objetivos: considerando a importância e a eficácia das faringoplastias como cirurgias reabilitadoras da fala e a importância dos aspectos anestésicos para um resultado cirúrgico adequado, este estudo objetiva documentar as intercorrências relativas às cirurgias de retalho faríngeo e seu possível envolvimento com os fatores anestésicos. Método: estudo retrospectivo e descritivo. Foram analisados 2679 prontuários de pacientes submetidos a faringoplastias, no Hospital de Reabilitação de Anomalias Craniofaciais- Universidade se São Paulo (HRAC-USP), entre 1980 e 2003. Foram selecionados os 2299 casos em que a técnica utilizada foi a do retalho faríngeo posterior e foram coletados parâmetros clínicos e sintomas sugestivos de complicações: permeabilidade de via aérea, sangramento, dor, náusea e vômito, agitação psicomotora, temperatura, pressão arterial e saturação de oxigênio. Resultados: dos 2299 procedimentos, 1042 apresentaram complicações. Vômito (16,31%) e dor (14,31%) foram as mais freqüentes. Complicações consideradas mais críticas, como obstrução de via aérea e hemorragia foram menos freqüentes, ocorrendo em 4,78% e 3,87% dos 2299 pacientes operados. As complicações mais críticas foram as determinantes da necessidade de reoperação no período pós-operatório precoce, ocorrendo em 39 pacientes. As menores chances de ocorrência de complicações foram verificadas com o anestésico inalatório sevoflurano, com o agente indutor propofol, com opióides na indução anestésica, com os analgésicos tramadol e nalbufina e com o antiemético ondansetron. Conclusão: houve associação entre medicações administradas na anestesia e ocorrência ou ausência de complicações no período pós-operatório precoce. O esquema medicamentoso, utilizado desde 1995, incluindo sevoflurano, propofol, opióides na indução, tramadol, nalbufina e ondansetron, é o que melhor atende às necessidades dos pacientes e anestesiologistas para cirurgia do retalho faríngeo, no HRAC-USP. / Objectives: considering the valuable and effectiveness of pharyngoplasty like surgical procedure designed to correct velopharyngeal dysfunction and the importance of anesthetic aspects in any surgery outcome, this study aimed to assess complications rates and a possible association with drugs used by anesthetist. Study design: we conducted a 23-year retrospective study at a tertiary craniofacial center: Hospital de Reabilitação de Anomalias Cranifaciais – Universidade de São Paulo (HRACUSP). Two thousand six hundred seventy nine patients charts between 1980 and 2003 were reviewed. Charts were selected when the posterior pharyngeal flap surgery was performed (2299 charts). Clinical parameters and symptoms linked to perioperative complications were collected: airway permeability, bleeding, pain, vomiting, agitation, temperature, arterial pressure and oxygen saturation. Results: from 2299 pharyngeal flaps, 1042 showed early postoperative complications. The most common complications were vomiting (16,31%) and pain (14,31%). Most critical complications were less frequent: airway obstruction occurred in 4,78% of all patients and bleeding occurred at a rate of 3,87%. Just 39 patients needed reoperation to control these critical complications. The best results with a low complications rate were achieved when anesthetist used sevoflurane, propofol, opioids in anesthesia induction, tramadol, nalbufine and ondansetron Conclusions: there was association between anesthetic drugs and early post operative complications. The drugs scheme (sevoflurane, propofol, opioids, tramadol, nalbufine, ondansetron) used by HRAC-USP anesthetists team since 1995 has been proved effective and appropriate.

