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Hernandez J, Leverson G, Thibeault SL. Effects of Cervical Bracing on Elderly Patients With Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2059-2066. [PMID: 38713804 DOI: 10.1044/2024_ajslp-23-00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
PURPOSE This study aimed to determine if cervical bracing with a PMT collar increases risk of airway invasion and pharyngeal residue in elderly patients with dysphagia. Additionally, it aimed to identify patient preference for cervical bracing during deglutition. METHOD Twenty-one patients underwent a videofluoroscopic swallow study. Thin liquid, nectar thick liquid, pudding, and cracker were administered with cervical collar on and off with order of condition randomized. The Penetration-Aspiration Scale (PAS) was used to grade swallows, with McNemar's test of symmetry used to determine whether the categorical PAS score was similar between conditions. Pharyngeal residue was measured following swallows. Patients were asked which condition they preferred, and which was more comfortable with "no difference" being a selection. RESULTS No significant difference in PAS categorization score was measured for any consistency (p = .317-.919). Significantly more pyriform sinus residue was measured in the collar off condition (p = .003), albeit amounts were within normative range, with no difference measured in vallecula residue between conditions (p = .939). Forty-five percent of participants preferred to swallow with the collar off, while 55% indicated no preference. Forty-one percent of participants indicated increased comfort with collar off, while 59% indicated no difference in comfort. No participant preferred swallowing or indicated increased comfort with the collar on. CONCLUSIONS Presence of a cervical collar in elderly patients with dysphagia did not result in a significant difference in airway invasion or total pharyngeal residue. There was significantly more residue in the pyriform sinuses when cervical bracing was removed. The majority of patients did not indicate a difference in preference or comfort between collar on/off conditions.
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Qu Y, Tian Y, Fang J, Tian Y, Han D, Ren L, Xu N, Wang C, Guo X, Wang S, Han Y. Preoperative radiological indicators for prediction of difficult laryngoscopy in patients with atlantoaxial dislocation. Heliyon 2024; 10:e23435. [PMID: 38148803 PMCID: PMC10750185 DOI: 10.1016/j.heliyon.2023.e23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
Background Difficult airway remains a great challenge in patients with atlantoaxial dislocation (AAD). Preoperative evaluation and reliable prediction are required to facilitate the airway management. We aimed to screen out reliable radiological indicators for prediction of difficult laryngoscopy in patients with AAD. Methods A retrospective nested case-control study within a single center longitudinal AAD cohort was conducted to investigate the radiological indicators. All the patients with difficult laryngoscopy from 2010 to 2021 were enrolled as the difficult laryngoscopy group. Others in the cohort without difficult laryngoscopy were randomly selected as the non-difficult laryngoscopy group by individually matching with the same gender, same surgery year, and similar age (±5 years) at a ratio of 6:1. Radiological data on preoperative lateral X-ray images between the two groups were compared. Bivariate logistic regression model was applied to screen out the independent predictive indicators and calculate the odds ratios of indicators associated with difficult laryngoscopy. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. Results A total of 154 patients were finally analyzed in this study. Twenty-two patients with difficult laryngoscopy and matched with 132 controls. Four radiological parameters showed significant difference between the two groups. Among which, ΔC1C2D (the difference of the distance between atlas and axis in the neutral and extension position), owned the largest AUC. Conclusions ΔC1C2D could be a valuable radiologic predictor for difficult laryngoscopy in patients with AAD.
