Radiotherapy for hyoid bone metastasis from lung adenocarcinoma:A case report

BACKGROUND Metastasis to the hyoid bone is an exceptionally rare occurrence,with documented cases limited to breast,liver,colon,skin,lung,and prostate cancers.This report highlights an unusual case involving the metastasis of lung adenocarcinoma to the hyoid bone,accompanied by a distinctive headache.Previous documentation involved surgical resection of the hyoid mass.We present a case displaying the benefits of palliative radiotherapy.CASE SUMMARY A 72-year-old non-smoking,non-alcoholic woman,initially under investigation for a year-long elevation in absolute lymphocyte count,presented with a monthlong history of intermittent throat pain.Despite negative findings in gastroenterological and otolaryngologic examinations,a contrast-enhanced chest computed tomography scan revealed a mediastinal mass and questionable soft tissue thickening in her left anterolateral neck.Subsequent imaging and biopsies confirmed the presence of lung adenocarcinoma metastasis to the hyoid bone.The patient was treated with platinum-based chemo-immunotherapy along with pembrolizumab.Ultimately,the lung cancer was unresponsive.Our patient opted for palliative radiation therapy instead of surgical resection to address her throat pain.As a result,her throat pain was alleviated,and it also incidentally resolved her chronic headaches.This is the second documented case of lung adenocarcinoma metastasizing to the hyoid bone.CONCLUSION Palliative radiotherapy may add to the quality of life in symptomatic patients with cancer metastatic to the hyoid bone.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction

Objective: Laryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection. Methods: Four patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated. Results: The four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months. Conclusion: The combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy.

Solitary hyoid plasmacytoma with unicentric Castleman disease:A case report and review of literature

BACKGROUND Solitary plasmacytoma and unicentric Castleman disease(UCD)are rare lymphoproliferative disorders characterized by monoclonal plasma cells and a single set of locally enlarged lymph nodes,respectively.CASE SUMMARY A 48-year-old Han Chinese man presented to our department with a neck mass and progressive foreign body sensation in his throat.18F-FDG positron emission tomography revealed focally increased radioactivity centered around the hyoid,and computed tomography(CT)revealed osteolytic lesions.Histopathology revealed Castleman-like features and CD138/CD38-positive mature plasma cells.Systemic work-up ruled out the possibility of POEMS syndrome,lymphoma,and multiple myeloma,leading to a final diagnosis of solitary hyoid plasmacytoma with UCD.The patient underwent partial hyoid resection and selective neck dissection,followed by intensity-modulated radiotherapy.99mTc-MDP singlephoton emission computed tomography/CT reevaluation showed neither local recurrence nor distant bone metastasis at the 40-mo follow-up.CONCLUSION The diagnostic process and differential diagnosis of this rare case provided valuable educational information to clinicians.

Hyoid Bone Position as an Etiological Factor in Mandibular Divergence and Morphology

Objectives: The objective is to determine whether there are differences in the position of the hyoid bone at rest in natural head position in subjects with mandibular hyperdivergence and to evaluate whether there are differences in hyoid position and antegonial notch depth in mandibular hyperdivergent males and females. Methods and Materials: This is a retrospective cohort study involving a review of lateral cephalometric radiographs of 45 adult men and women with mandibular hyperdivergency. Hyperdivergency was determined by cephalometric ranges of: SN-GoGn as least +2 SD from normal, Y-axis, PP-GoGN, and gonial angle greater than +1SD from normal. A group of 45 normodivergent adults served as a control, with cephalometric ranges of: SN-GoGn within ±1 SD of normal, with only one measurement of the other three between +1 and +1.5 standard deviations. A custom digital cephalometric analysis, the Hyoid Analysis, was designed, to measure the vertical and horizontal position and inclination of the hyoid and the antegonial notch depth. Results: In hyperdivergent subjects, the posterior aspect of the hyoid is located lower and more posterior, compared to the control group, while there is no difference in position of the anterior surface of the hyoid and the antegonial notch is 0.6 mm deeper. In males, the posterior aspect of hyoid is lower by 8.5 mm, while the anterior surface is located 9.0 mm lower. In males, the hyoid is inclined more steeply than in females by 4.4 degrees and the antegonial notch is deeper than in females by 0.6 mm. Conclusions: There are differences in hyoid bone position and mandibular morphology in hyperdivergent subjects compared to normodivergent subjects and in males compared to females.

