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Relationship Between the Electrical Activity of Suprahyoid and Infrahyoid Muscles During Swallowing and Cephalometry

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Relationship Between the Electrical Activity of Suprahyoid and Infrahyoid Muscles During Swallowing and Cephalometry 895 RELATIONSHIP BETWEEN THE ELECTRICAL ACTIVITY OF SUPRAHYOID AND INFRAHYOID MUSCLES DURING SWALLOWING AND CEPHALOMETRY Relação da atividade elétrica dos músculos supra e infra-hióideos durante a deglutição e cefalometria Maria Elaine Trevisan(1), Priscila Weber(2), Lilian G.K. Ries(3), Eliane C.R. Corrêa(4) ABSTRACT Purpose: to investigate the influence of the habitual head posture, jaw and hyoid bone position on the supra and infrahyoid muscles activity of the muscles during swallowing of different food textures. Method: an observational, cross-sectional study, with women between 19 and 35 years, without myofunctional swallowing disorders. The craniocervical posture, position of the mandible and hyoid bone were evaluated by cephalometry. The electromyographic activity of the supra and infrahyoid muscles was collected during swallowing water, gelatin and cookie. Results: sample of 16 women, mean age 24.19 ± 2.66 years. At rest, there were negative/moderate correlations between the electrical activity of the suprahyoid muscles with NSL/CVT (head position in relation to the cervical vertebrae) and NSL/OPT (head position in relation to the cervical spine) postural variables, and positive/moderate with the CVA angle (position of flexion/extension of the head). During swallowing the cookie, the activity of infrahyoid muscles showed a negative/moderate correlation with NSL/OPT angle. It was found higher electrical activity of the suprahyoid muscles during swallowing of all foods tested, and of the infrahyoid muscles at rest. There was difference on the muscle activity during swallowing of foods with different consistencies, which was higher with cookie compared to water and gelatin. Conclusion: the head hyperextension reflected in lower activity of the suprahyoid muscles at rest and of the infrahyoid muscles during swallowing. The consistency of food influenced the electrical activity of the suprahyoid and infrahyoid muscles, with greater muscle recruitment in swallowing solid food. KEYWORDS: Posture; Deglutition; Electromyography; Cephalometry INTRODUCTION (1) Physical Therapist; Professor at Physical Therapy Depart- ment (Master Degree) and doctoral student at Graduate Program of Human Communication Disorders, Federal Uni- The deglutition process is a complex sensory- versity of Santa Maria – UFSM, RS, Brazil. motor mechanism that involves, in a sequence, (2) Physical Therapist; Graduate Program Human Commu- excitation and inhibition of different levels of the nication Disorders (Master Degree), Federal University of 1,2 Santa Maria – UFSM, RS, Brazil. Central Nervous System (CNS) . It is charac- (3) Physical Therapist; Professor at Physical Therapy Depart- terized by three phases: oral, pharyngeal and ment (PhD), University of the Santa Catarina State – esophagic; which demand coordinated movements UDESC , SC, Brazil. of mouth, tongue, larynx and esophagus and they (4) Physical Therapist; Professor at Physical Therapy Depart- are independent of each other 1-3. Nevertheless, the ment (PhD) and Graduate Program of Human Communica- tion Disorders, Federal University of Santa Maria – UFSM, generation of the CNS patterns controls the time of RS, Brazil. these events and the peripherical manifestations of Conflict of interest: non-existent these phases that depend on peripherical sensory Rev. CEFAC. 2013 Jul-Ago; 15(4):895-903 896 Trevisan ME, Weber P, Ries LGK, Corrêa ECR stimulus3. The oral phase of the deglutition is a affect the stomatognathic functions, in particular, voluntary event, while the pharyngeal is involuntary the deglutition. and independent1. However, the deglutition always Recent studies have investigated the supra and occurs in the same sequence, being the pharynx infra-hyoid muscle behavior in different body and and esophagus responses dependent on the food head positioning during the swallowing function7,13-15. bolus properties1-3 Differently, this study aimed to investigate the The complexity of the pharyngeal phase must influence of the usual head posture, mandibular and be pointed out once it requires the concomitance hyoid bone position on the supra and infra-hyoid of a series of events, including the antero-posterior muscles during the swallowing of three different displacement of the hyoid bone and the thyroid types of food. cartilage; epiglottis closing; vocal cord closing and superior esophagic sphincter opening. The hyoid METHOD displacement to upward and forward occurs at the moment in which the bolus crosses the pharyngeal The present experiment was approved by the cavity and depends on the tongue basis and the Research Ethics Committee of the