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Chin tuck swallow9/7/2023 These findings can be explained by the previous study performed with VFSS and HRM in patients receiving occiput and cervical (OC) fusion. These findings imply that the chin-down maneuver limited prolonged UES relaxation in both groups and that the UES nadir duration is severely limited in the dysphagia group. However, UES nadir durations in the healthy group ranged from 0.30 to 0.32 seconds ( Table 3). Moreover, UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which were severely limited ( Table 2). With respect to the UES relaxation, UES nadir duration was significantly decreased in the dysphagia group’s honey-like liquid swallowing and the healthy group’s thin and honey-like liquid swallowing. In other words, the chin-down maneuver might not influence the contraction of pharyngeal constrictors, pre-UES contraction, and accumulation of pharyngeal residue in dysphagic patients. In addition, it has been suggested that the healthy group can generate sufficient pharyngeal pressure and, therefore, exhibit decreased contraction of both the pharyngeal constrictors and pre-UES, allowing smooth swallowing however, the dysphagia group did not show any change in these parameters. It is established that the healthy population can control the swallowing process according to the viscosity of the liquid, which was proven with a kinematic and pressure analysis. The possible reason for significance in the healthy group might be the sufficient generation of pressure and normal control system. The lack of significant finding with respect to honey-like liquid swallowing might be attributable to the small sample size. In the present study, only the healthy group showed a significant decrease in thin liquid swallowing and a decrease in honey-like liquid swallowing, with respect to the pharyngeal constrictors and pre-swallow peak UES pressure. Moreover, most of the previous studies were performed in healthy subjects, and to the best of our knowledge, only a few studies were performed incorporating only a small number of dysphagic patients (7 or 8 patients) moreover, no study was performed to compare the pharyngeal pressure generation between healthy subjects and dysphagic patients. However, the effects of the chin-down maneuver are not conclusive and require more detailed research with diets of varying thicknesses. Some suggested that patients with pharyngeal weakness should be treated with caution when in the chin-down position. Traditional manometry studies evaluating the chin-down maneuver showed various results, such as reduction and no changes of pharyngeal pressure. Asymmetric structure of the pharynx and its intricate skeletal muscle contractions hindered accurate assessment. In addition, manometric catheters containing three to five unidirectional sensors have traditionally been used to measure pharyngeal pressures. Manometry has commonly been used for esophagus physiology, and a few manometry studies evaluating the chin-down effect focused on the pharyngeal structure.
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