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome:Two case reports

BACKGROUND A swallowing disorder may occur following a brainstem stroke,especially one that occurs in the swallowing centers.Lateral medullary syndrome(referred to as LMS),a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery,has been reported to lead to more severe and longer lasting dysphagia.CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique(known as HEST).The two patients had no other functional incapacity back into life,but nasogastric feeding was the only possible way for nutrition because of severe aspirations.Swallowing function was evaluated by functional oral intake scale,modified water swallow test,surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration,pharyngeal residue,pharyngeal peristalsis,upper esophageal opening and the ability of deglutition.Both patients were treated with the HEST method for dysphagia and recovered quickly.CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.

Hyoid myotomy and suspension without simultaneous palate or tongue base surgery for obstructive sleep apnea

Objective:Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA).Method:Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic.Those who underwent concurrent palatal or tongue base sleep surgery were excluded.Outcomes included simultaneous procedures,apnea-hypopnea index (AHI),lowest oxyhemoglobin saturation (LSAT),and Epworth Sleepiness Scale (ESS).Results:Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery.The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71％).Concurrent procedures included the following:torus mandibularis excision (n =1),endoscopic sinus surgery (n =4),septoplasty (n =10),inferior turbinate reduction (n =12),and nasal valve repair (n =2).AHI improved signiflcantly from (39.7 ± 21.2) eventslh to (22.6 ± 22.7) events/h after HMS (P ＜ 0.01),which represented a 43％ reduction.LSAT significantly increased from (82.2％ ± 9.9％) to (86.6％ ± 6.2％),P ＜ 0.01.There was no improvement in ESS after surgery (8.2 ± 4.4) to (8.3 ± 5.2),P =0.904.A subset of patients with severe OSA (AHI ＞ 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h,P ＜ 0.01.Conclusion:HMS without palatal or tongue base sleep surgery improves OSA severity.It can be considered as a valid option in the treatment of OSA in appropriately-selected patients.

Effect and Safety of Tongyan Spray(通咽喷雾剂)on Hyoid Motion in Patients with Dysphagia after Ischemic Stroke

Objective:To observe the effects and safety of Tongyan Spray(通咽喷雾剂)on the range and time of hyoid motion in patients with ischemic post-stroke dysphagia.Methods:Seventy-two patients with ischemic post-stroke dysphagia were selected and randomly assigned to a treatment group(36 cases)and a control group(36 cases)by a random number table from January 2013 to October 2014.All patients swallowed 4 kinds of barium meals with different traits respectively,and each patient underwent video fluoroscopy(VF)examination twice.In the treatment group,Tongyan Spray was sprayed to the pharynx on both sides and the middle part once respectively.The spray was applied 30 min before the second examination.Purified water at room temperature was used as placebo in the control group.The changes in the range and time of hyoid motion in both groups were observed before and after treatment.Results:Six patients dropped out in each group,and 60 patients completed the study and were included in the final analysis.Significant improvement was observed in the range of superior hyoid excursion distance and the time of hyoid motion in the treatment group compared with the control group(P<0.05).There were no obvious adverse reactions observed in oral mucosa in both groups during the whole study.Conclusion:Tongyan Spray was an effective and safe medicine for improving swallowing function in patients with ischemic post-stroke dysphagia.

