Mandibular advancement impairs swallowing ability more than head extension but less than mouth opening in the supine position

Hanamoto, Hiroshi; Togawa, Eriko; Maegawa, Hiroharu; Yokoe, Chizuko; Inoue, Mika; Oyamaguchi, Aiko; Kudo, Chiho; Niwa, Hitoshi

doi:10.1038/s41598-019-56843-8

Cited by 5 publications

(8 citation statements)

References 28 publications

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“…To the best of our knowledge, this is the first study to evaluate swallowing volume including both spontaneous and voluntary swallowing under sedation. Major findings include estimated swallowing volume and electromyogram results not being affected by propofol sedation induced with C e < 1.5 μg ml −1 , unlike airway manoeuvres, which significantly decreased estimated swallowing volume in our previous studies 7,8 …”

Section: Discussionmentioning

confidence: 58%

“…To normalise the peak amplitude, the value in the neutral position was determined to be 100%. Both raw and normalised values of the peak amplitude were analysed 8 . A supplementary video was also used to determine the duration of the suprahyoid muscle activity 7 .…”

Section: Methodsmentioning

confidence: 99%

“…We previously elucidated that head extension 7 applied under sedation for airway management, decreased the estimated swallowing volume. Subsequently, we focused on the effects of mandibular advancement 8 on swallowing volumes. Moreover, both voluntary and spontaneous swallowing 9,10 can occur under sedation, and sedatives may affect the intra-oral fluid-retaining ability that influences the frequency of swallowing.…”

Section: Introductionmentioning

confidence: 99%

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Swallowing ability and intra-oral water-retaining ability during moderate propofol sedation in healthy human volunteers

Hanamoto

Togawa

Yokoe

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND The cough reflex or aspiration under monitored anaesthesia care might be associated with sedative-induced changes in swallowing and intra-oral water-retaining abilities. OBJECTIVES To investigate the effects of moderate propofol sedation on swallowing and intra-oral water-retaining ability. DESIGN Prospective observational study. SETTING Single tertiary care centre during 2017. PARTICIPANTS A total of 13 healthy adult volunteers. INTERVENTION Volunteers in the supine position were asked to retain 10 ml of orally injected water for 5 min. After 5 minutes or when the water was spontaneously swallowed, the retention time and residual intra-oral water volume were measured. Subjects then voluntarily swallowed a further 10 ml of injected water and the residual water volume was measured. This whole process was repeated under sedation with propofol at effect-site concentrations of 0.5, 1.0 and 1.5 μg ml−1. MAIN OUTCOME MEASURES The primary outcome was the estimated volume swallowed (swallowing volume); the secondary outcome was water retention time. RESULTS Median water retention time decreased from 300 to 11 s (P < 0.001), and greater spontaneous swallowing was induced with increased propofol effect-site concentrations measuring up to 1.5 μg ml−1 (P < 0.001). The median of the estimated swallowing volumes with voluntary swallowing while awake and with all three concentrations of propofol were 9.5, 9.6, 9.6 and 9.4 ml, respectively (P = 0.805); more water remained after spontaneous swallowing than after voluntary swallowing at all concentrations. Differences in mean estimated swallowing volumes between voluntary and spontaneous swallowing were 3.4 ml (95% CI, 0.9 to 6.0, P = 0.016) for 0.5 μg ml−1, 4.1 ml (95% CI, 1.8 to 6.3, P = 0.002) for 1.0 μg ml−1 and 5.1 ml (95% CI, 3.4 to 6.8, P < 0.001) for 1.5 μg ml−1. CONCLUSIONS Moderate propofol sedation decreases water-retaining ability but has no effect on voluntary swallowing. Ensuring that patients can respond under sedation may effectively prevent the unexpected cough reflex and aspiration by enabling occasional voluntary swallowing. TRIAL REGISTRATION UMIN Clinical Trials Registry identifier: UMIN000027517.

