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Görürgöz C, Yangıncı Y, Akçam MO, Orhan K. Is it possible to reveal a typical swallowing pattern for specific skeletal malocclusion types using M-mode sonographic imaging of tongue movements? J Orofac Orthop 2023; 84:392-404. [PMID: 35394138 DOI: 10.1007/s00056-022-00387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The present study aims to compare the M‑mode ultrasound findings of different skeletal malocclusions and to evaluate whether sonographic parameters can be used for the diagnosis of malocclusions. METHODS Tongue movements of 36 adolescents aged between 10.37 and 17.29 years (mean 14.25 ± 1.78 years) were assessed using simultaneous two-dimensional real-time B‑mode and M‑mode sonography. The swallowing patterns of the subjects were visualized recording the motion of the tongue surface in the ultrasound images utilizing a fixed scan line through the middle of the tongue. M‑mode scans of tongue motion during empty deglutition were recorded. The parameters range, duration, and speed were computed for the entirety of the swallowing process using M‑mode examination. Findings were evaluated and statistically analyzed. RESULTS No clear intraindividual repeatability in the M‑mode imaging of the subjects' swallowing process could be observed. Considering the setup used in the study, it was not always possible to distinguish individual swallowing stages in the M‑mode images with regard to the chosen reference points. The average duration, range of motion, and speed of swallowing were found to be 2.43 s, 24.06 mm, and 10.34 mm/s, respectively. The findings showed both intra- and intersubject variability during empty swallowing. CONCLUSION With the help of the metrics that could be calculated based on the M‑mode images, it was not possible to differentiate the swallowing acts of different skeletal malocclusion types. It remains unclear whether M‑mode imaging can accurately visualize the swallowing pattern. Therefore, further progress in technology and multidisciplinary work is needed in order to establish diagnostic references regarding swallowing.
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Affiliation(s)
- Cansu Görürgöz
- Department of Dentomaxillofacial Radiology, Bursa Uludag University, Faculty of Dentistry, 16059, Bursa, Turkey.
- Bursa Uludağ Üniversitesi Diş Hekimliği Fakültesi, Mimar Sinan Mah. Emniyet Cad. Yıldırım, Bursa, Turkey.
| | | | - Mehmet Okan Akçam
- Department of Orthodontics, Ankara University, Faculty of Dentistry, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry, Ankara, Turkey
- Medical Design Application and Research Center (MEDITAM), Ankara University, Ankara, Turkey
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Iida T, Matsuo K, Iida Y, Okazaki H, Yoda M, Taniguchi H, Brodsky MB, González-Fernández M, Palmer JB. Kinematics of lateral tongue-pushing movement in coordination with masticatory jaw movement: An anteroposterior projection videofluorographic study. Physiol Behav 2023; 270:114315. [PMID: 37536619 PMCID: PMC10530480 DOI: 10.1016/j.physbeh.2023.114315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE During the mastication of solid food, the tongue pushes the bolus laterally to place it onto occlusal surfaces as the jaw is opened. This movement is referred to as tongue-pushing (TP). TP has an important role in efficient chewing, but its kinematic mechanisms remain unclear. The present study quantified the kinematics of TP and its coordination with masticatory jaw movements. METHODS Videofluorography (VFG) in anteroposterior projection was recorded while 14 healthy young adults ate 6 g each of cookies and meat. Small lead markers were glued to the tongue surface (left, right, and anterior) and buccal tooth surfaces (upper molars and lower canines). The position of the tongue and lower canine markers relative to the upper occlusal plane was quantified with Cartesian coordinates, using the right upper molar as the origin. Jaw motion during chewing was divided into TP and Non-TP cycles, based on the lateral movement of the food and tongue markers. The side of the jaw that compressed food particles was defined as the working side, while the other side was termed the balancing side. Horizontal and vertical displacements of tongue and jaw markers were compared between TP and Non-TP cycles, as well as between food types. RESULTS The mediolateral displacement of all tongue markers was significantly larger in TP than in Non-TP cycles. Vertical displacement was also significantly greater in TP than in Non-TP cycles for the anterior and working side tongue markers. TP cycles occurred more frequently with meat-chewing than with cookie-chewing. CONCLUSION TP is accomplished by rotation and lateral movements of the tongue surface on the working side and the anterior tongue blade, along with medial movement on the balancing side. These movements produce lateral shift and rotation of the tongue surface toward the working side in concert with jaw opening. Designing exercises to improve the strength of the lateral motion and rotation of the tongue body may be useful for individuals with impaired tongue function for eating and swallowing.
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Affiliation(s)
- Takatoshi Iida
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Division of Dysphagia Rehabilitation, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Tobetsu, Ishikari, Hokkaido, Japan; Department of Speech-Language-Hearing therapy, School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, Ishikari, Hokkaido, Japan.
| | - Koichiro Matsuo
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Tokyo, Japan
| | - Yuki Iida
- Hokuyukai Neurological Hospital, Nijuyonken, Nishi-ku, Sapporo, Hokkaido, Japan
| | - Hideto Okazaki
- Department of Liaison Rehabilitation Medicine, School of Medicine, Fujita Health University Fujita Health University Nanakuri Memorial Hospital, Ootori, Tsu, Mie, Japan
| | - Mitsumasa Yoda
- Department of Rehabilitation Medicine Showa University School of Medicine, Hatanodai, Shinagawa, Tokyo, Japan
| | - Hiroshige Taniguchi
- Department of Dysphagia Rehabilitation, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Hodumi, Mizuho, Gifu, Japan
| | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jeffrey B Palmer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Vasilyeva MB, Guseynov NA. Adaptability of the tongue during orthodontic apparatus treatment. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-101-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
To date, most dentoalveolar deformities are associated with bad habits such as thumb sucking, tongue sticking out, and so on. According to the authors, protrusion of the tongue is normal in newborns, in which the tongue lies between the gingival pads, and the lower jaw is stabilized by the facial muscles during swallowing. With the eruption of temporary teeth, this physiological phenomenon disappears. The authors pointed out that there are such concepts as «simple tongue push» and «complex tongue push». The first relates to open bite push-outs. The second is observed in children with an open bite, as well as with respiratory complications and / or with a history of chronic diseases of the nasopharynx. The act of swallowing in the physiological sense is divided into 3 stages: oral, pharyngeal and esophageal. Each stage is characterized by different positions of the tongue in the oral cavity. Orthodontic hardware treatment of such patients is aimed at eliminating these habits, as well as correcting the bite. Although many studies have been conducted since 1965, to this day, aimed at studying the tongue protrusion in infantile swallowing, as well as in various malocclusion deformities, the authors found that these studies have shortcomings. For each patient, the shape, size, as well as the trajectory of movements may vary due to anatomical features (short frenulum of the tongue). In this review article, the authors consider such concepts as the adaptive ability of the tongue during infantile swallowing, as well as its trajectory of movements when using various methods of hardware treatment; various orthodontic devices for the treatment of tongue misalignments, their components and their purposes are described. The current classification, main characteristics of this pathological condition and its connection with the dentoalveolar system are considered. Based on the study, it can be concluded that there are several directions in the treatment of infantile swallowing. One of these areas is hardware treatment in the form of the use of plates with a flap for the tongue.