阻塞性睡眠呼吸暂停综合征患儿面部形态和舌骨位置的头影测量研究

目的分析阻塞性睡眠呼吸暂停综合征(OSAS)患儿面部形态和舌骨位置的头影测量指标结果。方法随机选取78例OSAS患儿纳入OSAS组,另选取未接受过耳鼻喉科、正畸或语言治疗的78名健康体检儿童纳入健康对照组。2组儿童均接受耳鼻喉科评估和头影测量,且OSAS组患儿接受夜间多导睡眠描记(PSG)检查。结果面部头影测量结果显示,OSAS组面部前高度(N-Me)、面部前下高度(ANS-Me)均高于健康对照组,差异有统计学意义(P<0.05);OSAS组面部上前高度(N-ANS)、面部后部总高度(S-Go)与健康对照组比较,差异无统计学意义(P>0.05)。舌骨测量结果显示,OSAS组舌骨点至下颌平面的垂直距离(HyS)、舌骨体之最前上方至第三颈椎之最前下点的线性距离(C3-H)、舌骨最前点(Dh-H)、舌骨最前点至腭平面的垂直距离(HyMP)、舌骨最后点(Dv-H)均大于健康对照组,差异有统计学意义(P<0.05)。结论相较于健康儿童,OSAS患儿面部生长发育存在明显变化,表现为N-Me和ANS-Me增加,HyS、C3-H、HyMP、Dh-H、Dv-H增加。

项针联合吞咽功能障碍治疗仪治疗脑梗死后吞咽功能障碍的临床观察

【目的】观察项针联合吞咽功能障碍治疗仪治疗脑梗死后吞咽功能障碍患者的临床疗效。【方法】将80例脑梗死后吞咽功能障碍患者随机分为观察组与对照组,每组各40例。对照组在常规治疗的基础上,给予吞咽功能障碍治疗仪治疗,观察组在对照组治疗的基础上,给予项针治疗,连续治疗4周。治疗1个月后,评价2组临床疗效,观察2组患者治疗前后洼田饮水试验(WST)评分和标准吞咽功能评价量表(SSA)评分的变化情况,以及2组患者吞咽时舌骨垂直与水平移动幅度的变化情况。比较2组患者治疗前后血清P物质(SP)含量的变化情况。并评价2组的安全性及不良反应的发生情况。【结果】(1)观察组总有效率为90.00%(36/40),对照组为67.50%(27/40)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的WST、SSA评分均明显改善(P<0.05),且观察组在改善WST、SSA评分方面明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的舌骨垂直位移、水平位移均明显改善(P<0.05),且观察组在改善舌骨垂直位移、水平位移方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的血清SP水平明显改善(P<0.05),且观察组在改善血清SP水平方面明显优于对照组,差异有统计学意义(P<0.05)。(5)观察组不良反应总发生率为5.00%(2/40);对照组为25.00%(10/40);观察组的不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。【结论】项针联合吞咽功能障碍治疗仪治疗脑梗死后吞咽功能障碍,能明显改善患者的吞咽功能,提高患者血清SP水平,增加舌骨位移距离,降低不良反应发生率,临床疗效显著。

拔牙矫治对成年骨性Ⅱ类高角错[牙合]患者上气道及周围组织的影响

目的:通过对比骨性Ⅱ类高角错[牙合]成年患者拔牙和不拔牙矫治前后上气道形态、舌骨位置和颅颌面结构的变化,分析拔牙矫治对该类患者上气道形态结构的影响,为其临床治疗方案的选择提供理论依据。方法:收集就诊于吉林大学口腔医院正畸科已完成正畸治疗的骨性Ⅱ类高角错[牙合]成年患者60例,根据是否进行减数矫治分为拔牙组和非拔牙组,每组30例,对2组患者的临床资料进行回顾性分析。获取患者治疗前后的头颅定位侧位片,应用Dolphin软件对患者上气道形态、舌骨位置和颅颌面组织结构进行定点描绘和测量,采用SPSS 23.0统计软件对相关测量数据进行统计学分析。结果:与矫治前比较,矫治后拔牙组患者悬雍垂尖与中咽壁点的距离(U-MPW)、会厌谷点与下咽壁点的距离(V-LPW)、上中切牙长轴与前颅底平面的下内交角(U1-SN)和下中切牙长轴与下颌平面的上内交角(L1-MP)明显减小(P<0.05),[牙合]平面与前颅底平面的夹角(OP-SN)和上下中切牙长轴之间的夹角(U1-L1)明显增大,(P<0.05),其余测量指标差异无统计学意义(P>0.05);与矫治前比较,矫治后非拔牙组患者矫治后上牙槽座点-鼻根点-下牙槽座点角(ANB)明显减小(P<0.05),OP-SN和L1-MP明显增大(P<0.05),其余测量指标差异无统计学意义(P>0.05)。结论:成年骨性Ⅱ类高角错[牙合]患者在拔牙矫治后上气道矢状径变窄,主要发生在上气道口咽段和喉咽段,而舌骨位置未发生明显改变。

