Search

Guitarfishes and sawfishes are included in the order Rhinopristiformes, which currently encompasses five families: Pristidae, Rhinobatidae, Trygonorrhinidae, Rhinidae and Glaucostegidae. Considering the low number of studies focused on oral structures in Rhinopristiformes and the need to better understand their internal morphology, this study aimed to (1) evaluate and describe the morphological variation of the oropharyngeal denticles of guitarfishes and sawfish; (2) evaluate and describe the ontogenetic and sexual variation of the oropharyngeal denticles of Zapteryx brevirostris; (3) propose characters potentially useful for taxonomic and systematic purposes and (4) discuss the possible functions and advantages of these structures. Tissue samples were taken from the oropharyngeal region of specimens preserved in 70% alcohol and then prepared for visualization in scanning electron microscopy. A new method for sampling the pharynx region is proposed herein. Considerable morphological variation between families and genera was observed. However, no variation between conspecifics was found. Regional variations of denticles when examining a single individual were observed in shape, ornamentation, and orientation. In Zapteryx brevirostris, males had a significantly higher density of denticles in the ventral region than females and lower densities were observed in juveniles. The four characters discussed here are based on the presence of keels, number of cusps, distal end elongation and width/length ratio of the oropharyngeal denticles. Among the possible functions and advantages of these structures are the improvement of food adherence, tissue protection against food abrasion and parasitism, and attenuation of hydrodynamic drag in the oropharyngeal cavity during food ingestion., (© 2024 Wiley Periodicals LLC.)

Dysphagia is common in neurological disease. However, our understanding of swallowing and its central nervous control is limited. Sensory information plays a vital role in the initiation of the swallowing reflex and is often reduced in stroke patients. We hypothesized that the sensitivity threshold of the anterior faucial pillar could be facilitated by either electrical stimulation (ES) or taste and smell information. The sensitivity threshold was measured by ES in the anterior faucial pillar region. The measurement was repeated 5 min after baseline. Thirty minutes after baseline, the participants underwent a test for taste and smell. Immediately after the test, the ES was repeated. Thirty healthy volunteers with a mean age of 27 ± 5.1 participated in the trial. Mean sensitivity threshold at baseline was 1.9 ± 0.59 mA. The values 5 min after baseline (1.74 ± 0.56 mA, p = 0.027) and 30 min after baseline (1.67 ± 0.58 mA, p = 0.011) were significantly lower compared to the baseline, but there was no difference between the latter (p = 0.321). After 5 min, a potentially facilitating effect was found on oral sensitivity by ES of the faucial pillar area. Thirty minutes later, this effect was still present.Trial registration Clinicaltrials.gov, NCT03240965. Registered 7th August 2017- https://clinicaltrials.gov/ct2/show/NCT03240965 .

Introduction: Post-nasal drip (PND)-induced cough is a common cause of chronic cough. However, there is little known about the characteristic physical findings of this condition., Objectives: We investigated views of the pharyngeal wall in patients with PND-induced cough using a handy endoscopic images., Methods: The subjects were 135 consecutive patients referred to our hospital with a sensation of something "dripping down the throat" as one of their symptoms. Physical findings for the oropharynx were examined using Wi-Fi endoscope camera. The difference in probability of symptoms in patients with acute cough and those with subacute/chronic cough was assessed using a Bayesian Fisher exact test on a 2 × 2 table., Results: Among the patients, 105 (78%) complained of cough, 78 (58%) of acute cough, 20 (15%) of subacute cough, and 7 (5%) of chronic cough; and 71 (53%) had coexisting asthma. Using Bayesian inference, a sore or scratchy throat and fever were more common in patients with acute cough than in those with subacute/chronic cough. In endoscopic images of the oropharynx, a reddish curtain sign on the posterior pharyngeal wall behind the palatopharyngeal arch was found in 121 patients (90%)., Conclusion: Patients with acute PND-induced cough have a component of acute upper respiratory infection, because of high probability of a sore or scratchy throat and fever as symptom. A reddish curtain sign may be a useful finding for identifying PND-induced cough in these cases., (© 2021 John Wiley & Sons Ltd.)

Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders., (© 2020 New York Academy of Sciences.)

Background: Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing., Objectives: To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea., Search Methods: We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers., Selection Criteria: We included RCTs that recruited adults and children with a diagnosis of OSA., Data Collection and Analysis: We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality., Main Results: We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence)., Authors' Conclusions: Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objective: To compare the level of continuous positive airway pressure (CPAP) delivered by three different CPAP delivery interfaces (RAM cannula system, Hudson prongs, and nasal mask) in preterm neonates with respiratory distress., Methods: Preterm neonates with gestation between 28 weeks and 34 weeks and birth weight more than or equal to 1000 g and requiring nasal CPAP for respiratory distress were eligible for the study. During the study period, consecutive infants requiring CPAP were started on Hudson prongs or RAM cannula or nasal mask in that order. We measured the mean oropharyngeal pressure, which approximates the applied CPAP level. Oropharyngeal pressures in the recruited neonates were measured between 24 and 48 hours of postnatal age, when stable and in sleep or quiet awake state. Comparison of the delivered oropharyngeal pressures when on three different nasal interfaces at the same set flow rate and at set CPAP of 5 cm or 6 cm of H 2 O was the primary outcome., Results: Data was analyzed from 30 neonates in each group. We found that measured oropharyngeal pressures were less than set CPAP level in all three studied interfaces. Maximum drop in oropharyngeal pressure was observed with use of RAM cannula with measured oropharyngeal pressures being 1.1 and 1.2 cm H 2 O less than set CPAP of 5 and 6 cm H 2 O respectively. Pharyngeal pressure best correlated to set CPAP level with the use of nasal mask., Conclusion: None of the nasal interfaces delivered oropharyngeal pressure equivalent to the set CPAP. However, nasal mask delivered oropharyngeal pressure best matched to the set CPAP., (© 2020 Wiley Periodicals, Inc.)

The Mexican salamander, Ambystoma mexicanum (Axolotl), is an excellent vertebrate model system to understand development and regeneration. Studies in axolotl embryos have provided important insights into taste bud development. Taste bud specification and determination occur in the oropharyngeal endoderm of axolotl embryos during gastrulation and neurulation, respectively, whereas taste bud innervation and taste cell differentiation occur later in development. Axolotl embryos are amenable to microsurgery, and tissue explants develop readily in vitro. We performed RNA-seq analysis to investigate the differential expression of genes in oropharyngeal explants at several stages of taste cell differentiation. Since the axolotl genome has only recently been sequenced, we used a Trinity pipeline to perform de novo assembly of sequencing reads. Linear models for RNA-seq data were used to identify differentially expressed genes. We found 1234 unique genes differentially expressed during taste cell differentiation stages. We validated four of these genes using RTqPCR and performed GO functional analysis. The differential expression of these genes suggests that they may play a role in taste cell differentiation in axolotls., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The history of research on the voice of opera soloists shows that there are certain functional features of the cranial nerves and cortical nerve centers. In this chapter, we review the most important findings in the field of canto voice neuroanatomy, which we corroborate with the results of our team research and experience. Our study focuses on the nerve structures involved in phonation at each level of the vocal formants: infraglottic, glottic, and oropharyngeal. We consider this research to have direct applicability in the fields of neurolaryngology, neuroscience, phoniatry, but also in the academic teaching. At the same time, the present study is a starting point for future research works on the anatomical and functional particularities of the structures involved during the act of phonation in canto soloists., (© 2020 S. Karger AG, Basel.)

