RESUMEN
BACKGROUND: Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture-modified food for patients with dysphagia. OBJECTIVES: The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy. MATERIALS AND METHODS: A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide (Jelly) and jelly made of pectin (Reset gel). Outcome measures of videofluoroscopic images, bolus transit time and hyoid movements were compared. RESULTS: The frequency of chewing movements was highest for Jelly, followed by Reset gel and Thick liquid. While the probability of oral residue was the highest for Reset gel, pharyngeal residue after swallowing was high for Thick liquid as compared to Jelly and Reset gel. Oral transit time and pharyngeal transit time for Thick liquid were significantly smaller than that for Jelly and Reset gel. Pharyngeal delay time was significantly smaller for Thick liquid than that for Jelly and Reset gel. There was no difference in hyoid elevation time and hyoid movement time among the conditions. CONCLUSION: Mildly thick liquid material may be optimal for patients with primarily oral motor function impairment and jelly, such as Reset gel, may be more suitable for patients with primarily pharyngeal motor function impairment or oral and pharyngeal coordinative motor function decline.
Asunto(s)
Trastornos de Deglución , Deglución , Humanos , Trastornos de Deglución/fisiopatología , Femenino , Masculino , Deglución/fisiología , Anciano , Persona de Mediana Edad , Fluoroscopía , Masticación/fisiología , Anciano de 80 o más Años , Grabación en Video , Hueso Hioides/fisiopatología , Hueso Hioides/diagnóstico por imagen , Adulto , AlimentosRESUMEN
PURPOSE: This study retrospectively examined patient-reported symptoms, quality of life, and swallowing kinematics in individuals with presumed muscle tension dysphagia (MTDg). METHOD: Twenty-six individuals met the inclusion criteria. Data were gathered from patient-reported outcome measures (PROs), symptomology, clinician reports of palpation, and hyolaryngeal and hyoid movements measured on a 20-ml thin liquid bolus during videofluoroscopic swallowing studies. RESULTS: All PROs were outside of typical limits, except for the Voice Handicap Index-10. Mean hyoid excursion was 1.52 cm (SD = 0.46, range: 0.76-2.43), and hyolaryngeal excursion was 0.77 cm (SD = 0.44, range: -0.42-1.68). A minority of participants (4%-19%) demonstrated atypical hyoid and/or hyolaryngeal excursion compared to the available normative reference value sets. CONCLUSIONS: Individuals demonstrated abnormalities in the clinical evaluation of the areas of palpation and reported perilaryngeal discomfort and symptoms of laryngeal hyperresponsiveness, with a negative impact on their quality of life across various PROs. Atypical hyoid and/or hyolaryngeal excursion during swallowing was rare when compared to available normative reference values. The clinical evaluation of MTDg may be enhanced by including components related to muscle tension and laryngeal hyperresponsiveness in order to differentiate MTDg from idiopathic functional dysphagia and lead the patient to the otolaryngology/speech-language pathology clinic for intervention and management.