舌刺+上颌[牙合]垫式矫治器对前牙反[牙合]伴吐舌习惯患儿舌骨位置、软硬组织变化的影响

目的探讨舌刺+上颌垫式矫治器在前牙反[牙合]伴吐舌习惯患儿中的应用价值。方法回顾性分析2021年5月至2022年5月河南省儿童医院郑州儿童医院口腔科收治的75例前牙反伴吐舌习惯患儿的临床诊治资料,根据治疗方案不同分为对照组36例和研究组39例。对照组患儿予以传统双曲舌簧[牙合]垫矫治器矫治,研究组患儿予以舌刺+双曲舌簧[牙合]垫矫治器矫治,比较两组患儿的矫治完成时间以及矫治前后舌骨位置、软硬组织的变化和随访一年后的复发率。结果研究组患儿的矫治完成时间为(14.82±3.25)周,明显短于对照组的(19.19±4.92)周,差异有统计学意义(P<0.05);矫治后,研究组患儿的舌骨点-蝶鞍点(H-S)、舌骨点-关节点(H-Ar)、颏唇角(PLA)分别为(90.50±3.11)mm、(66.99±5.08)mm、(132.87±7.86)°,明显优于对照组的(89.01±3.07)mm、(64.57±5.26)mm、(129.17±7.93)°,差异均有统计学意义(P<0.05);矫治后,研究组患儿的舌骨点-第三颈椎点(H-C3)为(30.90±1.57)mm,明显优于对照组的(31.62±1.51)mm,差异有统计学意义(P<0.05);随访1年,研究组患儿复发率为2.56%,明显低于对照组的19.44%,差异有统计学意义(P<0.05)。结论舌刺+上颌[牙合]垫式矫治器应用于前牙反[牙合]伴吐舌习惯患儿,可有效纠正其前牙反[牙合],促进舌骨位置向后下移位,且复发率较低。

空吞咽与不同容积和稠度吞咽任务对健康人舌骨肌群的影响

背景:改良食物稠度和容积是临床常用的吞咽代偿方法,空吞咽是常用的评估方法,舌骨肌群是吞咽的重要肌群,空吞咽与不同容积和稠度吞咽任务对舌骨肌群的激活水平产生的影响目前尚不明确。目的:探讨一次空吞咽与不同稠度和容积吞咽任务对健康成人舌骨肌群的影响。方法:2019年4-8月从山东体育学院招募44名健康成人,男19名,女25名,平均年龄(21.7±2.8)岁,每名受试者分别执行空吞咽与不同稠度[国际吞咽障碍食物标准(IDDSI)框架0-4级]和容积(5,10,20 mL)吞咽任务,实时记录执行每次吞咽任务时舌骨肌群的表面肌电信号。对原始肌电信号进行处理后,分析对比空吞咽与执行不同稠度和容积吞咽任务时舌骨肌群激活水平的差异。结果与结论:①0-4级20 mL、3级10 mL和4级5 mL吞咽任务对应的舌骨上肌群平均振幅值高于空吞咽(P<0.05);除3级外,20 mL不同稠度吞咽任务对应的舌骨上肌群平均振幅值均高于5 mL相应稠度吞咽任务(P<0.05);除2,3级外,20 mL不同稠度吞咽任务对应的舌骨上肌群平均振幅值均高于10 mL相应稠度吞咽任务(P<0.05);②所有吞咽任务所对应的舌骨下肌群平均振幅值均高于空吞咽(P<0.05);20 mL不同稠度吞咽任务对应的舌骨下肌群平均振幅值高于5,10 mL相应稠度吞咽任务(P<0.05);除3级外,10 mL不同稠度吞咽任务对应的舌骨下肌群平均振幅值均高于5 mL相应稠度吞咽任务(P<0.05);③结果提示,健康成人在执行不同容积和稠度吞咽任务时,舌骨肌群的激活水平不易受IDDSI 0-4级稠度的影响,易受容积的影响,容积越大舌骨肌群的激活水平越高。

