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Role of sensation in swallowing function.
1Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
The Laryngoscope
|December 11, 1999
Summary
Normal swallowing function can occur even with complete anesthesia of the upper aerodigestive tract. This study challenges the long-held belief in the critical role of sensation for effective swallowing.
Area of Science:
- Otolaryngology
- Swallowing Physiology
- Neuroscience
Background:
- The role of mucosal sensation in swallowing is debated.
- Reconstruction after cancer resection often prioritizes sensate tissue transfer to improve swallowing.
- A contrarian view suggests mucosal sensation is less critical for swallowing function.
Purpose of the Study:
- To test the hypothesis that normal swallow function can occur with anesthesia of the upper aerodigestive tract mucosa.
- To investigate the impact of topical anesthesia on swallowing function in healthy adults.
Main Methods:
- A prospective study involving 13 healthy adults.
- Baseline swallowing function assessed using video endoscopic swallow studies (VESS).
- Swallowing function reassessed after topical anesthesia (lidocaine) of the oral cavity, oropharynx, hypopharynx, and larynx.
Main Results:
- Minimal differences in swallowing ability were observed between sensate and anesthetized states.
- Subjects reported a perceived disruption in swallowing post-anesthesia.
- A slight increase in the time from food administration to swallow initiation was noted; trace aspiration was transient and easily corrected with coaching.
Conclusions:
- Normal swallowing can occur spontaneously or with simple coaching despite complete anesthesia of the upper aerodigestive tract mucosa.
- Current understanding of the importance of sensation in swallowing may require refinement.
- The value of sensate free flaps in reconstruction may need re-evaluation.