Clinical survey over the past 35 years at the clinic for maxillofacial prosthetics Tokyo Medical and Dental University

PURPOSE

The purpose of this survey was to examine the overview of maxillofacial prosthetic treatment at our department, in order to ascertain the actual status of patients and discuss future needs.

METHODS

Subjects were all patients who visited Clinic for Maxillofacial Prosthetics, Dental Hospital, Tokyo Medical and Dental University (TMDU) in the period from January 1, 1980 to December 31, 2014. Using medical records of the Clinic for Maxillofacial Prosthetics, Dental Hospital, TMDU, patients' data including sex, address, referring institution, and primary condition were analyzed throughout the period.

RESULTS

The number of patients over 35 years was 6219, with a man-to-woman ratio of 6:4. The number of patients in their 60s, 70s, and 80s showed an increasing trend. Patients with tumors accounted for about 50 % of cases in 1980-1984 and increased to 80 % in 2010-2014.

CONCLUSIONS

The survey showed an increasing number of elderly patients and patients with tumors. This suggests that more awareness and education about maxillofacial prosthetics are needed.

Evaluation of swallowing ability using swallowing sounds in maxillectomy patients

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.

Evaluation of Swallowing Sound Using a Throat Microphone with an AE Sensor in Patients Wearing Palatal Augmentation Prosthesis

An increase in the population of dysphagia patients due to an aging population has led to increased attention on examination methods based on swallowing sound as simple methods of screening aspiration. However, an issue with the conventional method of cervical auscultation is that its accuracy varies based on the examiner. Previous studies examined the use of throat microphones and acceleration sensors to examine the acoustic characteristics of swallowing sound. Nevertheless, extant studies to date did not reach a level of clinical application. This study focused on using a throat microphone that is conventionally used to measure swallowing sound and an AE sensor to measurement a high-frequency range equal to and exceeding 20 kHz (upper limit 2 MHz). The study involved measuring the sounds of swallowing water of healthy subjects and patients wearing palatal augmentation prosthesis who had done surgical operation to treat head and neck cancer with the objective of using swallowing sound for screening aspiration. Acoustic characteristics of measured swallowing sound were analyzed using probability distributions using Quantile-Quantile (Q-Q) plots and spectral analysis based on wavelet transform. The findings indicated that with respect to patients with PAP, the duration time of the swallowing sound and the Q-Q plot departure rate were both significantly higher when compared with those in healthy subjects. The analysis based on wavelet transform indicated that the AE sensor allowed measurements of waveforms at a higher frequency range when compared to those in the case of the throat microphone. Additionally, an increased frequency of higher-frequency signals was associated with patients with PAP when compared to healthy subjects. The results revealed that it is possible to measure waveforms in the high-frequency range by using the AE sensor. The findings suggested the validity of analysis of the swallowing sound based on probability distributions using the Q-Q plot to evaluate the swallowing sound.

Pilot Study on an Acoustic Measurements System of the Swallowing Function Using an Acoustic-Emissions Microphone

The goal of this study is to evaluate the swallowing functions of people with dysphagia using an acoustic microphone sensor. As a basic investigation towards this end, we measured the swallowing sounds using an acoustic emissions microphone sensor (AE sensor), then analyzed the frequency range of the measured signals, and we examined the method for obtaining the necessary information to evaluate the swallowing functions. For the measurement, two types of sensors, i.e., a condenser throat microphone and an AE sensor, were employed to measure the swallowing sounds. The acoustic signals obtained were subjected to spectral analysis using the wavelet transformation, and a comparison was performed between the measurable ranges of the acoustic signals obtained by the AE and the acoustic sensors. The results from the wavelet transformation of the acoustic signals obtained by the AE sensor indicated that acoustic signals generated during swallowing contained frequency information of 3 kHz and higher, which were not measurable with the acoustic sensor used in the experiment. In addition, we proposed a method of evaluating swallowing sounds using a novel approach based on the probability distribution. From the analysis results, it was found that the distance between the theoretical values and the measured values has a high correlation with the sample viscosity. Furthermore, it was found that the data measured with the AE sensor more sensitively reflected the difference in the sample viscosity. We were thus able to demonstrate the possibility of evaluating the swallowing function via the proposed method.