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Neurology Nov 2010Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement.
METHODS
This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images.
RESULTS
No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group.
CONCLUSIONS
EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement.
CLASSIFICATION OF EVIDENCE
This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.
Topics: Aged; Deglutition; Deglutition Disorders; Equipment Design; Exhalation; Female; Humans; Hyoid Bone; Inhalation; Larynx; Male; Middle Aged; Observer Variation; Parkinson Disease; Quality of Life; Resistance Training; Respiratory Muscles; Safety; Single-Blind Method
PubMed: 21098406
DOI: 10.1212/WNL.0b013e3181fef115 -
International Journal of Molecular... Jul 2021The mandibular and hyoid arches collectively make up the facial skeleton, also known as the viscerocranium. Although all three germ layers come together to assemble the... (Review)
Review
The mandibular and hyoid arches collectively make up the facial skeleton, also known as the viscerocranium. Although all three germ layers come together to assemble the pharyngeal arches, the majority of tissue within viscerocranial skeletal components differentiates from the neural crest. Since nearly one third of all birth defects in humans affect the craniofacial region, it is important to understand how signalling pathways and transcription factors govern the embryogenesis and skeletogenesis of the viscerocranium. This review focuses on mouse and zebrafish models of craniofacial development. We highlight gene regulatory networks directing the patterning and osteochondrogenesis of the mandibular and hyoid arches that are actually conserved among all gnathostomes. The first part of this review describes the anatomy and development of mandibular and hyoid arches in both species. The second part analyses cell signalling and transcription factors that ensure the specificity of individual structures along the anatomical axes. The third part discusses the genes and molecules that control the formation of bone and cartilage within mandibular and hyoid arches and how dysregulation of molecular signalling influences the development of skeletal components of the viscerocranium. In conclusion, we notice that mandibular malformations in humans and mice often co-occur with hyoid malformations and pinpoint the similar molecular machinery controlling the development of mandibular and hyoid arches.
Topics: Animals; Body Patterning; Cartilage; Hyoid Bone; Mandible
PubMed: 34299147
DOI: 10.3390/ijms22147529 -
Anatomy & Cell Biology Mar 2019The digastric muscle consists of the anterior belly and the posterior belly connecting the mandible, hyoid bone and temporal bone. Its unique morphology, structure and... (Review)
Review
The digastric muscle consists of the anterior belly and the posterior belly connecting the mandible, hyoid bone and temporal bone. Its unique morphology, structure and variations have drawn genuine interests in this muscle from anatomists, scientists and physicians for a long time, and the variations of the digastric muscle have been documented since the 18th century. As the usage of computed tomography and magnetic resonance imaging in the neck has become ever increasing, recognizing the variations of the digastric muscle can be a great value since it helps physicians to make better treatment plans and avoid unnecessary invasive procedures in the neck. Although the variations of the digastric muscle do not necessarily cause clinical symptoms, they still have important clinical applications. This article discusses the anatomy, embryology, descriptions of the morphological variations and clinical significance of the digastric muscle.
PubMed: 30984445
DOI: 10.5115/acb.2019.52.1.1 -
Journal of Speech, Language, and... Feb 2022Research remains equivocal regarding the links between hyoid movement and penetration-aspiration. The aims of this study were (a) to explore associations between hyoid...
PURPOSE
Research remains equivocal regarding the links between hyoid movement and penetration-aspiration. The aims of this study were (a) to explore associations between hyoid parameters, laryngeal vestibule closure (LVC) parameters, and penetration-aspiration on thin liquids; and (b) to determine which of these parameters are the strongest predictors of penetration-aspiration.
METHOD
This study involved retrospective analysis of an existing videofluoroscopy data set, collected in 305 participants (152 males) with noncongenital/nonsurgical/non-oncological risk for dysphagia. We extracted data for six thin liquid swallows per participant, and obtained measures of hyoid movement (peak position, speed) and LVC (complete/incomplete, timing, duration). Resulting values were coded as typical/atypical relative to healthy reference data. Relationships were explored using chi-square tests and odds ratios (a) for the entire data set and (b) for the subset of data with complete LVC. Hierarchical logistic regression models determined the strongest predictors of penetration-aspiration.
