination are an easy and cost-effective method to predict the swallowing disturbances in PSP.

Aged↗
PubMed1993

Distribution of swallow protein in egg chambers and embryos of Drosophila melanogaster.

The Drosophila maternal effect gene swallow has a role in localizing bicoid mRNA at the anterior margin of the oocyte during oogenesis, and a poorly characterized role in nuclear divisions in early embryogenesis. We have examined the distribution of swallow protein during oogenesis and embryogenesis using anti-swallow antibodies. During oogenesis, high levels of swallow protein are present in basal nurse cell cytoplasm, although small amounts are also present at the anterior oocyte margin, the site of bicoid RNA localization. Only a small fraction of swallow protein is in a position to interact directly with bicoid RNA during localization. The asymmetric distribution of swallow protein is disrupted in swallow ovaries, in which bicoid RNA becomes unlocalized late in oogenesis. swallow protein is uniformly distributed in eggs, but becomes localized to nuclei during early mitotic divisions in early embryogenesis. swallow protein enters each nucleus at the beginning of mitosis, occupies a position complementary to that of condensed chromatin, and leaves each nucleus at the end of mitosis. We show examples of nuclear division defects in swallow mutant embryos, and suggest that the abnormal nuclear divisions in early swallow embryos reflect a second function for swallow protein that contributes to abdominal segmentation defects common in swallow embryos.

Animals↗
PubMed1998

Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing.

BACKGROUND: The preservation of speech and swallowing function is the primary goal when reconstructing soft tissue defects in the oral cavity or oropharynx. The type of reconstructive procedure used should be based on outcome data examining speech and swallowing function; yet, there is a paucity of such information. OBJECTIVES: To present the results of a multi-institutional prospective study of speech and swallowing function before and after soft tissue reconstruction of the oral cavity and oropharynx, and to compare 3 methods of reconstruction with respect to speech and swallowing function: primary closure, distal myocutaneous flap, and microvascular free flap. DESIGN: Prospective case-comparison study. SETTING: Four leading head and neck cancer institutions. PATIENTS: The patients were selected from a database of 284 patients treated at the different institutions. The patients were matched for the location of the oral cavity or oropharyngeal defect and the percentage of oral tongue and tongue base resection. Those patients who had previous speech and swallowing deficits and patients in whom postoperative fistulas or wound infections developed were excluded from the study. METHODS: The patients underwent speech and swallowing evaluation preoperatively and 3 months after healing. This evaluation included videofluoroscopic studies of swallowing and tests of speech intelligibility and sentence articulation. Videofluoroscopy provided measures of swallowing efficiency and bolus movement. Liquid and paste consistencies were used in evaluating swallowing function. MAIN OUTCOME MEASURE: The functional results of the reconstruction. RESULTS: Patients who had primary closure were more efficient at swallowing liquids, had less pharyngeal residue, a longer oral transit time with paste, and higher conversational intelligibility than patients who underwent reconstruction with a distal flap. Compared with patients who underwent reconstruction with a free flap, those who had primary closure had more efficient swallowing of liquids, less pharyngeal residue, and shorter pharyngeal delay times with paste. No difference in the speech and swallowing function existed between patients treated with distal myocutaneous flaps and those treated with microvascular free flaps. CONCLUSION: Contrary to the current theory of oral and oropharyngeal reconstruction, we found that the use of primary closure resulted in equal or better function than the use of flap reconstruction in patients with a comparable locus of resection and percentage of oral tongue and tongue base resection.

Deglutition↗
PubMed1997

Super-supraglottic swallow in irradiated head and neck cancer patients.

BACKGROUND: After radiotherapy to the head and neck, many patients experience swallowing difficulties. Preliminary work indicates that these patients benefit from the super-supraglottic swallow maneuver. METHODS: Lateral videofluoroscopic studies examined oropharyngeal swallowing in 9 patients who suffered from dysphagia after radiation to the head and neck. Each patient completed two swallows each of 1 mL or 3 mL liquid barium without a voluntary swallow maneuver and with the super-supraglottic swallow designed to close the entrance to the airway early. The videotape of each swallow was digitized and the location of pharyngeal structures marked throughout the swallow. Movement over time plots were generated to measure changes in structural movement resulting from the maneuver. RESULTS: The super-supraglottic swallow resulted in changes in airway entrance closure and hyolaryngeal movement. One patient who aspirated without the maneuver stopped aspirating with the maneuver. Two others had aspiration reduced to a trace with the maneuver. Fewer swallowing disorders were observed with the maneuver. CONCLUSION: The super-supraglottic swallow results in improved biomechanics of swallow in irradiated head and neck cancer patients.