骨性Ⅲ类高角伴偏颌对上气道形态及舌骨位置的影响

目的应用锥形束CT(CBCT)测量分析骨性Ⅲ类高角伴偏颌对上气道形态及舌骨位置的影响。方法选取120例2019年9月—2022年12月于我院就诊的骨性Ⅲ类高角错牙合患者,所有受试者均拍摄CBCT,根据颏下点偏离正中矢状面的程度(mandibular deviation,MD),将120例患者分为3组:非偏颌组、轻度偏颌组、重度偏颌组。分别测量以上3组上气道体积以及舌骨位置并进行分析比较。结果3组之间鼻咽段,腭咽段体积和最小横截面积以及喉咽段最小横截面积,舌骨(hyoid bone,HB)在Y轴上的位置(Y-HB)和Z轴上位置(Z-HB)差异无统计学意义(P>0.05),偏颌重度组与其余两组相比,舌咽段、喉咽段体积、总体积和舌咽段最小横截面积显著减小(P<0.05),舌骨(hyoid bone,HB)在X轴的位置(X-HB)显著增大(P<0.05)。结论骨性Ⅲ类高角伴重度偏颌患者,舌咽段、喉咽段和上气道总体积以及舌咽段最小横截面积比其余两组小,X-HB比非偏颌组大,表明偏颌主要对上气道舌咽段以及喉咽段形态产生影响;偏颌对于舌骨的影响体现在X-HB,表明偏颌可导致舌骨偏离正中矢状面。

神经肌肉电刺激联合舌肌训练治疗卒中后吞咽障碍患者的效果

目的:观察神经肌肉电刺激联合舌肌训练治疗卒中后吞咽障碍患者的效果。方法:回顾性分析2021年5月至2023年7月该院收治的84例卒中后吞咽障碍患者的临床资料,按照治疗方案不同将其分为对照组和观察组各42例。对照组给予舌肌训练治疗,观察组在对照组基础上联合神经肌肉电刺激治疗。比较两组临床疗效,治疗前后吞咽功能[标准吞咽功能评价量表(SSA)]、生命质量[吞咽生活质量量表(SWAL-QOL)]评分、吞咽时舌骨下肌群表面肌电图(sEGM)指标水平、舌骨喉复合体动度,以及并发症发生率。结果:观察组治疗总有效率为92.86%(39/42),高于对照组的76.19%(32/42),差异有统计学意义(P<0.05);治疗后,观察组SSA评分低于对照组,SWAL-QOL评分高于对照组,差异均有统计学意义(P<0.05);治疗后,观察组吞咽时舌骨下肌群sEGM平均波幅及舌骨、甲状软骨上移、前移距离均大于对照组,吞咽时程短于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为7.14%(3/42),低于对照组的23.81%(10/42),差异有统计学意义(P<0.05)。结论:神经肌肉电刺激联合舌肌训练治疗卒中后吞咽障碍患者效果显著,可提高吞咽功能和生命质量,改善吞咽肌群sEGM指标水平和舌骨喉复合体动度,降低并发症发生率,效果优于单用舌肌训练治疗。

