Pre-pharyngeal Swallow Effects of Recurrent Laryngeal Nerve Lesion on Bolus Shape and Airway Protection in an Infant Pig Model.
Pre-pharyngeal Swallow Effects of Recurrent Laryngeal Nerve Lesion on Bolus Shape and Airway Protection in an Infant Pig Model.
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DOI：
10.1007/s00455-016-9762-2
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发表时间：
2017-06
期刊：
影响因子：
2.6
通讯作者：
German RZ
中科院分区：
文献类型：
--
作者：
Gould FDH;Yglesias B;Ohlemacher J;German RZ
婴儿喉返神经（RLN）损伤导致吞咽困难和吸入性肺炎增加。最近的工作表明，口内运输和吞咽运动学的变化后，喉返神经病变，提示潜在的变化，团形成之前，吞咽。在这项研究中，我们使用几何形态测量学来了解有和没有喉返神经病变的婴儿中团块形状对穿透和抽吸的影响。我们假设1）几何团注特性与气道保护结果相关，2）在RLN病变的婴儿中，几何团注特性与吞咽困难之间的关系发生变化。在5头幼猪中，使用婴儿哺乳动物穿透抽吸评分（IMPAS）评估了188次吞咽中的吞咽困难。使用来自高速VFSS的图像，对团块形状、团块面积和舌轮廓进行数字量化。采用椭圆傅立叶分析法分析弹丸形状，采用多项式曲线拟合法分析舌体轮廓。尽管个体间差异很大，但存在显著的个体内推注形状和推注面积对气道保护的影响。穿刺抽吸评分与病变后团块面积和形状变化的关系。病变前和病变后吞咽之间以及IMPAS评分不同的吞咽之间的舌形不同。推注的形状和面积影响气道保护效果。喉返神经病变改变了这种关系，表明正确的食团形成和舌头的控制需要完整的喉感觉。喉返神经病变对吞咽困难的影响是广泛的。
Recurrent laryngeal nerve (RLN) damage in infants leads to increased dysphagia and aspiration pneumonia. Recent work has shown that intra oral transport and swallow kinematics change following RLN lesion, suggesting potential changes in bolus formation prior to the swallow. In this study we used geometric morphometrics to understand the effect of bolus shape on penetration and aspiration in infants with and without RLN lesion. We hypothesized 1) that geometric bolus properties are related to airway protection outcomes and 2) that in infants with RLN lesion, the relationship between geometric bolus properties and dysphagia is changed. In five infant pigs, dysphagia in 188 swallows was assessed using the Infant Mammalian Penetration Aspiration Score (IMPAS). Using images from high-speed VFSS, bolus shape, bolus area, and tongue outline were quantified digitally. Bolus shape was analyzed using elliptical Fourier analysis, and tongue outline using polynomial curve fitting. Despite large inter-individual differences, significant within individual effects of bolus shape and bolus area on airway protection exist. The relationship between penetration-aspiration score and both bolus area and shape changed post lesion. Tongue shape differed between pre and post lesion swallows, and between swallows with different IMPAS scores. Bolus shape and area affect airway protection outcomes. RLN lesion changes that relationship, indicating that proper bolus formation and control by the tongue requires intact laryngeal sensation. The impact of RLN lesion on dysphagia is pervasive.