title: Effects of Chin-Down Maneuver on the Parameters of Swallowing Function After Esophagectomy With 3-Field Lymphadenectomy Examined by Videofluoroscopy.
abstract: To determine the effect of the chin-down maneuver after esophagectomy with 3-field lymphadenectomy (3FL) on pharyngeal residue, upper esophageal sphincter (UES) opening, and laryngeal closure.
  
  
  
  Prospective data were collected from a pharyngeal videofluoroscopic swallowing study.
  
  
  
  Dysphagia clinics.
  
  
  
  Patients selected according to the inclusion criteria (N=14; mean age, 65.9y) from a total of 43 patients who underwent esophagectomy with 3FL from May to December 2014 were enrolled.
  
  
  
  Videofluoroscopy was conducted in head-neutral and chin-down positions to measure the pharyngeal constriction ratio (PCR), amount of residue in the vallecula and pyriform sinus after the first swallow, UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure.
  
  
  
  The aforementioned parameters were compared statistically between the head-neutral and chin-down positions.
  
  
  
  In comparison with the neutral group, the PCR and residue in the pyriform sinus were significantly smaller in the chin-down group (P<.01). However, the residue in the vallecula did not differ significantly from that of the neutral group (P=.44). The UES opening diameter, duration of UES opening, and duration of laryngeal vestibule closure were all significantly larger in the chin-down group than in the neutral group (P<.05).
  
  
  
  This study demonstrates that use of the chin-down maneuver after esophagectomy with 3FL can help expedite swallowing by strengthening pharyngeal constriction, widening the UES, and enhancing laryngeal closure.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kumamoto University School of Medicine, Kumamoto, Japan. Electronic address: kumayoshi426yk@gmail.com.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kumai
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kumamoto University School of Medicine, Kumamoto, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Kamenosono
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kumamoto University School of Medicine, Kumamoto, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Matsubara
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kumamoto University School of Medicine, Kumamoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Samejima
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kumamoto University School of Medicine, Kumamoto, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yumoto
mesh_terms: D000368:Aged; D002680:Chin / Q000502:physiology*; D002933:Cineradiography; D003679:Deglutition / Q000502:physiology*; D049631:Esophageal Sphincter, Upper / Q000502:physiology; D016629:Esophagectomy / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007830:Larynx / Q000502:physiology; D008197:Lymph Node Excision / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies
keywords: Deglutition disorders; Esophageal sphincter, upper; Esophagectomy; Rehabilitation