Despite the importance of intraoral food transport and swallowing, relatively few studies have examined the biomechanics of these behaviors in non-tetrapods, which lack a muscular tongue. Studies show that elasmobranch and teleost fishes generate water currents as a 'hydrodynamic tongue' that presumably transports food towards and into the esophagus. However, it remains largely unknown how specific musculoskeletal motions during transport correspond to food motion. Previous studies of white-spotted bamboo sharks ( Chiloscyllium plagiosum ) hypothesized that motions of the hyoid, branchial arches and pectoral girdle, generate caudal motion of the food through the long oropharynx of modern sharks. To test these hypotheses, we measured food and cartilage motion with XROMM during intra-oropharyngeal transport and swallowing ( N =3 individuals, 2-3 trials per individual). After entering the mouth, food does not move smoothly toward the esophagus, but rather moves in distinct steps with relatively little retrograde motion. Caudal food motion coincides with hyoid elevation and a closed mouth, supporting earlier studies showing that hyoid motion contributes to intra-oropharyngeal food transport by creating caudally directed water currents. Little correspondence between pectoral girdle and food motion was found, indicating minimal contribution of pectoral girdle motion. Transport speed was fast as food entered the mouth, slower and step-wise through the pharyngeal region and then fast again as it entered the esophagus. The food's static periods in the step-wise motion and its high velocity during swallowing could not be explained by hyoid or girdle motion, suggesting these sharks may also use the branchial arches for intra-oropharyngeal transport and swallowing., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2019. Published by The Company of Biologists Ltd.)

To investigate the feasibility of ultrasonography in detecting the oropharynx movement during deep breathing and to quantitatively analyze oropharynx airway lumen changes during deep breathing. The motions of oropharynx were monitored, and sonographic measurements of airway lumen were obtained during deep breathing in 448 healthy volunteers. Adequate visualization of oropharynx movement was obtained on all healthy volunteers. The anterior-posterior (AP) diameters and AP/transverse (T) diameter ratios were greater at the end of deep inspiration than that at the end of deep expiration for each sex (p < 0.01). The anterior-posterior dimensional changes were greater than lateral airway dimensional changes each sex (p < 0.05). Ultrasonography could provide realistic impression of the process on the oropharynx movement during deep breathing and perform the quantitative analysis of the oropharynx airway lumen changes during deep breathing. The results were encouraging and supported the utility of ultrasonography in future studies., (Copyright © 2019 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Satiation is the process by which eating and drinking reduce appetite. For thirst, oropharyngeal cues have a critical role in driving satiation by reporting to the brain the volume of fluid that has been ingested 1-12 . By contrast, the mechanisms that relay the osmolarity of ingested fluids remain poorly understood. Here we show that the water and salt content of the gastrointestinal tract are precisely measured and then rapidly communicated to the brain to control drinking behaviour in mice. We demonstrate that this osmosensory signal is necessary and sufficient for satiation during normal drinking, involves the vagus nerve and is transmitted to key forebrain neurons that control thirst and vasopressin secretion. Using microendoscopic imaging, we show that individual neurons compute homeostatic need by integrating this gastrointestinal osmosensory information with oropharyngeal and blood-borne signals. These findings reveal how the fluid homeostasis system monitors the osmolarity of ingested fluids to dynamically control drinking behaviour.

Objective: Dynamic videofluoroscopic swallow study (VFSS) is used to investigate swallowing movements. However, it requires prolonged radiation exposure and mainly provides qualitative information. Herein, we present a multi-dimensional method for analyzing swallowing based on a pulsed, low-dose fluoroscopy technique that uses serial-shot images and evaluates the size, position, and temporal profile of the bolus to obtain a more comprehensive and realistic analysis of swallowing movements., Methods: Fifteen healthy adults drank two liquids: 20mL of pure water followed by 20mL of contrast medium mixture in a fluoroscopic study. Data were recorded in serial-shot images (7.5 frames/second, 1024×1024-pixel resolution, DICOM format). The images from the water and contrast swallows were inverted, synchronized, and subtracted to visualize the bolus in each frame. The pathway of the bolus was divided into 15 parts traversing the oropharynx, hypopharynx, and upper esophagus, and the total gray value was measured in each section. The results were presented as contour graphs., Results: The contour graphs allowed for information on the size, anatomical location, and temporal location of the bolus during swallowing to be displayed simultaneously. Two distinct swallowing patterns were observed in the subjects. The bolus showed two peaks-one in the hypopharynx and one in the upper esophagus-in all subjects. However, in nine of the 15 subjects, the two peaks were in different frames, whereas in six of the subjects, the two peaks were in the same frame., Conclusion: We developed a new method for quantitatively evaluating swallowing. The technique allows for multidimensional assessment of the size, position, and temporal profile of the movement of the bolus across the pharynx. This method evaluates the swallowing movements using sharp, high-resolution images obtained by serial-shot, pulsed fluoroscopy with low radiation exposure. Additional studies are required to further clarify the variability of swallowing patterns and their clinical relevance in the evaluation of swallowing movements in healthy subjects and in patients with swallowing disorders., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To assess the effect of age on swallowing with a focus on structural movement, timing and duration of physiologic events., Design: Cross-sectional study., Setting: Tertiary University Medical Center., Participants: Community-dwelling adults (3 age groups): younger 20 to 39 (n = 23; mean 32 ± 5), middle-aged 40 to 59 (n = 29; mean 49 ± 5) and older adults 60 to 74 (n = 15; mean 67 ± 5)., Intervention: One 10-mL honey-thick liquid (1700 mPa) swallow was studied using 320-row area detector computed tomography scanning., Measurements: Kinematic analysis was performed for each swallow including temporal characteristics and structural movements., Results: The duration of velopharyngeal closure and laryngeal closure (including epiglottis inversion, laryngeal vestibule closure, true vocal cord closure) was significantly different by age group (P = 0.002, P < 0.001, P = 0.017, P = 0.041, respectively). Events were prolonged in older adults compared with middle-aged and younger adults. The pharyngeal phase was longer for older adults. Velopharyngeal closure started earlier and continued until after complete UES opening. In younger adults, velopharyngeal and laryngeal opening occurred before complete UES opening. No differences were found in bolus movement through the oropharynx by group., Conclusion: During swallowing, older adults had a longer pharyngeal phase characterised by prolonged velopharyngeal and laryngeal closure. This difference may be a protective mechanism to compensate for age-related weakness. A better understanding of the mechanism by which this adaptation occurs is needed to tailor rehabilitation strategies and to maintain swallowing function during the lifespan., (© 2018 John Wiley & Sons Ltd.)

Background: Magazine's maneuver was developed for ease of insertion of the flexible bronchoscope, on encountering a closed lumen at the nasopharynx-oropharynx junction. The purposes of this study were to find the frequency of occurrence of such luminal closures and to compare the efficacy of Magazine's maneuver, with other variations of the maneuver, in improving visualization of the upper airway., Materials and Methods: Patients aged 18 years and above who were undergoing flexible bronchoscopy were included, and their demographic and clinical data were noted. The bronchoscope was inserted using the transnasal approach, and, at the junction of nasopharynx with oropharynx, the patency of the lumen between the soft palate and the posterior pharyngeal wall was recorded. The subjects were instructed to perform 4 variations of the maneuver. Observations at each variation were recorded as lumen open or closed; if the lumen was open, the size was noted as small or large and whether it closed during expiration., Results: Among 443 subjects, obstruction at the nasopharynx-oropharynx junction was observed, at baseline, in 105 (23.7%); whereas 338 (76.3%) had an open lumen. An open lumen was observed during nose and mouth breathing in 294 (66.4%) subjects, and, when head-tilt chin-lift was added to it, it was observed in 303 (68.4%). During Magazine's maneuver the lumen remained open in all 443 (100%) subjects. Half of the subjects (n=8) with body mass index >30 and one-third (n=29) above 65 years of age had luminal closure at baseline., Conclusion: Magazine's maneuver opens up the obstruction at the nasopharynx-oropharynx junction, whereas mouth and nose breathing mostly fails to do so. Adding head-tilt chin-lift to either of the 2 breathing techniques does not provide any additional benefit.