Asunto(s)
Trastornos de Deglución , Deglución , Tono Muscular , Calidad de Vida , Humanos , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Deglución/fisiología , Fenómenos Biomecánicos , Anciano , Estudios Retrospectivos , Adulto , Tono Muscular/fisiología , Hueso Hioides/fisiopatología , Medición de Resultados Informados por el Paciente , Anciano de 80 o más Años , Fluoroscopía , Grabación en Video , Palpación , Músculos Laríngeos/fisiopatologíaRESUMEN
El síndrome de Eagle o síndrome estilohioideo o sín-drome de la arteria carótida es un trastorno que se origina por la mineralización y elongación del pro-ceso estiloides. Factores traumáticos agudos y cró-nicos, así como otras teorías, han sido propuestos para explicar la etiología y patogenia de esta altera-ción. El conjunto de síntomas puede incluir: dolor fa-ríngeo, odinofagia, disfagia, cefalea, con irradiación a oreja y zona cervical. Si bien existen varias clasifi-caciones, de manera universal se acepta que existen principalmente dos formas de presentación de esta patología: el tipo I o clásico, generalmente asociado a un trauma faríngeo y acompañado de dolor en la zona faríngea y cervical, y el tipo II o carotídeo, que sue-le presentar molestia cervical, cefalea y alteración de la presión arterial, con riesgo de daño de la ac-tividad cardíaca. La identificación de este síndrome suele ser confusa dada la similitud de los síntomas con otras afecciones. El diagnóstico debe realizarse en base a los síntomas y a los estudios por imágenes específicos. El tratamiento puede ser conservador y actuar simplemente sobre los síntomas, o bien, qui-rúrgico. El objetivo del presente trabajo es realizar una revisión actualizada de la literatura sobre el sín-drome de Eagle y presentar tres casos clínicos con distintas manifestaciones (AU)
Eagle's syndrome or styloid syndrome or stylo-carotid artery syndrome is a disease caused by mineralization and elongation of the styloid process. Acute and chronic traumatic factors, along with other hypothesis, have been proposed to explain the aetiology and pathogenesis of this condition. Symptoms can include: pharynx pain, odynophagia, dysphagia, headache, with radiating pain to the ear and neck. Despite there are several classifications, it is universally accepted that this pathology can present in two forms: the type I or classic, generally associated to tonsillar trauma and characterized by pharyngeal and neck pain, and the type II or carotid artery type, which frequently presents with neck pain, headache, blood pressure variation, with risk of damage to cardiac function. Identifying of Eagle's syndrome is often confusing because some symptoms are shared with other pathologies. Diagnosis must be made on the basis of symptoms and imaging studies. Treatment can be conservative, acting only on symptoms, or surgical. The aim of this paper is to provide an updated review of the literature on Eagle syndrome and to present three clinical cases with different manifestations (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Faringe/fisiopatología , Síndrome , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades del Nervio Glosofaríngeo/fisiopatología , Hueso Hioides/fisiopatología , Orofaringe/diagnóstico por imagen , Vértebras Cervicales/fisiopatología , Neuralgia Facial/fisiopatología , Hueso Hioides/diagnóstico por imagen , Antiinflamatorios/uso terapéuticoRESUMEN
RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.
ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Trastornos de Deglución/diagnóstico por imagen , Hueso Hioides/fisiopatología , Laringectomía/efectos adversos , Laringectomía/rehabilitación , Carcinoma de Células Escamosas , Neoplasias Laríngeas/cirugía , Estudios Transversales , Cartílago Cricoides/cirugía , Epiglotis/cirugíaRESUMEN
Introducción: alteraciones de este aparato estilohioideo son frecuentes y se manifiestan por el alargamiento del proceso estiloides y también por la osificación del ligamento estilohioideo. Los cambios pueden ser asintomáticos o pueden desencadenar una serie de síntomas como el dolor en cabeza. Objetivo: determinar la prevalencia del alargamiento del proceso estiloide y de la osificación del ligamento estilohioideo en radiografías panorámicas, atendiendo a la distribución según edad, sexo y lado afectado. Métodos: se tomaron 300 radiografías panorámicas digitales de los archivos de un Servicio de Radiología Dental. Fueron seleccionadas al azar entre las realizadas en 2012, y evaluadas por un único examinador. Fueron consideradas las radiografías en las cuales el proceso estiloide del hueso temporal superaba en más de 1 cm el borde más inferior del cartílago del lóbulo de la oreja y aquellas en la que el ligamento estilohioideo aparecía radiopaco. Resultados: en este estudio, se encontraron 108 radiografías (36 por ciento) con estas condiciones. Hubo una mayor prevalencia de alargamiento del proceso estiloide y/o la osificación del ligamento estilohioideo en mujeres (63 por ciento); se presentó bilateralmente en 72 por ciento de los casos, con mayor prevalencia en el rango etario de 61 a 70 años. Conclusión: la prevalencia de alteraciones en el complejo estilohioideo en las radiografías analizadas fue de 36 por ciento, la mayoría con presentación bilateral; predominó en mujeres del grupo etario referido(AU)
