Search Results (13)

Introduction: This study aimed to evaluate the submental and masticatory muscles in patients of different age groups using magnetic resonance imaging (MRI) and computed tomography (CT) methods, and investigate potential associations between muscle morphology, temporomandibular joint (TMJ) structures, and disc displacement. Materials and Methods: A total of 185 MRI scans were retrospectively analyzed to assess the thickness of the digastric, geniohyoid, mylohyoid, medial pterygoid, masseter, and lateral pterygoid muscles bilaterally. TMJ hard tissue changes were classified using computed tomography (CT). Correlations between muscle thickness and TMJ structures were analyzed using Pearson correlation coefficients, with statistical significance set at p < 0.05. Results: The study population included 110 females and 75 males, with a mean age of 50.08 ± 20.15 years. The largest age group was 51–75 years (41%), followed by 18–35 years (28%). Significant correlations were observed between muscle thickness and TMJ structures as follows: Right digastric muscle showed a significant association with right disc–condyle position (p = 0.02). Right mylohyoid muscle exhibited a strong correlation with right disc–condyle position (p = 0.004). Left medial pterygoid muscle was significantly correlated with left condyle pathology (p = 0.02). Left masseter muscle showed a significant correlation with left condyle pathology (p = 0.014). Condylar flattening was the most frequent pathology, observed in 58% of right condyles and 53% of left condyles. Disc displacement was present in 41% of right TMJs and 34% of left TMJs. Conclusions: This study highlights the important associations between masticatory and submental muscle morphology and TMJ structures, suggesting that muscle function may play a role in condylar positioning and disc alignment. These findings emphasize the need for comprehensive muscle evaluation in TMJ disorder (TMD) diagnosis and treatment planning. Full article

(1) Background: Swallowing is a complex process that comprises well-timed control of oropharyngeal and laryngeal structures to achieve airway protection and swallowing efficiency. To understand its temporality, previous research adopted adherence measures and revealed obligatory pairs in healthy swallows and the effect of aging and bolus type on the variability of event timing and order. This study aimed to (i) propose a systemic conceptualization of swallowing physiology, (ii) apply sequence analyses, a set of information-theoretic and bioinformatic methods, to quantify and characterize swallowing temporality, and (iii) investigate the effect of aging and dysphagia on the quantified variables using sequence analyses measures. (2) Method: Forty-three participants (17 young adults, 15 older adults, and 11 dysphagic adults) underwent B-mode ultrasound swallowing examinations at the mid-sagittal plane of the submental region. The onset, maximum, and offset states of hyoid bone displacement, geniohyoid muscle contraction, and tongue base retraction were identified and sorted to form sequences which were analyzed using an inventory of sequence analytic techniques; namely, overlap coefficients, Shannon entropy, and longest common subsequence algorithms. (3) Results: The concurrency of movement sequence was found to be significantly impacted by aging and dysphagia. Swallowing sequence variability was also found to be reduced with age and the presence of dysphagia (H(2) = 52.253, p < 0.001, $\eta$² = 0.260). Four obligatory sequences were identified, and high adherence was also indicated in two previously reported pairs. These results provided preliminary support for the validity of sequence analyses for quantifying swallowing sequence temporality. (4) Conclusions: A systemic conceptualization of human deglutition permits a multi-level quantitative analysis of swallowing physiology. Sequence analyses are a set of promising quantitative measurement techniques for point-of-care ultrasound (POCUS) swallowing examinations and outcome measures for swallowing rehabilitation and evaluation of associated physiological conditions, such as sarcopenia. Findings in the current study revealed physiological differences among healthy young, healthy older, and dysphagic adults. They also helped lay the groundwork for future AI-assisted dysphagia assessment and outcome measures using POCUSs. Arguably, the proposed conceptualization and analyses are also modality-independent measures that can potentially be generalized for other instrumental swallowing assessment modalities. Full article

