Department of Surgical Sciences, Faculty of Medicine, School of Dentistry, University of Foggia, Italy.
Eur J Paediatr Dent. 2010 Sep;11(3):141-5.
Swallowing is a neuromuscular mechanism regulated by many nervous reflex arcs. Persistence of child swallowing at the end of dental eruption is called atypical swallowing (AS). This condition is related to a dysfunction of vertical maxillary growth called open bite. The authors treated this malocclusion with the Enveloppe Linguale Nocturne (ELN), or tongue positioner, created by Dr. Bonnet. The aim of this work is to evaluate the effect of ELN on swallowing and the postural variation obtained by its use.
Seven patients affected by AS were evaluated. Surface Electromyography (sEMG) testing was performed on each patient with different tongue positions, and swallowing was evaluated with and without the ELN. A surface Electromyograph (Biopack) with 8 channels was used (4 channels for the right muscles and 4 for the left) on 4 groups of muscles: temporals, masseters (MM), submental (SUB) and sternocleidmastoids. On each patient a postural test using a computerised Postural test (Lizard) was also performed. Statistical analysis was done using the Graph pad Instat 3 both for sEMG activity and for computerised postural analysis.
All seven subjects had different results in the sEMG and footrest tests. The sEMG test results indicated that muscle activation and swallowing duration varied greatly with the use of ELN, with a reduction of time of swallow act (p = 0.002) and variation in contraction of muscles. Mean MM activation was higher without ELN than in tests performed with the appliance (p = 0.002). Mean SUB activation was higher with than without ELN (p = 0.0033). ELN has a therapeutic effect on posture too. Computerised postural test without device showed in all patients an alteration of barycentre as well as an elevated oscillatory record (A mmq; V mms). With ELN footrest kilogram difference (p = 0.0110), Oscillatory Area (P = 0.0102) and velocity of oscillation (P = 0.0102) presented a great reduction in respect to patients record without ELN.
With ELN the tongue reaches the physiologic position during the swallowing and it is possible to have a low dental contact without tongue interference. ELN has no dental retention or contact. For this reason sEMG swallowing test shows that ELN induces a Mm activation reduction compared to swallowing test without ELN (P = 0.002) and an increase of SUB activation (P = 0.0033). In the same way with ELN there is a significant reduction of time of swallowing (c.f. oral phase) (P = 0.002). Patients with ELN changed their posture with a complete modification of barycentre (Footrest unbalancing kg P = 0.0110), oscillatory movement area (Footrest Area difference P = 0.0102), and oscillatory Velocity (Footrest Velocity oscillation difference P = 0.0102). These data suggest that this appliance has a function in the rehabilitation of atypical swallowing. ELN produces a physiologic neuromuscular mechanism that induces the correction of tongue position.
吞咽是一种受许多神经反射弧调节的神经肌肉机制。牙齿萌出结束时儿童持续吞咽称为非典型吞咽（AS）。这种情况与称为开颌的垂直上颌生长功能障碍有关。作者使用 Bonnet 博士发明的 Enveloppe Linguale Nocturne（ELN）或舌位器治疗这种错颌。本研究旨在评估 ELN 对吞咽和使用 ELN 获得的姿势变化的影响。
评估了 7 例 AS 患者。对每位患者进行不同舌位的表面肌电图（sEMG）测试，并在有无 ELN 的情况下评估吞咽。使用 8 通道生物包（Biopack）（右侧 4 个通道，左侧 4 个通道）对 4 组肌肉进行测试：颞肌、咬肌（MM）、颏下（SUB）和胸锁乳突肌。每位患者还使用计算机化姿势测试（Lizard）进行了姿势测试。使用 Graph pad Instat 3 对 sEMG 活动和计算机化姿势分析进行了统计分析。
所有 7 名受试者的 sEMG 和足部测试结果均不同。sEMG 测试结果表明，使用 ELN 时肌肉激活和吞咽持续时间差异很大，吞咽时间明显缩短（p = 0.002），肌肉收缩也发生变化。无 ELN 时 MM 平均激活率高于使用 ELN 时（p = 0.002）。SUB 的平均激活率高于有 ELN 时（p = 0.0033）。ELN 对姿势也有治疗作用。无装置的计算机化姿势测试显示，所有患者的重心均发生改变，且摆动记录升高（Ammq；V mms）。使用 ELN 后，足部测试的公斤差（p = 0.0110）、摆动面积（P = 0.0102）和摆动速度（P = 0.0102）均明显降低。
使用 ELN 时，舌头在吞咽过程中到达生理位置，并且可以在没有舌头干扰的情况下进行低牙接触。ELN 没有牙齿保留或接触。因此，与无 ELN 的吞咽测试相比，sEMG 吞咽测试显示 ELN 会导致 MM 激活减少（P = 0.002），SUB 激活增加（P = 0.0033）。同样，使用 ELN 时，吞咽时间明显缩短（口咽期）（P = 0.002）。使用 ELN 的患者改变了姿势，重心完全改变（足部不平衡公斤数 P = 0.0110）、摆动运动面积（足部测试面积差异 P = 0.0102）和摆动速度（足部测试速度摆动差异 P = 0.0102）。这些数据表明，该装置在非典型吞咽的康复中具有作用。ELN 产生一种生理性神经肌肉机制，可诱导舌位矫正。