茎突舌骨韧带骨化1例

1临床资料 患者,男性,48岁,因头晕伴左颈部及肩部疼痛、麻木不适6年,加重2个月于2009-05-20入院治疗。6年前患者无明显原因的出现间歇性头晕伴左颈部及肩部疼痛、麻木不适,曾就诊于多家医院,行颈椎CT、颅脑CT等检查，诊断为左侧耳后韧带钙化，行物理疗法，患者头晕及左颈部及肩部疼痛无缓解。

神经肌肉电刺激治疗对脑卒中后恢复期吞咽障碍患者吞咽功能及营养状况的影响

目的 探析脑卒中后恢复期吞咽障碍患者应用神经肌肉电刺激治疗对其营养状况、舌骨喉复合动度及吞咽功能的改善效果。方法 2021年06月-2024年02月期间96例脑卒中后吞咽功能障碍患者作为研究对象,采用随机数字表法进行分组,对照组48例给予常规吞咽功能训练,观察组48例联合神经肌肉电刺激进行康复治疗,对比两组患者吞咽功能[洼田饮水试验评分、吞咽筛查量表(Eating Assessment Tool-10,EAT-10)评分],舌骨喉复合体动度及营养状况[甘油三酯(Triglycerides, TG)、总胆固醇(Total Cholesterol, TC)、血清白蛋白(Albumin, ALB)、体重指数(Body Mass Index, BMI)]。结果 治疗30d后,观察组洼田饮水试验评分及EAT-10评分均低于对照组(P<0.05);观察组患者BMI指数、TC、ALB及TG水平均高于对照组(P<0.05);观察组患者甲状软骨前移距离、甲状软骨上移距离、舌骨上移距离及舌骨前移距离均高于对照组(P<0.05)。结论 联合神经肌肉电刺激治疗,能明显增加脑卒中后恢复期吞咽功能障碍患者舌骨喉复合体动度,增强改善吞咽功能,改善营养状况。

通关利窍四步针法联合涤痰化浊利咽方治疗缺血性脑卒中后吞咽障碍临床研究

目的:观察通关利窍四步针法联合涤痰化浊利咽方治疗缺血性脑卒中后吞咽障碍的临床疗效,以及对舌骨肌群表面肌电图、神经因子水平的影响。方法:选取126例缺血性脑卒中后吞咽障碍患者,采用随机数字表法分为对照组和试验组各63例。2组均进行常规治疗,对照组在此基础上给予涤痰化浊利咽方治疗,试验组在对照组基础上给予通关利窍四步针法治疗。2组均治疗8周。比较2组临床疗效、吞咽功能、舌骨肌群表面肌电图及血清神经因子水平。结果:治疗后,试验组总有效率93.65%,高于对照组80.95%(P<0.05)。2组标准吞咽功能评价量表(SSA)、洼田氏饮水试验评分均较治疗前降低(P<0.05),电视透视吞咽功能检查(VFSS)评分均较治疗前升高(P<0.05);试验组SSA、洼田氏饮水试验评分均低于对照组(P<0.05),VFSS评分高于对照组(P<0.05)。2组舌骨上肌群、舌骨下肌群最大波幅均较治疗前增加(P<0.05),舌骨上肌群、舌骨下肌群吞咽时程均较治疗前缩短(P<0.05);试验组舌骨上肌群、舌骨下肌群最大波幅均大于对照组(P<0.05),舌骨上肌群、舌骨下肌群吞咽时程均短于对照组(P<0.05)。2组血清生长分化因子15(GDF-15)水平均较治疗前降低(P<0.05),血清中枢神经特异蛋白(S-100β)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)水平均较治疗前升高(P<0.05);试验组血清GDF-15水平低于对照组(P<0.05),血清S-100β、BDNF、NGF水平均高于对照组(P<0.05)。结论:通关利窍四步针法联合涤痰化浊利咽方能够有效改善缺血性脑卒中后吞咽障碍患者的吞咽功能,提高舌骨肌群神经传导速度,调节神经因子水平。

