Ultrasound of oral and masticatory muscles: Why every neuromuscular swallow team should have an ultrasound machine

Abstract

Patients with neuromuscular disorders often present with swallowing difficulties due to oral phase problems and pharyngeal residue after swallow. It is important to assess the underlying pathology and cause of the swallowing disturbance in this patient group, such as dystrophic changes in oral and masticatory muscles. This allows for more patient-tailored recommendations, for example optimal compensation strategies to maintain function for longer. Ultrasound can show structural changes caused by dystrophy or denervation of muscles, detect involuntary movements such as fasciculations, and provide dynamic video images of tongue motion during swallowing attempts. This article, based on the authors' extensive experience with ultrasound in neuromuscular disease, explains the concepts of oral muscle ultrasound and its proven value in assessing neuromuscular mastication and swallowing problems. As a patient-friendly and portable technique, we advocate its use as a standard tool for analyzing neuromuscular dysphagia. Clin. Anat. 30:183-193, 2017. © 2017 Wiley Periodicals, Inc.

Speech–Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function

“…Manometry and ultrasound can also be utilized in some cases. 81,82 The FEES approach to evaluating deglutition offers a direct observation of the pharyngeal structures during eating. 27,[74][75][76]83 This examination can be conducted at bedside in acute and inpatient hospital contexts, or in an outpatient clinic.…”

High-Resolution Cervical Auscultation Signal Features Reflect Vertical and Horizontal Displacements of the Hyoid Bone During Swallowing

“…The elusive “holy grail” of dysphagia diagnostics is a noninvasive method of detecting dysphagia before patients are placed at risk of aspiration. Less invasive methods to assess specific aspects of dysphagia have been investigated in previous studies such as ultrasonography to assess soft tissue function [30], manometry to assess pressure generation and propagation from the oral cavity through the esophagus [31], [32], and electromyography to assess the timing and sequence of muscle activation [33]. Cervical auscultation (CA) which uses stethoscopes to observe sounds emanating from the pharyngeal mechanism to infer about swallow physiology [16], [34]–[41], enables an examiner to “hear”a swallow, however it has been shown repeatedly to provide inconsistent information leading to subjective interpretations by the examiner due limitations of the human auditory system and to variations in instrument design since stethoscopes are not designed to transmit pharyngeal sounds [42], [43].…”

Mastication Problems and Dysphagia In 4 Patients with Treacher Collins Syndrome Due to Affected Orofacial Muscles

“…Nevertheless, this phenomenon might be an explanation that besides thinner mastication and tongue muscles, we also found a deviant structure of the masseter and temporal muscles expressed by the high z-scores on the echogenicity (> +2). A high echogenicity or whiter image means a disruption of normal architecture by which the muscle fibers are interspersed with fat and fibrosis [12]. Moreover, a high echogenicity of skeletal and mastication muscles reduces the ability to generate force (Jansen et al, 2012; van den Engel-Hoek et al, 2016).…”