Males of several species of deer have a descended and mobile larynx, resulting in an unusually long vocal tract, which can be further extended by lowering the larynx during call production. Formant frequencies are lowered as the vocal tract is extended, as predicted when approximating the vocal tract as a uniform quarter wavelength resonator. However, formant frequencies in polygynous deer follow uneven distribution patterns, indicating that the vocal tract configuration may in fact be rather complex. We CT-scanned the head and neck region of two adult male fallow deer specimens with artificially extended vocal tracts and measured the cross-sectional areas of the supra-laryngeal vocal tract along the oral and nasal tracts. The CT data were then used to predict the resonances produced by three possible configurations, including the oral vocal tract only, the nasal vocal tract only, or combining the two. We found that the area functions from the combined oral and nasal vocal tracts produced resonances more closely matching the formant pattern and scaling observed in fallow deer groans than those predicted by the area functions of the oral vocal tract only or of the nasal vocal tract only. This indicates that the nasal and oral vocal tracts are both simultaneously involved in the production of a non-human mammal vocalization, and suggests that the potential for nasalization in putative oral loud calls should be carefully considered., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2018. Published by The Company of Biologists Ltd.)

The successful performance of a swallow requires dynamic integration between a wide range of sensory inputs and muscle activities to produce the coordinated kinematics of oropharyngeal structures. Damage to the recurrent laryngeal nerve (RLN) produces dysphagia in infants, with food or liquid entering the airway despite this nerve having minimal direct sensory or motor connections to the act of swallowing, apart from vocal fold closure. Previous results have demonstrated that a complete RLN lesion disrupts both performance and kinematics before initiation of the pharyngeal swallow in infants. We tested the hypothesis that a RLN lesion produces changes in the normal activity of oral floor, tongue, and infrahyoid muscles during a swallow. We recorded swallowing in our validated infant pig model, with synchronous high-speed imaging and fine-wire, chronic electromyography. We found changes in the timing, duration, and amplitude of the motor pattern in an array of muscles that are supplied by several different cranial and cervical nerves. Some of these changes in muscle activity are associated with the preparatory aspects of bolus aggregation or movement and so occur before the pharyngeal swallow. Taken with previous biomechanical results, these patterns suggest an intricate brain stem sensorimotor integration that occurs as part of a swallow. In particular, the execution of oral motor function is changed as a result of this simple lesion. NEW & NOTEWORTHY Damage to the recurrent laryngeal nerve compromises swallowing despite an absent or minimal contribution to either the motor or sensory aspects of this function. This study documents EMG changes, following RLN lesion, to non-RLN innervated muscles that are active during swallowing in an infant model. Some of these muscles fire before the pharyngeal swallow and are associated with the preparatory aspects of bolus aggregation and movement, suggesting important sensorimotor integration at a brain stem level.

Objective: To investigate the effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in class Ⅰ adult patients with bimaxillary protrusion. Methods: Thirty class Ⅰ patients with bimaxillary protrusion that received fixed orthodontic treatment in Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University from January 2011 to September 2014 were selected using random number table. All the patients were treated with extraction of four first premolars and retraction of anterior teeth using implant anchorage. Cone-beam CT (CBCT) scans were performed before and after incisor retraction for all patients. The CBCT data of the upper airway were constructed using Mimics 16.0, and the flow field characteristics inside the upper airway were simulated using Ansys 14.0. The changes of volume (V), mean cross-sectional area (mCSA), maximum lateral diameters/maximum anteroposterior diameters (LP/AP) of cross section, the maximum pressure of airflow (P(max)), the minimum pressure of airflow (P(min)) and pressure drop (△P) of nasopharynx, oropharynx and hypopharynx before and after incisor retraction were measured and compared using paired t test. The correlation between the variation of △P in the most significant pharyngeal part and the morphological variables after incisor retraction was analyzed using Pearson correlation test. Results: No statistical differences were observed in the morphology and flow field in nasopharynx before and after incisor retraction ( P> 0.05). Before incisor retraction, the oropharyngeal volume and mCSA were (7 580±622) mm(3) and (217±40) mm(2), respectively, and the hypopharyngeal volume and mCSA were (2 564±162) mm(3), and (239±43) mm(2), respectively. After incisor retraction, the volumes of oropharynx and hypopharynx were (6 885±601) mm(3) and (2 535±156) mm(3), respectively, and mCSA of oropharynx and hypopharynx were (197±37) mm(2) and (236±42) mm(2), respectively. The volume and mCSA of oropharynx and hypopharynx were significantly decreased after incisor retraction ( P< 0.05). The greatest changes in pharyngeal volume and mCSA occurred in the oropharynx. In addition, the LP/AP of oropharynx after incisor retraction was changed from 1.9±0.6 to 2.1±0.7, which was significantly increased compared with the levels before incisor retraction ( P< 0.05). After simulation of pharyngeal airflow, the oropharyngeal P(min), hypopharyngeal P(max) and P(min) were (-13.7±4.3), (-8.3±3.8) and (-42.8±9.5) Pa, respectively, whereas the values turned to (-16.4±6.5), (-11.9±3.6) and (-46.0±11.0) Pa, respectively after incisor retraction, which was significantly reduced ( P< 0.05). △P of oropharynx was significantly increased from (42.7±10.1) Pa to (45.2±13.0) Pa after incisor retraction ( P< 0.05) and the variation of oropharyngeal △P was negatively correlated with the variation of V and mCSA in oropharynx before and after incisor retraction ( r= -0.681, P= 0.001; r= -0.844, P= 0.000). Conclusions: The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adult class Ⅰ patients with bimaxillary protrusion. A comprehensive and systematic evaluation of the pharyngeal morphology and ventilatory function were very important for making a scientific and rational clinical treatment plan.

Background: Heated humidification is paramount during neonatal high-flow nasal cannula (HFNC) therapy. However, there is little knowledge about the influence of flow rate and mouth leak on oropharyngeal humidification and temperature., Methods: The effect of the Optiflow HFNC on oropharyngeal gas conditioning was investigated at flow rates of 4, 6 and 8 L min -1 with and without mouth leak in a bench model simulating physiological oropharyngeal air conditions during spontaneous breathing. Temperature and absolute humidity (AH) were measured using a digital thermo-hygrosensor., Results: Without mouth leak, oropharyngeal temperature and AH increased significantly with increasing flow (P < 0.001). Mouth leak did not affect this increase up to 6 L min -1 , but at 8 L min -1 , temperature and AH plateaued, and the effect of mouth leak became statistically significant (P < 0.001)., Conclusions: Mouth leak during HFNC had a negative impact on oropharyngeal gas conditioning when high flows were applied. However, temperature and AH always remained clinically acceptable.

Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

The purpose of this study was to evaluate the airway volume changes associated with rapid maxillary expansion (RME) protocols using different activation rates. A sample of forty RME treated cases was classified into two groups according to the rate of RME activation (Group A: 0.8mm per day and Group B: 0.5mm per day). Three-dimensional images were obtained for each case before and three months after expansion. Dolphin imaging software was used to identify landmarks and calculate airway volumes. Intraclass correlation coefficient was used to confirm reliability and Wilcoxon signed rank tests were used for comparison between the initial and final measurements within each group and between groups. Significant increase in the nasal cavity volume for both groups was observed (P<0.0001 and P=0.001 for groups A and B respectively). The increase in nasopharynx volume was significant in the group with a more rapid activation rate (P=0.0006). Significant differences between the two groups in post-treatment changes were detected in the nasal cavity volume (P<0.0001), nasopharynx volume (P=0.0035), and soft palate area (P=0.0081). A more rapid activation rate results in a higher volume increase for the nasal cavity and nasopharynx than a slower activation rate., (Published by Elsevier Masson SAS.)

The aim of this study was to determine if bolus and dry swallow showed similar pressure changes in the oropharynx using our newly developed device. A unique character of it includes that baropressure can be measured with the sensor being placed in the balloon and can assess the swallowing mechanics in terms of pressure changes in the oropharynx with less influences of direct contacts of boluses and oropharyngeal structures during swallow indirectly. Fifteen healthy subjects swallowed saliva (dry), 15 ml of water, 45 ml of water, and 15 ml of two different types of food in terms of viscosity (potage soup-type and mayonnaise-type foods). Suprahyoid muscle activity was recorded simultaneously. Three parameters, area under the curve (AUC), peak amplitude, and duration of pressure, were analyzed from each swallow. Almost all of the bolus swallowing events had biphasic baropressure responses consisting of an early phase and late phase (99%), whereas 90% of the saliva swallowing events had a single phase. AUC, peak, and duration displayed greater effects during the late phase than during the early phase. Baropressure of the early phase, but not of the late phase, significantly increased with increasing volume; however, small but significant viscosity effects on pressure were seen during both phases. Peak pressure of the late phase was preceded by maximum muscle activity, whereas that of the early phase was seen when muscle activity displayed a peak response. These findings indicated that our device with the ability to measure baropressure has the potential to provide additional parameter to assess the swallow physiology, and biphasic baropressure responses in the early and late phases could reflect functional aspects of the swallowing reflexes.

Swallowing is a very important and complex physiological behaviour. The dynamic of swallowing has created great interest as any procedural abnormality will result in dysphagia and even lower quality of life. However, a non-invasive evaluation of biomechanical coordination during oropharyngeal swallowing, which includes the activities of the tongue, the hyoid and swallowing-related muscles, has not yet been achieved. In the present study, we recruited fifteen subjects, and a non-invasive sensing system composed of a pressure sensor, a bend sensor, surface electrodes and a microphone was created to simultaneously monitor tongue pressure, hyoid motion, and surface EMG of swallowing-related muscles, as well as take sound recordings, when the subjects swallowed 5 ml of water. In addition to obtaining the durations of certain motor events, the considerable time (beginning, peak and ending time) of tongue pressure production, suprahyoid and infrahyoid muscle activity and hyoid motion were successfully measured. Moreover, the significant correlations between swallowing-related muscles, tongue pressure, and the hyoid were confirmed. These findings suggest that the non-invasive sensing system has potential as a good candidate for monitoring and evaluating the oropharyngeal process of swallowing, which may be useful in clinical work involving dysphagia evaluation and rehabilitation.

Oral sensory function is essential for the successful performance of a range of ingestion. Although the perception of object size is important in determining the degree of manipulation, evidence suggests that people does not always perceive the size of the object in oral cavity accurately. The purpose of this study was to investigate the factors affecting the intraoral perception of object size. Twenty-three healthy young volunteers detected the size of cylinders inserted into oral cavity blindly and identified it from the reference set. The diameter of cross section varied from 10 to 14 mm in a gap of 1 mm and had three different temperatures (5, 36, 50 °C) in each. The perceived size was recorded, and the difference with the actual size was assessed. The required time for identification was also measured and compared between gender and between temperatures. The results demonstrated that the direction of size illusion was significantly affected by the required time for identification. Long manipulation led to overestimation, and short manipulation led to underestimation of object size irrespective of temperature and size. Gender was the other factor affecting intraoral size perception. The rate of overestimation was low in female participants comparing with male participants in this experiment, although the number of participants was limited. We therefore concluded that in order to detect the other factors affecting intraoral size perception, regulating oral manipulation time is indispensable., (© 2017 John Wiley & Sons Ltd.)

Purpose: Literature review on the onset locations of the pharyngeal phase of swallowing in asymptomatic and symptomatic adults and elderly people., Research Strategies: Research was conducted in the PubMed, BIREME and SciELO databases through the descriptors fluoroscopy (fluoroscopia), deglutition (deglutição) and pharynx (faringe)., Selection Criteria: Studies published between 2005 and 2015, carried out with adults and elderly people who underwent swallowing videofluoroscopy (SVF), and citing the onset location of the pharyngeal phase of swallowing., Data Analysis: Descriptive analysis and meta-analysis were performed, evaluating the heterogeneity and the measures grouped with random effects through I2 statistics. For ratio calculation in the meta-analysis, the locations described in the articles were classified according to the Modified Barium Swallowing protocol - Measurement Tool for Swallowing Impairment (MBSImp)., Results: Twelve articles were selected for descriptive analysis and seven for meta-analysis. Heterogeneity was found between studies, especially due to clinical and methodological differences. The random effect indicated predominance (58%) of the onset of the pharyngeal phase of swallowing at levels 0 and 1 of the MBSImP. In asymptomatic individuals, the onset of the pharyngeal phase was observed in the oral cavity, base of the tongue, dorsum of the tongue and vallecula. In symptomatic individuals, onset was mainly observed in the oropharynx, vallecula, hypopharynx and pyriform sinus., Conclusion: We noted a greater frequency of the onset of the pharyngeal phase of swallowing in the vallecula. The onset of the pharyngeal phase in the hypopharynx and pyriform sinus was more often observed among elderly individuals or with comorbidities that could alter swallowing.

Background: Oropharyngeal dysphagia (OD) is a highly prevalent symptom in older people. Appropriate oropharyngeal sensory feedback is essential for safe and efficient swallowing. However, pharyngeal sensitivity decreases with advancing age and could play a fundamental role in the physiopathology of swallowing dysfunction associated with aging. We aimed to characterize pharyngeal sensitivity and cortical response to a pharyngeal electrical stimulus in healthy volunteers (HV) and older patients with and without OD., Methods: Eight young HV, eight older HV without OD, and 14 older patients with OD were studied by electroencephalography through 32 scalp electrodes. Pharyngeal event-related potentials (ERP) were assessed following electrical stimulation of the pharynx. Sensory and tolerance thresholds to the electrical stimulus and latency, amplitude, and scalp current density of each ERP component were analyzed and compared. An ERP source localization study was also performed using the sLORETA software., Key Results: Older participants (with and without OD) presented an increased sensory threshold to pharyngeal electrical stimulation (10.2 ± 1.7 mA and 11.5 ± 1.9 mA respectively), compared with young HV (6.0 ± 1.2 mA). The cortical activation of older HV in response to pharyngeal electrical stimulus was reduced compared with young HV (N2 amplitude: 0.22 ± 0.79 vs -3.10 ± 0.59, P<.05). Older patients with OD also presented disturbances to the pharyngo-cortical connection together with disrupted pattern of cortical activation., Conclusions and Inferences: Older people present a decline in pharyngeal sensory function, more severe in older patients with OD. This sensory impairment might be a critical pathophysiological element and a potential target for treatment of swallowing dysfunction in older patients., (© 2016 John Wiley & Sons Ltd.)

