Patrones de Deglución y Metodología de Evaluación. Una Revisión de la Literatura / Swallowing Patterns and Evaluation Methodology. A Review of the Literature

RESUMEN: La deglución es una función indispensable para el ser humano, es una actividad compleja que necesita de la participación y coordinación de múltiples estructuras. Actualmente existen diferentes métodos para evaluar este proceso, sin embargo, la capacidad de describir el comportamiento de las estructuras en sus tres dimensiones es limitada. Se ha demostrado que el movimiento lingual, es clave para la formación del bolo alimenticio y la propulsión de este a la orofaringe. Es así como se han identificado patrones de movimiento lingual a través de diferentes técnicas. El objetivo de esta revisión es reportar las diferentes técnicas de evaluación de la deglución e identificar los patrones que establece cada una de ellas. Se realizó una revisión de la literatura en distintas bases de datos, a través de una estrategia de búsqueda sistematizada. Se utilizaron las palabras clave "Deglutition" "Swallowing" "Movement Tracking" "evaluation" y "patterns" en inglés y español. Se incluyeron estudios sin límite en la fecha de publicación, realizados en humanos, en idioma inglés, español y portugués. Se encontraron diferentes técnicas para evaluar la deglución, videofluoroscopía, endoscopía, articulografía electromagnética, electromiografía, tomografía computarizada, manometría, electropalatografía y ultrasonido. Entre las cuales la videofluoroscopía es una de las más utilizadas, con esta técnica se ha intentado describir patrones del movimiento durante la deglución, al igual que la articulografía electromagnética. Por otro lado, la electromiografía ha descrito patrones de deglución, pero en relación a la contracción y relajación de ciertos grupos musculares. Existen diferentes métodos para evaluar la deglución, cada una de estas técnicas ha permitido dilucidar de mejor forma este proceso, no obstante, es necesario una mayor cantidad de estudios comparativos que permitan resolver las dudas sobre la validez y la eficacia de las técnicas descritas.

ABSTRACT: Swallowing is a critical function for the human being. It is a complex activity that requires the coordination of multiple structures. Currently there are different methods to evaluate this process, however, the ability to describe the behavior of structures in its three dimensions is limited. It has been shown that lingual movement is key for food bolus formation and propulsion to the oropharynx. Hence, lingual movement patterns have been identified through various techniques. The objective of this review is to report the different swallowing assessment techniques and identify the patterns established by each of them. A review of the literature was carried out in different databases, through a systematic search strategy. The key words "Deglutition", "Swallowing", "Movement Tracking", "evaluation" and "patterns" were used in English and Spanish. Unlimited studies without restriction on the date of publication, carried out in human subjects, in English, Spanish and Portuguese, were included. Different techniques were found to evaluate swallowing, videofluoroscopy, endoscopy, electromagnetic articulation, electromyography, computed tomography, manometry, electropalatography and ultrasound. Videofluoroscopy is one of the most popular methods used, this technique has attempted to describe patterns of movement during swallowing, as well as electromagnetic articulation. On the other hand, electromyography has described swallowing patterns, but in relation to the contraction and relaxation of certain muscle groups. There are different methods to assess swallowing. Each of the techniques has made it possible to elucidate this process better, nonetheless, a greater number of comparative studies is necessary to resolve doubts about the validity and effectiveness of the techniques described.

Quantitative analysis of the TMJ movement with a new mandibular movement tracking and simulation system / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to develop a system for the measurement and simulation of the TMJ movement and to analyze the mandibular movement quantitatively. MATERIALS AND METHODS: We devised patient-specific splints and a registration body for the TMJ movement tracking. The mandibular movements of the 12 subjects with facial deformity and 3 controls were obtained by using an optical tracking system and the patient-specific splints. The mandibular part was manually segmented from the CT volume data of a patient. Three-dimensional surface models of the maxilla and the mandible were constructed using the segmented data. The continuous movement of the mandible with respect to the maxilla could be simulated by applying the recorded positions sequentially. Trajectories of the selected reference points were calculated during simulation and analyzed. RESULTS: The selected points were the most superior point of bilateral condyle, lower incisor point, and pogonion. There were significant differences (P<0.05) between control group and pre-surgical group in the maximum displacement of left superior condyle, lower incisor, and pogonion in vertical direction. Differences in the maximum lengths of the right and the left condyle were 0.59+/-0.30 mm in pre-surgical group and 2.69+/-2.63 mm in control group, which showed a significant difference (P<0.005). The maximum of differences between lengths of the right and the left calculated during one cycle also showed a significant difference between two groups (P<0.05). CONCLUSION: Significant differences in mandibular movements between the groups implies that facial deformity have an effect on the movement asymmetry of the mandible.