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Improvement of Dysphagia in a Chronic Brain Injury Patient with Temporomandibular Joint Dysfunction: A Case Report

Kyu Wan KWAK ; Hyo Jeong LEE ; Yoon Ghil PARK

Journal of the Korean Dysphagia Society.2021;11(2):147-153. doi:10.34160/jkds.2021.11.2.010

Acquired brain injury patients who present dysphagia associated with temporomandibular joint dysfunction (TMJD) are more common than expected. TMJD is associated with restriction of mouth opening and jaw movements, thereby interfering with the oral phase of the swallowing process. An 18-year-old female with traumatic brain injury mainly complained of dysphagia when first admitted. After nearly one year of conventional dysphagia therapy, the patient could barely eat a minced diet. The videofluoroscopic swallowing study showed that a soft and bite-sized diet was tolerable to the patient, but the restricted mouth opening and mandibular movement imposed a major limitation of the dietary build-up. After examining the imaging studies, the patient was diagnosed with TMJD attributed to muscle lesion and misaligned stomatognathic system. The patient subsequently underwent a stomatognathic alignment and TMJ strengthening exercise program over a span of two weeks, after which the therapeutic effects were evaluated with the craniomandibular index (CMI) and Mann Assessment of Swallowing Ability (MASA) parameters, before and after the exercise program. The results showed improvements in the neck mobility and orofacial movements, and the patient was able to consume soft and bite-sized diet in the clinical setting. Thus, we propose that active exercise to achieve postural correction and TMJ muscle strengthening are effective treatment options for dysphagia associated with TMJD.

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Dysphagia due to Physiological Constriction after Stroke: A Case Report

Minjoon BAE ; Inhyun KANG ; Yangrok HUR ; Kihun HWANG

Journal of the Korean Dysphagia Society.2021;11(2):143-146. doi:10.34160/jkds.2021.11.2.009

The aortic arch normally causes no symptomatic physiological constriction of the esophagus. Symptoms of dysphagia are generally observed in the presence of specific conditions, such as an aortic aneurysm. In the present case, during a videofluoroscopic swallowing study (VFSS), the authors incidentally found that despite the absence of an aortic lesion, the dysphagia observed in a stroke patient was caused by compression from the aortic arch. The patient complained of discomfort when swallowing, similar to a bolus lodged in the chest, which was consistent with compression by the aortic arch found on the VFSS and chest computed tomography (CT). After undergoing dysphagia therapy, the VFSS after 52 days revealed improved swallowing function; however, the sensation of food lodging in the chest due to compression by the aortic arch persisted. We conclude that although the physiological constriction of the esophagus by the aortic arch is usually asymptomatic, the constriction can be a factor that exacerbates the swallowing function in patients with dysphagia, and should therefore be considered during the differential diagnosis.

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Transoral Videolaryngoscopic Surgery for Pharyngeal Stenosis:Two Case Studies

Jangwook GWAK ; Yoon Se LEE

Journal of the Korean Dysphagia Society.2021;11(2):137-142. doi:10.34160/jkds.2021.11.2.008

Pharyngeal stenosis (PS) is an unwanted consequence of chemo-radiation treatment of pharyngeal carcinomas, or a rare complication of rheumatic diseases. We present two cases of PS treated with the novel use of transoral videolaryngoscopic surgery (TOVS). In the first case, a 63-year-old male presented with dysphagia due to PS after adjuvant chemo-radiation therapy. Laryngoscopy revealed fibrotic bands obstructing both pyriform sinuses. Impaired swallowing reflex and weak pharyngeal muscle during the pharyngeal phase were identified in VFSS. To secure the oropharyngeal space, the fibrotic band was removed using a monopolar cautery with TOVS. The second case involved a 49-year-old female afflicted with IgG4-related rheumatic disease who presented with dysphagia. A pharyngeal stricture between the epiglottis and adjacent lateral pharyngeal wall was accountable for stenosis of the oropharynx. Adhesiolysis around the pharyngeal aperture was performed during TOVS. In both cases, steroid was injected into the resection site to prevent subsequent adhesions. Both patients resumed oral intake of a soft meal the day after surgery, and eventually progressed to regular meals. Stable pharyngeal function was demonstrated after 2 months. No major complications from the surgery were observed in both cases. We propose that TOVS is a feasible surgical option to resolve and prevent PS, and the application of TOVS can potentially be expanded for oropharyngeal lesions.

