The effect of a chin-down maneuver after esophagectomy on oropharyngeal swallowing pressure measured using high-resolution manometry

Matsubara, Keigo; Kumai, Yoshihiko; Miyamoto, Takumi; Samejima, Yasuhiro; Yoshida, Naoya; Baba, Hideo; Orita, Yorihisa

doi:10.1016/j.anl.2019.06.001

Cited by 8 publications

(21 citation statements)

References 15 publications

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“…Moreover, several biomechanical abnormalities in swallowing can develop after esophagectomy [6,14]. These abnormalities, which include delayed onset of swallowing, reduced hyoid or hyolaryngeal elevation, and reduced UES opening, are demonstrated by videofluoroscopic examination and highresolution manometry [7,15]. The reconstruction route may also cause swallowing abnormalities [1].…”

Section: Discussionmentioning

confidence: 99%

Cricopharyngeal myotomy for cricopharyngeus muscle dysfunction after esophagectomy

et al. 2020

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Background: Pharyngoesophageal dysphagia sometimes develops after esophagectomy. However, severe dysphagia after esophagectomy due to cricopharyngeus muscle dysfunction is a rare complication. There are no recommended clinical treatments for cricopharyngeus muscle dysfunction after esophagectomy. We report a case of myotomy for cricopharyngeus muscle dysfunction after esophagectomy. Case presentation: A 75-year-old man with mild dysphagia diagnosed with advanced esophageal cancer by esophagogastroduodenoscopy at a clinic was admitted to our hospital. He had occasional mild dysphagia when he swallowed solid foods. After chemotherapy, the patient underwent minimally invasive esophagectomy with regional lymph node dissection and was reconstructed with a gastric conduit and cervical anastomosis by the retrosternal route. Aspiration pneumonia developed after esophagectomy without paralysis of the vocal cords. In esophagoscopy, there was no stricture around the anastomosis. However, severe pharyngoesophageal dysphagia with cricopharyngeus muscle dysfunction was revealed by videofluoroscopic examination. Bilateral cricopharyngeal myotomy was performed because balloon dilations had failed. The histological findings revealed atrophy and fibrosis of the cricopharyngeus muscle fibers. Pharyngoesophageal dysphagia improved immediately after myotomy. The patient swallowed solid food easily without dysphagia 12 months after myotomy. Conclusion: Dysphagia after esophagectomy was worsened by cricopharyngeus muscle dysfunction. Cricopharyngeus myotomy may lead to long improvement of pharyngo-oesophageal dysphagia after esophagetomy.

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Section: Discussionmentioning

confidence: 99%

Cricopharyngeal myotomy for cricopharyngeus muscle dysfunction after esophagectomy

et al. 2020

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“…Moreover, the head flexion posture reduces the UES opening time 9 . One report stated that the neck flexion posture enlarges the UES opening, increases the UES opening time, and increases laryngeal closure time in patients following esophagectomy 11 . However, to the best of our knowledge, no study demonstrated the effects of the head flexion posture in patients with dysphagia.…”

Section: Introductionmentioning

confidence: 93%

“…9 One report stated that the neck flexion posture enlarges the UES opening, increases the UES opening time, and increases laryngeal closure time in patients following esophagectomy. 11 However, to the best of our knowledge, no study demonstrated the effects of the head flexion posture in patients with dysphagia. In addition, the head and neck flexion angles were not evaluated in the chin-down, neck flexion, or head flexion posture, except for one article based on healthy individuals.…”