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Affiliation(s)
- Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yang Tian
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jingchao Fang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Dengyang Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Linyu Ren
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chao Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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Nagashima Y, Nishimura Y, Awaya T, Hata N, Tanei T, Ishii M, Oyama T, Nishii T, Fukaya N, Abe T, Kato H, Saito R. Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study. Neurol Med Chir (Tokyo) 2023; 63:200-205. [PMID: 37045771 PMCID: PMC10241534 DOI: 10.2176/jns-nmc.2022-0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/21/2022] [Indexed: 04/14/2023] Open
Abstract
The Occipito (O) -C2 angle reflects the correct craniocervical spine alignment; however, the poor image quality of standard intraoperative fluoroscopy at times lead to inaccurate measurements. Herein, we preliminarily investigated the relationship between the O-C2 angle and the Gonion-C2 distance, which is based on the positioning of the mandible and the cervical spine. We enrolled patients who underwent cervical spine radiography in neutral, flexion, and extension positions from January 2020 to October 2020. The difference by posture changes for each parameter was defined as the Δ value, and the Spearman's rank correlation coefficient was determined. Furthermore, we determined the cutoff value of the ΔGonion-C2 distance to predict a decrease of > 10° in the ΔO-C2 angle, which is reported to be related to dysphagia and dyspnea. Seventy-four patients were included. Spearman's rank correlations for the neutral, flexion, and extension positions were 0.630 (P < 0.001), 0.471 (P < 0.001), and 0.625 (P < 0.001), respectively, while the cutoff values of the ΔGonion-C2 distance for predicting > 10° in the ΔO-C2 angle were 9.3 mm for the neutral flexion change (sensitivity: 0.435, specificity: 0.882) and 8.3 mm for the extension-neutral change (sensitivity: 0.712, specificity: 0.909). The O-C2 angle and Gonion-C2 distances correlated; however, this correlation was weaker in the flexed position. Nevertheless, the ΔGonion-C2 distance can be used as a warning sign for postoperative complications after posterior occipital bone fusion surgery, because a decrease of > 10° in the ΔO-C2 angle can be predicted with high specificity.
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Affiliation(s)
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | | | | | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Motonori Ishii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Takahiro Oyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Tomoya Nishii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Nobuhisa Fukaya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Takashi Abe
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Hiroyuki Kato
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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Sun D, Mou J, Wang Z, Liu P. Analysis of risk factors for postoperative dysphagia after C1-2 fusion. Front Surg 2022; 9:977500. [PMID: 36311942 PMCID: PMC9608138 DOI: 10.3389/fsurg.2022.977500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Objective This study aimed to analyze the risk factors for dysphagia after C1-2 fusion in patients with C1-2 junction diseases. Summary of the background data Dysphagia is a common postoperative complication of posterior C1-2 junction surgery. The incidence is 9.5% to 26.3%. However, the etiopathogenisis of postoperative dysphagia remains controversial. Methods This retrospective study included patients who underwent C1-2 fusion from January 2016 to January 2020. The patients were divided into dysphagia group and control group in accordance with the Bazaz R dysphagia scoring system. The patients' age, gender, BMI(body mass index), cause of disease, and changes in the C01cobb, C02cobb, C12cobb, C27cobb, dC02cobb, dC01cobb, dC12cobb, d C27cobb angles before and after operation, were recorded. The parameters and changes were compared to analyze the risk factors for dysphagia after C1-2 fusion. Results 65 cases (15, with dysphagia; 50, without dysphagia) were included. The incidence of postoperative dysphagia was 23%. The differences in age, gender ratio, and BMI between the two groups were not significant (P > 0.05). The differences among postoperative C12 (29.8° ± 11.24° vs. 20.46° ± 13.39°), postoperative C27cobb (10.56° ± 8.53° vs. 20.21° ± 13.21°), and dC12cobb (9.49° ± 5.16° vs. 1.07° ± 12.44°) between the two groups were significant (P < 0.05). Multiple logistic regression analyses revealed that dC12cobb > 5° was a significant independent risk factor for postoperative dysphagia, And preoperative C27cobb was a preventive factor of postoperative dysphagia. Conclusions Dysphagia after the C1-2 fusion was common. dC02cobb and dC12cobb were the significant independent risk factors for postoperative dysphagia. Preoperative c27cobb was a preventive factor of dysphagia.