RESULTS
Significant associations were found between penetration-aspiration and incomplete LVC, prolonged time-to-most-complete-LVC, short LVC duration, reduced anterior hyoid peak position, and reduced hyoid speed. Hyoid measures were also significantly associated with LVC parameters. In the first regression model, incomplete LVC and prolonged time-to-most-complete-LVC were the only significant predictors of penetration-aspiration. For cases with complete LVC, the only significant predictor was prolonged time-to-most-complete-LVC.
CONCLUSIONS
Although reduced anterior hyoid peak position and speed are associated with penetration-aspiration on thin liquids, these measures do not independently account for penetration-aspiration when considered in conjunction with measures of LVC. When identifying mechanisms explaining penetration-aspiration, clinicians should focus on LVC (complete/incomplete) and timeliness of LVC.
Topics: Biomechanical Phenomena; Cineradiography; Deglutition; Deglutition Disorders; Fluoroscopy; Humans; Hyoid Bone; Male; Retrospective Studies
PubMed: 34982956
DOI: 10.1044/2021_JSLHR-21-00238 -
Einstein (Sao Paulo, Brazil) 2022To describe the patterns of displacement of the hyoid bone in healthy individuals, considering their displacements during swallowing of different consistencies.
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).
Topics: Adult; Aged; Deglutition; Deglutition Disorders; Female; Health Status; Humans; Hyoid Bone; Male
PubMed: 35293528
DOI: 10.31744/einstein_journal/2022AO6268 -
Medicina (Kaunas, Lithuania) Aug 2023: The carotid bifurcation (CB) is presented in most anatomy textbooks as having a unique location at the upper margin of the thyroid cartilage. Although a number of case...
: The carotid bifurcation (CB) is presented in most anatomy textbooks as having a unique location at the upper margin of the thyroid cartilage. Although a number of case reports have provided evidence of the possibility of carotid artery location either lateral or medial to the greater hyoid horn, these reports have not established specific anatomic possibilities and prevalences. : We retrospectively analysed a batch of 147 CT angiograms for 12 types of carotid-hyoid relationships and classified the bilateral combination possibilities of these types. : In 168/294 sides there were no carotid-hyoid relationships. Type I, external carotid artery (ECA) medial to the greater horn of the hyoid bone (GHHB), was observed in 0.34%; type II, internal carotid artery (ICA) medial to GHHB, in 0.34%; type III, ICA and ECA medial to GHHB, in 1.02%; type IV, common carotid artery (CCA) medial to GHHB, in 1.02%; type V, CB medial to GHHB, in 0.34%; type VI, ECA lateral to GHHB, in 20.41%; type VII, ICA lateral to GHHB, was not recorded; type VIII, ECA and ICA lateral to GHHB, in 3.74%; type IX, CCA lateral to GHHB, in 8.5%; type X, CB lateral to GHHB, in 6.46%; type XI, ECA lateral and ICA medial to GHHB, in 0.34%; and type XII, ICA lateral and ECA medial to GHHB, in 0.34%. Bilateral symmetry was found in 70.74% of cases, including the null types without carotid-hyoid relationships as well as types IV, VI, VIII, IX, and X. There was a highly significant association between the left and right variants of the carotid-hyoid relationship. : Mechanical compression of the hyoid bone on the carotid arteries has various undesirable effects on the ICA and cerebral circulation. Underlying these are several variational anatomical patterns of carotid-hyoid relationships, which can be accurately documented on CT angiograms. A case-by-case anatomical study is better than assuming the carotid anatomy learned from textbooks.
Topics: Humans; Hyoid Bone; Retrospective Studies; Carotid Artery, Common; Neck; Angiography
PubMed: 37629784
DOI: 10.3390/medicina59081494 -
Journal of Dental Sciences Sep 2020The hyoid bone and its attached muscles play an important role in the maintenance of the pharyngeal airway space. The aim of the present study was to investigate the...
BACKGROUND/PURPOSE
The hyoid bone and its attached muscles play an important role in the maintenance of the pharyngeal airway space. The aim of the present study was to investigate the correlations between hyoid bone and pharyngeal airway spaces among three skeletal patterns.