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3D-CT Evaluation of Swallowing: Metrics of the Swallowing Response Using Swallowing CT. Dysphagia 2021; 37:237-249. [PMID: 33818630 PMCID: PMC8948108 DOI: 10.1007/s00455-021-10288-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 10/28/2022]
Abstract
Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental evaluation of swallowing were limited by technique and positioning. The advent of 320-row area detector CT solved previous challenges and allowed for the study of swallowing physiology and dysphagia in greater detail. In this summary, we describe the history and evolution of CT technology and describe research and clinical applications for the evaluation of swallowing physiology and pathophysiology.
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Joujima T, Oda M, Sasaguri M, Habu M, Kataoka S, Miyamura Y, Wakasugi-Sato N, Matsumoto-Takeda S, Takahashi O, Kokuryo S, Sago T, Yoshiga D, Tanaka T, Morimoto Y. Evaluation of velopharyngeal function using high-speed cine-magnetic resonance imaging based on T2-weighted sequences: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:432-441. [PMID: 31451304 DOI: 10.1016/j.ijom.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
The objective was to introduce a new technique for visualizing the three-dimensional (3D) movements of velopharyngeal-related muscles using high-speed cine-magnetic resonance imaging (MRI) based on T2-weighted sequences. The evaluation of phonation- and water swallowing-related events was performed in 11 healthy subjects. Specifically, whether cine-MRI could precisely visualize normal velopharyngeal function during these two events was examined. The 3D movements of the soft palate, superior pharyngeal constrictor muscles, and levator veli palatini muscles were visualized in all 11 subjects. A noteworthy finding was that the magnetic resonance signals of the superior constrictor pharyngeal muscles and the levator veli palatini muscles were significantly higher during phonation and during water swallowing than at rest. This initial study suggests that the 3D movements of velopharyngeal-related muscles can be successfully and precisely visualized without side effects. The magnetic resonance signal changes seen in the superior pharyngeal constrictor and levator veli palatini muscles using the technique described here should be useful to develop better methods of evaluation of velopharyngeal function.
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Affiliation(s)
- T Joujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - M Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kataoka
- Division of Anatomy, Kyushu Dental University, Kitakyushu, Japan
| | - Y Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - N Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - S Matsumoto-Takeda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - O Takahashi
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Sago
- Division of Dental Anaesthesiology, Kyushu Dental University, Kitakyushu, Japan
| | - D Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Y Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan.
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Oxilia G, Bortolini E, Martini S, Papini A, Boggioni M, Buti L, Figus C, Sorrentino R, Townsend G, Kaidonis J, Fiorenza L, Cristiani E, Kullmer O, Moggi‐Cecchi J, Benazzi S. The physiological linkage between molar inclination and dental macrowear pattern. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 166:941-951. [PMID: 29633246 PMCID: PMC6120545 DOI: 10.1002/ajpa.23476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/14/2018] [Accepted: 03/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Exact symmetry and perfect balance between opposite jaw halves, as well as between antagonistic teeth, is not frequently observed in natural masticatory systems. Research results show that asymmetry in our body, skull, and jaws is often related to genetic, epigenetic, environmental and individual ontogenetic factors. Our study aims to provide evidence for a significant link between masticatory asymmetry and occlusal contact between antagonist teeth by testing the hypothesis that tooth inclination is one of the mechanisms driving distribution of wear in masticatory phases in addition to dietary and cultural habits. MATERIALS AND METHODS The present work investigates the relationship between dental macrowear patterns and tooth inclinations on a sample of complete maxillary and mandibular 3D models of dental arches from 19 young and adult Yuendumu Aboriginal individuals. The analysis was carried out on first molars (M1) from all quadrants. Occlusal Fingerprint Analysis was used for the quantification of macrowear patterns, and 2D cross-sectional geometric analysis was carried out to investigate asymmetry in dental arches. RESULTS The asymmetry is highly variable on both arches, and it is associated with differences in the inclination of upper M1 crowns. Each molar has variable inclination (buccal/lingual) which influence tooth to tooth contact, producing greater or lesser variation in wear pattern. Interindividual variability of morphological variation of the occlusal relationship has to be considered in macrowear analysis. DISCUSSION Our results suggest that overall asymmetry in the masticatory apparatus in modern humans affects occlusal contact areas between antagonist teeth influencing macrowear and chewing efficiency during ontogeny.