Importance: Sensory function in the oral cavity and oropharynx is integral to effective deglutition and speech production. The main hurdle to evaluation of tactile consequences of upper aerodigestive tract diseases and treatments is access to a reliable clinical tool. We propose a rapid and reliable procedure to determine tactile thresholds using buckling monofilaments to advance care., Objective: To develop novel sensory testing monofilaments and map tactile thresholds of oral cavity and oropharyngeal structures., Design, Setting, and Participants: A prospective cross-sectional study of 37 healthy adults (12 men, 25 women), specifically without a medical history of head and neck surgery, radiation, or chemotherapy, was carried out in an academic tertiary medical center to capture normative data on tactile sensory function in oral structures., Interventions: Cheung-Bearelly monofilaments were constructed by securing nylon monofilament sutures (2-0 through 9-0) in the lumen of 5-French ureteral catheters, exposing 20 mm for tapping action., Main Outcomes and Measures: Buckling force consistency was evaluated for 3 lots of each suture size. Sensory thresholds of 4 oral cavity and 2 oropharyngeal subsites in healthy participants (n = 37) were determined by classical signal detection methodology (d-prime ≥1). In 21 participants, test-retest reliability of sensory thresholds was evaluated. Separately in 16 participants, sensory thresholds determined by a modified staircase method were cross-validated with those obtained by classical signal detection., Results: Buckling forces of successive suture sizes were distinct (P < .001), consistent (Cronbach α, 0.99), and logarithmically related (r = 0.99, P < .001). Test-retest reliability of sensory threshold determination was high (Cronbach α, >0.7). The lower lip, anterior tongue, and buccal mucosa were more sensitive than the soft palate, posterior tongue, and posterior pharyngeal wall (P < .001). Threshold determination by classical signal detection and modified staircase methods were highly correlated (r = 0.93, P < .001). Growth of perceptual intensity was logarithmically proportional to stimulus strength (P < .01)., Conclusions and Relevance: Topography of normal oral cavity and oropharyngeal tactile sensation is organized in accordance to decreasing sensitivity along the anteroposterior trajectory and growth of perceptual intensity at all subsites is log-linear. Cheung-Bearelly monofilaments are accessible, disposable, and consistent esthesiometers. This novel clinical tool is deployable for quantitative sensory function assessment of oral cavity and oropharyngeal structures.

The act of eating is a source of pleasure for people and is a major factor in maintaining a good quality of life. Several types of products for dysphagia patients are available to decrease aspiration of food that often accompanies daily food intake. The final goal of these products is to improve the ease of forming a food bolus and/or the safety of the swallowing process; however, tastes of products are not a major concern with initiation of swallowing. In the present study, we investigated the effect of bitter taste stimuli (quinine) and the combination of quinine and umami (monosodium glutamate: MSG) applied to the oropharynx on reflex swallows evoked by electrical stimulation to the oropharyngeal mucosa. Each of the distilled water (DW), quinine and quinine-MSG mixture solution (volume of each solutions, 100 µl) was applied 1 s prior to electrical stimulation. No swallow was evoked when each of the solutions was applied without electrical stimulation. The application of DW and lower concentration of quinine (<100 µM) did not affect the latency of reflex swallow, but 100 µM quinine application increased the latency of the reflex swallow. In addition, application of quinine-MSG mixture solution counteracted the increase in latency induced by quinine application alone. These findings suggest that MSG enhances the initiation of swallowing along with its well-known increase in appetite stimulation. Adding MSG might be effective when creating food to promote swallowing.

Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for poststroke OD. The pathophysiology of oropharyngeal biomechanics can be assessed by videofluoroscopy, as delayed laryngeal vestibule closure is closely associated with aspiration. Stroke may affect afferent or efferent neuronal circuits participating in deglutition. The integrity of oropharyngeal-cortical afferent pathways can be assessed by electroencephalography through sensory-evoked potentials by pharyngeal electrical stimulation, while corticopharyngeal efferent pathways can be characterized by electromyography through motor-evoked potentials by transcranial magnetic stimulation. Dysfunction in both cortico-mediated evoked responses is associated with delayed swallow response and aspiration. Studies have reported hemispherical asymmetry on motor control of swallowing and the relevance of impaired oropharyngeal sensitivity on aspiration. Advances in treatment include improvements in compensatory strategies but are mainly focused on (1) peripheral stimulation strategies and (2) central, noninvasive stimulation strategies with evidence of their clinical benefits. Characterization of poststroke OD is evolving from the assessment of impaired biomechanics to the sensorimotor integration processes involved in deglutition. Treatment is also changing from compensatory strategies to promoting brain plasticity, both to recover swallow function and to improve brain-related swallowing dysfunction., (© 2016 New York Academy of Sciences.)

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., (© 2016 John Wiley & Sons Ltd.)

Presbyphagia represents the physiological aging evolution of the swallowing function. It is related to the natural changes of the anatomical structures involved in the swallowing process. These age-related modifications can be asymptomatic in the early stages of life, but in the late stages, they could lead to dysphagia, aspiration pneumonia, dehydration, or malnutrition, reducing the quality of life. Videofluoromanometry (VFM) is the combined study of videofluoroscopy (VFS) and oropharyngeal manometry that allows simultaneous identification of functional and morphological features of the presbyphagia, also in asymptomatic otherwise healthy elderly adults. This study retrospectively evaluated the effectiveness of the VFM and the role of a multidisciplinary team of specialists in the analysis of a large cohort of old patients with presbyphagia, with the objective of achieving early diagnosis of the disease and the best therapy to delay the development of complications such as aspiration pneumonia, malnutrition, and dehydration., (Copyright © 2016. Published by Elsevier Ltd.)

To best prevent and treat eating/swallowing problems, it is essential to understand how components of oral physiology contribute to the preservation and/or degradation of eating/swallowing in healthy ageing. Anticipatory, pre-swallow motor movements may be critical to safe and efficient eating/swallowing, particularly for older adults. However, the nature of these responses is relatively unknown. This study compared the magnitude of anticipatory mouth opening during eating in healthy older (aged 70-85) and younger (aged 18-30) adults under four eating conditions: typical self-feeding, typical assisted feeding (being fed by a research assistant resulting in proprioceptive loss), sensory loss self-feeding (wearing blindfold/headphones resulting in exteroceptive loss) and sensory loss assisted feeding (proprioceptive and exteroceptive loss). Older adults opened their mouths wider than younger adults in anticipation of food intake under both typical and most non-oropharyngeal sensory loss conditions. Further, the loss of proprioceptive and exteroceptive cues resulted in decreased anticipatory mouth opening for all participants. Greater mouth opening in older adults may be a protective compensation, contributing to the preservation of function associated with healthy ageing. Our finding that the loss of non-oropharyngeal sensory cues resulted in decreased anticipatory mouth opening highlights how important proprioception, vision, and hearing are in pre-swallow behaviour. Age- and disease-related changes in vision, hearing, and the ability to self-feed may reduce the effectiveness of these pre-swallow strategies., (© 2016 John Wiley & Sons Ltd.)