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Ohmura SI, Tamechika SY, Miyamoto T, Kunieda K, Naniwa T. Impact of dysphagia and its severity on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathies other than inclusion body myositis. Int J Rheum Dis 2022; 25:897-909. [PMID: 35678075 DOI: 10.1111/1756-185x.14365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the impact of dysphagia on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathy other than inclusion body myositis. METHODS We retrospectively evaluated consecutive patients with idiopathic inflammatory myopathy other than inclusion body myositis to investigate the impact of dysphagia and its severity assessed using the Food Intake LEVEL Scale on survival and swallowing function outcomes. Time-to-event analyses were used, including Kaplan-Meier curves with log-rank (trend) test, cumulative incidence with Gray's test, and Cox proportional hazards models. RESULTS Of the 254 patients, 26 were dysphagic, including eight severe (Food Intake LEVEL Scale [FILS] score 2, 3) and six most severe (FILS score 1) cases; 210 were non-dysphagic, and 18 were indeterminate cases. During the 5 years after myositis diagnosis, 15 (57.7%) dysphagic and 31 (14.8%) non-dysphagic patients died, and dysphagic patients had significantly shorter survival. However, multivariate analysis showed that shorter survival was significantly associated with baseline age-adjusted Charlson Comorbidity Index (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.36-1.82]), but not with dysphagia (HR 1.46, 95% CI 0.69-3.10). Dysphagia severity was significantly associated with delayed recovery of dysphagia. In 20 non-severe or severe dysphagic cases, 19 restored swallowing function within 1 year. The most severe cases had a significantly higher cumulative probability of death before recovery from dysphagia than severe cases. CONCLUSION The poor survival of dysphagic myositis patients was largely confounded by advanced age and comorbid malignancies. However, patients with the most severe dysphagia had a significantly worse swallowing function and survival prognosis than those with milder dysphagia.
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Affiliation(s)
- Shin-Ichiro Ohmura
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, and Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shin-Ya Tamechika
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, and Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Taio Naniwa
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, and Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Chu ECP, Lee LYK. Cervicogenic dysphagia associated with cervical spondylosis: A case report and brief review. J Family Med Prim Care 2021; 10:3490-3493. [PMID: 34760778 PMCID: PMC8565143 DOI: 10.4103/jfmpc.jfmpc_359_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/26/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022] Open
Abstract
Dysphagia (swallowing difficulty) is most often related to another health problems, including brain or spinal cord injury, neurological damage, neuromuscular disorders, and anatomical conditions. Dysphagia can have detrimental effects on pulmonary health and also impact nutritional intake. The right treatment depends on the cause established. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. This report describes a 53-year-old female patient with sore throat, swallowing difficulty for solids, and acid reflux for 2 years. Radiographs revealed anterior osteophytic lipping and kyphosis of the cervical spine and thoracolumbar (right convex) scoliosis. After 6 months of chiropractic treatment, her complaints and spinal deformity were obviously resolved. Our case report is unique in that the patient had an unusual presentation, i.e. cervical osteophytes, cervical kyphosis, and thoracolumbar scoliosis, which are all contributable causes of dysphagia. Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.
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Affiliation(s)
- Eric C P Chu
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong SAR, China.,School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR, China
| | - Linda Y K Lee
- School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR, China
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Miyagi M, Takahashi H, Sekiya H, Ebihara S. Role of preoperative cervical alignment on postoperative dysphagia after occipitocervical fusion. Surg Neurol Int 2021; 12:350. [PMID: 34345490 PMCID: PMC8326147 DOI: 10.25259/sni_547_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Dysphagia is one of the most serious complications of occipitocervical fusion (OCF). The previous studies have shown that postoperative cervical alignment, documented with occipito (O)-C2 angles, C2-C6 angles, and pharyngeal inlet angles (PIA), impacted the incidence of postoperative dysphagia in patients undergoing OCF. Here, we investigated the relationship of preoperative versus postoperative cervical alignment on the incidence of postoperative dysphagia after OCF. Methods: We retrospectively reviewed the clinical data/medical charts for 22 patients following OCF (2006– 2019). The O-C2 angles, C2-C6 angles, PIA, and narrowest pharyngeal airway spaces (nPAS) were assessed using plain lateral radiographs of the cervical spine before and after the surgery. The severity of dysphagia was assessed with the functional oral intake scale (FOIS) levels as documented in medical charts; based on this, patients were classified into the nondysphagia (FOIS: 7) versus dysphagia (FOIS: 1–6) groups. Results: Seven patients (35%) experienced dysphagia after OCF surgery. Preoperative PIA and nPAS were smaller in the dysphagia group. Spearman rank correlation showed a positive correlation between preoperative PIA and FOIS and between preoperative nPAS and FOIS. Conclusion: This study suggests that preoperative cervical alignment may best predict the incidence of postoperative dysphagia after OCF.
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Affiliation(s)
- Midori Miyagi
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Hideki Sekiya
- Department of Oral Surgery, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
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