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Affiliation(s)
- Gregorio Oxilia
- Department of Oral and Maxillo Facial SciencesSapienza University, Via Caserta 6Roma 00161Italy
- Department of BiologyUniversity of Florence, Via del Proconsolo, 12Firenze 50122Italy
- Department of Cultural HeritageUniversity of Bologna, Via degli Ariani 1Ravenna 48121Italy
| | - Eugenio Bortolini
- Department of Cultural HeritageUniversity of Bologna, Via degli Ariani 1Ravenna 48121Italy
| | - Sergio Martini
- Dental Lab Technician, via Milani, 1ParonaVerona 37124Italy
| | - Andrea Papini
- Dentist's Surgery, via Walter Tobagi 35Prato 59100Italy
| | - Marco Boggioni
- Dentist's Surgery, via D'Andrade 34/207Genova Sestri Ponente 16154Italy
| | - Laura Buti
- Department of Cultural HeritageUniversity of Bologna, Via degli Ariani 1Ravenna 48121Italy
| | - Carla Figus
- Department of Cultural HeritageUniversity of Bologna, Via degli Ariani 1Ravenna 48121Italy
| | - Rita Sorrentino
- Department of Cultural HeritageUniversity of Bologna, Via degli Ariani 1Ravenna 48121Italy
- Department of Biological, Geological and Environmental Sciences—BiGeAUniversity of Bologna, Via Selmi 3Bologna 40126Italy
| | - Grant Townsend
- Adelaide Dental SchoolThe University of AdelaideAdelaideAustralia
| | - John Kaidonis
- Adelaide Dental SchoolThe University of AdelaideAdelaideAustralia
| | - Luca Fiorenza
- Department of Anatomy and Developmental BiologyMonash UniversityMelbourneVIC 3800Australia
- Earth SciencesUniversity of New EnglandArmidaleNSW 2351Australia
| | - Emanuela Cristiani
- Department of Oral and Maxillo Facial SciencesSapienza University, Via Caserta 6Roma 00161Italy
| | - Ottmar Kullmer
- Senckenberg Research Institute, Senckenberganlage 25Frankfurt am Main 60325Germany
- Department of Paleobiology and EnvironmentInstitute of Ecology, Evolution, and Diversity, Johann Wolfgang Goethe University, Max‐von‐Laue‐Str. 13Frankfurt 60438Germany
| | - Jacopo Moggi‐Cecchi
- Department of BiologyUniversity of Florence, Via del Proconsolo, 12Firenze 50122Italy
| | - Stefano Benazzi
- Department of Cultural HeritageUniversity of Bologna, Via degli Ariani 1Ravenna 48121Italy
- Department of Human EvolutionMax Planck Institute for Evolutionary Anthropology, Deutscher Platz 6Leipzig 04103Germany
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Ohkubo M, Scobbie JM. Tongue Shape Dynamics in Swallowing Using Sagittal Ultrasound. Dysphagia 2018; 34:112-118. [PMID: 29955953 DOI: 10.1007/s00455-018-9921-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
Abstract
Ultrasound imaging is simple, repeatable, gives real-time feedback, and its dynamic soft tissue imaging may make it superior to other modalities for swallowing research. We tested this hypothesis and measured certain spatial and dynamic aspects of the swallowing to investigate its efficacy. Eleven healthy adults wearing a headset to stabilize the probe participated in the study. Both thickened and thin liquids were used, and liquid bolus volumes of 10 and 25 ml were administered to the subjects by using a cup. The tongue's surface was traced as a spline superimposed on a fan-shaped measurement space for every image from the time at which the tongue blade started moving up toward the palate at the start of swallowing to the time when the entire tongue was in contact with the palate. To measure depression depth, the distance (in mm) was measured along each radial fan line from the location at which the tongue's surface spline intersected the fan line to the point where the hard palate intersected the fan line at each timepoint. There were differences between individual participants in the imageability of the swallow, and so we defined quantitatively "measureable" and "unmeasurable" types. The most common type was measureable, in which we could find a clear bolus depression in the cupped tongue's surface. Indeed, with 10 ml of thin liquids, we were able to find and measure the depression depth for all participants. The average maximum radial distance from the palate to the tongue's surface was 20.9 mm (median) (IQR: 4.3 mm) for swallowing 10 ml of thin liquid compared to 24.6 mm (IQR: 3.3 mm) for 25 ml of thin liquid swallow (p < 0.001). We conclude that it is possible to use ultrasound imaging of the tongue to capture spatial aspects of swallowing.
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Affiliation(s)
- Mai Ohkubo
- Division of Dysphagia Rehabilitation, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan.
| | - James M Scobbie
- Clinical Audiology, Speech and Language (CASL) Research Centre, Queen Margaret University, Edinburgh, UK
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Li C, Li J, Zhang C, Cao X, Li N, Song D, Yu T. Application of B+M-Mode Ultrasonography in Assessing Deglutitive Tongue Movements in Healthy Adults. Med Sci Monit 2015; 21:1648-55. [PMID: 26049721 PMCID: PMC4469009 DOI: 10.12659/msm.893591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study was to evaluate tongue movements during swallowing in healthy adults using the B+M-mode ultrasonography, and to determine a common feature in the M-mode traces for quantitative measurement and individual comparison of tongue movements. Material/Methods Ninety healthy subjects were divided into 3 groups according to age (20–39, 40–59, and 60–80 years). The tongue movements during 3 saliva swallows were examined using real-time B+M-mode ultrasonography. The M-mode traces of tongue movements were recorded and evaluated. Results Both intra-individual and inter-individual differences were detected in the M-mode traces during the 3 saliva swallows. Characteristic types were seen during the individual swallowing phases of M-mode traces: 2 activity types in phase I, 2 types in phase IIb, and 3 types in phase III. However, no variations were seen during phase IIa, in which all subjects displayed a continuous upsloping trace. The average range of swallow-related tongue radial displacement during phase IIa decreased gradually with age, while the average duration of tongue movement during phase IIa increased gradually with age. These 2 trends were not statistically significant across age groups. However, differences between sexes were found in both the range of tongue radial displacement and the duration of deglutitive lingual actions during phase IIa in all 3 age groups (P<0.05). Conclusions B+M-mode ultrasonography may offer a quick and safe alternative for the preliminary evaluation of deglutitive tongue movements.
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Affiliation(s)
- Changtian Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Junlai Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Changsheng Zhang
- Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Xiaolin Cao
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Nan Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Danfei Song
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Tengfei Yu
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China (mainland)
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Late Oropharyngeal Functional Outcomes of Suicidal Maxillofacial Gunshot Wounds. J Craniofac Surg 2015; 26:691-5. [DOI: 10.1097/scs.0000000000001588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Sequential coordination between lingual and pharyngeal pressures produced during dry swallowing. BIOMED RESEARCH INTERNATIONAL 2014; 2014:691352. [PMID: 25580436 PMCID: PMC4281446 DOI: 10.1155/2014/691352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/07/2014] [Accepted: 09/21/2014] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate oropharyngeal pressure flow dynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP. There was no significant difference between the offset of TP and PP. The onset of PP was temporally time-locked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing.
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Tanaka T, Oda M, Nishimura S, Kito S, Wakasugi-Sato N, Kodama M, Kokuryo S, Habu M, Miyamoto I, Yamashita Y, Aso A, Sadasue K, Nagashima R, Tominaga K, Yoshioka I, Morimoto Y. The use of high-speed, continuous, T2-weighted magnetic resonance sequences and saline for the evaluation of swallowing. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:490-6. [PMID: 25240997 DOI: 10.1016/j.oooo.2014.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/30/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To introduce a new high-speed, continuous, T2-weighted magnetic resonance imaging (MRI) technique for the evaluation of swallowing by visualizing the flow of saline. STUDY DESIGN In 20 healthy participants, high-speed (10 frames per second), continuous MRI of the pharynx and larynx was performed during administration of 5 mL of saline. The extent to which fluid flow and swallowing (including flow to the esophagus or trachea) could be visualized was determined for all 20 participants. RESULTS Solution flow was visualized, and swallowing events, including the direction of flow to the esophagus, could be visualized with high-speed, continuous MRI for all 20 participants. CONCLUSIONS This initial study suggests that the visualization of saline flow using our method may facilitate functional evaluation of swallowing without side effects.
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Affiliation(s)
- Tatsurou Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Masafumi Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Shun Nishimura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Shinji Kito
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Nao Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Kodama
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Shinya Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuya Miyamoto
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Yuichi Yamashita
- Department of Magnetic Resonance Imaging, Toshiba Medical Systems Co, Tochigi, Japan
| | - Asaka Aso
- Department of Magnetic Resonance Imaging, Toshiba Medical Systems Co, Tochigi, Japan
| | - Kazuhiro Sadasue
- Department of Radiology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Riichirou Nagashima
- Department of Radiology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Izumi Yoshioka
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Yasuhiro Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan; Center for Oral Biological Research, Kyushu Dental University, Kitakyushu, Japan.
