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Evaluation of Swallowing Using 320-detector-row Multislice CT. Part II: Kinematic Analysis of Laryngeal Closure during Normal Swallowing

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Abstract

The purpose of this study was to (1) depict normal dynamic swallowing and (2) measure (a) the temporal characteristics of three components of laryngeal closure, i.e., true vocal cord (TVC) closure, closure of the laryngeal vestibule at the arytenoid to epiglottic base, and epiglottic inversion, and (b) the temporal relationship between these levels of laryngeal closure and other swallowing events, hyoid elevation, and the pharyngoesophageal segment (PES) using 320-detector-row multislice computed tomography (320-MSCT). The swallowing of a 10-ml portion of honey-thick liquid (5% w/v) was examined in six healthy volunteers placed in a 45° reclining position. Three-dimensional CT images were created in 29 phases at an interval of 0.10 s over a 2.90-s duration. Dynamic swallowing and TVC movement were depicted clearly. The sequence for laryngeal closure was the following: (1) the hyoid started to elevate, (2) the PES opened, (3) TVC closure and closure at the arytenoid to epiglottic base occurred almost simultaneously during the hyoid elevation, and (4) the epiglottic maximum inversion occurred after the hyoid maximum displacement. Those results indicated that the onset of hyoid elevation and the early opening of the PES occurring before three levels of laryngeal closure are critical components for airway protection. 320-MSCT allowed the 3D depiction and kinematic analysis of target structures, which will increase our knowledge of airway protection mechanisms during swallowing.

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Acknowledgments

The authors thank Mr. Y. Ida and Mr. T. Nakai, Radiological Technologists at Fujita Health University hospital, for their invaluable assistance with the CT study. They also appreciate the valuable advice provided by Dr. Rebecca Z. German at the Department of Physical Medicine and Rehabilitation, Johns Hopkins University.

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Authors and Affiliations

  1. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Yoko Inamoto, Mikoto Baba & Sumiko Okada

  2. Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Naoko Fujii & Kazuhiro Katada

  3. Department of Rehabilitation, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Eiichi Saitoh, Yasunori Ozeki & Daisuke Kanamori

  4. Departments of Physical Medicine and Rehabilitation, Otolaryngology-Head and Neck Surgery, and Center for Functional Anatomy and Evolution, Johns Hopkins University, Baltimore, MD, 21287, USA

    Jeffrey B. Palmer

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  1. Yoko Inamoto
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  2. Naoko Fujii
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  3. Eiichi Saitoh
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  4. Mikoto Baba
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  5. Sumiko Okada
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  6. Kazuhiro Katada
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  7. Yasunori Ozeki
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  8. Daisuke Kanamori
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  9. Jeffrey B. Palmer
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Correspondence to Yoko Inamoto.

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Inamoto, Y., Fujii, N., Saitoh, E. et al. Evaluation of Swallowing Using 320-detector-row Multislice CT. Part II: Kinematic Analysis of Laryngeal Closure during Normal Swallowing. Dysphagia 26, 209–217 (2011). https://doi.org/10.1007/s00455-010-9276-2

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  • DOI: https://doi.org/10.1007/s00455-010-9276-2

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