Clinical observation on acupuncture treatment of post-windstroke pseudobulbar palsy
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Pseudobulbar palsy
Epiglottis
Epiglottis
Thermal burn
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Objective:To investigate the method and value of barium dynamic imaging of pharynx in patients with deglutition disor-der(DD) and normal swallowing.Methods:The study population of the normal swallowing consisted of 299 cases and the deglutition dis-order consisted of 235.In order to observe the swallowing status compared with the transporting time of pharynx measured in this study,all cases were examined with anterior-posterior and lateral projection dynamic acquisition from C7 to the skull base.The dynamic imag-ings of 235 deglutition disorder patients were studied.Results:There was no statistical difference of transporting time of pharynx between the different age and sex.The transporting time of pharynx for normal cases was(0.7273±0.2132)s.235 cases of deglutition disorder oc-curred mainly in patients of esophageal carcinoma after radiotherapy or resection,stroke,laryngeal tumor,the transporting time of pharynx for the deglutition disorders cases was(0.9288±0.1627)s.Conclusion:This method is the first choice in the examination of deglutition disorder,it can record the entire process of barium sulphate fluid flowing through the pharynx.
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Epiglottis
Occult
Respiratory tract
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The pathways for air and food cross in the pharynx. In breathing, air may flow through either the nose or the mouth, it always flows through the pharynx. During swallowing, the pharynx changes from an airway to a food channel. The pharynx is isolated from the nasal cavity and lower airway by velopharyngeal and laryngeal closure during the pharyngeal swallow. During mastication, the food bolus accumulates in the pharynx prior to swallow initiation. The structures in the oral cavity, pharynx and larynx serve multiple functions in breathing, speaking, mastication and swallowing. Thus, the fine temporal coordination of feeding among breathing, mastication and swallowing is essential to provide proper food nutrition and to prevent pulmonary aspiration. This review paper will review the temporo-spatial coordination of the movements of oral, pharyngeal, and laryngeal structures during mastication and swallowing, and temporal coordination between breathing, mastication, and swallowing.
Mastication
Pharyngeal muscles
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The significance of a meal in medical treatment or care is important concerning QOL such as the recovering ability or mental status of patients. However, typical inspection methods for aspiration have many problems; the device is large in size, invasive, and not objective. Then, a simple, compact and objective diagnosis method that can be used at bedside is needed. It is important for swallowing that the epiglottis closes down the trachea and prevents aspiration. We constructed a system that can evaluate the condition of epiglottis. We measured the swallowing sounds of fifty people in normal health after they drank water (5, 10 and 15ml) and jelly (5, 10 and 15ml) in one bite. We carried out a time-frequency analysis of the swallowing sounds using wavelet transformation and obtained three wave patterns showing the swallowing function. These waves were named soundI,soundII and soundIII in the order of occurrence. The following assumptions were made: soundI is the contact sound when the epiglottis closes down by the swallowing reflection, soundII is the flow sound of food and soundIII is the opening sound of the epiglottis. In addition, the time position of soundII can show an index of the swallowing function. We evaluated the function using soundII generated in a swallowing sound. As a result, we found a decline of swallowing with aging due to delay of soundII.
Epiglottis
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Epiglottis
Etiology
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Manometric analysis of swallowing was conducted on 35 subjects, aged 44 to 60. The course of physiological changes in pressure during oral and pharyngeal phase of swallowing was analysed. To objectify the evaluation of analysed phenomena, parameters that include both pressure values inside pharynx and oesophagus and time dependences connected with changes in their value were used as proposed by the authors of this paper and as applied by other authors involved with these issues.
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Repeatable epiglottic movement patterns were recorded during a videofluoroscopic swallow evaluation of 95 patients who had undergone a total or partial glossectomy due to a neoplasm. Because no epiglottic function assessment was performed preoperatively, for the purpose of this study it was assumed that epiglottic mobility was "normal" during this time and that all abnormalities found afterward resulted from the growth of the neoplasm and the glossectomy. It was noted that in the early postoperative period, absence of epiglottic movement was accompanied by aspiration and made swallowing incompetent in a majority of cases (9 of 10). A correlation of movement between the epiglottis and the extent of oral tissue excision was found. Epiglottic mobility was evaluated as "normal" in 72% of the patients, i.e., in 67 of 91 (74%) patients after a partial or nearly total glossectomy and in 1 of 4 people who underwent a total glossectomy. In the subgroup (16%) of patients who underwent a total or nearly total glossectomy and then had videofluoroscopic examinations, 60% of the cases had normal epiglottic movements and 40% had an immobile epiglottis. Compensatory mechanisms implemented by the patients on their own initiative, such as additional swallows and prolonged apnea during deglutition, enabled them to avoid aspiration. However, upward head movement and downward chin tilting during deglutition as compensatory mechanisms used by patients with no epiglottic movement did not reduce the aspiration risk in the early postoperative period and were found to accompany incompetent swallowing attempts.
Epiglottis
Glossectomy
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Two forms of swallowing were observed during videofluoroscopy in 166 asymptomatic patients, consisting of an air-containing ("open") pharynx in 120 (72%) and an occluded ("closed") pharynx in 46 (28%). The epiglottis inverted differently in the two forms of swallowing.
Epiglottis
Cineradiography
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Controversy has continued for well over 100 years regarding the role of the epiglottis in deglutition. We describe the effect of isolated epiglottectomy on swallowing success in a case series of 3 adult human subjects with isolated epiglottectomy due to trauma, surgery, or cancerous erosion. The patients were 42, 51, and 70 years of age, and swallowing was analyzed objectively with videofluoroscopy. All subjects exhibited successful swallowing with all food types: Thin liquid, puree, and solid food. Specifically, the patient with traumatic epiglottectomy exhibited rapid swallowing success, the patient with surgical epiglottectomy exhibited a short period of dysphagia due to postoperative edema, followed by swallowing success, and the patient with epiglottectomy due to cancerous erosion of the entire epiglottis exhibited long-term adaptation, with successful swallowing maintained. We conclude that the epiglottis is not essential for successful swallowing in humans, because individuals can readily adapt to isolated epiglottectomy and avoid tracheal aspiration.
Epiglottis
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