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Ohkubo M, Higaki T, Nishikawa K, Otonari-Yamamoto M, Sugiyama T, Ishida R, Wako M, Sano T. Optimization of parameter settings in cine-MR imaging for diagnosis of swallowing. THE BULLETIN OF TOKYO DENTAL COLLEGE 2014; 55:131-7. [PMID: 25212558 DOI: 10.2209/tdcpublication.55.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Videofluorography is frequently used to evaluate swallowing and is considered the "gold standard" among imaging modalities. This modality, however, has several disadvantages, including radiation exposure and limitations in the detection of soft tissues. Conversely, magnetic resonance imaging (MRI) offers excellent contrast resolution in soft tissue without radiation exposure. A major drawback of MRI in evaluating swallowing, however, is that temporal resolution is poor. The aim of this study was to investigate a new cine-MRI modality. Imaging parameters were optimized and the efficacy of this new technique is discussed. Three techniques for speeding up MRI were combined: true fast imaging with steady state precession, generalized auto-calibrating partially parallel acquisition, and key-hole imaging. The effects of the receiver coils used, receiving bandwidth, slice thickness, and flip angle on each image were determined. The optimal imaging parameters obtained comprised a reduction factor of 2, receiving bandwidth of 1,000 Hz/pixel (repetition time of 151.7 milliseconds and echo time of 1.4 milliseconds), flip angle of 50°, and slice thickness of 6 mm. Neck and spine coils were used. Under these conditions, the new cine-MR imaging technique investigated showed a temporal resolution of 0.1 sec/slice (10 frames/sec). Even with optimized parameter settings, this technique did not allow a true temporal resolution of 30 frames/sec by a large margin. Motion artifacts persisted. Further study is needed on how to speed up this technique.
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Affiliation(s)
- Mai Ohkubo
- Department of Dysphagia Rehabilitation and Community Dental Care, Tokyo Dental College
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Chitose SI, Haraguchi M, Nagata S, Katayama R, Sato K, Fukahori M, Sueyoshi S, Kurita T, Abe T, Nakashima T. Analysis of passive motion of para- and retropharyngeal structures during swallowing using dynamic magnetic resonance imaging. Dysphagia 2014; 29:387-95. [PMID: 24859486 DOI: 10.1007/s00455-014-9531-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to analyze passive motion of the para- and retropharyngeal space (PRS) during swallowing using dynamic magnetic resonance imaging (MRI). We conducted a preliminary study involving 30 healthy volunteers who underwent dynamic MRI. Consecutive MRI axial images were obtained by examining the plane parallel to the hard palate at the level of the anterior inferior corner of C2. Anterior displacement of the posterior pharyngeal wall (PPW) was measured as a motion index of pharyngeal contraction. The displacement and internal angle of the bilateral external and internal carotid arteries (ECA and ICA) and the bilateral centroids of the PRS area, as well as the increase in PRS area, were calculated at rest and at maximum pharyngeal contraction. In most participants, the bilateral ECA, ICA, and centroids were anterointernally displaced by pharyngeal contraction. The normalized ECA displacement (r = 0.64, r (2) = 0.41), normalized ICA displacement (r = 0.60, r (2) = 0.37), and normalized centroid displacement (r = 0.43, r (2) = 0.19) were more than moderately positively correlated with the normalized PPW displacement. The normalized PRS area increase (r = 0.35, r (2) = 0.12) was weakly positively correlated with the normalized PPW displacement. These results revealed that PRS area increased as the ECA and ICA were drawn anterointernally via its passive motion by pharyngeal contraction.
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Affiliation(s)
- Shun-ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Fukuoka, Japan,
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Zu Y, Narayanan SS, Kim YC, Nayak K, Bronson-Lowe C, Villegas B, Ouyoung M, Sinha UK. Evaluation of swallow function after tongue cancer treatment using real-time magnetic resonance imaging: a pilot study. JAMA Otolaryngol Head Neck Surg 2014; 139:1312-9. [PMID: 24177574 DOI: 10.1001/jamaoto.2013.5444] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Magnetic resonance imaging (MRI) has the advantage of imaging swallow function at any anatomical level without changing the position of patient, which can provide detailed information than modified barium swallow, by far the gold standard of swallow evaluation. OBJECTIVE To investigate the use of real-time MRI in the evaluation of swallow function of patients with tongue cancer. DESIGN, SETTING, AND PARTICIPANTS Real-time MRI experiments were performed on a Signa Excite HD 1.5-T scanner (GE Healthcare), with gradients capable of 40-mT/m (milli-Tesla per meter) amplitudes and 150-mT/m/ms (mT/m per millisecond) slew rates. The sequence used was spiral fast gradient echo sequence. Four men with base of tongue or oral tongue squamous cell carcinoma and 3 age-matched healthy men with normal swallowing participated in the experiment. INTERVENTIONS Real-time MRI of the midsagittal plane was collected during swallowing. Coronal planes between the oral tongue and base of tongue and through the middle of the larynx were collected from 1 of the patients. MAIN OUTCOMES AND MEASURES Oral transit time, pharyngeal transit time, submental muscle length change, and the distance change between the hyoid bone and anterior boundary of the thyroid cartilage were measured frame by frame during swallowing. RESULTS All the measurable oral transit and pharyngeal transit times of the patients with cancer were significantly longer than the ones of the healthy participants. The changes in submental muscle length and the distance between the hyoid bone and thyroid cartilage happened in concert for all 60 normal swallows; however, the pattern differed for each patient with cancer. To our knowledge, the coronal view of the tongue and larynx revealed information that has not been previously reported. CONCLUSIONS AND RELEVANCE This study has demonstrated the potential of real-time MRI to reveal critical information beyond the capacity of traditional videofluoroscopy. Further investigation is needed to fully consider the technique, procedure, and standard scope of applying MRI to evaluate swallow function of patients with cancer in research and clinic practice.