Background: Recurrent upper airway obstruction during sleep is a common feature of obstructive sleep apnea (OSA). Risk factors for the development of OSA include obesity, male gender and smoking. In addition, anatomical factors contribute to the development of the disease; however, the heritability of the anatomical structures that determine upper airway narrowing is poorly understood. In this study, we aimed to investigate the background of anatomical structures associated with upper airway narrowing in discordant monozygotic (MZ) twin pairs. Methods: 33 adult MZ twin pairs (median age and Q1-Q3: 50 (42–56) years) from the Hungarian Twin Registry underwent head and neck MR (Philips Ingenia 1.5 T). T1- and T2-weighted images in sagittal, coronal and axial planes were used to measure cephalometric, soft tissue and adipose tissue structures. In addition, the twin pairs underwent carotid and femoral ultrasound scans (Samsung RS85) and full-body composition measurements (OMRON BF500). The analysis of discordant MZ twins for anatomical markers in relation to clinical background, blood test, vascular ultrasound and body composition results was performed using a paired permutation test. Results: We found a significant association between parapharyngeal adipose tissue area and body weight, waist circumference and metabolism (p < 0.05). Submental adipose tissue thickness showed an association with lower body muscle percentage (<0.05). Carotid intima-media thickness showed a negative association with parapharyngeal adipose tissue, tongue volume and submental adipose tissue thickness (<0.05). Conclusions: Our study found a significant association between anatomical structures potentially involved in upper airway narrowing and obesity-related markers such as weight, BMI, hip and waist circumference, and whole body composition analysis results (body fat percentage, visceral fat percentage, muscle percentage). This study may help to better understand the background of anatomical structures potentially involved in upper airway narrowing and the possible development of obstructive sleep apnea. Full article

Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice. Full article

Recently, a therapeutic method to stimulate the suprahyoid muscle using peripheral magnetic stimulation for dysphagia rehabilitation has been reported. However, clinical evidence, application protocol, and intervention method remain unclear. Therefore, a systematic review of the published literature is needed. The objective of this study was to systematically review clinical studies of peripheral magnetic stimulation applied for rehabilitation of dysphagia. Issues to be considered in future studies are also suggested. This systematic review performed a literature search of four databases (Medline, Embase, CINAHL, and Web of Science) to identify relevant studies published on the application of repetitive peripheral magnetic stimulation (rPMS) for swallowing-related muscles between 2010 and 2022. Seven studies were reviewed. Randomized controlled trials and one-group pre–post, case study designs were included. In the included studies, rPMS was applied to strengthen the submental suprahyoid muscles. The intervention regime varied. The rPMS was applied at a frequency of 30 Hz for 2 s. Rest time ranged from 8 s to 27–28 s. The number of intervention sessions ranged from 2–3 to 30. The intensity ranged from pain-inducing minimum intensity (90% of maximum stimulus output) to non-painful intensity (70–80% of maximum intensity). The rPMS on the suprahyoid muscles had positive effects on physiological changes in the swallowing function, such as displacement of the hyoid bone, muscle strength (cervical flexor, jaw-opening force), swallowing safety, swallowing performance, and swallowing-related quality of life. Participants also reported little pain and adverse reactions during rPMS. Although rPMS is a therapeutic option that can help improve the swallowing function as a non-invasive stimulation method in the rehabilitation of dysphagia, clinical evidence is needed for the development of clear stimulation protocols and guidelines. Full article

Introduction: Over the past few years, attention has been paid to the coexistence of dysphonia with dysphagia, in the context of functional disorders. The aim of this work was to objectify logopaedic examination of dysphonic patients with coexisting swallowing difficulties by surface electromyography. Methods: The material of the work included 58 patients with muscle tension dysphonia (MTD). Each patient underwent otolaryngologic, phoniatric and logopaedic examination. We collected information about medical history and asked patients to fill out Reflux Symptom Index (RSI), Eating Assessment Tool (EAT-10), Dysphagia Handicap Index (DHI) and Swallowing Disorder Scale (SDS). The algorithm of dysphagia diagnostics in our clinic assumes parallel surface electromyography (SEMG) during Functional Endoscopic Evaluation of Swallowing. Results: In comparison to patients suffering from atypical swallowing, patients with muscle tension dysphagia (MTDg) obtained higher values from almost all questionnaires. Logopaedic evaluation revealed abnormalities in the structure and efficiency of the articulatory organs and in the assessment of primary functions. Patients with more abnormalities in logopaedic examination had significantly higher infrahyoid muscle activity during swallowing observed in EMG. Patients with non-normative swallowing pattern had significantly greater asymmetry of the average and maximum amplitude of masseters, as well as submental muscles. Patients with higher percent of muscles asymmetry gained higher scores in questionnaires. Conclusions: Surface electromyography objectifies logopaedic examination of patients with swallowing difficulties. The results of this work showed that, apart from longer swallows, patients with MTDg differ from patients with non-normative swallowing patterns in the muscle activity measured by SEMG, abnormalities in logopaedic evaluation and the severity of complaints reported by patients. Full article