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Section: Discussionmentioning

confidence: 58%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Swallowing ability and intra-oral water-retaining ability during moderate propofol sedation in healthy human volunteers

Hanamoto

Togawa

Yokoe

et al. 2021

European Journal of Anaesthesiology

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“…However, saline treated mice performed more head up postures overall (irrespective of treatment), and despite the shorter cycle times, mice exposed to CO 2 had longer total durations in a head up posture. Although the precise interpretation of this behaviour remains to be elucidated, it could represent an attempt to open the airways through stretching the neck to relieve dyspnoea [ 31 ]. Alternatively, it may reflect exploratory ‘environmental sampling’ behaviour, similar to mandibulation in poultry [ 15 ], which seems to be a response to hypoxia, not hypobaria [ 15 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Striving for humane deaths for laboratory mice: hypobaric hypoxia provides a potential alternative to carbon dioxide exposure

Clarkson

Martin

Sparrey³

et al. 2023

Proc. R. Soc. B.

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Killing is often an unavoidable and necessary procedure for laboratory mice involved in scientific research, and providing a humane death is vital for public acceptance. Exposure to carbon dioxide (CO 2 ) gas is the most widely used methodology despite well proven welfare concerns. Consequently, the continued use of CO 2 and its globally permitted status in legislation and guidelines presents an ethical dilemma for users. We investigated whether killing with hypobaric hypoxia via gradual decompression was associated with better welfare outcomes for killing laboratory mice. We compared the spontaneous behaviour of mice exposed to CO 2 , decompression or sham conditions, and used analgesic or anxiolytic interventions to determine their relative welfare impact. Gradual decompression resulted in longer times to unconsciousness and death and the pharmacological interventions support the notion of a minimally negative animal experience, while providing further evidence for pain and anxiety associated with exposure to CO 2 . Decompression resulted in moderate ear haemorrhage, but our welfare assessment suggests this may happen when mice are unconscious. Hence, gradual decompression could be the basis of significant refinement for killing laboratory mice. Future work should corroborate behaviour with neurobiological markers of loss of consciousness to verify the conscious phase of concern for animal welfare.

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“…5 In recent years, MAD application has shown promising results by increasing oropharyngeal space through alteration of the jaw and tongue position. 6 Although some studies investigated the effect of jaw protrusion using a MAD on the electromyographic (EMG) muscle activity in genioglossus, suprahyoid muscle, [7][8][9][10] no studies have yet investigated the possible effects of a MAD on the motor control of the involved muscles. To understand the mechanism and therapeutic effect of MAD, it is vital to understand if MAD would have the potential to induce plasticity in the corticomotor control related to the tongue and masseter muscles.…”

Section: Introductionmentioning

confidence: 99%

Effect of mandibular advancement device on plasticity in corticomotor control of tongue and jaw muscles

Matsuzaki

Shimada

Tanaka

et al. 2021

Journal of Clinical Sleep Medicine

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Study Objectives: This study aims to investigate whether the use of a mandibular advancement device (MAD) is associated with neuroplasticity in corticomotor control of tongue and jaw muscles. Methods: Eighteen healthy individuals participated in a randomized crossover study with 3 conditions for 2 weeks each: baseline, wearing an oral appliance (sham MAD), or MAD during sleep. The custom-made MAD was constructed by positioning the mandible to 50% of its maximal protrusion limit. Transcranial magnetic stimulation was applied to elicit motor-evoked potentials (MEPs). The MEPs were assessed by constructing stimulus-response curves at 4 stimulus intensities: 90%, 100%, 120%,and 160% of the motorthreshold from theright tongue andright masseter and thefirst dorsal interosseous muscles (control) at baseline, afterthe first and the second intervention. Results: There was a significant effect of condition and stimulus intensity both on the tongue and on masseter MEPs (P < .01). Tongue and masseter MEPs were significantly higher at 120% and 160% after the MAD compared with the oral appliance (P < .05). There were no effects of condition on first dorsal interosseous muscle MEPs (P = .855). Conclusions: The finding suggests that MAD induces neuroplasticity in the corticomotor pathway of the tongue and jaw muscles associated with the new jaw position. Further investigations are required in patients with obstructive sleep apnea to see whether this cortical neuroplasticity may contribute or perhaps predict treatment effects with MADs in obstructive sleep apnea.

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Mandibular advancement impairs swallowing ability more than head extension but less than mouth opening in the supine position

Cited by 5 publications

References 28 publications

Swallowing ability and intra-oral water-retaining ability during moderate propofol sedation in healthy human volunteers

Swallowing ability and intra-oral water-retaining ability during moderate propofol sedation in healthy human volunteers

Striving for humane deaths for laboratory mice: hypobaric hypoxia provides a potential alternative to carbon dioxide exposure

Effect of mandibular advancement device on plasticity in corticomotor control of tongue and jaw muscles

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