Introduction: alterations of the stylohyoid chain are common, taking the shape of styloid process elongation and stylohyoid ligament ossification. Changes may either be asymptomatic or trigger a number of symptoms such as headache. Objective: determine the prevalence of styloid process elongation and stylohyoid ligament ossification in panoramic radiographs based on distribution by age, sex and affected side. Methods: examination was conducted of 300 digital panoramic radiographs from the registries of a dental radiology service. Radiographs were randomly selected from among those performed in 2012, and evaluated by a single researcher. The radiographs considered were those in which the temporal styloid process exceeded in more than 1 cm the lowermost edge of the earlobe cartilage and those in which the stylohyoid ligament was radiopaque. Results: the study found 108 radiographs (36 percent) meeting these requirements. There was a higher prevalence of styloid process elongation and/or stylohyoid ligament ossification among women (63 percent), whereas the condition was bilateral in 72 percent of the cases, with a predominance of the 61-70 age group. Conclusion: prevalence of alterations of the stylohyoid complex in the radiographs analyzed was 36 percent. Most alterations were bilateral. There was a predominance of women from the above-mentioned age group(AU)
Asunto(s)
Humanos , Femenino , Anciano , Radiografía Panorámica/métodos , Osificación Heterotópica/epidemiología , Hueso Hioides/fisiopatologíaRESUMEN
OBJETIVO: Avaliar a mastigação e a deglutição em mulheres com e sem desordem temporomandibular (DTM) e investigar a posição da mandíbula e do osso hioide, por serem estruturas importantes para a realização destas funções. MÉTODOS: Setenta mulheres foram avaliadas quanto à presença de DTM segundo o instrumento Critérios de Diagnóstico para Pesquisa de Desordem Temporomandibular, sendo que 34 delas, com DTM, constituíram o grupo de estudo (GE) e 36 participaram do grupo controle (GC). A avaliação da mastigação e deglutição foi baseada no Protocolo de Avaliação Miofuncional Orofacial com Escores (AMIOFE). As variáveis referentes à posição da mandíbula e osso hioide aferidas pela análise cefalométrica. RESULTADOS: Os indivíduos com DTM apresentaram diferença significativa quanto à postura de língua (p=0,03) e lábios (p=0,04) durante a função de deglutição, bem como a adoção mais frequente de um padrão mastigatório unilateral crônico (p=0,03). Além disso, apresentaram posição mais baixa do osso hioide em relação à mandíbula (p=0,00). CONCLUSÃO: A presença de DTM promoveu maior frequência de alterações miofuncionais orofaciais durante as funções de mastigação e deglutição. A maior distância entre o osso hioide e a mandíbula, bem como a presença da sintomatologia álgica, podem justificar, em parte, os comportamentos atípicos da língua e dos lábios observados no grupo com DTM. A repercussão da DTM sobre as funções alimentares em uma faixa etária jovem explica a importância do diagnóstico e da intervenção terapêutica precoce nestes indivíduos.
PURPOSE: To evaluate chewing and swallowing functions in women with and without temporomandibular disorder (TMD) and investigate the position of the mandible and the hyoid bone as they are important structures in the development of these functions. METHODS: Seventy women were evaluated in relation to TMD diagnosis according to the Research Diagnostic Criteria, among them, 34 composed the study group (SG) with TMD and 36 took part in the control group (CG). Evaluation of the masticatory and swallowing functions was performed according to the Protocol of Orofacial Myofunctional Evaluation with Scores. Mandibular and hyoid bone position variables were measured by cephalometric analysis. RESULTS: TMD subjects showed a significant difference on tongue (p=0.03) and lip (p=0.04) posture during swallowing function, and a more frequent adoption of a chronic unilateral chewing pattern as well (p=0.03). Moreover, they presented a lower position of the hyoid bone in relation to the mandible (p=0,00). Conclusion: TMD presence resulted on a higher frequency of myofunctional alterations during masticatory and swallowing functions. A greater distance from hyoid bone to the mandible in addition with the presence of painful symptom can justify, partly, the atypical behaviors of the tongue and lips observed on TMD group. The TMD repercussion on alimentaires functions in a young age group justifies the importance of an earlier diagnosis and therapeutic intervention in these individuals.