OBJECTIVES: This retrospective cohort study tested the effect of Rapid Maxillary Expansion (RME) on symmetrical volumetric changes in the nasal cavity. Volumetric changes in overall nasal cavity, nasopharynx, and oropharynx were also assessed as well as minimum cross-sectional width changes and molar angulation in association with RME. METHODS: CBCT scans of before and after RME treatment for 28 subjects (17 females, 11 males, average age 9.85 ± 2.42 years) were collected from a previously de-identified database. All subjects were treated for maxillary constriction using banded hyrax expanders. Mimics software was utilized to segment the nasal and pharyngeal airways and create various compartments (left and right nasal cavity, nasopharynx, and oropharynx) for volumetric analysis. Minimum cross-sectional width measurements and maxillary first molar angulation were also assessed. Paired T-test was used to quantify the changes brought about by expansion. Statistical significance was set at the 0.05 level. RESULTS: Posterior expansion as measured between right and left greater palatine foramen (GPF) averaged 2.41 mm (SD = 1.03 mm). There were statistically significant differences in overall nasal cavity (2249.6 ± 2102.5 mm3), right nasal cavity (968.8 ± 1082.7), left nasal cavity (1197.3 ± 1587.0), nasopharyngeal (1000.6 ± 917.7), and oropharyngeal (2349.2 ± 2520.8) volumes. In comparing the right to left nasal cavity, no significant changes were noted for initial volume, post-expansion volume, or pre to post-expansion changes (T2-T1). For cross-sectional analysis, the right nasal cavity (0.13 ± 0.07 mm) and left nasal cavity (0.11 ± 0.06 mm) showed significant increases in minimum crosssectional width measurements. Initial maxillary molar angulation had no significant correlation to initial nasal cavity volume on either side. CONCLUSIONS: RME has significant benefits to increasing nasal and pharyngeal airway cavity volumes in all segments of the airway. Nasal cavity expands symmetrically. Minimum cross-sectional width of the left and right nasal cavities showed highly symmetrical improvements. Initial maxillary molar angulation has no relationship to initial nasal cavity volume.

Introdução: O primeiro e segundo arcos faríngeos contribuem com o desenvolvimento craniofacial e, interferências no desenvolvimento normal destas estruturas podem resultar em anomalias maxilar, mandibular e auricular. Hipoplasia de mandíbula, dermóide epibulbar e anomalias vertebrais são as características clínicas mais frequentes em associação com anomalias de orelha, resultando no grupo denominado espectro oculoauriculovertebral (EOAV). Trata-se de uma condição de etiologia heterogênea e complexa com grande variabilidade clínica. Objetivos: Investigar os sinais clínicos de uma amostra de indivíduos com diagnóstico de espectro oculoauriculovertebral; calcular a frequência dos sinais clínicos presentes nesses indivíduos e estabelecer possíveis associações entre os principais achados clínicos observados nos indivíduos da presente casuística. Indivíduos Estudados e Métodos: Estudo retrospectivo de 389 indivíduos com diagnóstico clínico de EOAV. O critério mínimo estabelecido para o estudo foi a presença de microtia isolada e/ou apêndice pré-auricular associados, ou não, à hipoplasia mandibular. Os resultados foram analisados por meio de estatística descritiva, utilizando as frequências absolutas (n) e relativas (%) e verificadas por meio do teste Qui-quadrado, com cálculo de odds ratio e intervalo de confiança. Resultados e Conclusão: Razão sexual 4M:3F; casos de recorrência, gemelaridade e consanguinidade foram observados em 15,56%, 3,85% e 2,22% da amostra, respectivamente. Intercorrências gestacionais foram relatadas por 15,09% das genitoras. Análise citogenética apontou 2 indivíduos com alteração estrutural e 2 indivíduos com alteração numérica. Frequências altas foram encontradas, principalmente, em assimetria facial (96,40%), hipoplasia do ramo mandibular (96,40%), microtia (87,40%), anomalia de coluna vertebral (77,17%), apêndice pré-auricular (60,41%), fissura Tessier 7 (31,62%), dermóide epibulbar (19,02%), fissura de lábio com ou sem palato (18,25%) e fissura de palato (15,42%). Envolvimento craniofacial bilateral foi observado em 48,82% e, unilateral, em 51,18%, estando o lado direito envolvido em 59,49% dos casos. Microtia do tipo III estava presente em 57,11% e do tipo II, em 36,01%. Dentre as anomalias estruturais de orelha média e/ou interna, o acometimento de orelha média foi o mais frequente, sendo observado em 27,91%. Em relação à deficiência auditiva, o tipo condutivo foi o mais frequente, encontrado em 70,42% das orelhas. Dentre as