The ground breaking advances in taste cell receptor cell physiology over the last 20 years have established a functional basis which enables neural pathways to be mapped. There is.only one, or perhaps several, types of taste receptors for salt, sour, sweet and umami (meaty) tastes and stimulation of each receptor type elicits responses in different cognitive regions. These findings support the labelled-line neural pathway model. In contrast, there are 25 types of the bitter taste receptors which all produce the same cognitive sensation, a finding which supports the across-fiber pattern model. This paper compiles the findings.of several human studies investigating the impact of bitter tastants on postprandial hemodynamics, to demonstrate that diverse bitter tastants are capable of eliciting a range of characteristic reflex cephalic phase responses in the autonomic and cardiovascular systems. These findings indicate that neural pathways from the oropharyngeal bitter taste receptors to the nucleus of the solitary tract are either partially or completely labelled-line. Consequently, the hedonics of a bitter tastant are not an accurate indicator of the cephalic phase responses elicited by the tastant. The finding that secondary metabolites present in dietary condiments modulate autonomic activity and in particular postprandial hemodynamics is novel and adds a new dimension to our understanding of the ways in which humans are influenced by their diet, both in health and disease. These findings suggest that condiments play a role in food digestion, unrelated to their. hedonistic qualities. Consequently, condiments may be of significance to those with digestive disorders and especially for diabetics experiencing gastroparesis and/or postprandial hypotension. Additionally, the findings suggest a noninvasive method to assess the integrity of multiple neural pathways. For investigators exploring the effect of condiments on autonomic reflexes, traditional cuisines may be a valuable source as they are full of uncharted human recordings.

Objective: Heating and humidification of inspired gases is routine during neonatal non-invasive respiratory support. However, little is known about the temperature and humidity delivered to the upper airway. The International Standards Organization (ISO) specifies that for all patients with an artificial airway humidifiers should deliver ≥33 g/m(3) absolute humidity (AH). We assessed the oropharyngeal temperature and humidity during different non-invasive support modes in a neonatal manikin study., Methods: Six different modes of non-invasive respiratory support were applied at clinically relevant settings to a neonatal manikin, placed in a warmed and humidified neonatal incubator. Oropharyngeal temperature and relative humidity (RH) were assessed using a thermohygrometer. AH was subsequently calculated., Results: Measured temperature and RH varied between devices. Bubble and ventilator continuous positive airway pressure (CPAP) produced temperatures >34°C and AH >38 g/m(3). Variable flow CPAP resulted in lower levels of AH than bubble or ventilator CPAP, and AH decreased with higher gas flow. High-flow (HF) therapy delivered by Optiflow Junior produced higher AH with higher gas flow, whereas with Vapotherm HF the converse was true., Conclusions: Different non-invasive devices deliver inspiratory gases of variable temperature and humidity. Most AH levels were above the ISO recommendation; however, with some HF and variable flow CPAP devices at higher gas flow this was not achieved. Clinicians should be aware of differences in the efficacy of heating and humidification when choosing modes of non-invasive respiratory support., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Head and jaw position influence upper airway patency and electromyographic (EMG) activity of the main upper airway dilator muscle, the genioglossus. However, it is not known whether changes in genioglossus EMG activity translate into altered muscle movement during respiration. The aim of this study was to determine the influence of head and jaw position on dilatory motion of the genioglossus in healthy adult men during quiet breathing by measuring the displacement of the posterior tongue in six positions--neutral, head extension, head rotation, head flexion, mouth opening, and mandibular advancement. Respiratory-related motion of the genioglossus was imaged with spatial modulation of magnetization (SPAMM) in 12 awake male participants. Tissue displacement was quantified with harmonic phase (HARP) analysis. The genioglossus moved anteriorly beginning immediately before or during inspiration, and there was greater movement in the oropharynx than in the velopharynx in all positions. Anterior displacements of the oropharyngeal tongue varied between neutral head position (0.81 ± 0.41 mm), head flexion (0.62 ± 0.45 mm), extension (0.39 ± 0.19 mm), axial rotation (0.39 ± 0.2 mm), mouth open (1.24 ± 0.72 mm), and mandibular advancement (1.08 ± 0.65 mm). Anteroposterior displacement increased in the mouth-open position and decreased in the rotated position relative to cross-sectional area (CSA) (P = 0.002 and 0.02, respectively), but CSA did not independently predict anteroposterior movement overall (P = 0.057). The findings of this study suggest that head position influences airway dilation during inspiration and may contribute to variation in airway patency in different head positions., (Copyright © 2016 the American Physiological Society.)

Safe, efficient liquid feeding in infant mammals requires the central coordination of oropharyngeal structures innervated by multiple cranial and spinal nerves. The importance of laryngeal sensation and central sensorimotor integration in this system is poorly understood. Recurrent laryngeal nerve lesion (RLN) results in increased aspiration, though the mechanism for this is unclear. This study aimed to determine the effect of unilateral RLN lesion on the motor coordination of infant liquid feeding. We hypothesized that 1) RLN lesion results in modified swallow kinematics, 2) postlesion oropharyngeal kinematics of unsafe swallows differ from those of safe swallows, and 3) nonswallowing phases of the feeding cycle show changed kinematics postlesion. We implanted radio opaque markers in infant pigs and filmed them pre- and postlesion with high-speed videofluoroscopy. Markers locations were digitized, and swallows were assessed for airway protection. RLN lesion resulted in modified kinematics of the tongue relative to the epiglottis in safe swallows. In lesioned animals, safe swallow kinematics differed from unsafe swallows. Unsafe swallow postlesion kinematics resembled prelesion safe swallows. The movement of the tongue was reduced in oral transport postlesion. Between different regions of the tongue, response to lesion was similar, and relative timing within the tongue was unchanged. RLN lesion has a pervasive effect on infant feeding kinematics, related to the efficiency of airway protection. The timing of tongue and hyolaryngeal kinematics in swallows is a crucial locus for swallow disruption. Laryngeal sensation is essential for the central coordination in feeding of oropharyngeal structures receiving motor inputs from different cranial nerves., (Copyright © 2016 the American Physiological Society.)

Introduction: During the aging process, one of the functions that changes is swallowing. These alterations in oropharyngeal swallowing may be diagnosed by methods that allow both the diagnosis and biofeedback monitoring by the patient. One of the methods recently described in the literature for the evaluation of swallowing is the Sonar Doppler., Objective: To compare the acoustic parameters of oropharyngeal swallowing between different age groups., Methods: This was a field, quantitative, study. Examination with Sonar Doppler was performed in 75 elderly and 72 non-elderly adult subjects. The following acoustic parameters were established: initial frequency, first peak frequency, second peak frequency; initial intensity, final intensity; and time for the swallowing of saliva, liquid, nectar, honey, and pudding, with 5- and 10-mL free drinks., Results: Objective, measurable data were obtained; most acoustic parameters studied between adult and elderly groups with respect to consistency and volume were significant., Conclusion: When comparing elderly with non-elderly adult subjects, there is a modification of the acoustic pattern of swallowing, regarding both consistency and food bolus volume., (Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Electrophysiological assessment provides valuable information on physiological and pathophysiological characteristics of human swallowing. Here, new electrophysiological measures for the evaluation of oropharyngeal swallowing were assessed: (1) the activation pattern of the submental/suprahyoid EMG activity (SHEMG); (2) the reproducibility of the oral and pharyngeal phases of swallowing, by calculating the similarity index (SI) of the SHEMG (SI-SHEMG) and of the laryngeal-pharyngeal mechanogram (SI-LPM) during repeated swallows; and (3) kinesiological measures related to the LPM. An electrophysiological-mechanical method for measuring the activation pattern of the SHEMG, the SI-SHEMG, and the SI-LPM, and maximal LPM velocity and acceleration during swallowing was applied in 65 healthy subjects divided into three age groups (18-39, 40-59, 60 years or over). All the measures were assessed during three trials of eight consecutive swallows of different liquid bolus volumes (3, 12, and 20 ml). A high overall reproducibility of oropharyngeal swallowing in healthy humans was recorded. However, while values of SI-SHEMG were similar in all the age groups, the SI-LPM was found to fall significantly in the older age group. Both the SI-SHEMG and the SI-LPM were found to fall with increasing bolus volumes. The activation pattern of the SHEMG and the LPM kinesiological measures were differently modified by bolus volume and age in the older subjects with respect to the others. We describe a new approach to the electrophysiological study of swallowing based on computed semi-automatic analyses. Our findings provide insight into some previously uninvestigated aspects of oropharyngeal swallowing physiology, considered in relation to bolus volume and age. The new electrophysiological measures here described could prove useful in the clinical setting, as it is likely that they could be differently affected in patients with different kinds of dysphagia.