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Affiliation(s)
- Yihe Zu
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | | | - Yoon-Chul Kim
- Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Krishna Nayak
- Viterbi School of Engineering, University of Southern California, Los Angeles
| | | | - Brenda Villegas
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
| | - Melody Ouyoung
- Department of Speech Pathology, Keck Hospital of University of Southern California, Los Angeles
| | - Uttam K Sinha
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles
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Amin MR, Achlatis S, Lazarus CL, Branski RC, Storey P, Praminik B, Fang Y, Sodickson DK. Dynamic magnetic resonance imaging of the pharynx during deglutition. Ann Otol Rhinol Laryngol 2013; 122:145-50. [PMID: 23577565 DOI: 10.1177/000348941312200301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We utilized dynamic magnetic resonance imaging to visualize the pharynx and upper esophageal segment in normal, healthy subjects. METHODS A 3-T scanner with a 4-channel head coil and a dual-channel neck coil was used to obtain high-speed magnetic resonance images of subjects who were swallowing liquids and pudding. Ninety sequential images were acquired with a temporal resolution of 113 ms. Imaging was performed in axial planes at the levels of the oropharynx and the pharyngoesophageal segment. The images were then analyzed for variables related to alterations in the area of the pharynx and pharyngoesophageal segment during swallowing, as well as temporal measures related to these structures. RESULTS All subjects tolerated the study protocol without complaint. Changes in the area of the pharyngeal wall lumen and temporal measurements were consistent within and between subjects. The inter-rater and intra-rater reliabilities for the measurement tool were excellent. CONCLUSIONS Dynamic magnetic resonance imaging of the swallow sequence is both feasible and reliable and may eventually complement currently used diagnostic methods, as it adds substantive information.
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Affiliation(s)
- Milan R Amin
- New York University Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY 10016, USA
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Gokce SM, Gokce HS, Gorgulu S, Karacay S, Akca E, Olmez H. Relationship between Class III malocclusion and hyoid bone displacement during swallowing: a cine-magnetic resonance imaging study. Korean J Orthod 2012; 42:190-200. [PMID: 23112950 PMCID: PMC3481984 DOI: 10.4041/kjod.2012.42.4.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/01/2012] [Accepted: 03/05/2012] [Indexed: 11/25/2022] Open
Abstract
Objective The displacement of the hyoid bone (HB) is a critical biomechanical component of the swallowing function. The aim of this study was to evaluate the swallowing-induced vertical and horizontal displacements of the HB in subjects with 2 different magnitudes of skeletal Class III malocclusion, by means of real-time, balanced turbo-field-echo (B-TFE) cine-magnetic resonance imaging. Methods The study population comprised 19 patients with mild skeletal Class III malocclusion, 16 with severe skeletal Class III malocclusion, and 20 with a skeletal Class I relationship. Before the commencement of the study, all subjects underwent cephalometric analysis to identify the nature of skeletal malformations. B-TFE images were obtained for the 4 consecutive stages of deglutition as each patient swallowed 10 mL of water, and the vertical and horizontal displacements of the HB were measured at each stage. Results At all stages of swallowing, the vertical position of the HB in the severe Class III malocclusion group was significantly lower than those in the mild Class III and Class I malocclusion groups. Similarly, the horizontal displacement of the HB was found to be significantly associated with the severity of malocclusion, i.e., the degree of Class III malocclusion, while the amount of anterior displacement of the HB decreased with an increase in the severity of the Class III deformity. Conclusions Our findings indicate the existence of a relationship between the magnitude of Class III malocclusion and HB displacement during swallowing.
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Affiliation(s)
- Sila Mermut Gokce
- Department of Orthodontics, Dental Science Center, Gulhane Military Medical Academy, Ankara, Turkey
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Vijay Kumar KV, Shankar V, Santosham R. Assessment of swallowing and its disorders-a dynamic MRI study. Eur J Radiol 2012; 82:215-9. [PMID: 23068561 DOI: 10.1016/j.ejrad.2012.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 09/04/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
Abstract
Magnetic resonance imaging overcomes the limitations of videofluoroscopy in assessing without radiation exposure. The clinical utility of dynamic MRI for swallowing disorders is not well documented. This study demonstrates the feasibility of using dynamic MRI in assessment of swallowing disorders. Ten normal and three brainstem lesion patients participated in this study. GE Signa HDxt 1.5 Tesla MRI scanner with head-and-neck coil as a receiver and fast imaging employing steady state acquisition sequence was used. The swallow was analyzed in terms of symmetry and amplitude of movements of velum, faucial pillars, tongue, epiglottis and cricopharyngeous and images from the sagittal, coronal and axial planes. In sagittal plane posterior movement of tongue and its compression on velum, elevation of hyoid bone, elevation of larynx and lid action of epiglottis, in the coronal view the symmetrical movements of the faucial pillars and pharyngeal constrictor muscles and in axial plane three anatomical landmarks were targeted based on their role in swallowing, viz. velum, epiglottis and cricopharyngeous were studied. In brainstem lesion individuals, posterior movement of tongue, and elevation of larynx were not seen. Asymmetrical movements of faucial pillars and cricopharyngeous muscle were appreciated in the dynamic MRI. This demonstrates that, dynamic MRI is an efficient tool to understand the swallowing physiology and helps the speech language pathologist in modifying the swallowing maneuvers. Dynamic MRI is an effective tool in assessing swallowing and its disorders. This muscle specific information is not appreciated in videofluoroscopy and this information is necessary to modify the therapy maneuvers.
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Affiliation(s)
- K V Vijay Kumar
- Department of Speech, Language and Hearing Sciences, SRU, India.
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Amin MR, Lazarus CL, Pai VM, Mulholland TP, Shepard T, Branski RC, Wang EY. 3 Tesla turbo-FLASH magnetic resonance imaging of deglutition. Laryngoscope 2012; 122:860-4. [PMID: 22253090 DOI: 10.1002/lary.22496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/27/2011] [Accepted: 10/18/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS In this article we describe a methodology for obtaining high-quality dynamic magnetic resonance imaging (MRI) sequences of the swallow sequence in healthy volunteers. The study includes comparison to previous work done in our lab using a 1.5 Tesla (T) magnet. STUDY DESIGN Case series. METHODS Three healthy volunteers underwent turbo-fast low angle shot MRI at 3T while swallowing liquid boluses delivered via intravenous tubing to the oral cavity. Imaging was performed in the sagittal and axial planes. RESULTS Imaging provided by this sequence provided high temporal resolution, with the ability to depict deglutition in the axial and sagittal planes. Comparison with imaging at 1.5 T demonstrated benefits in temporal resolution and signal-to-noise. Anatomic information provided differed from comparative videofluoroscopy. CONCLUSIONS MRI of swallowing using the described technique is reliable and provides a unique evaluation of the swallowing sequence.
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Affiliation(s)
- Milan R Amin
- New York University Voice Center, Department of Otolaryngology/Head and Neck Surgery, New York University School of Medicine, New York, New York 10016, USA.
