Effects of chin-down maneuver on the parameters of swallowing function following esophagectomy with three-field lymphadenectomy examined by videofluoroscopy

Publication date: Available online 10 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yoshihiko Kumai, Naoya Yoshida, Yuta Kamenosono, Keigo Matsubara, Yasuhiro Samejima, Hideo Baba, Eiji Yumoto
ObjectivesThis study quantitatively determined the effect of the chin-down maneuver following esophagectomy with three-field lymphadenectomy (3FL) on pharyngeal residue, upper esophageal sphincter (UES) opening, and laryngeal closure.DesignProspective data were collected from a pharyngeal videofluoroscopic swallowing study.SettingDysphagia clinics at the ENT Department of Kumamoto University Hospital.ParticipantsA total 14 patients (mean age, 65.9 y) selected according to the inclusion criteria from a total of 43 patients who underwent esophagectomy with 3FL at the Department of Gastroenterological Surgery, Kumamoto University Hospital from May to December 2014 were enrolled.InterventionsVideoflurorscopy was conducted in head- neutral and chin-down positions to measure the pharyngeal constriction ratio (PCR), amount of residue in the vallecula and pyriform sinus after the first swallow, UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure.Main Outcome MeasuresThe above parameters were compared statistically, between the neutral and chin-down positions.ResultsIn comparison with the neutral group, the PCR and residue in the pyriform sinus were significantly smaller in the chin-down group (p < 0.01). However, the residue in the vallecula did not differ significantly from that of the neutral group (p = 0.44). The UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure were all significantly larger in the chin-down group than in the neutral group (p < 0.05).ConclusionThis study demonstrates that use of the chin-down maneuver after esophagectomy with 3FL can help expedite swallowing by strengthening pharyngeal constriction, widening the UES, and enhancing laryngeal closure.



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