Swallowing kinematics and airway protection after palatal local anesthesia in infant pigs

Authors

  • Shaina D. Holman BS,

    Corresponding author
    1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, U.S.A.
    • Send correspondence to Shaina Devi Holman, Department of Neural and Pain Sciences, University of Maryland School of Dentistry, 650 W. Baltimore St., Baltimore, MD 21201. E-mail: swahl001@umaryland.edu

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  • Regina Campbell-Malone PhD,

    1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Peng Ding MD, PhD,

    1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Estela M. Gierbolini-Norat BS,

    1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Stacey L. Lukasik BA,

    1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    Current affiliation:
    1. Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, U.S.A.
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  • Danielle R. Waranch BS,

    1. Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, U.S.A.
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  • Rebecca Z. German PhD

    1. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, U.S.A.
    Current affiliation:
    1. Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, U.S.A.
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  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

  • This project was funded by a 2012 American Association for Dental Research Student Research Fellowship to s.d.h.; funded by the National Institutes of Health: T32 DE07309, which provided training support to s.d.h.; F30 DE021944 to s.d.h.; T32 HD007414, which provided training support to r.c.-m.; and R01 DC03604 to r.z.g. r.c.-m. was supported in part by a United Negro College Fund/Merck Science Initiative Postdoctoral Fellowship sponsored by the United Negro College Fund and Merck Company Foundation.

Abstract

Objectives/Hypothesis

Abnormal kinematics during swallowing can result in aspiration, which may become life threatening. We tested the role of palatal sensation in the motor control of pharyngeal swallow in infants.

Study Design

In eight infant pigs, we reduced palatal sensation using local anesthesia (PLA) and measured the impact on swallowing kinematics and airway protection.

Methods

The pigs drank milk containing barium while we simultaneously recorded videofluoroscopy and electromyography from fine wire bipolar electrodes in several hyolaryngeal muscles. We compared these results to control feedings and feedings following palatal saline injections.

Results

After PLA, four pigs had extreme jaw movements and abnormal tongue movement uncharacteristic of sucking. For this reason, we evaluated differences between these group B pigs and the others that could suck normally after PLA (group A). In the four group A pigs, after PLA there was less hyoid elevation (P < .001) but normal jaw and tongue movements. In group B, in addition to greater jaw movement (P < .001) there was more anterior and superior tongue movement (P < .001) and a larger range of hyoid movement (P < .001).

Conclusions

The airway was protected in all of the pigs, indicating that these changes allowed successful adaptation to the reduction in palatal sensation. However, the oral and pharyngeal phases of the swallow were functionally linked, and trigeminal sensation influenced the motor control of the pharyngeal swallow.

Level of Evidence

N/A Laryngoscope, 124:436–445, 2014

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