associações de achados clínicos realizadas, observou-se associação estatisticamente significativa entre fissura Tessier 7 e anomalia ocular (incluindo dermóide epibulbar); entre dermóide epibulbar e outras anomalias oculares; entre lateralidade da fissura de lábio com ou sem palato e acometimento craniofacial; entre anomalia de orelha média e microtia tipo III; entre anomalia de orelha interna e microtia tipo II; entre anomalia de orelha média e interna com microtia tipo III; e entre ausência de anomalia de orelha interna e/ou externa e ausência de microtia. Diante dos resultados obtidos, investigação sistemática por imagem de osso temporal, coluna vertebral, costelas e sistema cardíaco deve fazer parte do protocolo de avaliação dos indivíduos com EOAV. / Introduction: The first and second pharyngeal arches contribute to the craniofacial development, and any interference in the normal development of these structures can result in maxilar, mandibular and auricular anomalies. Mandibular hypoplasia, epibulbar dermoids, and vertebral anomalies are the most frequently clinical aspects associated with auricular anomaly, resulting in a condition defined as oculoauriculovertebral spectrum, which is a heterogeneous, variable and complex clinical condition. Objectives: Investigate the clinical findings of individuals with OAVS clinically diagnosed, calculate the frequency of the clinical findings presented in these individuals and establish possible associations among the main clinical findings observed in these series of individuals. Purpose and Methods: Retrospective study of the individuals with OAVS clinically diagnosed. The minimal criteria established for the study was the presence of isolated microtia and/or preauricular tags, associated or not associated with mandibular hypoplasia. The results were analyzed by means of descriptive analyzes, using the absolute (n), relative (%) frequency and verification by means of Qui-square test, with odds ratio calculation and trust interval. Results and Conclusion: Sex ratio 4M:3F; cases of familial recurrence, twinning and consanguinity were observed at 15.56%, 3.85% and 2.22% of the sample, respectively. Pregnancy complications were reported by 15.09% of the mothers. Cytogenetic analysis showed two individuals with structrural anomaly and two with numerical alterations. High frequences were observed mainly in facial asymmetry (96.40%), mandibular hypoplasia (96.40%), microtia (87.40%), vertebral anomalies (77.17%), preauricular tags (60.41%), Tessier 7 cleft (31.62%), epibulbar dermoid (19.02%), cleft lip and/or cleft palate (18.25%), and cleft palate (15.42%). Bilateral craniofacial involvement was observed in 48.82% and unilateral in 51.18%. The right side was involved in 59.49% of the cases. Microtia type III was observed in 57.11% of the ears and type II in 36.01%. Among the structural abnormalities of the middle and/or internal ear, the involvement of middle ear was the most frequent, being observed in 27.91%, regarding that the hearing loss of the conductive type was the most frequent, observed in 70.42% of the ears. Among the clinical associations performed, there was a statistically significant association between Tessier 7 cleft and eye abnormalities (including dermoid epibulbar); between epibulbar dermoid and other eye abnormalities; between the lateral cleft lip with or without palate and craniofacial involvement; between middle ear anomaly and microtia type III; between inner ear anomaly and microtia type II; between middle and inner ear anomaly with microtia type III; and between absence of inner and/or external ear anomaly and absence of microtia. Based on these results, systematic investigation by image of temporal bone, spine, ribs and heart system should be part of the evaluation protocol of individuals with OAVS.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-05-17Bitstream added on 2014-06-13T20:28:22Z : No. of bitstreams: 1 cola_pc_me_botfm.pdf: 756192 bytes, checksum: cfc7c96b2f22ee653b211037fae8901d (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A influência do sabor e da temperatura sobre a deglutição normal e patológica tem sido bastante estudada nas últimas décadas. No entanto, persistem questões a serem solucionadas, incluindo a lateralização hemisférica das lesões. O papel do sabor com e sem a mudança de temperatura em indivíduos disfágicos ainda não é totalmente esclarecido. Este estudo tem por objetivo verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito faríngeo da deglutição em indivíduos após acidente vascular encefálico (AVE) hemisférico isquêmico. Participaram deste estudo 30 indivíduos adultos, 15 com lesão à direita e 15 com lesão