Mai Ohkubo

MR Evidence of Characteristics in Symptomatic Osteoarthritis of the Temporomandibular Joint: Increased Signal Intensity Ratio on Proton Density-Weighted Images of Bone Marrow in the Mandibular Condyle

Abstract The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p<0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p<0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.

Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults

Dysphagia is common in dependent older adults. Thus, a method of evaluating eating and swallowing functions that can be used to diagnose and manage dysphagia in a simple and robust manner is required. In 2002, the Mann Assessment of Swallowing Ability (MASA) was introduced to identify dysphagia in acute‐stage stroke patients. As the MASA enables easy screening, it might also be applicable to dependent older adults if appropriate MASA cut‐off values and the most useful assessment items could be determined. In the present study, we attempted to determine suitable MASA cut‐off values, and the most useful assessment items for predicting aspiration and pharyngeal retention in dependent older adults.

Effects of varying fixed lingual apex positions on tongue pressure during straw drinking.

We investigated the impact of tongue-thrusting on lingual pressure during fluid intake with a straw. In this study, 12 healthy young dentate individuals (two women and 10 men; 19-33 years) were instructed to drink 15 mL of water with a regular drinking straw at 37 °C, when indicated by the investigator. Participants drank after adjusting tongue position to one of the following patterns: (i) Holding the tip of the straw between the lips (Normal Position: NP), (ii) Sticking out the tongue to the vermilion zone of the lower lip and inserting the straw 1 cm past the front teeth (Tongue-thrusting Position: TP). Five recordings were conducted for each participant in a randomised order. To measure tongue pressure during swallowing, a specially designed 0.1-mm thick sensor sheet (Nitta, Osaka, Japan) with a tactile system for measurement of pressure distribution (I-SCAN; Nitta) was used. Duration, maximal magnitude and integrated value of tongue pressure were analysed based on the wave of tongue pressure recorded while water was swallowed. Magnitude, duration and integrated value of tongue pressure were significantly lower in TP than in NP at the median line (Ch1-3). Magnitude and integrated value of tongue pressure at the lateral part of the tongue (Ch5) were significantly lower in TP than in NP. When duration, maximal magnitude and integrated values were compared by channel, no significant differences were observed in NP, but a significant difference was found between Ch3 and the lateral areas Ch4/Ch 5 in TP. When the tongue was thrust forward, movement dynamics of the entire tongue changed and influenced contact between the tongue and palate during liquid intake with a straw. The impact was noticeably weaker on the median line than in lateral areas.

Two-year Survey of Trends at Food Introduction Booth at Suidobashi Hospital of Tokyo Dental College

A working group established at Tokyo Dental College Suidobashi Hospital considered how to manage patients experiencing difficulties with food intake during the process of dental treatment. This resulted in the opening of an in-hospital booth dedicated to providing advice on such problems. A survey was performed to determine the number of patients utilizing this facility and the department which they were attending with the aim of investigating factors involved in eating-related problems. The results revealed that patients were being referred to the booth from the departments of dental prosthetics, conservative dentistry, oral and maxillofacial surgery (by both dentists and dietitians), oral implantation, and orthodontics. Patients were provided with information on the booth by their dentist or dietician, either by means of introductory materials or verbally. These patients were requested to complete a questionnaire, with informed consent, over a 2-year period. The participants were classified according to age and original dental problem on attending this hospital and the results analyzed. The inability to eat hard foodstuffs, difficulty in chewing, inability to open the mouth, insufficient nutrition, unbalanced nutrition, intraoral pain, and difficulty in swallowing were all identified as problems related to eating. A total of 1,948, 413 visitors had received introductory materials, while 156 had learned of the facility verbally. Looking at department as a factor, the inability to eat hard foodstuffs and difficulty chewing occupied a large percentage of the reported problems for all departments. Taken together, these results revealed that many patients experienced difficulties in eating during the process of treatment. This indicates that it is necessary to give the appropriate eating instructions to each patient according to their specific needs and stage of dental treatment.

Swallowing Rehabilitation Affects Period of Hospitalization after Surgery for Tongue Cancer

Functional rehabilitation has been reported to improve swallowing. The effect of the presence or absence of such rehabilitation has yet to be compared in oral cancer patients, however. The purpose of this study was to investigate its effect on correlations between the period of hospitalization and the period of tube feeding (from the day of surgery to termination of tube feeding) and period of oral nutrition (from termination of tube feeding to discharge). Body weight was also measured on admission and discharge and the difference calculated. A correlation was observed between period of hospitalization and period of tube feeding in the rehabilitation group, and with the periods of tube feeding and oral nutrition in the non-rehabilitation group. In the rehabilitation group, the period of tube feeding appeared to affect period of hospitalization. On the other hand, termination of tube feeding did not tend to affect period of hospitalization. These results suggest that both periods were factors affecting period of hospitalization in the non-rehabilitation group. Not performing swallowing rehabilitation, therefore, resulted in the period of oral nutrition affecting the period of hospitalization. This suggests that it is essential that nutrients be ingested in moderation after termination of tube feeding, when they are only taken orally. Moreover, these results also indicate that rehabilitation is important in improving quality of life after discharge.

Influence of cervical, thoracic and lumbar spines, and shoulder girdle range of motion on swallowing function of dependent older adults

The present study examined the cervical, thoracic and lumbar spines, and shoulder girdle range of motion (ROM) of dependent older adults to clarify the influence of these variables on swallowing function, in order to evaluate the efficiency of ROM training to maintain older adults’ swallowing function.

Optimal contrast enhancement liquid for dynamic MRI of swallowing

Several dynamic magnetic resonance imaging (MRI) techniques to observe swallowing and their parameters have been reported. Although these studies used several contrast enhancement liquids, no studies were conducted to investigate the most suitable liquids. The purpose of this study was to identify the optimal contrast enhancement liquid for dynamic MRI of swallowing. MRI was performed using a new sequence consisting of true fast imaging with steady-state precession, generalised auto-calibrating partially parallel acquisition and a keyhole imaging technique. Seven liquids were studied, including pure distilled water, distilled water with thickener at 10, 20 and 30 mg mL(-1) concentrations and oral MRI contrast medium at 1, 2 or 3 mg mL(-1) . Distilled water showed the highest signal intensity. There were statistically significant differences among the following contrast media: distilled water with thickener at 20 mg mL(-1) and the oral MRI contrast medium at 2 mg mL(-1) and 1 mg mL(-1) . It can be concluded that the optimal liquid for dynamic MRI of swallowing is a water-based substance that allows variations in viscosity.