Bolus volume has been widely studied, and research has demonstrated a variety of physiological impacts on swallowing and swallowing disorders. Oral perception of bolus volume has not, to our knowledge, been investigated in association with normal ageing processes. Research suggests many sensory changes with age, some within the oral cavity, and changes in swallowing function with age have been defined. The role of perception in oropharyngeal deglutition with age requires further investigation. The purpose of this study was to establish the psychophysical relationship between liquid volume and oral perception and examine changes with age. Healthy young and older adults were prospectively assessed using a magnitude estimation task differentiating five volumes of water delivered randomly to the oral cavity. Results suggest a fourfold increase in liquid volume is required by older participants to perceive an approximate twofold increase in the perception of volume compared with younger healthy adults. Sensory receptors in the oral cavity provide a feedback loop that modulates the swallowing motor response so that it is optimal for the size and consistency of the bolus. Changes in perception of bolus volume with age are consistent with other perceptual changes and may provide valuable information regarding sensorineural rehabilitation strategies in the future., (© 2015 John Wiley & Sons Ltd.)

This paper describes the use of real-time MRI at 30 frames/s in studying motor function within the oropharyngeal cavity of a trumpet, horn, trombone, and tuba player. Using Image J and customized MB-Ruler Pro software, analyses of discrete 33.3 ms snapshots of motion extracted from real-time MRI films obtained during an ascending five note sequence performed on a plastic practice device (B.E.R.P.) revealed inter-instrument differences in oropharyngeal cavity size and tongue conformation when moving from lower to higher notes. Tuba and trombone show a progressive decrease in oropharyngeal area featuring an upward and forward displacement of the tongue. Trumpet showed progressive increases in oropharyngeal area, with the posterior compartment showing the largest change, while horn essentially showed no change. A novel dynamic quantitative analysis method is also described utilizing Matlab. This method employs user-specified line profiles, aligned to the direction of the movement of interest. It takes advantage of time-varying pixel luminescence to derive spatial and temporal gradients. These gradients make possible the acquisition of kinematic data to describe movement in terms of slower position changes (spatial gradient) as well as fast, articulatory movements (temporal gradient). Spatial gradient analysis for the trumpet player demonstrates a progressive raising of the tongue during the ascending five note exercise. Temporal gradient analysis of double-tonguing revealed similarities in range of motion, anti-phase behavior, and frequency across instruments with respect to movements of the tongue tip and back of tongue. The paper concludes by making recommendations for extending these methods to studying musician's dystonia., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Aim: Previous studies have shown that the process of swallowing changes with aging, a phenomenon known as presbyphagia. These subtle and subclinical age-related changes make older adults more vulnerable to dysphagia during disease insults. However, there are limited studies of the swallowing process in older adults, because measurements are typically invasive or require exposure to X-rays. In the present study, we used integrated non-invasive measurements to determine aging-related changes of swallowing, and in the coordination of swallowing and respiration for a population of healthy participants., Methods: The non-invasive system provided measurements of larynx movement with piezoelectric sensors, submental muscle activity with surface electromyography and respiration-swallowing coordination by measurement of nasal airflow. We recruited 112 healthy participants from the community, 35 in a young-age group (age 20-30 years), 38 in a middle-age group (age 31-50 years) and 39 in an old-age group (age 51-70 years)., Results: The oropharyngeal swallowing parameters of the old-age group had delayed onset latency and longer swallowing apnea duration relative to the other groups, and these differences were greater for larger boluses. The middle- and old-age groups had less expiratory-expiratory respiratory phase pattern than the young-age group. The probability of piecemeal deglutition was highest in the old-age group and lowest in the young-age group. These results show that the phases of oropharyngeal swallowing and the coordination of swallowing with respiration gradually change with aging., Conclusions: We used integrated non-invasive measurements to document age-related changes in swallowing, and in the coordination of swallowing and respiration in healthy adults., (© 2014 The Authors. Geriatrics & Gerontology International published by Wiley Publishing Asia Pty Ltd on behalf of Japan Geriatrics Society.)

Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.

Primary snoring (PS) is one of the sleep breathing disorders with suboptimal results of treatment. It is recommended that Oropharyngeal exercises can be a therapeutic choice for the patients with mild to moderate degrees of PS. We assessed the effects of oropharyngeal-lingual (OPL) exercises on patients with primary snoring (PS) referred to Amiralmomenin University Hospital, Rasht, Iran in 2012. Fifty-three patients with PS underwent the sets of OPL exercises for 3 months, 5 days a week, and 30 min a day under the supervision of a speech therapist. Severity of the snoring was assessed by use of Visual Analogue Scale (VAS) and Snoring Scale Score (SSS) criteria before and after the exercises, and data were analyzed using SPSS version 17. Mean SSS before the study was 7.01 ± 1.72, while it was 3.09 ± 2.7 after the study; and the mean VAS scores were 8.54 ± 1.89 and 4.69 ± 2.94 before and after the study, respectively (P = 0.0001). There was a significant relationship between having conflicts with roommates (P = 0.0001), duration of snoring occurrence (P = 0.0001), severity of snoring (P = 0.0001) before and after the intervention. In conclusion, doing the OPL exercises significantly decreases the severity of PS.

Background: Assessment of the upper airway volume, morphology, and mechanics is of great importance for the orthodontic patient. We hypothesize that upper airway dimensions have significant effects on the dynamics of the airway flow and that both the dimensions and mechanics of the upper airway are greatly affected by orthodontic and orthopedic procedures such as rapid maxillary expansion (RME). The aim of the current study was to assess the effect of RME on the airway flow rate and pattern by comparing the fluid dynamics results of pre- and post-treatment finite element models., Methods: Customized pre- and post-treatment computational fluid dynamics models of the patient's upper airway were built for comparison based on three-dimensional computed tomogram. The inhalation process was simulated using a constant volume flow rate for both models, and the wall was set to be rigid and stationary. Laminar and turbulent analyses were applied., Results: Comparisons between before and after RME airway volume measurements showed that increases were only detected in nasal cavity volume, nasopharynx volume, and the most constricted area of the airway. Pressure, velocity, and turbulent kinetic energy decreased after dental expansion for laminar and turbulent flow. Turbulent flow shows relatively larger velocity and pressure than laminar flow., Conclusions: RME showed positive effects that may help understand the key reasons behind relieving the symptom of breathing disorders in this patient. Turbulence occurs at both nasal and oropharynx areas, and it showed relatively larger pressure and velocity compared to laminar flow.

