Neuroprostheses for management of dysphagia resulting from cerebrovascular disorders

Swallowing is a complicated process that involves intricate timing between many different muscles in the mouth and neck. The primary purpose of swallowing is to move food through the mouth and pharynx and into the esophagus for transport to the stomach for digestion. Dysphagia is a general term that refers to a disruption in any part of the process. The consequences of dysphagia include social embarrassment; malnutrition; and aspiration. Of these, aspiration is the most significant as it is associated with a significantly greater risk of pneumonia and death. If patients fail to adequately protect the airways with standard exercise and therapy, they are often disallowed from taking food by mouth and receive nutrition by alternate means. If patients still experience frequent pneumonia, more drastic surgical measures that permanently separate the airway from foodway are required. As an alternative to these surgical procedures, neuroprostheses can dynamically restore airway protection. There are two primary protective mechanisms that neuroprostheses seek to restore. The first is laryngeal elevation and the second is vocal fold closure. The present article is an introductory overview of the swallowing process, the primary muscles and nerves related to swallowing, the effects of dysphagia, the standard treatment options, and the neuroprosthetic options.