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Cine MRI of swallowing in patients with advanced oral or oropharyngeal carcinoma: a feasibility study. Eur Arch Otorhinolaryngol 2012; 269:1703-11. [PMID: 22218846 PMCID: PMC3345119 DOI: 10.1007/s00405-011-1861-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 11/21/2011] [Indexed: 12/30/2022]
Abstract
Treatment of oral and oropharyngeal cancer may cause dysphagia. Purpose is to examine whether cine magnetic resonance imaging (MRI) yields additional information compared to standard examination in the evaluation of posttreatment dysphagia and mobility of oral and oropharyngeal structures. Thirty-four cine MRIs were made in 23 patients with advanced oral and oropharyngeal cancer, consisting of an MR image every 800 ms during swallowing which is compared to videofluoroscopy and quality of life questionnaires. A scoring system was applied to assess mobility on cine MR and videofluoroscopy leading to a score ranging from 9 to 17. Cine MRI of the swallowing in a midsagittal plane visualized the tumor (if located in the same plane), important anatomic structures and surgical reconstructions. Posttreatment mobility on cine MRI and videofluoroscopy was significantly diminished compared to pretreatment, mean pretreatment cine MRI score was 10.8 and posttreatment 12.4 (p = 0.017). Impaired mobility on cine MRI was significantly correlated to more swallowing problems (Spearman's correlation coefficient 0.73, p = 0.04), on videofluoroscopy not. Cine MRI is a promising new technique as an adjunct to standard examinations for evaluation of swallowing in patients with oral and oropharyngeal cancer. Cine MRI directly visualizes the dynamics of swallowing and allows evaluation of pre- and posttreatment differences. Abnormal findings are significantly correlated with subjective swallowing complaints of patients.
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Gokce HS, Gokce SM, Akin E, Bulakbasi N, Akyol M. Effect of complete denture wearing on deglutition time: a cine-magnetic resonance imaging study. J Oral Rehabil 2011; 39:198-209. [PMID: 22150643 DOI: 10.1111/j.1365-2842.2011.02272.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of the study was to evaluate the effect of complete denture wearing on deglutition time (DT), hyoid bone and larynx movements in edentulous patients with real-time balanced turbo field echo cine-magnetic resonance imaging. Subjects were examined by cine-magnetic resonance imaging in supine position during swallowing water. Two sets of images for 23 edentulous (with/without wearing complete dentures) and one for 23 dentulous patients were obtained. Radiographic outputs representing three consecutive deglutition stages (oral, pharyngeal and oesophageal) were provided to perform measurements. Deglutition time significantly increased when edentulous patients wore their dentures (mean 0·75 s increased to 1·17 s), whereas dentulous patients' DT was about 0·91 s (P ≤ 0.05). The duration of deglutition is crucial because prolonged pharyngeal transit times increases the risk of aspiration. Within the limitations of the study, complete denture wearing could increase the shortened DT of the edentulous patients.
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Affiliation(s)
- H S Gokce
- Beytepe Military Hospital, Dental Service, Golbasi, Turkey.
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Functional magnetic resonance in the evaluation of oesophageal motility disorders. Gastroenterol Res Pract 2011; 2011:367639. [PMID: 21904543 PMCID: PMC3166566 DOI: 10.1155/2011/367639] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/24/2011] [Accepted: 06/25/2011] [Indexed: 11/23/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) has been recently proposed for the evaluation of the esophagus.
Our aim is to assess the role of fMRI as a technique to assess morphological and functional parameters of the esophagus in patients with esophageal motor disorders and in healthy controls. Subsequently, we assessed the diagnostic efficiency of fMRI in comparison to videofluoroscopic and manometric findings in the investigation of patients with esophageal motor disorders. Considering that fMRI was shown to offer valuable information on bolus transit and on the caliber of the esophagus, variations of these two parameters in the different types of esophageal motor alterations have been assessed. fMRI, compared to manometry and videofluoroscopy, showed that a deranged or absent peristalsis is significantly associated with slower transit time and with increased esophageal diameter. Although further studies are needed, fMRI represents a promising noninvasive technique for the integrated functional and morphological evaluation of esophageal motility disorders.
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Görgülü S, Sağdıç D, Akin E, Karaçay S, Bulakbası N. Tongue movements in patients with skeletal Class III malocclusions evaluated with real-time balanced turbo field echo cine magnetic resonance imaging. Am J Orthod Dentofacial Orthop 2011; 139:e405-14. [PMID: 21536182 DOI: 10.1016/j.ajodo.2009.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 07/01/2009] [Accepted: 07/01/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the position and movements of the tongue in patients with skeletal Class III malocclusion. METHODS Sixty-six patients (31 male, 35 female) with Class III malocclusion were divided into 3 groups according to cephalometric analysis. The first group comprised 23 patients (13 male, 10 female) with mandibular prognathism, the second group comprised 21 patients (9 male, 12 female) with maxillary retrognathism, and the third group comprised 22 patients (9 male, 13 female) with both maxillary retrognathism and mandibular prognathism. Twenty-two skeletal Class I patients (10 male, 12 female) were also included as the control group. RESULTS Dentofacial morphology affects the position and the movements of the tongue during deglutition. Contact of the anterior portion of the tongue with the rugae area of the hard palate decreased in the Class III malocclusion groups. The posterior portion of the dorsal tongue was positioned more inferiorly, and the root of the tongue was positioned more inferiorly and anteriorly in patients with Class III malocclusion than in the control group. The tip of the tongue was also in a more anterior position in the Class III groups. When the deglutition stages were evaluated, we observed that the manner of bolus transfer was different in patients with skeletal Class III malocclusion than in those with skeletal Class I malocclusion. CONCLUSIONS Tongue posture is affected by dentofacial structures, and adaptive changes occur in the tip, dorsum, and root of the tongue. Deglutitive tongue movements in patients with skeletal Class III malocclusion are also different from those with skeletal Class I malocclusion.
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Affiliation(s)
- Serkan Görgülü
- Department of Orthodontics, Center of Dental Sciences, Gulhane Military Medical Academy, Ankara, Turkey.
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Paulson ES, Bradley JA, Wang D, Ahunbay EE, Schultz C, Li XA. Internal margin assessment using cine MRI analysis of deglutition in head and neck cancer radiotherapy. Med Phys 2011; 38:1740-7. [DOI: 10.1118/1.3560418] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kim YC, Hayes CE, Narayanan SS, Nayak KS. Novel 16-channel receive coil array for accelerated upper airway MRI at 3 Tesla. Magn Reson Med 2010; 65:1711-7. [PMID: 21590804 DOI: 10.1002/mrm.22742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/01/2010] [Accepted: 11/07/2010] [Indexed: 11/09/2022]
Abstract
Upper airway MRI can provide a noninvasive assessment of speech and swallowing disorders and sleep apnea. Recent work has demonstrated the value of high-resolution three-dimensional imaging and dynamic two-dimensional imaging and the importance of further improvements in spatio-temporal resolution. The purpose of the study was to describe a novel 16-channel 3 Tesla receive coil that is highly sensitive to the human upper airway and investigate the performance of accelerated upper airway MRI with the coil. In three-dimensional imaging of the upper airway during static posture, 6-fold acceleration is demonstrated using parallel imaging, potentially leading to capturing a whole three-dimensional vocal tract with 1.25 mm isotropic resolution within 9 sec of sustained sound production. Midsagittal spiral parallel imaging of vocal tract dynamics during natural speech production is demonstrated with 2 × 2 mm(2) in-plane spatial and 84 ms temporal resolution.