Tongue pressure plays a critical role in the oral and pharyngeal stages of swallowing, contributing considerably to bolus formation and manipulation as well as to safe transporting of food from the mouth to the stomach. Smooth swallowing relies not only on effective coordination of respiration and pharynx motions but also on sufficient tongue pressure. Conventional methods of measuring tongue pressure involve attaching a pressure sheet to the hard palate to monitor the force exerted by the tongue tip against the hard palate. In this study, an air bulb was inserted in the anterior oral cavity to monitor the pressure exerted by the extrinsic and intrinsic muscles of the tongue. The air bulb was integrated into a noninvasive, multisensor approach to evaluate the correlation of the tongue pressure with other swallowing responses, such as respiratory nasal flow, submental muscle movement, and thyroid cartilage excursion. An autodetection program was implemented for the automatic identification of swallowing patterns and parameters from each sensor. The experimental results indicated that the proposed method is sensitive in measuring the tongue pressure, and the tongue pressure was found to have a strong positive correlation with the submental muscle movement during swallowing. Full article

Study Design: Descriptive cross-sectional. Objective: The origin of the lingual artery (LA) has been well studied due to its implication in neck dissection, but the course thereafter to the oral cavity is less described. This cadaveric study traced the journey of the LA from the external carotid artery to its terminal branches in the tongue. Methods: Following bilateral neck dissections in 35 black Kenyan cadavers, the incidence of Beclard’s, Lesser’s and Pirogoff’s triangles, the types of LA origin with its length, relationship to the hyoglossus muscle and anastomosis with other vessels were documented. Results: Beclard’s triangle was found in 64 dissections (91.42%), Lesser’s in 46 dissections (65.71%) and Pirogoff’s in 39 dissections (55.71%). The LA presented either as a solitary branch (67.15%) or as a branch of either the linguofacial (LFT–24.29%), thyrolingual (TLT–2.72%) or thyrolinguofacial (TLFT–2.86%) trunk. The solitary LA was the longest at 6.93 mm, followed by the TLT branch (6.58 mm), LFT branch (6.12 mm) and TLFT branch (5.65 mm). The majority of solitary LA and LA branches of LFT and TLFT passed through the hyoglossus, while all LA branches of the TLT coursed medial to the muscle. All variants of LA have been found to anastomose with the submental artery (SMA) at frequencies that ranged from 11.10% to 100%. Conclusions: The LA was found in all cadavers and all Beclards’ triangles. There is a significant incidence of LFT and TLFT variants in the Kenyan population. The LA passed either through or medial to the hyoglossus with no lateral relationship being observed. Full article

Asthma and chronic obstructive pulmonary disease are associated with nocturnal cough and changes in heart rate. In this work, the authors propose a proof-of-concept non-contact system for performing capacitive electrocardiogram (cECG) and cough-associated capacitive electromyogram (cEMG) measurements using cloth electrodes under a pillowcase. Two electrodes were located along with the approximate vector of lead II ECG and were used for both cECG and cEMG measurements. A signature voltage follower was introduced after each electrode to detect biopotentials with amplitudes of approximately 100 µV. A bootstrapping technique and nonlinear electrical component were combined and implemented in the voltage follower to attain a high input impedance and rapid static discharge. The measurement system was evaluated in a laboratory experiment for seven adult males and one female (average age: 22.5 ± 1.3 yr). The accuracy of R-wave detection for 2-min resting periods was 100% in six subjects, with an overall average of 87.5% ± 30.0%. Clearly visible cEMGs were obtained for each cough motion for all subjects, synchronized with reference EMGs from submental muscle. Although there remains room for improvement in practical use, the proposed system is promising for unobtrusive detection of heart rate and cough over a prolonged period of time. Full article

