title: Ptosis aggravates dysphagia in oculopharyngeal muscular dystrophy.
abstract: BACKGROUND
  Ptosis and dysphagia are important features in oculopharyngeal muscular dystrophy (OPMD).
  
  
  OBJECTIVE
  Retroflexion of the head is a well known compensatory mechanism for ptosis, but generally retroflexion has a negative effect on swallowing. We hypothesised that severity of ptosis is related to degree of retroflexion and that this compensation is responsible for deteriorating dysphagia.
  
  
  METHODS
  Nine OPMD patients were examined in the conditions "head position adapted to ptosis" and "head position slightly flexed". Ptosis was quantified by photogrammetry and retroflexion of the head by digital photographs. The severity of dysphagia was measured using visual analogue scales (VAS) and by calculating swallowing volumes and oropharyngeal swallow efficiency (OPSE) based on videofluoroscopy.
  
  
  RESULTS
  Statistical analyses show a significant relationship between ptosis and degree of retroflexion. The degree of retroflexion of the head correlated significantly with VAS scores and with the maximum swallowing volume. The slightly flexed head position significantly improved VAS scores as well as swallowing volumes and OPSE.
  
  
  CONCLUSIONS
  In OPMD patients, ptosis significantly correlates with retroflexion of the head, which has a negative effect on swallowing. Subjective and objective reduction of swallowing problems was found when patients were instructed to eat and drink with a slightly flexed head position.
authors.affiliation: 304 Neuromuscular Centre Nijmegen, Institute of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. b.deswart@neuro.umcn.nl
authors.forename: B J M
authors.initials: BJ
authors.lastname: de Swart
authors.forename: B M
authors.initials: BM
authors.lastname: van der Sluijs
authors.forename: A M C
authors.initials: AM
authors.lastname: Vos
authors.forename: J G
authors.initials: JG
authors.lastname: Kalf
authors.forename: S
authors.initials: S
authors.lastname: Knuijt
authors.forename: J R M
authors.initials: JR
authors.lastname: Cruysberg
authors.forename: B G M
authors.initials: BG
authors.lastname: van Engelen
mesh_terms: D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000175:diagnosis* / Q000503:physiopathology; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D039141:Muscular Dystrophy, Oculopharyngeal / Q000175:diagnosis* / Q000503:physiopathology; D009960:Oropharynx / Q000503:physiopathology; D010147:Pain Measurement; D012307:Risk Factors; D013223:Statistics as Topic