Toshikazu Nagasaki

Influence of aging and denture use on liquid swallowing in healthy dentulous and edentulous older people.

OBJECTIVES: To clarify the influence of aging and denture use on swallowing in healthy edentulous people aged 75 and older.

Improved inspection of the lateral pharyngeal recess using cone-beam computed tomography in the upright position

ObjectivesTo evaluate the structure of the lateral pharyngeal recess (LPR) and surrounding structures in computed tomography (CT) images obtained from subjects in the supine and upright positions.MethodsSix subjects were evaluated using cone-beam CT (CBCT) in the upright position, and with a four-row multidetector helical CT (MDCT) in the supine position. All of the voxel sizes were adjusted to 0.3 × 0.3 × 0.3 mm3 in the x, y, z coordinate system. The posterior nasal spine and basion were used as references. The LPR and surrounding structures were measured and compared in the two different modalities.ResultsIn 83% of the cases, the LPR was deeper when the position was changed from supine to upright.ConclusionsOur results suggest that imaging of the LPR using CBCT with the subject in the upright position is superior to that using MDCT with the subject in the supine position.

A morphological comparison of the piriform sinuses in head-on and head-rotated views of seated subjects using cone-beam computed tomography

ObjectivesFood flow in the oropharynx changes when the head is rotated. The purpose of this study was to evaluate morphological differences in the upper and lower piriform sinuses in head-on (HO) versus head-rotated (HR) positions.MethodsTen healthy adult volunteers with no previous history of dysphagia were subjected to cone-beam computed tomography (CBCT) in the HO and HR positions. Binary CBCT images were created at 50% gray scale to examine morphological changes in the lower piriform sinuses.ResultsUpon rotation to the right, the cross-sectional area of the left lower piriform sinus increased significantly (P = 0.037). The depth of the right lower piriform sinus also increased significantly (P = 0.011) upon rotation. The volume of the lower piriform sinuses increased significantly on both sides (right, P = 0.009; left, P = 0.013). The upper piriform sinuses acquired a teardrop shape, with the rotated side narrowed and opposite side enlarged.ConclusionsThese results suggest that changes in food flow during head rotation result mainly from changes in the size and shape of the upper piriform sinuses.

Differences of Aspiration between Liquid and Solid Foods in Video Fluoroscopic Swallowing Study: A Review of Literature

The videofluoroscopic swallowing study (VFSS) is commonly considered the gold standard for assessing a patient’s swallowing ability. Most dysphagic patients arrange food to make it thicker or softer and thus easier and safer to swallow. A popular point of discussion, even argument, about VFSS among clinicians is whether to use barium sulfate in isolation or in combination with real food. No firm answer has emerged from these discussions, and proponents of both perspectives have seemingly valid points. The aim of the present study was to review whether there were differences between the results using liquid or solid foods in VFSS. We performed a literature search and interpreted the data acquired according to a systematic method. After data extraction and interpretation, we were left with 14 publications that were considered relevant. Most of the research showed that the rate of aspiration was higher with liquids than with solid foods. According to the results of VFSS by using the various textured-foods, the aspiration risk was highest with two-phase food diet such as the mixtures of liquid and solid foods. However, descriptions of their results were often inadequate although many test foods were used for the VFSS. There were a few publications containing the detailed information of the food textures. As the VFSS images provide valuable data, the methods and the results should be described in as much detail as possible to help readers of the articles. Most patients make allowances for the differences in thin liquids, thick liquids, and solid foods. Hence, writing the details of test food textures would lead to improve the quality of the VFSS in the future.

Candy eating behaviour to improve swallowing function in dementia subjects

OBJECTIVES To develop and assess a dysphagia training method involving lollipop sucking training in older adults with dementia, clarify its effectiveness for improving oral function. METHODS Twenty-five older adults with dementia (5 males and 20 females, mean age 90.8 ± 6.7 years) were participated in this study. Participants were trained in lollipop sucking once a day, 3 times a week for 6 months. Mini-Mental State Examination (MMSE), Barthel Index (BI), Candy Sucking Test (CST), and BMI values were measured before and after the training. Participants were grouped into those who achieved >0.1 g/min increase in CTS value after the training (increase group) and those who did not (nonincrease group). RESULTS No significant change was observed after the training. The increase group contained 4 patients and the non-increase group contained 21 patients. There were no significant differences in MMSE, BI, or BMI between the two groups before and after the training. However, the CST values of the increase group before the training (0.31 ± 0.13 g/min) were significantly lower than non-increase group (0.69 ± 0.27 g/min) (p < 0.01). Respective changes in BMI before and after training were 1.13 ± 0.85 kg/m² and -0.53 ± 1.76 kg/m² in the increase and non-increase, and the difference in these changes was statistically significant (p = 0.04). CONCLUSIONS Our new rehabilitation method was well accepted by older adults with dementia, and there was an improvement in oral function as a result of the rehabilitation, which had some good influence on weight gain.

Deglutitive tongue movement after correction of mandibular protrusion

OBJECTIVE To investigate any change in deglutitive tongue movement following the correction of malocclusion by orthognathic surgery. MATERIALS AND METHODS The subjects were nine patients with mandibular protrusion. A control group consisted of 10 individuals with a similar age range and normal occlusion. Swallowing events before and after mandibular setback via sagittal split ramus osteotomy were recorded by cineradiography, and the tongue movement was analyzed. Time and linear measurements were compared before and after surgical treatment by the Wilcoxon signed rank test; control and test subjects were compared with the Mann-Whitney U-test. RESULTS Tongue-palate contact and the tongue-tip position changed after orthognathic surgery and became similar to those of the controls. Movements of the anterior and middorsal regions of the tongue did not change after orthognathic surgery and remained different from those of the controls. CONCLUSION Our findings suggest that tongue-palate contact and tongue-tip position during deglutition adapted to the corrected oral and maxillofacial morphology, but the anterior and middorsal regions of the tongue during deglutition may have been affected by pharyngeal constrictors rather than by the oral and maxillofacial morphology.

Application of a palatal plate in amyotrophic lateral sclerosis: a case report

This paper reports the case of a 47-year-old woman with dysphagia due to amyotrophic lateral sclerosis (ALS). Swallowing impairment was improved for 9 months by the application of a palatal plate prosthesis. The patient’s swallowing condition was evaluated by the swallowing function of ALS severity scale and cinefluoroscopy. The effect on ALS patients of oral prostheses as an aid to swallowing is discussed herein.