à esquerda, sendo que 16 eram do gênero masculino e 14 do gênero feminino, destros, com faixa etária variando de 41 a 88 anos (média de 62,3 anos) com ictus que variou de 1 a 30 dias (mediana de 6 dias). Para analisar o tempo de trânsito faríngeo da deglutição foi realizado o exame de videofluoroscopia da deglutição. Cada indivíduo foi observado durante a deglutição de bolo na consistência pastosa, oferecido em colher, com 5 ml cada, sendo ao todo 4 estímulos diferentes, um por vez, na seguinte ordem: natural, gelado, azedo e azedo gelado. Posteriormente as imagens foram digitalizadas e foi realizada através de software a medição do tempo de deslocamento do bolo pela fase faríngea. Os resultados mostraram que o tempo de trânsito faríngeo da deglutição foi significativamente menor ao deglutir o bolo com estímulo azedo gelado quando comparado aos outros estímulos. Concluindo-se, portanto, que os estímulos sabor azedo e temperatura fria concomitantes provocam mudanças na dinâmica da deglutição e podem proporcionar efeitos positivos em indivíduos com disfagia orofaríngea. / Over the past decade there were many studies over normal and pathological swallowing that discuss the influence of taste and temperature. Nevertheless there were many questions on the issue that remains to be solved, including the hemispheric lateralization of lesions dysphagic patients remains also to be fully understood. The objective is to establish the effect of sour taste and cold temperature on the pharyngeal swallowing transit time after ischemic hemisphere stroke. It was analyzed 30 patients, 15 subjects have right lesion and 15 at the left side, 16 male and 14 females with age range between 41 and 88 years old. The data were recorded one to 30 days after the ictus (median 6). Videofluoroscopy with specific software developed to measure the time of oral and pharyngeal transit was applied in patients each of them receiving 5 ml of paste bolus, including natural, cold, sour and cold sour, in this order. The results show that the time of pharyngeal transit bolus was significantly lower with sour taste compared with other kind of stimulus. The author concluded that sour taste with concomitant cold temperature shows influence over swallowing dynamics and may have benefic effects to patients with oropharyngeal dysphagia.

The cell surface is an active area where extracellular molecules meet their receptors and affect the cellular fate by inducing for example cell proliferation and adhesion. Syndecans and integrins are two transmembrane molecules that have been suggested to fine-tune these activities, possibly in cooperation. Syndecans are proteoglycans, i.e. proteins with specific types of carbohydrate chains attached. These chains are glycosaminoglycans and either heparan sulfate (HS) or chondroitin sulfate (CS). Syndecans are known to influence cell adhesion and signaling. Integrins in turn, are important adhesion molecules that connect the extracellular matrix with the cytoskeleton, and hence can regulate cell motility. In an attempt to study how the two types of glycosaminoglycans attached to syndecan-1 can interact with integrins, a cell based model system was used and functional motility assays were performed. The results showed that HS, but not CS, on the cell surface was capable of regulating integrin-mediated cell motility. Regulation of intracellular signaling is crucial to prevent abnormal cellular behavior. In the second part of this thesis, the aim was to see how the presentation of glycosaminoglycan chains to the FGF signaling complex could affect the cellular response. When attached to the plasma membrane via syndecan-1, CS chains could support the intracellular signaling, although not promoting as strong signals as HS. When glycosaminoglycans were attached to free ectodomains of syndecan-1, both types of chains sequestered FGF2 from the receptors to the same extent, pointing towards functional overlap between CS and HS. To further study the interplay between HS and CS, their roles in the formation of pharyngeal cartilage in zebrafish were established. HS was important during chondrocyte intercalation and CS in the formation of the surrounding extracellular matrix. Further, the balance between the biosynthetic enzymes determined the ratio of HS and CS, and HS biosynthesis was prioritized over CS biosynthesis. The results presented in this thesis provide further insight into the regulation of HS biosynthesis, as well as the roles of both HS and CS on the cell surface. It is evident, that in certain situations there is a strict requirement for a certain HS structure, albeit in other situations there is a functional overlap between HS and CS.