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Affiliation(s)
- Yoon-Chul Kim
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California 90089-2564, USA.
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Galén S, Jost-Brinkmann PG. B-mode and M-mode Ultrasonography of Tongue Movements during Swallowing. J Orofac Orthop 2010; 71:125-35. [PMID: 20354839 DOI: 10.1007/s00056-010-9928-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 02/10/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study investigated the possibility of using B-mode and M-mode ultrasonography to differentiate between the visceral and somatic swallowing patterns. SUBJECTS AND METHODS Tongue movements during empty swallowing by 11 volunteers with a visceral swallowing pattern were traced in B-mode and M-mode ultrasound imaging before and after successful myofunctional therapy. Thirteen subjects with a somatic swallowing pattern served as the control group. We examined and compared the B-mode sequences and M-mode images of at least six of each study subject's swallowing processes for reproducible characteristics and parameters. RESULTS We observed wide intraindividual variability, making interindividual comparison difficult or meaningless. We identified no qualitative characteristic features in B-mode imaging that could be designated as solely visceral or physiological swallowing movements. There was no obvious intraindividual reproducibility in the M-mode sonogram of the swallowing act. Given the experimental set-up we used (without a submandibular cushioning pad), it was not possible to differentiate individual swallowing phases, that is, the initial, transporting, and returning phases, on the M-mode images based on characteristic trace points, as described in the literature. We determined the amplitude and velocity of vertical tongue movement as well as total swallowing duration on the M-mode images. These parameters revealed wide intra- and interindividual variability. CONCLUSIONS No qualitative differences could be established in B-mode imaging with the ultrasound method selected for this study. The parameters that could be measured on the M-mode images are not suitable for differentiating between visceral and somatic swallowing.
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Affiliation(s)
- Steffi Galén
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, CharitéCentrum für Zahn-, Mund- und Kieferheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Evaluation of Swallowing Using 320-Detector-Row Multislice CT. Part I: Single- and Multiphase Volume Scanning for Three-dimensional Morphological and Kinematic Analysis. Dysphagia 2010; 26:99-107. [DOI: 10.1007/s00455-009-9268-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 12/18/2009] [Indexed: 12/30/2022]
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Hartl DM, Kolb F, Bretagne E, Bidault F, Sigal R. Cine-MRI swallowing evaluation after tongue reconstruction. Eur J Radiol 2008; 73:108-13. [PMID: 19091505 DOI: 10.1016/j.ejrad.2008.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/03/2008] [Accepted: 10/10/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the feasibility of cine-MRI for non-invasive swallowing evaluation after surgery for lingual carcinoma with reconstruction using microvascular free flaps. METHODS Ten patients with stage IV carcinoma of the mobile tongue and/or tongue base treated by surgical resection and reconstruction with a free flap were evaluated after an average of 4.3 years (range: 1.5-11 years), using cine-MRI in "single-shot fast spin echo" (SSFSE) mode. Fiberoptic laryngoscopy of swallowing was performed before MRI to detect aspiration. The tolerance and ability to complete the exam were noted. The mobilities of the oral and pharyngeal structures visualized were evaluated as normal, reduced or increased. RESULTS Cine-MRI was well tolerated in all cases; "dry" swallow was performed for the 2 patients with clinical aspiration. Tongue base-pharyngeal wall contact was observed in 5 cases. An increased anterior tongue recoil, increased mandibular recoil, increased posterior oropharyngeal wall advancement and an increased laryngeal elevation were observed in 4 cases. One case of a passive "slide" mechanism was observed. CONCLUSIONS Cine-MRI is a safe, non-invasive technique for the evaluation of the mobility of oral and oropharyngeal structures after free-flap reconstruction of the tongue. For selected cases, it may be complementary to clinical examination for evaluation of dysphagia after surgery and free-flap reconstruction. Further technical advances will be necessary before cine-MRI can replace videofluoroscopy, however.
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Affiliation(s)
- Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institute Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France.
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Ohkubo M, Sano T, Ishida R, Higaki T, Nishikawa K, Hayakawa Y, Otonari T, Yamamoto-Otonari M, Harada T, Wakoh M. Static MR Images for Diagnosis of Swallowing. THE BULLETIN OF TOKYO DENTAL COLLEGE 2008; 49:113-9. [PMID: 19129686 DOI: 10.2209/tdcpublication.49.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mai Ohkubo
- Department of Dysphagia Rehabilitation and Community Dental Care, Tokyo Dental College, Chiba, Japan
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Honda Y, Hata N. Dynamic imaging of swallowing in a seated position using open-configuration MRI. J Magn Reson Imaging 2007; 26:172-6. [PMID: 17659564 DOI: 10.1002/jmri.20992] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the feasibility of dynamic MRI of swallowing in a seated position using an open-configuration MRI scanner, and to compare its capacity for motion analysis around the pharyngeal wall with that of videofluorography. MATERIALS AND METHODS Six healthy individuals (four women and two men, mean age = 31.4 +/- 7.5 years) were examined with an open-configuration MRI system using a fast spoiled gradient-recalled echo (SPGR) sequence. Dynamic imaging was performed while the subjects were in a seated position after they swallowed oral contrast medium from a cup. An oral and maxillofacial radiologist measured the motion of six structures: the hyoid bone (HB), larynx (LX), upper oropharynx (UOP), lower oropharynx (LOP), pharyngoesophageal segment (PES) behind the vocal folds, and upper esophagus (ESO). The measured motions were compared with reported values from videofluorography-based observations. RESULTS Open-configuration MRI depicted the anatomic structures related to swallowing (lip, tongue, soft palate, mandible, pharynx, HB, LX, and PES), and the course of the mylohyoid muscle (MM). The vertical and anteroposterior displacements of these structures did not differ significantly from those measured by videofluorography. CONCLUSION Dynamic imaging of swallowing using open-configuration MRI provides image information comparable to that obtained from videofluorography.
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Affiliation(s)
- Yasutoshi Honda
- Department of Oral and Maxillofacial Radiology, Graduate School of Medicine and Dentistry, Okayama University, Okayama, Japan.
