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Timing of True Vocal Cords Closure for Safe Swallowing: A Review of 5 Studies Using 3D Analysis Using Computerized Tomography (CT)

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Abstract

Timely and complete laryngeal closure is critical for a successful swallow. Researchers have studied laryngeal closure, including true vocal cords (TVC) closure, closure of the arytenoids to the epiglottis base (laryngeal vestibule closure), and epiglottic inversion, but the most commonly available imaging tools have limitations that do not allow the study of these components individually. Swallowing computerized tomography (CT) has enabled three-dimensional dynamic visualization and quantitative evaluation of swallowing events providing a unique view of swallowing-related structures and their motion. Using CT, TVC closure can be visualized and evaluated on any plane or cross-section without being obscured by of laryngeal vestibule closure or epiglottis inversion. The current review summarizes the results of five papers evaluating the effects of bolus consistency and volume, posture, and age on TVC closure. The combined results of these studies suggest that TVC closure is responsive to oral sensory input based on bolus consistency and size and can be modulated in response to conditions perceived to increase the risk of airway invasion. These results are meaningful for dysphagia rehabilitation as it suggests that interventions to improve TVC closure are likely to enhance airway protection.

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Acknowledgements

The authors sincerely appreciate the members of department of Radiology, department of Rehabilitation Medicine I, and faculty of Rehabilitation of Fujita Health University for their assistance and suggestions.

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Authors and Affiliations

  1. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Yoko Inamoto

  2. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan

    Yoko Inamoto & Eiichi Saitoh

  3. Department of Physical Medicine and Rehabilitation and Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Marlís González-Fernández

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Inamoto, Y., González-Fernández, M. & Saitoh, E. Timing of True Vocal Cords Closure for Safe Swallowing: A Review of 5 Studies Using 3D Analysis Using Computerized Tomography (CT). Dysphagia 39, 313–320 (2024). https://doi.org/10.1007/s00455-023-10620-y

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