Velofarynxinsufficiens (VPI) innebär en otillräcklig förmåga att stänga passagen mellan mun- och näshåla. En ofullständig slutning får konsekvenser framför allt för talet, då luft passerar genom näsan även vid orala språkljud och leder till en avvikande talklang och artikulation. Dessa avvikelser kan vara mer eller mindre framträdande i talet och innebära allt ifrån en lätt förvrängning av talklangen till att talet blir oförståeligt för omgivningen, vilket får allvarliga konsekvenser för möjligheten att kommunicera verbalt.   VPI kan behandlas på flera sätt, dels protetiskt, dels med kirurgi. Deltagarna i denna studie har alla genomgått operation med uppåtbaserad farynxlambå, som är en väldokumenterad och effektiv metod för att behandla VPI. En vanligt förekommande biverkning till operationen är luftvägshinder, exempelvis nästäppa, snarkning och sömnapné.    Syftet med studien var att undersöka deltagarnas egen uppfattning om operationsresultatet gällande tal och biverkningar, med hjälp av en enkät för självskattning. 61 patienter opererade med uppåtbaserad svalglambå under perioden 2000-2011 vid Akademiska Sjukhuset i Uppsala deltog i studien. Deltagarna delades in i tre undergrupper utifrån etiologi: deltagare med spalt (n  =  35), deltagare med spalt och syndrom (n  =  13), samt deltagare utan spalt (n  =  13).   Resultat: 55 av 61 deltagare (90  %) ansåg att operationen förbättrade deras tal. 49 av 61 deltagare (80  %) skulle dessutom rekommendera operationen till någon annan med samma besvär. 42 av 61 deltagare (68,8  %) uppgav att de är nöjda med sitt tal. Kvarstående biverkningar som rapporterades var nästäppa, snarkning, dagtrötthet och muntorrhet. Deltagarna upplevde dock dessa biverkningar i liten grad. Ingen tydlig skillnad sågs mellan de olika patientgrupperna. / Velopharyngeal insufficiency (VPI) is the inability to completely close the velopharyngeal port. Velopharyngeal closure is an important part of speech. VPI leads to a leakage of air into the nasal cavity during speech, which can cause hypernasal resonance and misarticulations. The effect of VPI on speech differs depending on the nature of the insufficiency. It can affect speech intelligibility severely.   VPI can be treated prosthetically or surgically. The patients in this study have all undergone pharyngeal flap surgery; a well established surgical method with documented effect in correcting VPI and reducing hypernasality in speech. Pharyngeal flap surgery can have negative consequences, such as airway obstruction, sleep apnea and snoring.   The aim of this study was to investigate the patients experiences of speech, complications and side-effects after pharyngeal flap surgery, through self-reports. 61 patients who underwent superior pharyngeal flap surgery during the period 2000 to 2011 at Uppsala University Hospital participated in the study. They were divided into three sub-groups: patients with cleft (n  =  35), patients with cleft and syndrome (n  =  13), patients without cleft (n  =  13).   Result: 55 of 61 participants (90 %) were of the opinion that the pharyngeal flap surgery had improved their speech. 49 of 61 participants (80 %) said they would recommend someone else with the same problem to undergo the operation. 42 of 61 participants (68,8 %) were content with their speech. Reported residual side effects, though experienced in low degree, were nasal congestion, snoring, weariness during daytime and dry mouth. No evident difference was seen between the sub-groups.