Asunto(s)
Adulto , Femenino , Humanos , Adulto Joven , Deglución/fisiología , Hueso Hioides/fisiopatología , Mandíbula/fisiopatología , Masticación/fisiología , Trastornos de la Articulación Temporomandibular/fisiopatología , Estudios de Casos y Controles , Cefalometría , Estudios TransversalesRESUMEN
INTRODUÇÃO: a cirurgia de avanço de mento isolado tem sido cada vez mais indicada para a correção de deficiência anterior da mandíbula, harmonizando o perfil e gerando alterações funcionais. OBJETIVO: essa pesquisa teve a finalidade de avaliar os efeitos da cirurgia de avanço de mento no tamanho da orofaringe e nas posições do osso hioide e da língua. MÉTODOS: a amostra constou de 22 radiografias cefalométricas de perfil de 11 indivíduos que se submeteram à cirurgia de mentoplastia de avanço isolada. Dessas radiografias, 11 retratavam o período imediatamente pré-cirúrgico (T0) e 11 o pós-cirúrgico de, pelo menos, quatro meses (T1). As radiografias foram digitalizadas e transferidas para o programa Radiocef Studio 2.0, por meio do qual foram feitas as medições entre os pontos demarcados. RESULTADOS: verificaram-se diferenças estatisticamente significativas entre T0 e T1 quanto à posição do osso hioide e da língua no sentido horizontal e ao tamanho da orofaringe. O osso hioide se apresentou posicionado mais anterior em T1 (p = 0,01), assim como a língua, aumentando o tamanho da orofaringe (p = 0,01). CONCLUSÃO: houve aumento do espaço aéreo da orofaringe com o posicionamento mais anterior da base da língua, bem como a reposição do osso hioide anteriormente.
INTRODUCTION: Advancement genioplasty has been increasingly indicated for the correction of anterior mandibular deficiency as it balances the patient's profile and generates functional changes. OBJECTIVE: Thus, the aim of this study was to assess the effects of advancement genioplasty in the oropharyngeal size and in the position of the hyoid bone and tongue. METHODS: The sample comprised 22 lateral cephalometric radiographs of 11 individuals who had undergone advancement genioplasty alone. Eleven of these radiographs depicted the immediate preoperative period (T0) and the other 11 the postoperative period after at least four months (T1). The radiographs were scanned and exported to the Radiocef Studio 2.0® software (Radio Memory Ltda., Belo Horizonte, MG, Brazil). The landmarks were then identified and automatically measured by the program. RESULTS: The results showed statistically significant differences between the horizontal position of the hyoid bone and tongue and in the oropharyngeal size. The hyoid bone and tongue were repositioned anteriorly after surgery (p = 0.01), thereby increasing the dimension of the oropharyngeal airspace (p = 0.01). CONCLUSIONS: The oropharyngeal dimension increased as the tongue base and hyoid bone were repositioned more anteriorly.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Mentón/cirugía , Mentoplastia , Hueso Hioides/fisiopatología , Avance Mandibular , Orofaringe/anatomía & histología , Orofaringe/patología , Lengua/fisiopatología , Cefalometría , Músculos del Cuello/fisiología , Tamaño de los Órganos , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aimed to evaluate the possibility of any correlation between disc displacement and parameters used for evaluation of skull positioning in relation to the cervical spine: craniocervical angle, suboccipital space between C0-C1, cervical curvature and position of the hyoid bone in individuals with and without symptoms of temporomandibular dysfunction. MATERIAL AND METHODS: The patients were evaluated following the guidelines set forth by RDC/TMD. Evaluation was performed by magnetic resonance imaging for establishment of disc positioning in the temporomandibular joints (TMJs) of 30 volunteer patients without temporomandibular dysfunction symptoms and 30 patients with symptoms. Evaluation of skull positioning in relation to the cervical spine was performed on lateral cephalograms achieved with the individual in natural head position. Data were submitted to statistical analysis by Fisher's exact test at 5%significance level. To measure the degree of reproducibility/agreements between surveys, the kappa (K) statistics was used. RESULTS: Significant differences were observed between C0-C1 measurement for both symptomatic (p=0.04) and asymptomatic (p=0.02). No statistical differences were observed regarding craniocervical angle, C1-C2 and hyoid bone position in relation to the TMJs with and without disc displacement. Although statistically significant difference was found in the C0-C1 space, no association between these and internal temporomandibular joint disorder can be considered. CONCLUSIONS: Based on the results observed in this study, no direct relationship could be determined between the presence of disc displacement and the variables assessed.