Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan; Department of Gerodontology, Division of Gerontology and Gerodontology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):310-4. doi: 10.1016/j.jstrokecerebrovasdis.2013.02.019. Epub 2013 Mar 27.
Laterality of bolus passage in the pharynx is often seen in patients with medullary infarction. We evaluated the dominant side of bolus passage in the pharynx and investigated the factors that cause the passage to dominantly occur on the affected side. Forty-one patients (35 men and 6 women, 64 ± 9 years) with unilateral medullary infarction participated in this study. Bolus passage of 4 mL of thick liquid was evaluated in 3 regions (oropharyngeal, thyropharyngeal, and cricopharyngeal) and classified into 4 patterns (dominantly on the unaffected side [UAS], on both sides without clear laterality [BS], dominantly on the affected side [AS], and nonpassage of the bolus [NP]) by videofluoroscopic examination of swallowing. The bolus passages were as follows: UAS, BS, and AS occurred in 2, 32, and 7 patients in the oropharyngeal region; UAS, BS, and AS occurred in 5, 20, and 16 patients in the thyropharyngeal region; and UAS, BS, AS, and NP occurred in 11, 9, 10, and 11 patients in the cricopharyngeal region, respectively. In the thyropharyngeal region, the proportion of patients in whom the swallowing reflex occurred when the bolus was in the oropharynx and the proportion of patients with unilateral pharyngeal constrictor paralysis were greater in patients whose bolus passage was AS than in patients whose passage was BS. This suggests that the bolus predominantly passed through the affected side of the thyropharyngeal portion because of the asymmetry of pharyngeal contraction during swallowing in the early period after onset.
延髓梗死患者常可见到咽腔中食团的偏侧通过。我们评估了咽腔中食团通过的优势侧，并研究了导致食团优势通过患侧的因素。41 例单侧延髓梗死患者（男 35 例，女 6 例，64±9 岁）参与了本研究。通过吞咽的视频荧光透视检查，评估了 4 mL 稠液在 3 个区域（口咽、喉咽和环咽）的通过情况，并将通过情况分为 4 种模式（健侧优势通过[UAS]、双侧无明显偏侧性[BS]、患侧优势通过[AS]和食团无法通过[NP]）。在口咽区域，UAS、BS 和 AS 分别出现在 2、32 和 7 例患者中；在喉咽区域，UAS、BS 和 AS 分别出现在 5、20 和 16 例患者中；在环咽区域，UAS、BS、AS 和 NP 分别出现在 11、9、10 和 11 例患者中。在喉咽区域，食团在口咽时发生吞咽反射的患者比例和单侧咽缩肌麻痹的患者比例在 AS 患者中大于 BS 患者，这表明由于发病早期吞咽时咽收缩的不对称性，食团主要通过患侧的喉咽段。