Schlucken ist ein lebensnotwendiger Prozess, dessen Diagnose und Therapie eine enorme Herausforderung bedeutet. Die Erkennung und Beurteilung von Schlucken und Schluckstörungen erfordert den Einsatz von technisch aufwendigen Verfahren, wie Videofluoroskopie (VFSS) und fiberoptisch-endoskopische Schluckuntersuchung (FEES), die eine hohe Belastung für die Patienten darstellen. Beide Verfahren werden als Goldstandard in der Diagnostik von Schluckstörungen eingesetzt. Die Durchführung obliegt in der Regel ärztlichem Personal. Darüber hinaus erfordert die Auswertung des Bildmaterials der Diagnostik eine ausreichend hohe Erfahrung. In der Therapie findet neben den klassischen Therapiemethoden, wie z.B. diätetische Modifikationen und Schluckmanöver, auch zunehmend die funktionelle Elektrostimulation Anwendung. Ziel der vorliegenden Dissertationsschrift ist die Evaluation eines im Verbundprojekt BigDysPro entwickelten Bioimpedanz (BI)- und Elektromyographie (EMG)-Messsystems. Es wurde geprüft, ob sich das BI- und EMG-Messsystem eignet, sowohl in der Diagnostik als auch in der Therapie als eigenständiges Messsystem und im Rahmen einer Schluckneuroprothese eingesetzt zu werden. In verschiedenen Studien wurden gesunde Probanden für die Überprüfung der Reproduzierbarkeit (Intra-und Interrater-Reliabilität), der Unterscheidbarkeit von Schluck- und Kopfbewegungen und der Beeinflussung der Biosignale (BI, EMG) durch verschiedene Faktoren (Geschlecht der Probanden, Leitfähigkeit, Konsistenz und Menge der Nahrung) untersucht. Durch zusätzliche Untersuchungen mit Patienten wurde einerseits der Einfluss der Elektrodenart geprüft. Andererseits wurden parallel zur BI- und EMG-Messung auch endoskopische (FEES) und radiologische Schluckuntersuchungen (VFSS) durchgeführt, um die Korrelation der Biosignale mit der Bewegung anatomischer Strukturen (VFSS) und mit der Schluckqualität (FEES) zu prüfen. Es wurden 31 gesunde Probanden mit 1819 Schlucken und 60 Patienten mit 715 Schlucken untersucht. Die Messkurven zeigten einen typischen, reproduzierbaren Signalverlauf, der mit anatomischen und funktionellen Änderungen während der pharyngalen Schluckphase in der VFSS korrelierte (r > 0,7). Aus dem Bioimpedanzsignal konnten Merkmale extrahiert werden, die mit physiologischen Merkmalen eines Schluckes, wie verzögerter laryngealer Verschluss und Kehlkopfhebung, korrelierten und eine Einschätzung der Schluckqualität in Übereinstimmung mit der FEES ermöglichten. In den Signalverläufen der Biosignale konnten signifikante Unterschiede zwischen Schluck- und Kopfbewegungen und den Nahrungsmengen und -konsistenzen nachgewiesen werden. Im Gegensatz zur Nahrungsmenge und -konsistenz zeigte die Leitfähigkeit der zu schluckenden Nahrung, das Geschlecht der Probanden und die Art der Elektroden keinen signifikanten Einfluss auf die Messsignale. Mit den Ergebnissen der Evaluation konnte gezeigt werden, dass mit dem BI- und EMG-Messsystem ein neuartiges und nicht-invasives Verfahren zur Verfügung steht, das eine reproduzierbare Darstellung der pharyngalen Schluckphase und ihrer Veränderungen ermöglicht. Daraus ergeben sich vielseitige Einsatzmöglichkeiten in der Diagnostik, z.B. Langzeitmessung zur Schluckfrequenz und Einschätzung der Schluckqualität, und in der Therapie, z.B. der Einsatz in einer Schluckneuroprothese oder als Biofeedback zur Darstellung des Schluckes, von Schluckstörungen. / Swallowing is a vital process. Its diagnosis and therapy represent enourmous medical challenges. The detection and assessment of swallows and swallowing disorders require elaborate techniques such as videofluoroscopy (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES), which entail a high burden for the patient. Both methods are currently used as a goldstandard in the diagnosis and therapy of swallowing disorders. The measurements must, in general, be performed and evaluated by experienced medical personnel. In therapy, dietary modifications and swallowing maneuvers are common methods. But also functional electrical stimulation (FES) is increasingly used. The goal of this doctoral