Objective: Upper airway distention during mask ventilation could reduce gas volumes entering the lung compared with ventilation via an endotracheal tube. Therefore, respiratory tract volumes were measured in lambs and tidal volumes were compared in preterm infants before and after intubation., Design: In seven preterm lambs, volumes of the airways (oropharynx, trachea, lungs) were assessed. In 10 preterm infants, delta pressures, tidal volumes and leak were measured during ventilation 2 min before (mask ventilation) and 2 min after intubation (endotracheal ventilation). Inflations coinciding with breaths were excluded., Outcome Measures: Amount of upper airway distention in lambs and differences in inspiratory and expiratory tidal volume before and after intubation., Results: In lambs, the combined trachea and oropharynx contributed to 14 (12-21) % (median (IQR), whereas the oropharynx contributed to 9 (7-10) % of the total tidal volume measured at the mouth. In preterm infants, inspiratory (11.1 (7.9-22.6) mL/kg vs 5.8 (3.9-9.6) mL/kg (p=0.01)) and expiratory (8.3 (6.8-15.4) mL/kg vs 4.9 (3.9-9.6) mL/kg (p=0.02)) tidal volumes were significantly larger during mask ventilation compared with endotracheal ventilation. Leak was 18.7 (3.3-28.7) % before versus 0 (0-2.3) % after intubation (p<0.0001). Delta pressure was 23.7 (20.8-25.6) cm H2O before versus 24.8 (20.8-26.0) cm H2O after intubation (p>0.05). During mask ventilation, expiratory tidal volume increased from 10.0 (5.4-15.6) mL/kg to 11.3 (7.6-17.0) mL/kg (p=0.01), but remained unchanged during endotracheal ventilation., Conclusions: During neonatal mask ventilation, distention of the upper respiratory tract contributes to the tidal volumes measured and should be taken into account when targeting tidal volumes during mask ventilation., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The oropharyngeal administration of mother's milk-placing drops of milk onto the infant's oral mucosa-may serve as a preventative strategy against necrotizing enterocolitis (NEC) for extremely low-birth-weight (ELBW: birth weight <1000 g) infants. Necrotizing enterocolitis is a devastating gastrointestinal disorder which is associated with significant mortality for ELBW infants. Survivors are at risk for costly and handicapping morbidities, including severe neurological impairment. The oropharyngeal administration of mother's milk to ELBW infants may serve to expose the infant's oropharynx to protective (immune and trophic) biofactors (also present in amniotic fluid) and may protect the infant against NEC. Emerging evidence suggests that this intervention may have many benefits for extremely premature infants including protection against bacteremia, NEC, and ventilator-associated pneumonia, an earlier attainment of full enteral feeds, enhanced maturation of oral feeding skills, improved growth, and enhanced breast-feeding outcomes. While more research is needed to definitively establish safety and efficacy of this intervention, this article will examine biological plausibility and will describe the theoretical mechanisms of protection against NEC for ELBW infants who receive this intervention. Nurses play a key role in advancing the science and practice of this intervention. Future directions for research and implications for nursing practice will also be presented.

A photonic traditional Chinese medicine (TCM) information therapy was developed that has applications in whole health nursing including the prevention and treatment of ischemic cardiovascular and cerebrovascular diseases as well as the conditioning of the subhealth state. This therapy utilizes the beam of a 630 nm LED light to irradiate the oropharynx, while simultaneously employing two beams of 650 nm LED light to irradiate corresponding acupuncture points resulting in a synergistic outcome. This method was named "1 + 2 phototherapy." The principle mechanism of the therapy is a series of photon induced biological effects that are triggered by stimulating the photosensitive tissues of the oropharynx. This tissue includes the oral mucosa, capillaries, lymph nodes, saliva glands, nerves, and Jingluo and is stimulated by light beams of certain photon energy and imitative acupuncture information. Thermal tomography imaging shows that the average temperature of the upper-body was improved significantly after oropharyngeal irradiation under irradiation of "Futu point": the heat radiation of the spine, as well as chest, shoulders, arms, and clavicle, increased under irradiation of "Hoku," whereas the overall average temperature was below the temperature before irradiation. The experiment indicates that this therapy can promote blood circulation, regulate varied physiological parameters, and have holistic effects in whole health nursing.

Objectives: To investigate the laryngopharyngeal reflux (LPR) episodes and pH values in patients with suspected obstructive sleep apnoea (OSA) using the Dx-pH oropharyngeal probe., Design: Prospective cohort study., Setting: Tertiary medical centre., Participants: Forty patients with complaint of snoring or suspected OSA were prospectively enrolled to receive full nocturnal polysomnography (PSG). The patients were divided into 2 groups: a simple snorers group if the Respiratory Disturbance Index (RDI) was < 5 and an OSA group if the RDI was ≥ 5., Main Outcome Measures: The patients simultaneously received Dx-pH oropharyngeal probe monitoring for 12 h from about 6 pm to 6 am of the next day. The number of LPR events was recorded if the nadir of rapid pH drops was below pH 5.0 and 5.5. The difference of LPR events between the two groups and the difference of LPR events between awake and sleep periods in each group were analysed, respectively., Results: There were 18 (45%) patients diagnosed as OSA with a mean RDI of 28.7, and 22 patients (55%) diagnosed as simple snorers. Between 2 groups, there were no significant differences in the LPR events and pH values during the awake period, sleep period or overall recording period. Comparison of the LPR events and minimum pH values between the awake period and the sleep period revealed there were no significant differences in either group., Conclusion: Using the new sensitive Dx-pH oropharyngeal probe with PSG, we found that OSA does not correlate with a higher incidence of LPR episodes., (© 2014 John Wiley & Sons Ltd.)

Magnetic Resonance Imaging (MRI) of subjects in a supine position can be used to evaluate the configuration of the vocal tract during phonation. However, studies of speech phonation have shown that gravity can affect vocal tract shape and bias measurements. This is one of the reasons that MRI studies of singing phonation have used professionally trained singers as subjects, because they are generally considered to be less affected by the supine body position and environmental distractions. A study of untrained singers might not only contribute to the understanding of intuitive singing function and aid the evaluation of potential hazards for vocal health, but also provide insights into the effect of the supine position on singers in general. In the present study, an open configuration 0.25 T MRI system with a rotatable examination bed was used to study the effect of body position in 20 vocally untrained subjects. The subjects were asked to sing sustained tones in both supine and upright body positions on different pitches and in different register conditions. Morphometric measurements were taken from the acquired images of a sagittal slice depicting the vocal tract. The analysis concerning the vocal tract configuration in the two body positions revealed differences in 5 out of 10 measured articulatory parameters. In the upright position the jaw was less protruded, the uvula was elongated, the larynx more tilted and the tongue was positioned more to the front of the mouth than in the supine position. The findings presented are in agreement with several studies on gravitational effects in speech phonation, but contrast with the results of a previous study on professional singers of our group where only minor differences between upright and supine body posture were observed. The present study demonstrates that imaging of the vocal tract using weight-bearing MR imaging is a feasible tool for the study of sustained phonation in singing for vocally untrained subjects.

Acoustic monitoring of swallow frequency has become important as the frequency of spontaneous swallowing can be an index for dysphagia and related complications. In addition, it can be employed as an objective quantification of ingestive behavior. Commonly, swallowing complications are manually detected using videofluoroscopy recordings, which require expensive equipment and exposure to radiation. In this study, a noninvasive automated technique is proposed that uses breath and swallowing recordings obtained via a microphone located over the laryngopharynx. Nonlinear diffusion filters were used in which a scale-space decomposition of recorded sound at different levels extract swallows from breath sounds and artifacts. This technique was compared to manual detection of swallows using acoustic signals on a sample of 34 subjects with Parkinson's disease. A speech language pathologist identified five subjects who showed aspiration during the videofluoroscopic swallowing study. The proposed automated method identified swallows with a sensitivity of 86.67 %, a specificity of 77.50 %, and an accuracy of 82.35 %. These results indicate the validity of automated acoustic recognition of swallowing as a fast and efficient approach to objectively estimate spontaneous swallow frequency.