Background: A widely used method for assessing swallowing dysfunction is the videofluoroscopic swallow study (VFSS) examination. However, this method has a risk of radiation exposure. Therefore, using wearable, non-invasive and radiation-free sensors to assess swallowing function has become a research trend. This study addresses the use of a surface electromyography sensor, a nasal airflow sensor, and a force sensing resistor sensor to monitor the coordination of respiration and larynx movement which are considered the major indicators of the swallowing function. The demand for an autodetection program that identifies the swallowing patterns from multiple sensors is raised. The main goal of this study is to show that the sensor-based measurement using the proposed detection program is able to detect early-stage swallowing disorders, which specifically, are useful for the assessment of the coordination between swallowing and respiration. Methods: Three sensors were used to collect the signals from submental muscle, nasal cavity, and thyroid cartilage, respectively, during swallowing. An analytic swallowing model was proposed based on these sensors. A set of temporal parameters related to the swallowing events in this model were defined and measured by an autodetection algorithm. The verification of this algorithm was accomplished by comparing the results from the sensors with the results from the VFSS. A clinical application of the long-term smoking effect on the swallowing function was detected by the proposed sensors and the program. Results: The verification results showed that the swallowing patterns obtained from the sensors strongly correlated with the laryngeal movement monitored from the VFSS. The temporal parameters measured from these two methods had insignificant delays which were all smaller than 0.03 s. In the smoking effect application, this study showed that the differences between the swallowing function of smoking and nonsmoking participants, as well as their disorders, is revealed by the sensor-based method without the VFSS examination. Conclusions: This study showed that the sensor-based non-invasive measurement with the proposed detection algorithm is a viable method for temporal parameter measurement of the swallowing function. Full article

Dysphagia is a condition that happens when a person cannot smoothly swallow food from the mouth to the stomach. It causes malnourishment in patients, or can even cause death due to aspiration pneumonia. Recently, more and more researchers have focused their attention on the importance of swallowing and respiration coordination, and the use of non-invasive assessment systems has become a hot research trend. In this study, we aimed to integrate the timing and pattern monitoring of respiration and swallowing by using a portable and non-invasive approach which can be applied at the bedside in hospitals or institutions, or in a home environment. In this approach, we use a force sensing resistor (FSR) to detect the motions of the thyroid cartilage in the pharyngeal phase. We also use the surface electromyography (sEMG) to detect the contraction of the submental muscle in the oral phase, and a nasal cannula to detect nasal airflow for respiration monitoring during the swallowing process. All signals are received and processed for swallowing event recognition. A total of 19 volunteers participated in the testing and over 57 measurements were made. The results show that the proposed approach can effectively distinguish the swallowing function in people of different ages and genders. Full article

The purpose of the current investigation was to explore how intra-oral negative pressure and submental muscle activity vary across sips from straws varying in internal diameter and across conditions of low versus high effort. Healthy adults took discrete sips from four straws varying in internal diameter. Sips were performed under normal and high effort conditions. Submental surface electromyography (sEMG) and negative intra-oral pressure were recorded during sips. Significant main effects of straw condition were observed for negative intra-oral pressure. A non-significant trend for increased muscle activity associated with smaller straw diameter was also observed. Significant main effects of effort condition were observed for both submental sEMG and negative intra-oral pressure. The findings are interpreted as supporting the clinical hypothesis that high resistance drinking straws varying in diameter may offer systematic overload to the oral musculature. The findings also support encouraging maximum effort to achieve even further overload. Full article

Deviations in muscle tone are presumed to accompany speech motor control deficits in select forms of dysarthria, although there is little confirmation of these associations. For patients experiencing neuromuscular impairments, therapeutic interventions and/or principles have been devised to alleviate tone deviations where they occur and to prevent the development or exacerbation of tone deviations. Potentially therapeutic effects of these interventions on muscle tone in the speech musculature have not been studied empirically. One reason for the paucity of research is that tools for assessing muscle tone in the speech musculature are not generally available. This pilot study explored the feasibility of a commercially available, handheld instrument for measuring submental muscle compliance during relaxed and active conditions in 16 women with normal speech and swallowing. Additionally, the study examined changes in muscle compliance when interventions presumed to impact muscle tone were applied to the submental region. The Myotonometer™ was sensitive to changes in tissue compliance related to active contraction of the submental musculature. Applying ice or vibration to the submental region resulted in no systematic changes in submental tissue compliance in the relaxed or contracted state. Additional research is needed to validate the use of this instrument to reliably assess muscle tone and other contributors to tissue compliance. If successful, studies should examine the sensitivity of the Myotonometer™ to assess intervention-induced tissue compliance changes in patient groups with suspected muscle tone impairments. Further study of intervention effects across muscle groups and dosage levels can help inform clinical decisions about the potential usefulness of tone-altering interventions for the orofacial musculature. Full article