thesis was the evaluation of the combined bioimpedance (BI) and electromyography (EMG) measurement system that was developed within the research project BigDysPro. In particular, it should be examined whether the system can be used in the diagnosis and therapy of swallowing disorders as an independent measurement system and in the context of a swallowing neuroprosthesis. Several studies were conducted with healthy subjects to assess the reproducibility of the measurements, the distinction of swallowing from head movements, and the influence of different factors (i.e. the subject's gender as well as amount, consistency, and conductivity of the food) on the bioimpedance and electromyography. In additional experiments with patients, the influence of the electrode type, i.e. surface vs. needle electrodes, was examined. Furthermore, patients were examined with FEES and VFSS in parallel measurements with the new system. Thereby, the correlation of the BI and EMG signals with movements of anatomical structures (VFSS) and with the swallowing quality (FEES) was assessed. In these studies, 31 healthy subjects with 1819 swallows and 60 patients with 715 swallows were examined. The measured signals show a typical, reproducable run of the curve, that correlates with the anatomical and functional alterations observed by videofluoroscopy during the pharyngeal phase of swallowing (r > 0, 7). From the curve of the bioimpedance, features were extracted to assess the quality of swallowing. These features were demonstrated to correlate with physiological phenomena, such as delayed laryngeal closure and larynx elevation. Therefore, they were used to assess the swallow quality in accordance with fiberoptic endoscopic examination of swallowing. Significant differences were found in the measurement signals of swallows and head movements, as well as in the signals from different food amounts and consistencies. In contrast, the conductivity of the food, the gender of the subjects, and the type of electrodes had no significant effect on the curve of the bioimpedance and the electromyography. From the results of the evaluation, it is concluded that the combined bioimpedance and electromyography measurement system represents a novel, non-invasive tool. It enables the reproducible assessment of the pharyngeal phase of swallowing. In diagnosis, the system might be used, e.g., in long-time measurements for the assessment of swallowing frequency and quality. In therapy, the method can be implemented in a swallowing neuroprosthesis or might be used in a biofeedback system.

Background and Aims The accurate differentiation between a delayed pharyngeal swallow (sensory impairment) and premature spillage secondary to poor oro-lingual control (motor impairment) is essential to effective dysphagia management. However both physiologic abnormalities result in an identical radiographic sign, that of pre-swallow pooling of the bolus in the pharynx. The dysphagia literature does not provide satisfactory guidelines for making this distinction on videofluoroscopy. The purpose of this study was to assess the validity of a three-part rating scale for differentiating between these two impairments. Methods Videofluoroscopy was used to evaluate the swallowing of 29 participants presenting with dysphagia following stroke. Sensory thresholds for these participants were established by electrical stimulation of the anterior faucial pillars. The videofluoroscopic swallowing studies were analysed using the three-part rating scale and results from this were compared to sensory thresholds using Pearson's product moment correlation. Results There was no significant correlation between the three-part criteria and sensory thresholds. Inter-rater reliability for some measures was poor. Conclusions The three-part criteria was not shown to be a valid measure for differentiating between delayed pharyngeal swallow and premature spillage secondary to poor oro-lingual control. Possible explanations for these findings are discussed, including the relevance of faucial pillar sensation to swallowing.