MATERIALS AND METHODS
Cephalograms of 90 male and 90 female were divided into skeletal patterns: Class I, Class II, and Class III. The following pharyngeal airway spaces were measured: SP, soft palate related pharyngeal airway; BP, B point related pharyngeal airway; C2P, second cervical vertebra related pharyngeal airway; and LP, laryngopharyngeal airway. The paired t-test, one-way analysis of variance, and Pearson correlation analysis were used in the statistical analyses.
RESULTS
SP was significantly longer in Class III (12.4 mm) than in Class I (10.7 mm) and Class II (9.5 mm), and BP was significantly greater in Class III (16.3 mm) than in Class II (12.4 mm). The hyoid bone had a significantly anterior location in Class III compared to Class II, whereas vertical positions of the hyoid bone showed no significant differences among the three skeletal patterns. Among female with a Class III skeletal pattern, the horizontal position of the hyoid bone had a positive moderate, significant correlation with the C2P, whereas among male, this was not observed.
CONCLUSION
The location of the maxilla (SNA) was not significantly correlated with the pharyngeal airway space. However, the more protruding the mandible (SNB) is, the more anterior the hyoid bone and the longer the pharyngeal airway will be.
PubMed: 32952886
DOI: 10.1016/j.jds.2020.05.012 -
Journal of the Formosan Medical... Oct 2022The anterior-superior movement of the hyoid bone plays a significant role in securing the airway and smooth passage of food through the cricopharyngeal muscle. The hyoid... (Review)
Review
The anterior-superior movement of the hyoid bone plays a significant role in securing the airway and smooth passage of food through the cricopharyngeal muscle. The hyoid bone can be detected easily with instruments such as the videofluoroscopic swallow study (VFSS) and ultrasonography (US), which have made quantitative kinematic analysis possible. Dysphagia is a critical issue in different diseases, including stroke, Parkinson's disease (PD), head and neck cancer, and amyotrophic lateral sclerosis (ALS), and the data obtained on these diseases from swallowing kinematic analysis has been accumulating. In this review article, we aimed to present the distinct features of kinematic analysis of hyoid movement in stroke, PD, head and neck cancer, and ALS. We also present the possible relationship between altered hyoid kinematics and dysphagia.
Topics: Amyotrophic Lateral Sclerosis; Biomechanical Phenomena; Deglutition; Deglutition Disorders; Head and Neck Neoplasms; Humans; Hyoid Bone; Parkinson Disease; Stroke
PubMed: 35469721
DOI: 10.1016/j.jfma.2022.04.007 -
Ear, Nose, & Throat Journal Aug 2023The tongue and hyoid bone are responsible for the oral phase of swallowing. The purpose of this study was to assess tongue strength and endurance, and to evaluate...
PURPOSE
The tongue and hyoid bone are responsible for the oral phase of swallowing. The purpose of this study was to assess tongue strength and endurance, and to evaluate swallowing functions in patients who underwent hyoid bone resection surgery.
MATERIAL AND METHODS
This was an experimental, non-randomized trial. It included participants who underwent hyoid bone resection surgery, divided into 2 groups; post-Sistrunk procedure and post-total laryngectomy. Swallowing problem history was recorded, and tongue strength and endurance were measured using the Iowa Oral Performance Instrument (IOPI). Post-Sistrunk procedure participants also underwent flexible endoscopic evaluation of swallowing (FEES) to assess objective swallowing function. Descriptive and bivariate statistics were used to analyze the association between the tongue strength and endurance, and the type of surgeries.
RESULTS
The study involved 26 participants, including 16 males and 10 females, with a mean age of 58.4 ± 12.8 years. A total of 10 subjects underwent the Sistrunk procedure and 16 underwent total laryngectomy surgery. The average tongue strength of all participants was 40.8 ± 11.7 kPa and the average tongue endurance was 30.6 ± 13.2 s. The difference in average tongue strength between the post-Sistrunk procedure group and post-total laryngectomy group was not significantly different (37.5 ± 11.6 kPa vs. 44.1 ± 11.3kPa, = .153). However, there was a statistically significant difference in average tongue strength between male and female participants (46.3 ± 10.0 kPa vs. 32.0 ± 8.5 kPa, = .001). FEES did not reveal any evidence of objective swallowing abnormalities in the post-Sistrunk group.
CONCLUSION
The resection of the hyoid bone, whether partial or total, did not significantly affect tongue strength and swallowing functions.
PubMed: 37608452
DOI: 10.1177/01455613231191019