and Bolus Transit During the Oral and Pharyngeal Phases of Swallowing. Ian J. Cook, M.D., Wylie J. Dodds, M.D., Roberto O. Dantas, M.D., Mark K. Kern, M.S.,.
Dysphagia4:8 15(1989)
Dysphagia ~ Spri nger-Verlag New York I no. 1980
Timing of Videofluoroscopic, Manometric Events, and Bolus Transit During the Oral and Pharyngeal Phases of Swallowing I a n J. C o o k , M . D . , Wylie J. D o d d s , M . D . , R o b e r t o O. D a n t a s , M . D . , M a r k K. K e r n , M.S., Benson T. Massey, M . D . , R e z a Shaker, M . D . , and W a l t e r J. H o g a n , M . D . Departments of Radiology and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Abstract. T h e aims o f this s t u d y were to evaluate
Key words: Swallowing, oral p h a s e - Swallowing,
a n d q u a n t i f y the timing o f events associated with the oral and p h a r y n g e a l phases o f liquid swallows. F o r this p u r p o s e , we recorded 0 - 2 0 ml b a r i u m swallows in three g r o u p s o f volunteers using videoradiographic, electromyographic, and manometric m e t h o d s . T h e study findings indicated that a leading c o m p l e x o f t o n g u e tip and tongue base m o v e m e n t as well as onset o f superior hyoid m o v e m e n t a n d m y l o h y o i d myoelectric activity o c c u r r e d in a tight t e m p o r a l relationship at the inception o f swallowing. T w o distinct general types o f normal swallows were observed. T h e c o m m o n " i n c i s o r - t y p e " swallow b e g a n with the bolus positioned on the tongue with the t o n g u e tip pressed against the u p p e r incisors and m a x i l l a r y alveolar ridge. At the onset o f the " d i p p e r - t y p e " swallow the bolus was located b e n e a t h the a n t e r i o r t o n g u e a n d the t o n g u e tip s c o o p e d the bolus to a supralingual location. Beginning with t o n g u e - t i p peristaltic m o v e m e n t at the u p p e r incisors, the two swallow types were identical. Swallow events t h a t occurred after lingual peristaltic m o v e m e n t at the m a x i l l a r y incisors showed a v o l u m e - d e p e n d e n t forw a r d m i g r a t i o n in time that led to earlier m o v e m e n t o f the hyoid a n d larynx as well as earlier o p e n i n g o f the u p p e r e s o p h a g e a l sphincter in o r d e r to receive the large boluses that arrived s o o n e r in the p h a r y n x during the swallow sequence t h a n did smaller boluses. The study findings indicated that timing o f swallow events should be considered in reference to b o t h swallow type a n d bolus volume. T h e findings also indicated an i m p o r t a n t distinction between peristaltic transit a n d bolus clearance.
p h a r y n g e a l phase - Bolus transit - H y o i d m o v e ment
Wylie J. Dodds, M.D., Professor of Radiology and Medicine, Medical College of Wisconsin, Froedtert Memorial Lutheran t lospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA Address reprint requests to."
C o n t r o v e r s y exists a b o u t the o p t i m a l critcria and e n d p o i n t s for e v a l u a t i n g bolus transit and related deglutitive p h e n o m e n a during the first two phases o f swallowing [1-3]. T h e aims o f o u r study were to record oral and p h a r y n g e a l events by videofluoroscopic, m a n o m e t r i c , a n d m y o g r a p h i c methods during swallowing; to evaluate m e a s u r e m e n t criteria for the a s s c s s m c n t o f n o r m a l swallowing; and to e x a m i n e the timing and d u r a t i o n o f deglutitive p h e n o m e n a as functions o f swallowed bolus v o l u m e and different m e a s u r e m e n t criteria.
Methods and Subjects We studied 21 healthy men age 18 36 years. The subjects were classified into three groups of 7. [n each group, barium swallows were evaluated concurrently by videofluoroscopy and intraluminal manometry. Submental electromyography (EMG) was also measured in groups 1 and 2. The subjects were studied sitting with their head in a neutral position, turned lateral to an image intensifier. Videofluoroscopic recordings were obtained using 9 inch or 6 inch magnification. The 9 inch intensitier provided imaging of the entire mouth and pharynx while the 6 inch intensifier gave a magnified view of the pharynXImaging was done at 80-90 KeV without a grid. In each subject, we recorded swallows of high-density barium, 250% wt/vol (E-Z-EM Inc., Westbury, NY). Swallows were recorded in duplicate using a Beta video recorder (Sony SLHF 900) with a 0.5-inch tape run at 30 frames/s. Barium was delivered to the mouth using a syringe. Each fluoroscopic sequence was -
