Preterm Birth Impacts the Timing and Excursion of Oropharyngeal Structures during Infant Feeding

Synopsis Swallowing in mammals requires the precise coordination of multiple oropharyngeal structures, including the palatopharyngeal arch. During a typical swallow, the activity of the palatopharyngeus muscle produces pharyngeal shortening to assist in producing pressure required to swallow and may initiate epiglottal flipping to protect the airway. Most research on the role of the palatopharyngeal arch in swallowing has used pharyngeal manometry, which measures the relative pressures in the oropharynx, but does not quantify the movements of the structures involved in swallowing. In this study, we assessed palatopharyngeal arch and soft palate function by comparing their movements in a healthy population to a pathophysiological population longitudinally through infancy (term versus preterm pigs). In doing so, we test the impact of birth status, postnatal maturation, and their interaction on swallowing. We tracked the three-dimensional (3D) movements of radiopaque beads implanted into relevant anatomical structures and recorded feeding via biplanar high-speed videofluoroscopy. We then calculated the total 3D excursion of the arch and soft palate, the orientation of arch movement, and the timing of maximal arch constriction during each swallow. Soft palate excursion was greater in term infants at both 7 and 17 days postnatal, whereas arch excursion was largely unaffected by birth status. Maximal arch constriction occurred much earlier in preterm pigs relative to term pigs, a result that was consistent across age. There was no effect of postnatal age on arch or soft palate excursion. Preterm and term infants differed in their orientation of arch movement, which most likely reflects both differences in anatomy and differences in feeding posture. Our results suggest that the timing and coordination of oropharyngeal movements may be more important to feeding performance than the movements of isolated structures, and that differences in the neural control of swallowing and its maturation in preterm and term infants may explain preterm swallowing deficits.

Pharyngeal Manometry in Pediatric Dysphagia Assessment

Purpose Reliable measures to capture swallowing pathophysiology and outcomes from therapeutic interventions are needed in the pediatric setting. Therefore, this review presents the current best evidence for manometry investigation and its application in pediatric dysphagia. For oropharyngeal dysphagia assessment, videofluoroscopic swallow study is considered the gold standard, and fiberoptic endoscopic examination of swallowing is also employed in some settings. In clinical practice, both tests mostly rely on qualitative interpretation of image data and have variable reliability to detect pathophysiology. Conclusion Acknowledging that swallowing is a pressure-driven event, the role of manometry is now being considered as an objective, nonradiological technique that can be performed as an adjunct to other clinical swallow evaluations. The latest high-resolution manometry catheter technologies are miniaturized and simple to use, enhancing their potential application in pediatric clinical and research contexts.

The Utility of High-Resolution Pharyngeal Manometry in Dysphagia Treatment

Purpose High-resolution pharyngeal manometry (HRPM) is an emerging technology that shows promise as both an adjuvant diagnostic and therapeutic tool in oropharyngeal dysphagia management. Advances in manometric technology, including increased number of sensors and topographical pressure plots, enhance the biofeedback potential for the pharynx. This clinical focus article serves as an overview of the utility of HRPM in dysphagia treatment. Conclusion HRPM-facilitated biofeedback aids the patient in the correct implementation of clinical recommendations and also provides the clinician an assessment of the effectiveness and accuracy of those targeted interventions. Topographic pressure plots provide intuitive feedback, allow easier swallow-to-swallow comparisons, and produce visually color-coded pressure information for the patient and clinician in real time. Paired with existing, evidence-based interventions, HRPM biofeedback may facilitate maneuver and strategy planning, exercise training and monitoring, temporal coordination, upper esophageal segment relaxation and duration, swallow mapping (topographic pattern recognition and approximation), fatigue monitoring, dose planning, adherence tracking, and efficacy assessment of selected interventions. Although competency training is needed to effectively utilize HRPM, there are growing opportunities for the speech-language pathologist to acquire and implement this technology for the benefit of patients.