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Hartl DM, Kolb F, Bretagne E, Marandas P, Sigal R. Cine magnetic resonance imaging with single-shot fast spin echo for evaluation of dysphagia and aspiration. Dysphagia 2007; 21:156-62. [PMID: 16718621 DOI: 10.1007/s00455-006-9026-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to determine the feasibility of and interest in evaluation of swallowing using dynamic magnetic resonance imaging (cine-MRI) in patients with dysphagia and aspiration caused by an abnormal pharyngeal phase of swallow. A cohort of six patients previously treated for head and neck cancer with persistent dysphagia and/or aspiration were evaluated an average of 47 months after treatment. The morphology and mobility of the oral, oropharyngeal, and laryngeal structures were analyzed using cine-MRI using single-shot fast spin echo technology. The qualitative observations were compared with a clinical fiberoptic swallowing evaluation. Swallowing physiology was analyzable for dry (saliva) swallow in all patients. MRI was well-tolerated by all six patients and no clinical aspiration occurred during the MRI. In five of six cases, further information on the cause of dysphagia was obtained using cine-MRI compared with the clinical evaluation alone. In the remaining case, cine-MRI confirmed the clinical evaluation. Cine-MRI using the dry swallow technique is feasible and without risk in patients with clinical aspiration. Cine-MRI is complementary to clinical evaluation of swallowing in patients with an abnormal pharyngeal phase of swallowing resulting from treatment of cancer.
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Affiliation(s)
- Dana M Hartl
- Otolaryngology and Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.
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Kulinna-Cosentini C, Schima W, Cosentini EP. Dynamic MR imaging of the gastroesophageal junction in healthy volunteers during bolus passage. J Magn Reson Imaging 2007; 25:749-54. [PMID: 17340641 DOI: 10.1002/jmri.20868] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the feasibility of noninvasive dynamic fast magnetic resonance imaging (MRI) during swallowing in healthy volunteers, and to determine esophageal function at the gastroesophageal junction during swallowing. MATERIALS AND METHODS A total of 20 healthy volunteers underwent MRI while swallowing in the supine position. Dynamic gradient-echo (GRE) sequences (balanced fast field echo [B-FFE]) were employed in three planes on a 1.5T unit using a phased-array body coil. Buttermilk spiked with gadolinium (Gd) chelate (40:1) for bolus passage was used as an oral contrast agent. We evaluated visualization of esophageal bolus transit, bolus transit time (BTT), peristalsis, identification of the gastroesophageal junction, and reflux during the Valsalva maneuver. RESULTS The mean visible length of the esophagus was 16.2+/-5.3 cm in the sagittal view, and 13.8+/-4.9 cm in the coronal view. In the sagittal view the BTT was defined in 15 of 20 volunteers and was 7.6+/-1.4 seconds. The BTT in the coronal view was measured in seven of 20 volunteers and was 8+/-1.3 seconds on average. The axial view yielded higher scores (2.25) than the coronal (1.98) and sagittal (1.78) views for identification of the cardia and during the Valsalva maneuver. Bolus contrast was better displayed in the sagittal (2.2) view than in the coronal (2.08) or axial (1.73) planes. In six volunteers, gastroesophageal abnormalities, such as axial hernia, reflux, and nonperistaltic contractions, were identified. For statistical analysis we used the Friedman test and a one-way analysis of variance (ANOVA). CONCLUSION The results indicate that dynamic MR swallowing is a feasible and reproducible technique that warrants further studies in patients.
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Karacay S, Akin E, Ortakoglu K, Bengi AO. Dynamic MRI Evaluation of Tongue Posture and Deglutitive Movements in a Surgically Corrected Open Bite. Angle Orthod 2006; 76:1057-65. [PMID: 17090175 DOI: 10.2319/112005-405] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Accepted: 12/01/2005] [Indexed: 11/23/2022] Open
Abstract
Abstract
Tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.
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Affiliation(s)
- Seniz Karacay
- Department of Orthodontics, Dental Sciences Center, Gulhane Military Academy, Ankara, Turkey
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Karaçay S, Akin E, Sayin MO, Bulakbaşi N. Real time balanced turbo field echo Cine-MRI in the analysis of deglutition events and transit times. J Oral Rehabil 2006; 33:646-53. [PMID: 16922737 DOI: 10.1111/j.1365-2842.2005.01605.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Investigation of swallowing is an important part of oral diagnosis. It usually plays a role in the aetiology of some orofacial deformities and open-bite as well as in the relapse of treated open-bite patients. In recent years, the movements of the anatomical structures that participate in deglutition have been investigated by several methods such as cineradiography, electromyography, electropalatography, electromagnetic articulography and ultrasonography. However, all these techniques have various disadvantages. Recently, dynamic magnetic resonance imaging has become available in the evaluation of swallowing function. In this study we intended to present this new technique to the dental literature and aimed to obtain dynamic images of the deglutition process. We also compared the timing of events in subjects with anterior open-bite and normal overbite during swallowing 10 mL water.
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Affiliation(s)
- S Karaçay
- Department of Orthodontics, Dental Sciences Center, Gulhane, Military Medical Academy, Ankara, Turkey.
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KARACAY S, AKiN E, SAYiN MO, BULAKBASi N. Real time balanced turbo field echo Cine-MRI in the analysis of deglutition events and transit times. J Oral Rehabil 2006. [DOI: 10.1111/j.1365-2842.2006.01605.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Akin E, Sayin MO, Karaçay S, Bulakbaşi N. Real-time balanced turbo field echo cine-magnetic resonance imaging evaluation of tongue movements during deglutition in subjects with anterior open bite. Am J Orthod Dentofacial Orthop 2006; 129:24-8. [PMID: 16443474 DOI: 10.1016/j.ajodo.2005.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Revised: 11/05/2004] [Accepted: 11/05/2004] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate tongue movements in subjects with anterior dental open bites during deglutition by using real-time balanced turbo field echo cine-magnetic resonance imaging. METHODS The study included 28 subjects. Two groups were formed according to the presence of anterior open bite (at least 2 mm). The open-bite group (OBG) consisted of 18 patients (14 girls, 4 boys) with a mean age of 14.5 +/- 2.7 years. The control group (CG) consisted of 10 patients (5 girls, 5 boys) with a mean age of 14.5 +/- 2.6 years. We evaluated deglutition during 3 stages: oral (stage 1), pharyngeal (stage 2), and esophageal stage (3). RESULTS Results indicated that (1) in the OBG, from stage 2 to stage 3, the anterior portion of the tongue dorsum was elevated [corrected] whereas its midportion was lowered [corrected]; (2) in the CG, its posterior portion was lowered [corrected] from stage 2 to stage 3; (3) in the CG, the tongue tip was positioned more posteriorly [corrected] at stage 2 than at stage 1; (4) in the OBG, the tongue tip moved more anteriorly in all stages of deglutition than in the CG. CONCLUSIONS Compensatory tongue functions occur in patients with anterior dental open bites. Dynamic MRI is a promising tool for evaluating swallowing patterns in these patients.
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Affiliation(s)
- Erol Akin
- Department of Orthodontics, Dental Sciences Center, Gulhane Military Medical Academy, Ankara, Turkey.
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