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Muscles of the Upper Airway and Accessory Respiratory Muscles
Published in Alan D. Miller, Armand L. Bianchi, Beverly P. Bishop, Neural Control of the Respiratory Muscles, 2019
Erik van Lunteren, Thomas E. Dick
The third major respiratory role of the upper airway muscles is to regulate the route of airflow. During quiet breathing and with mild levels of exertion airflow traverses the nasal route, which has the advantage of allowing better humidification, warming, and filtering of inspired air than when inspiration occurs through the mouth. However, with increased ventilatory demands posed especially by exercise but also by respiratory diseases, the nose imposes a level of resistance which is too high for the thoracic muscles to overcome, and breathing occurs through both the nose and mouth or only the mouth. This requires opening of the mouth by relaxing jaw elevator musculature (e.g., the masseter) and contracting muscles which pull the jaw caudally (e.g., the geniohyoid muscle), depressing the tongue and, in order for flow to avoid the nasal route, moving the soft palate posteriorly.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The submandibular (Wharton’s) duct is 5 cm long. First it lies between mylohyoid and hyoglossus muscles and then between the sublingual gland and geniohyoid muscle. The duct develops in the ectoderm from a groove in the floor of the mouth. It opens into the floor of the mouth adjacent to the frenulum. The facial nerve (CN VII) runs through the parotid gland.
Anatomy and Embryology of the Mouth and Dentition
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The main muscle forming the floor of the mouth is the mylohyoid muscle (Figures 41.6 and 41.7). Immediately above it is the geniohyoid muscle. The mylohyoid muscle is a flat, triangular sheet attached to the mylohyoid line of the mandible. The posterior fibres pass medially and slightly downwards to the front of the body of the hyoid bone near its lower border. The middle and anterior fibres from each side decussate in a median fibrous raphe that stretches from the symphysis menti to the hyoid bone.
Utilization of submandibular ultrasound to measure oral cavity changes with interventions in routine airway management
Published in Baylor University Medical Center Proceedings, 2022
Alexandra Helbing, Esther Lee, Raymond Pla, Eric Heinz
Ultrasound scanning was performed by two attending anesthesiologists with previous experience and training in airway POCUS. Airway sonography was performed using a SonoSite X-porte Ultrasound system (FujiFilm, Philips Healthcare, Bothell, WA) equipped with a 3 to 8 MHz curvilinear transducer. For the preoperative measurements of TT and OCH, the patient was placed in a supine position with the head in a relaxed position. The ultrasound was placed in a sagittal orientation. TT was measured between the geniohyoid muscle and the dorsum of the tongue, and OCH was measured as the geniohyoid muscle to the hard palate. For the postinduction measurements, the patient was placed in a similar position and imaging was performed in a similar manner with the airway device placed by the anesthesiologist (Figure 1).
Concept of diverse sleep treatments in physiotherapy
Published in European Journal of Physiotherapy, 2019
An alternative to all these devices is exercise training, not only because of resulting weight loss [83]. Different studies show the effects especially of oropharyngeal exercises activating muscles opening the airway (e.g. the genioglossus and the geniohyoid muscle) [84,85]. One of the most famous studies is the one with Didgeridoo playing [86]. This training method with circular breathing was also developed by a Swiss patient suffering from sleep apnoea. The study wants to prove that the sleepiness of the Didgeridoo playing group decreases more than that of the control group. However, it illustrates that the results of randomised studies can be senseless: One of the 11 patients of the control group could not improve at all, because he was not sleepy at the beginning. Also the second patient of the control group was not sleepy enough. The mean sleepiness of the two groups at the beginning was about the same, but the standard deviation of the controls was too big. Conducting a randomised study, researchers should be aware of such facts, but this mistake is seen in many randomised ‘controlled’ trials, published in different journals. Statistics are really useless, if researchers do not consider the context.
Swallowing and ageing
Published in Speech, Language and Hearing, 2019
Within the oral phase, there is a general consensus that tongue strength decreases with age (Crow & Ship, 1996; Fei et al., 2013; Robbins et al., 1995; Robbins, Humpal, Banaszynski, Hind, & Rogus-Pulia, 2016; Vanderwegen et al., 2013; Youmans, Youmans, & Stierwalt, 2009) and that this change is gradual over time (Vanderwegen et al., 2013). Sakai et al. (2018) suggest that in older people suspected as having sarcopenia, lip force and tongue strength may be useful independent indices for diagnosing sarcopenic dysphagia. Butler, Stuart, Leng, et al. (2011) found that reduced posterior and anterior tongue strength for swallowing was significantly associated with aspiration in otherwise healthy adults. Atrophy of geniohyoid muscle was also found to be associated with aspiration in healthy older adults (Feng et al., 2013). There is an argument that tongue pressure measures on non-swallowing tasks will differ from swallowing tasks and there are variations even between saliva and water swallows. Fei et al. (2013) found that while maximum isometric tongue pressures were reduced in a cohort of older adults (>60 years) saliva and water swallowing pressures were not influenced by age. It is further suggested that biomechanical aspects of swallowing are influenced by bolus type rather than age (Fei et al., 2013; van den Engel-Hoek et al., 2012).