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Reliability of Suprahyoid and Infrahyoid Electromyographic Measurements during Swallowing in Healthy Subjects

Myung Woo PARK ; Dongheon LEE ; Han Gil SEO ; Tai Ryoon HAN ; Jung Chan LEE ; Hee Chan KIM ; Byung-Mo OH

Journal of the Korean Dysphagia Society.2021;11(2):128-136. doi:10.34160/jkds.2021.11.2.007

Objective: To evaluate the reliability of suprahyoid and infrahyoid electromyography (EMG) measurement during swallowing. Methods: In all, 10 healthy volunteers were evaluated for the following surface EMG (sEMG) parameters in the suprahyoid and infrahyoid muscles during swallowing: onset latency, offset latency, duration, peak latency, maximal amplitude during swallowing, and the area under curve (AUC) of the rectified EMG signal. The sEMG was recorded while the participants swallowed five times each of the four fluid volumes (saliva, 2 ml, 5 ml, and 20 ml of water), totaling to 20 swallows. Moreover, the intra-participant variability per parameter was evaluated using the coefficient of variation (CV). Results: Suprahyoid muscles were activated 0.095 s (95% CI, 0.062-0.128) earlier than the infrahyoid muscles.Maximal amplitudes during the 20 ml swallow were 17.484 (−1.543-36.512) and 13.490 (1.254-25.727) μV higher than values obtained during the 2 ml swallow in the suprahyoid and infrahyoid muscles, respectively. Furthermore, the AUC of the rectified EMG signal increased with the volume of swallow in both muscle groups (P=0.003, suprahyoid; P＜0.002, infrahyoid). The intra-individual variabilities of offset latency, duration, and maximal amplitude were relatively low (＜30% CV) in both muscle groups with respect to other parameters. The assessment of each parameter using EMG was highly reliable, with an intraclass correlation coefficient of ＞0.8. Conclusion Among the variable sEMG parameters assessed, the offset latency, duration, and maximal amplitude were the least variable. Although reliability on the rater side showed good results, the swallow-to-swallow variability of the parameters need to be considered in swallowing studies using sEMG.

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Depression is Associated with Chewing and Swallowing Function among Elderly Vendors in a Conventional Market: A Preliminary Research

Hyo Jeong SONG ; Yong Taek YOON ; Sungjoon KIM ; Minhee YANG ; Moonju LEE

Journal of the Korean Dysphagia Society.2021;11(2):121-127. doi:10.34160/jkds.2021.11.2.006

Objective: This study aimed to investigate the level of chewing and swallowing function (CSF) and the factors related to CSF among elderly vendors in a conventional market. Methods: The cross-sectional study was conducted between August 10 through September 8, 2020, using a self-reporting questionnaire to collect data. The study sample comprised 61 elderly vendors aged 65 years and over, from a conventional market at Jeju-si. CSF was measured using the Questionnaire for Chewing and Swallowing Function of the elderly, and depression was assessed by applying the Center for Epidemiologic Studies Depression Scale. Results: Chewing and swallowing dysfunctions were reported by 34.4% of elderly vendors. CSF was significantly associated with the current smoking status (β=0.39, P=0.001) and depression (β=0.33, P=0.006). Conclusion These results indicate that current smoker and depression are significant factors affecting CSF. The factors determined in this study may be used in community health programs for preventing and managing chewing and swallowing dysfunction among the elderly vendors in a conventional market.

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Management and Treatment of Drooling: Focus on Non-Invasive Therapy for Children

Kyoung-chul MIN ; Sang-min SEO ; Hee-soon WOO

Journal of the Korean Dysphagia Society.2021;11(2):111-120. doi:10.34160/jkds.2021.11.2.005

Drooling is defined as the unintentional flow of saliva out of the mouth or to the back of the pharynx due to salivary control problems and swallowing difficulties. Drooling is caused by posture, oral sensori-motor and cognitive problems, and medical symptoms. Treatments of drooling are defined under two criteria: 1) non-invasive treatment, which includes posture and oral motor therapy, and 2) invasive treatment, including botox injection and surgery.Drooling treatment should be initiated non-invasively and in a step-wise manner in all individuals. This mode of treatment is safe, age-free, and is considered the first line of therapy, before subjecting to invasive treatment.Clinical professionals provide non-invasive treatment via manual approaches, through passive sensori-motor stimulation to active oral motor activities. Comprehensive therapy protocols such as oral motor facilitation technique (OMFT) for oral sensory normalization, head and neck postural control, and oral motor function improvements, are required to help control drooling. Clinical professionals therefore need to deeply understand the reason for drooling, and provide qualified non-invasive treatment for intensifying drooling control.

