Hyoid displacement patterns in healthy swallowing

ABSTRACT Objective To describe the patterns of displacement of the hyoid bone in healthy individuals, considering their displacements during swallowing of different consistencies. Methods Two hundred one swallowing videofluoroscopy exams of 67 adult and elderly individuals without swallowing disorders were analyzed. Descriptive analysis was performed to identify and describe the patterns of displacement of the hyoid bone. Results Seven types of displacement of the hyoid bone were found: H1 (horizontal), H2 (short vertical and long horizontal), H3 (vertical and diagonal to upper), H4 (long vertical and short horizontal), H5 (vertical), H6 (diagonal), and H7 (brief). The standards were maintained in different consistencies. The most frequent pattern of displacement was type H2. The distribution of the types of displacement of the hyoid was different among men and women. Conclusion Seven patterns of displacement of the hyoid bone during swallowing of normal adults and older people have been described. The most frequent pattern of displacement was horizontal, with variations in distribution between men and women. The displacement pattern was maintained during the swallowing of the three different consistencies (thin, pasty and solid liquid).

Benefícios da aplicação de toxina botulínica associada à fonoterapia em pacientes disfágicos graves / Benefits of botulinum toxin associated to swallowing therapy in patients with severe dysphagia

Estudo de casos para caracterizar os benefícios da aplicação de toxina botulínica em glândulas salivares, associada à fonoterapia em pacientes disfágicos graves. Foram analisados cinco prontuários de pacientes neurológicos, em uso exclusivo de via alternativa de alimentação, com idades entre 17 e 70 anos, sendo quatro do gênero masculino e um do gênero feminino. Do total, quatro pacientes eram traqueostomizados. Foi considerado como critério de inclusão apresentar disfagia grave, com manifestações clínicas de escape extra oral e/ou acúmulo de saliva em cavidade oral e aspiração traqueal maciça de saliva, com limitação da fonoterapia. Quanto à avaliação clínica da deglutição, foram coletados dados pré e pós-fonoterapia associada à aplicação de toxina botulínica, quanto aos seguintes aspectos: mobilidade e força das estruturas orofaríngeas (lábios, língua, bochechas), elevação laríngea, grau da disfagia, uso de via alternativa de alimentação e traqueostomia. Quanto aos resultados pós- fonoterapia foi observado, em quatro pacientes, melhora da mobilidade e força de lábios, língua, bochechas e laringe. Quatro pacientes apresentaram deglutição funcional e um teve modificação do grau de gravidade da disfagia. Desta forma, a maioria foi capaz de receber dieta exclusiva por via oral e apenas um permaneceu com dieta mista, ou seja, gastrostomia e dieta via oral na consistência pastosa. Todos os pacientes traqueostomizados tiveram a cânula de traqueostomia removida. O estudo mostrou que o tratamento descrito acima contribui para a reabilitação da deglutição, reintrodução de alimentos por via oral e retirada da cânula de traqueostomia.

Case report with the aim to characterize the benefits of botulinum toxin injection into salivary glands in association with swallowing therapy in patients with severe dysphagia. The medical records of five neurological patients (four male and one female, aged between 17 and 70 years) who exclusively used alternative feeding were analyzed. Four patients were tracheostomized. Inclusion criterion was to present severe dysphagia associated to clinical manifestations of drooling and/or sialorrhea with significant aspiration of saliva, restricting the improvement in swallowing rehabilitation. Data were collected before and after intervention associated with botulinum toxin injection, regarding the following aspects: mobility and strength of oropharyngeal structures (lips, tongue and cheeks), laryngeal elevation, severity degree of dysphagia, use of alternative tube feeding and tracheostomy. After swallowing therapy, four patients showed improvement in mobility and strength of the lips, tongue, cheeks and larynx. Four patients presented functional swallowing and one of them modified had the severity degree of dysphagia changed. Therefore, most patients were able to receive exclusive oral feeding, and only one remained on mixed feeding, that is, gastrostomy and oral feeding with pasty consistence. All tracheostomized patients had the tracheostomy cannula removed. The study showed that the treatment described contributed to swallowing rehabilitation, reintroduction of oral feeding, and withdrawal of the tracheostomy cannula.