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Vértebras Cervicales/fisiopatología , Cabeza/fisiopatología , Postura , Trastornos de la Articulación Temporomandibular/fisiopatología , Estudios de Casos y Controles , Cefalometría , Vértebras Cervicales , Luxaciones Articulares/patología , Luxaciones Articulares/fisiopatología , Luxaciones Articulares , Dolor Facial/fisiopatología , Hueso Hioides/fisiopatología , Hueso Hioides , Imagen por Resonancia Magnética , Músculo Masetero/fisiopatología , Dimensión del Dolor , Palpación , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación TemporomandibularRESUMEN
El síndrome de Eagle se caracteriza clínicamente por la presencia de dolor facial y/o orofaríngeo en pacientes amigdalectomizados y presentar en los estudios radiológicos un alargamiento de las apófisis estiloides. Presentamos el caso clínico de una paciente de49 años con una historia de larga evolución de dolor cervical y en la que los estudios con tomografía computarizada demostraron un alargamiento de ambas apófisis estiloides
Eagle syndrome is characterized by unilateral pain in oropharynx, the side of the face, and cervical region in patients after tonsillectomy. It is caused by an elongated styloid process. The authors present a case of a woman who suffered from pain in the cervical region during many years. TheTC-3D scan showed bilateral elongation of the styloid process
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Apófisis Odontoides/fisiopatología , Tonsilectomía/efectos adversos , Dolor de Cuello/etiología , Enfermedades del Nervio Glosofaríngeo/diagnóstico , Hueso Hioides/fisiopatologíaRESUMEN
No disponible
Asunto(s)
Humanos , Disección de la Arteria Carótida Interna/complicaciones , Hueso Hioides/fisiopatología , Diagnóstico DiferencialRESUMEN
Se presenta el caso de paciente de sexo femenino con una calcificación sintomática del Ligamento Estilohioideo, patología diagnosticada bajo el nombre de Síndorme de Eagle. Los síntomas asociados se pueden confundir con una Patología Disfuncional Temporomandibular por lo cual el diagnóstico específico determinado por un detallado examen clínico y un importante análisis de los exámenes imagenológicos permitirán diferenciar patologías que su manejo clínico y terapias son particulares en cada caso
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Dolor Facial/etiología , Hueso Hioides/fisiopatología , Osificación Heterotópica/diagnóstico , Diagnóstico Clínico , Enfermedades Mandibulares/diagnóstico , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico , Hueso TemporalRESUMEN
La investigación se realizó en base a las historias clínicas del Ateneo de Odontología de la ciudad de Rosario en el transcurso del año 1995, extrayendo datos de ellas y realizando mediciones sobre las teleradiografías de 43 pacientes. Se verificó la existencia de posiciones diferentes del hueso hioides con respecto a estructuras adyacentes: columna cervical y plano mandibular, en pacientes de ambos sexos, con distintos tipos de crecimiento rotacional del maxilar inferior y diskinesias orofaciales (deglución atípica y respiración bucal). De los 43 pacientes estudiados, 21 (48,9 por ciento) prsentaban crecimiento divergente del maxilar inferior, con edades comprendidas entre 5 y 9 años del sexo femenino. La respiración bucal se observó en 33 pacientes (78,7 por ciento) mientras que 31 pacientes (72,1 poir ciento) mostraron deglución atípica, quedando en evidencia la prevalecencia de diskinesias orofaciales en la población estudiada. Un único pacientes presentó localización del hioides al plano mandibular con distancia esperada, de los 42 pacientes restntes, 33 (76,7 por ciento) tenían localización con distancia aumentada del hioides y 20 de ellos (46,5 por ciento) respiración bucal y deglución atípica en todos los crecimientos rotacionales. Con respecto a la relación hioides-columna cervical, 9 pacientes presentaron localización esperada (20,9 por ciento) y entre los 34 pacientes restantes, 18 (41,9 por ciento) localización elevada en la norma, de los cuales, 12 (35,3 por ciento) tenían deglución atípica y respiración bucal en todos los crecimientos mandibulares. Este trabajo destaca la importancia de evaluar los cambios en la posición del hueso hioides concomitantes a diskinesias orofaciales, a través del análisis cefalométrico