Five laryngectomized individuals underwent mfMRI before and after six exercises. Three conventional (Effortful Swallow, Masako, Shaker) and three SEA exercises (Chin Tuck, Jaw Opening and Effortful Swallow Against Resistance (CTAR, JOAR and ESAR, resp.)) were assessed. T2 mapping scans were made pre and post all exercises carried out until exhaustion. Muscles of interest were the medial and lateral pterygoids, intrinsic and extrinsic tongue, suprahyoid, superior pharyngeal constrictor, masseter and sternocleidomastoid muscles. Primary parameter was the difference (Δ) of the post- and pre-exercise T2 map values in milliseconds.
This mfMRI study shows that after total laryngectomy swallowing muscles still can be activated with swallowing exercises. The SEA-based exercises CTAR and JOAR showed the highest percentage of bilateral activation.
In total, 1.490 annotated muscles were analyzed. Following the swallowing exercises, true positive Δ T2 map values were found in up to 90% of these muscles. Each exercise (conventional and SEA-based) activated at least three muscles of interest, in varying numbers per exercise. Among all annotated muscles, percentages of positive Δ T2 map values were highest for the lateral pterygoid muscles following the SEA exercises CTAR and JOAR (70 and 90%, resp.).
After total laryngectomy, dysphagia is common due to changes in anatomy and physiology. Currently, it is unclear if the remaining muscles still can be activated with swallowing exercises. This study aims to assess which muscles, if any, are activated after conventional or resistance-based exercises with the Swallowing Exercise Aid (SEA) using mfMRI-based T2maps.
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