local institution, 4-6 supra-hyoid muscle contraction . under protocol CAAE number 0281.0.243.000-08. For an efficient swallowing function, the mandible The volunteers were included in the research after adopts a fix and stable position, by the intercuspal of signing the Consent Term. the occlusal surfaces, immediately before the tongue It consists of a cross-sectional observational 7 impulses the food bolus to the oropharynx . On the study, with quantitative data analysis. The partici- other hand, the mandibular stabilization allows the pants were evaluated by an experienced speech suprahyoid muscle contraction and, consequently, language pathologist in orofacial motricity, according the hyoid bone and larynx antero-superior traction to the Myofunctional Evaluation with Scores Protocol 7,8 assuring a safe deglutition . (AMIOFE)16, prior to participating in the study. There are evidences that the mandibular rest The inclusion criteria were: female gender, age position suffers alterations due to occlusal interfer- from 19 to 35 years old, without myofunctional ences, temporomandibular, stress, nasal obstruction alterations during the masticatory and swallowing and head posture9. Considering the established functions. relations between the craniocervical posture and The exclusion criteria were: facial trauma, craniofacial morphology, body posture changes, craniomandibular or cervical orthopedic surgical especially in the head, tend to modify the activity procedures, musculoskeletal deformities, temporo- of the muscles that take part in the positioning of mandibular disorder (TMD), Angle Class II and III 10 the mandibular rest . Suprahyoid muscles are occlusions, tooth loss, anterior and posterior open directly involved in the mandible stabilization during bite, cross bite, edge-to-edge bite and overbite, as intercuspal and food grinding, as well in the active well as being wearing braces. The TMD presence elevation of the hyoid bone and the larynx during was investigated by only one examiner according swallowing, having close association between the to the Research Criteria for Temporomandibular functions that involve the mandible posture and the Disorder (RDC/TMD)17. The occlusion was evaluated 11 supra and infra-hyoid muscle action . through intra-oral photographies observed by an Forward head posture is a commonly observed Orthodontist. postural change that leads to compensations such The craniocervical posture, mandible and as cranium and upper cervical spine hyperextension hyoid position were evaluated using cephalometric and lower cervical curvature flexion. It also produces analysis. The volunteers have undergone a right alterations in the mandible, hyoid and tongue lateral radiography of the cranium and cervical position, modifying the craniocervicomandibular spine in standing position, without any instruction biomechanical relations and, consequently, the for aligning it. In order to reproduce the natural head mandibular rest position. The mandible in a more position, they were oriented to keep staring at the retruded and elevated position pulls the supra-hyoid reflection of their eyes in a mirror placed at one-meter musculature12. distance18,19. The radiography was performed on the Harmony and balance between form and Orthophos Plus (Siemens, Germany) equipment, function are essential to determine the system with 1.52 m of focus-film distance. stomatognathic health condition. Therefore, under- The angle variables that assess the cranio- standing the relation between the craniocervical cervical posture were: CVT/EVT angle – cervical posture, mandible and hyoid bone position and the curve (figure 1); NSL/OPT and NSL/CVT – cranium supra and infra-hyoid muscle activity may elucidate inclination in relation to C2 and in relation to the the biomechanical changes that, occasionally, cervical spine (C2 –C4), respectively (Figure 2); Rev. CEFAC. 2013 Jul-Ago; 15(4):895-903 Hyoid muscles in swallowing and cefalometry 897 CVA- flexion/extension head position and CPL/ The cephalograms were manually traced, by the Horizontal line – forward head posture (Figure same examiner, on acetate paper with the aid of a 3) 18,20-22. The mandibular and hyoid bone spatial mechanical pencil with 0.3mm tip, tape, soft rubber, position were determined, respectively, by NSL/ML with the radiographs placed on a negatoscope in (cranium basis inclination related to the mandible)18 order to allow a better visualization of the structures. and by the linear distance from the hyoid to mentum A protractor, for the angular measurements, and a (HY/ME), to mandible (HY/ ML) and to third cervical millimeter ruler for the linear measures were used. 4,22 vertebra (HY/C3) (Figure 4) . CV2tg – the tangent point at the superior posterior extremity sp – anterior nasal spine; pm – posterior nasal spine; O – basi- of the odontoid process of the second cervical vertebra (C2); -occiput; CV2Ap –
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