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confidence: 88%

Effects of head flexion posture in patients with dysphagia

Nagura

Kagaya

Inamoto

et al. 2022

J of Oral Rehabilitation

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Background The chin‐down posture is often used as a compensatory manoeuvre for patients with dysphagia. This posture presumably involves flexion of the head and/or neck, but this is not clearly defined. Objective This study aimed to assess the effects of head flexion posture in a retrospective study of videofluoroscopic examination of swallowing (VF). Methods A total of 73 patients who underwent VF both with and without head flexion posture in the lateral projection were included in the analysis. The head and neck angles at the initiation of the swallowing reflex, penetration–aspiration scale (PAS), nasopharyngeal closure time, stage transition duration, duration of laryngeal closure, time from swallowing reflex to laryngeal closure and to the opening of upper oesophageal sphincter (UES), duration of UES opening, location of the bolus leading edge at swallowing reflex, and bolus transition time were evaluated. Results The head flexion angle increased (p < 0.001), but the neck flexion angle did not change in the head flexion posture. Moreover, PAS improved (p < 0.001), aspiration was reduced (p < 0.001), the time between the swallowing reflex and the onset of laryngeal closure was shortened (p = 0.006), and the leading edge of the bolus at swallowing reflex became shallower (p = 0.004) in the head flexion posture. Other parameters did not significantly change. Conclusion The head flexion posture resulted in earlier laryngeal closure and a shallower position of the leading bolus edge at swallowing reflex, resulting in PAS improvement and decreased aspiration.

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“…studies. 6,8,9,[20][21][22][23][24][25][26][27][28][29] Four studies were published in Korea, four studies were published in the United States of America and the rest in Japan. Included studies were published between 1993 and 2022.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two of the included studies reported maximum swallowing pressure at Velopharynx. 24,25 Matsubara et al 24 measured pharyngeal swallowing pressure using high-resolution manometry (HRM) in neutral and chin-down positions, and the results found that the maximum SP at velopharynx was significantly lower in the chin-down position compared to the neutral position (211.4 vs. 201.9, p < .05). Lee et al 25 explored the effects of chin-down manoeuvre by using HRM, 64 dysphagia patients swallow thin and honey-like liquid in neutral position and chin-down position.…”

Section: Effects On Maximum Swallowing Pressure At Velopharynxmentioning

confidence: 99%

The effectiveness of chin‐down manoeuvre in patients with dysphagia: A systematic review and meta‐analysis

Li,

Huang,

Ding

et al. 2023

J of Oral Rehabilitation

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AimThe chin‐down posture is a widely used compensatory manoeuvre for patients with dysphagia. The aim of this study was designed to systematically measure the effectiveness of chin‐down manoeuvre application.MethodologyWe retrieved the PubMed, Web of Science, Embase, Cochrane Library, EBSCO, Medline, CNKI, WANFANG, VIP and SinoMed databases from inception to 30 August 2022. Raters independently screened literature according to inclusion and exclusion criteria. The quality of the included literature was evaluated, and data were extracted. The software Review Manager software 5.3 was used for statistical analysis.ResultsFourteen studies with a total of 571 patients were included in this meta‐analysis. The meta‐analysis indicated that chin‐down manoeuvre could significantly reduce the risk of aspiration (MD = −1.35, 95% CI [−2.25, −0.44], Z = 2.92, p < .01), decrease the chin angle (MD = −12.20, 95% CI [−14.61, −9.79], Z = 9.91, p < .001), shorten oral transit time (MD = −0.81, 95% CI [−1.20, −0.43], Z = 4.17, p < .001), reduce the maximum swallowing pressure at upper oesophageal sphincter (MD = −82.07, 95% CI [−112.77, −51.37], Z = 5.24, p < .001) and decrease pharyngeal residue.ConclusionsExisting evidence indicated that chin‐down manoeuvre could reduce the risk of aspiration and pharyngeal residue, decrease the maximum swallowing pressure at UES. More large‐sample, high‐quality clinical trials are still needed in the future to further ascertain the results of this research.

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The effect of a chin-down maneuver after esophagectomy on oropharyngeal swallowing pressure measured using high-resolution manometry

Cited by 8 publications

References 15 publications

Cricopharyngeal myotomy for cricopharyngeus muscle dysfunction after esophagectomy

Cricopharyngeal myotomy for cricopharyngeus muscle dysfunction after esophagectomy

Effects of head flexion posture in patients with dysphagia

The effectiveness of chin‐down manoeuvre in patients with dysphagia: A systematic review and meta‐analysis

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