Orientador: Roberta Gonçalves da Silva / Coorientador: Célia Maria Giacheti / Coorientador: Paula Cristina Cola / Banca: Dionísia Aparecida Cusin Lamônica / Banca: Larissa Cristina Berti / Resumo: As alterações nas funções orofaciais encontradas em indivíduos com síndromes genéticas pouco têm sido estudadas. Com relação as alterações na biomecânica da deglutição orofaríngea, os estudos utilizaram com maior frequência procedimentos qualitativos para a avaliação, não encontrando-se trabalhos que tenham realizado análise quantitativa desta função orofacial por meio de software. Diante da escassez da literatura, este estudo teve por objetivo mensurar o tempo de trânsito oral e faríngeo da deglutição em indivíduos com diagnóstico de síndrome genética. Foram inclusos neste estudo 14 indivíduos com diagnóstico genético distinto, com diagnóstico genético confirmado por meio clínico ou laboratorial, idade variando de 2 meses a 7 anos. A análise do tempo de trânsito oral (TTO) e tempo de trânsito faríngeo (TTF) foi realizada com uso de software proposto por Spadotto et AL. (2008). Foram encontradas alterações nos TTO e TTF da população estudas, que podem ser atribuídas à presença de alterações estruturais no esqueleto miofuncional, bem como às dificuldades de controle neuromotor da deglutição que encontram-se alteradas na casuística do presente estudo. Conclui-se que a alteração no TTO e TTF faz parte do fenótipo das síndromes genéticas. / Abstract: The changes in orofacial functions found in individuals with genetic disease have not been thoroughly studied. In relation to the oropharyngeal deglutition biomechanic, the studies frequently utilized qualitative procedures to the evaluation, and it were not found studies which have performed quantitative analysis by software. This study aimed to measure the oral and pharyngeal transit time (OTT and PTT) in genetic syndromes. Participated these study 14 subjects with genetic diagnosis and swallowing or food complaints. The analysis of oral transit time and pharyngeal transit time are performed using specific software. It was verified, both liquid and paste, the OTT and PTT, showed different levels in oral and pharyngeal transit. It is concluded that the change in OTT and PTT can be part of the phenotype of the genetic syndromes. Therefore, it is necessary the specific evaluation of swallowing in this population. However, is necessary to investigate larger samples and more homogeneous in order to better understand the reasons for the changes in the oropharyngeal transit in different population with genetic syndromes. / Mestre

Made available in DSpace on 2014-06-11T19:24:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-04-26Bitstream added on 2014-06-13T20:27:06Z : No. of bitstreams: 1 sales_avmn_me_mar.pdf: 631470 bytes, checksum: c7b8fbdcb8f9da554f1898bc60491c06 (MD5) / As alterações nas funções orofaciais encontradas em indivíduos com síndromes genéticas pouco têm sido estudadas. Com relação as alterações na biomecânica da deglutição orofaríngea, os estudos utilizaram com maior frequência procedimentos qualitativos para a avaliação, não encontrando-se trabalhos que tenham realizado análise quantitativa desta função orofacial por meio de software. Diante da escassez da literatura, este estudo teve por objetivo mensurar o tempo de trânsito oral e faríngeo da deglutição em indivíduos com diagnóstico de síndrome genética. Foram inclusos neste estudo 14 indivíduos com diagnóstico genético distinto, com diagnóstico genético confirmado por meio clínico ou laboratorial, idade variando de 2 meses a 7 anos. A análise do tempo de trânsito oral (TTO) e tempo de trânsito faríngeo (TTF) foi realizada com uso de software proposto por Spadotto et AL. (2008). Foram encontradas alterações nos TTO e TTF da população estudas, que podem ser atribuídas à presença de alterações estruturais no esqueleto miofuncional, bem como às dificuldades de controle neuromotor da deglutição que encontram-se alteradas na casuística do presente estudo. Conclui-se que a alteração no TTO e TTF faz parte do fenótipo das síndromes genéticas. / The changes in orofacial functions found in individuals with genetic disease have not been thoroughly studied. In relation to the oropharyngeal deglutition biomechanic, the studies frequently utilized qualitative procedures to the evaluation, and it were not found studies which have performed quantitative analysis by software. This study aimed to measure the oral and pharyngeal transit time (OTT and PTT) in genetic syndromes. Participated these study 14 subjects with genetic diagnosis and swallowing or food complaints. The analysis of oral transit time and pharyngeal transit time are performed using specific software. It was verified, both liquid and paste, the OTT and PTT, showed different levels in oral and pharyngeal transit. It is concluded that the change in OTT and PTT can be part of the phenotype of the genetic syndromes. Therefore, it is necessary the specific evaluation of swallowing in this population. However, is necessary to investigate larger samples and more homogeneous in order to better understand the reasons for the changes in the oropharyngeal transit in different population with genetic syndromes.