脑卒中后吞咽障碍的异常模式

目的:初步探讨脑卒中后吞咽器官在X线透视下是否存在不同的异常运动模式。方法:对80例脑卒中后吞咽困难患者进行电视透视检查,吞咽60%W/V液体钡剂5ml,对吞咽器官的异常运动进行定性和定量测量,区分不同模式。结果:脑卒中后吞咽困难的患者表现出三种不同的吞咽模式,分别为以舌肌无力为主的口腔期吞咽困难、以舌骨及喉结构复合体运动保留的咽期运动损伤模式、以舌骨及喉结构运动分离为主的吞咽异常。结论:脑卒中后吞咽困难有多种模式,可能与病变部位有关。明确不同的模式有助于采用不同的康复方法。

超声测量舌骨-甲状软骨间距评估脑卒中后吞咽功能障碍的价值研究

背景吞咽功能障碍是脑卒中患者常见的并发症,准确地评估吞咽功能在此类患者的康复治疗中具有重大意义。传统的评估方法正确率和特异度较低,且兼具辐射性以及操作复杂等特点,不能在临床上广泛应用。超声作为一项无创、便捷、可重复性高的检查手段,可准确地测量舌骨-甲状软骨间距(HLA),为评估吞咽功能提供了新思路。目的探讨HLA评估脑卒中后吞咽功能障碍的价值。方法选取2018年1—12月在贵港市人民医院住院治疗的脑卒中后吞咽功能障碍患者共42例为研究组,同期另选取本院40例健康体检者为对照组。研究组均经吞咽荧光透视检查(VFSS)证实存在吞咽功能障碍。两名超声科医生(检查者Ⅰ、Ⅱ)分别对5例健康受检者进行检查,评估超声检查的可靠性。两组受检者均进行咽部超声检查,测量或计算舌骨-甲状软骨间最大距离(MHLA)、最小距离(NHLA)和舌骨-甲状软骨缩短距离(HLAS)以及舌骨-甲状软骨间距离缩短率(ASR),比较两组间各超声测值的差异,并将各超声测值与VFSS评分进行相关性分析;绘制NHLA、HLAS及ASR诊断吞咽功能障碍的受试者工作特征曲线(ROC曲线),并计算ROC曲线下面积(AUC)及最佳截断值、灵敏度、特异度、约登指数。结果检查者Ⅰ、Ⅱ测量MHLA的组内相关系数(ICC)分别为0.975和0.949,测量NHLA的ICC分别为0.924和0.957。研究组NHLA大于对照组,HLAS、ASR小于对照组(P<0.05)。VFSS评分与NHLA呈负相关(rs=-0.581,P<0.001),而与HLAS及ASR呈正相关(rs值分别为0.575、0.778,P值均<0.001)。NHLA、HLAS及ASR诊断吞咽功能障碍的AUC分别为0.907〔95%CI(0.822,0.960)〕、0.852〔95%CI(0.757,0.921)〕和0.972〔95%CI(0.910,0.996)〕。ASR诊断吞咽功能障碍的AUC大于NHLA和HLAS(Z=2.012、3.421,P=0.044、<0.001)。ASR诊断吞咽功能障碍的最佳截断值为40.63%,灵敏度、特异度及约登指数分别为85.71%、100.00%、0.857。结论ASR诊断吞咽功能障碍的AUC大于NHLA和HLAS,灵敏度、特异度较高,提示超声测量HLA能够用于脑卒中后吞咽功能障碍的评估。其中ASR是诊断脑卒中后吞咽功能障碍的最佳指标。

阻塞性睡眠呼吸暂停综合征患者舌骨位置的X线头影测量研究

目的揭示OSAS患者舌骨位置的异常及其代偿机制，为OSAS患者的诊断和治疗提供形态学依据。方法借助计算机X线头形测量对44例阻塞性睡眠呼吸暂停综合征（OSAS）患者及100例正常的人群舌骨位置进行测量分析。结果在垂直方向上，OSAS患者舌骨位置明显降低，绝大多数在第四至第六颈椎水平；在矢状方向上，舌骨位置因参照平面或参照点不同，表现为后移或正常位。结论OSAS患者的发病可能与舌骨位置异常有关。