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Evaluation and Management of Dysphagia Based on Digital Health Technologies

Woo Hyung LEE

Journal of the Korean Dysphagia Society.2021;11(2):105-110. doi:10.34160/jkds.2021.11.2.004

The need for non-contact practice during the COVID-19 pandemic has resulted in a rapidly growing interest in digital health technologies (DHTs). Until recently, swallowing evaluations and treatments have been performed face-to-face in the field of dysphagia, which has now encountered huge challenges in the COVID-19 era. This review aims to provide an overview of the DHTs, and investigate the current research trends of DHTs applied to dysphagia evaluation and management. Previous studies on dysphagia using DHTs were reviewed based on four categories: data, machine learning, wearable sensors, and telemedicine. The reports are further discussed for their current limitations and future potentials. We conclude that clinical utility and regulations need to be considered in developing new methods of swallowing evaluation and management based on DHTs.

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Head and Neck Surgery for Dysphagia in the COVID-19 Era

Gene HUH ; Doh Young LEE

Journal of the Korean Dysphagia Society.2021;11(2):99-104. doi:10.34160/jkds.2021.11.2.003

Treatment of patients with dysphagia has become more complicated due to the worldwide COVID-19 pandemic. A surgical field involving the upper respiratory tract, and the aerosol-generating nature of the surgery implies a higher risk of infection transmission to the surgeon and operating theater (OT) staff. Thus, most guidelines released during the COVID-19 era recommend postponement of surgical treatment for these patients. The surgical treatment for dysphagia can be classified into procedures improving swallowing functions, procedures preventing aspiration, and tracheostomy to preserve the airways. Dysphagia surgeries that improve swallowing functions and prevent aspirations have a lower priority, and therefore, should be delayed until the risk of infection decreases. However, tracheostomy is considered a high priority regardless of the infection risk. As per our experience, a tracheostomy can be conducted safely following strict infection control measures, such as proper personal protective equipment, isolated surgical field, and sterilization of surgical equipment, etc. Other dysphagia surgeries may also be conducted safely if attempted under a strict protocol, although careful assessment of the patient status and the institutional situation should be carried out in advance.

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Assessment and Management of Dysphagia during the COVID-19Pandemic

Sung-Hwa KO

Journal of the Korean Dysphagia Society.2021;11(2):93-98. doi:10.34160/jkds.2021.11.2.002

Dysphagia is a complication seen in patients with coronavirus disease 2019 (COVID-19). Even in a COVID-19 pandemic situation, the management of dysphagia caused by other diseases as well as dysphagia-related COVID-19cannot be ignored. Because COVID-19 is transmitted via droplets, contact, and aerosol, there is fear of transmission to healthcare professionals. Due to this, it has not been possible to manage a COVID-19 dysphagia patient, in the same way as it was practiced prior to the COVID-19 pandemic. As a result, health professionals make a limited assessment of the patient with dysphagia. Healthcare professionals can use appropriate personal protective equipment to evaluate and treat a patient with COVID-19 associated dysphagia. Further, practice guidelines for dysphagia management should be established according to the presentation in different clinical situations and the status of the COVID-19 outbreak in various countries.

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The Pathologic Mechanisms and Epidemiology of Dysphagia Associated with COVID-19

Doo Young KIM

Journal of the Korean Dysphagia Society.2021;11(2):87-92. doi:10.34160/jkds.2021.11.2.001

Through the recent development and supply of COVID-19 vaccines, there is a growing interest in the management of post-treatment complications of survivors after infection, rather than the COVID-19 infection itself.Complications of COVID-19 include respiratory complications, cognitive dysfunction, central nervous system disorders, peripheral nerve disorders, critical-illness related myopathy and polyneuropathy, and dysphagia. However, there are insufficient studies on the pathologic mechanisms and epidemiology associated with COVID-19 and dysphagia. By examining similar coronavirus cases and direct cases, it has been proposed that the dysphagia arises due to damage to the central and peripheral nervous systems, critical-illness related myopathy and polyneuropathy related to intensive care unit management, and intubation damage. Understanding the epidemiology and pathological mechanisms of dysphagia that occur after COVID-19 will help prevent the affliction and manage the prognosis of high-risk patients.

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