Adult↗
PubMedDate not supplied

Maternal plasma hypo-osmolality: effects on spontaneous and stimulated ovine fetal swallowing.

Fetal swallowing is a major route of amniotic fluid resorption, and thus swallowing activity may alter amniotic fluid volume. Near-term ovine fetal swallowing increases in response to plasma and/or cerebrospinal fluid hypertonicity. As maternal hydration status alters amniotic fluid volume, we hypothesized that maternal plasma hypotonicity may alter fetal swallowing activity. Pregnant ewes (130 +/- 1 d; n = 6) were chronically prepared with maternal and fetal vascular catheters, a fetal esophageal flow probe, and fetal thyrohyoid and nuchal and thoracic esophagus electromyogram electrodes. Spontaneous fetal swallowing and hypertonic saline thresholds for stimulated swallowing were determined prior to and following maternal hypotonicity induced with water loading and intravenous DDAVP (arginine vasopressin V2 agonist). Fetal swallowing thresholds were determined with intracarotid injections (0.15 ml/kg) of increasing sodium chloride concentrations (0.15-1.2 M) at 2-min intervals. Maternal DDAVP infusion significantly decreased mean (+/-SEM) maternal and fetal plasma osmolalities (298 +/- 2-284 +/- 3; 295 +/- 2-278 +/- 3 mOsm/kg, respectively) and sodium concentrations (147.3 +/- 0.4-137.5 +/- 0.9; 142.7 +/- 0.8-133.5 +/- 1.0 mEq/l, respectively), suppressed spontaneous swallowing activity and volume (1.1 +/- 0.2-0.6 +/- 0.1 swallows/min; 0.7 +/- 0.2-0.5 +/- 0.1 ml/min, respectively) and significantly increased the osmotic threshold for swallowing stimulation (0.77 +/- 0.08-1.03 +/- 0.09 M NaCl). We conclude that: (1) maternal, and thus fetal, plasma hypotonicity results in suppression of spontaneous fetal swallowing activity and a decrease in volume swallowed, suggesting that spontaneous fetal ingestive behavior results, in part, from tonic dipsogenic stimulation, and (2) under hypotonic conditions, the intracarotid NaCl injection concentration for swallowing stimulation increases. These results suggest that the reset (lower) maternal plasma osmolality during human pregnancy may serve to minimize fetal ingestive and perhaps arginine vasopressin-mediated antidiuretic responses to acute maternal hypertonicity.

Amniotic Fluid↗
PubMedDate not supplied

Recovery of postoperative swallowing in patients undergoing partial laryngectomy.

This study assessed the achievement of postoperative swallowing in patients undergoing partial laryngectomy surgery. Oropharyngeal swallow efficiency was used to predict time to achievement of outcome. Fifty-five patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a videofluoroscopic evaluation enabled the measurement of swallowing efficiency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial curves. Patients with hemilaryngectomies achieved swallowing rehabilitation sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did patients undergoing supraglottic laryngectomies with tongue base resection (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. Higher early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, functional swallowing and eating may be achieved within 3 months of surgery while for other types, significant impairment remains up to 9 months postoperatively Early radiographic assessments of swallowing function are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved oral intake before radiotherapy is started.

Cineradiography↗
PubMedDate not supplied

Effects of maneuvers on swallowing function in a dysphagic oral cancer patient.

This study examined the effects of three swallow maneuvers: (1) the supraglottic swallow (voluntary closure of the vocal folds prior to the swallow); (2) the super-supraglottic swallow (airway closure at the level of the arytenoid to base of epiglottis); and (3) the Mendelsohn maneuver (voluntary prolongation of laryngeal elevation and cricopharyngeal opening during swallow) on swallow functioning in a 47-year-old patient who underwent right composite resection for a squamous cell carcinoma of the right retromolar trigone. All maneuvers were employed during the same videofluorographic (VFG) swallow study conducted 6 months after the patient's surgery. Biomechanical analysis of 3-mL swallows defined the extent and timing of tongue base retraction to the posterior pharyngeal wall, laryngeal elevation, laryngeal closure and cricopharyngeal opening during swallows with and without maneuvers. Airway closure duration was prolonged during supraglottic and super-supraglottic swallows, but aspiration was not eliminated. Use of the Mendelsohn maneuver improved coordination and timing of pharyngeal swallow events, including timing of posterior movement of the tongue base to the pharyngeal wall in relation to airway closure and cricopharyngeal opening, with elimination of aspiration. The Mendelsohn maneuver compensated for anatomic and physiologic changes in the oropharyngeal swallow and enabled reinstatement of safe oral intake in this surgically treated head and neck cancer patient who was previously unable to take nutrition orally.

Carcinoma, Squamous Cell↗