PDF(Pubmed)
Abstract：
Understanding the mechanisms underlying dysphagia is crucial in devising effective, etiology-centered interventions. However, current clinical assessment and treatment of dysphagia are still more symptom-focused due to our limited understanding of the sophisticated symptom-etiology associations causing swallowing disorders. This study aimed to elucidate the mechanisms giving rise to penetration flows into the laryngeal vestibule that results in aspirations with varying symptoms. Methods: Anatomically accurate, transparent throat models were prepared with a 45° down flapped epiglottis to simulate the instant of laryngeal closure during swallowing. Fluid bolus dynamics were visualized with fluorescent dye from lateral, rear, front, and endoscopic directions to capture key hydrodynamic features leading to aspiration. Three influencing factors, fluid consistency, liquid dispensing site, and dispensing speed, were systemically evaluated on their roles in liquid aspirations. Results: Three aspiration mechanisms were identified, with liquid bolus entering the airway through (a) the interarytenoid notch (notch overflow), (b) cuneiform tubercle recesses (recess overflow), and (c) off-edge flow underneath the epiglottis (off-edge capillary flow). Of the three factors considered, liquid viscosity has the most significant impact on aspiration rate, followed by the liquid dispensing site and the dispensing speed. Water had one order of magnitude higher aspiration risks than 1% w/v methyl cellulose solution, a mildly thick liquid. Anterior dispensing had higher chances for aspiration than posterior oropharyngeal dispensing for both liquids and dispensing speeds considered. The effects of dispending speed varied. A lower speed increased aspiration for anterior-dispensed liquids due to increased off-edge capillary flows, while it significantly reduced aspiration for posterior-dispensed liquids due to reduced notch overflows. Visualizing swallowing hydrodynamics from multiple orientations facilitates detailed site-specific inspections of aspiration mechanisms.
摘要：
了解吞咽困难的潜在机制对于设计有效的，以病因学为中心的干预措施。然而,由于我们对导致吞咽障碍的复杂症状-病因学关联的了解有限,目前对吞咽困难的临床评估和治疗仍更关注症状.这项研究旨在阐明导致渗透流入喉前庭的机制，从而导致具有不同症状的期望。方法:解剖学准确,用45°向下拍打的会厌制备透明的喉咙模型，以模拟吞咽过程中喉闭合的瞬间。流体推注动力学用荧光染料从侧面可视化，后部,前面,和内窥镜方向，以捕获导致抽吸的关键流体动力学特征。三个影响因素，流体稠度,液体分配部位，和分配速度，对它们在液体愿望中的作用进行了系统评估。结果：确定了三种抽吸机制，液体丸剂通过（a）软骨间凹口（凹口溢出）进入气道，(b)楔形文字结节凹陷(凹陷溢出)，和(c)会厌下方的离缘流(离缘毛细管流)。在考虑的三个因素中，液体粘度对抽吸速率的影响最大，其次是液体分配部位和分配速度。水的吸入风险比1%w/v甲基纤维素溶液高一个数量级。轻微粘稠的液体。考虑到液体和分配速度，前分配比后口咽分配具有更高的误吸机会。分散速度的影响各不相同。较低的速度增加了前分配液体的抽吸由于增加的边缘毛细管流动，同时由于减少了凹口溢出，因此显着减少了对后分配液体的抽吸。从多个方向可视化吞咽流体动力学有助于对抽吸机制进行详细的现场特定检查。
