吉田 光由

BACKGROUND: Muscle quality, along with muscle mass, deteriorates with disuse, ageing and various disorders, underscoring the need to evaluate the internal characteristics of swallowing-related muscles. Previous studies have reported an association between oral function and echo intensity (EI), but the association between oral function and the stiffness of swallowing-related muscles, as well as the degree of this association, remains insufficiently understood. OBJECTIVE: To examine the association between oral function and the intramuscular characteristics of swallowing-related muscles, focusing on muscle stiffness. MATERIALS AND METHODS: A total of 196 older women (78.1 ± 5.2 years) participated in a physical fitness measurement session in this cross-sectional study. The stiffness and EI of the geniohyoid muscle (GHM) were measured, and oral function was evaluated using oral diadochokinesis (ODK; /pa/, /ta/, /ka/) and tongue pressure. Multiple regression analysis was used to investigate the association between oral function, stiffness and EI. By standardising the variables, we evaluated these associations independently of the units. RESULTS: ODK, /pa/ (β = -0.144, p = 0.002), /ta/ (β = -0.134, p = 0.011) and /ka/ (β = -0.093, p = 0.043) showed a negative association with GHM stiffness. After standardisation, the association between ODK (/pa/, /ta/, /ka/) and GHM stiffness (β: -0.144, -0.134, -0.093) was comparable to that between ODK and EI (β: -0.008, -0.148, -0.075). CONCLUSION: GHM stiffness was associated with oral motor function in older women living in the community. Assessing the stiffness of swallowing-related muscles could be important for evaluating oral function to a degree comparable to EI.

ABSTRACT Objective We aimed to examine the effects of oral care in patients with terminal cancer approaching death. Background Patients with terminal‐stage cancer often experience symptoms like oral dryness and candidiasis. Previous studies showed that without professional dental care, oral hygiene significantly worsens within 3 weeks before death. Therefore, oral management is essential for patients with terminal cancer. However, the specific effects of oral hygiene in these patients remain unclear. Material and Methods Twenty patients were admitted to two palliative care units at our institution between June 2022 and May 2023 and received oral care multiple times before death. Oral hygiene was assessed using the Oral Health Assessment Tool (OHAT), and oral dryness was evaluated with an oral moisture checker. The Face Rating Scale (FRS) was assessed before and after professional oral care. Results During the week of death, the number of people who were able to speak and follow instructions decreased, while the number who used sedatives and oxygen increased. There was no significant difference in the degree of oral dryness before oral care between the time of hospitalisation and the week of death. However, oral dryness improved significantly after oral care at admission (before: 21.0 ± 8.3, after: 26.7 ± 3.2) and the week of death (before: 16.8 ± 8.4, after: 25.8 ± 3.7). There was no difference in the time taken for oral care or FRS scores at admission and the week of death. Conclusion Continuous oral care in patients with terminal cancer can prevent worsening oral hygiene and maintain moisture.

This study investigated the swallowing dynamics of jelly, thickened liquid, and thin liquid in selected stroke patients who exhibited near-normal swallowing function with screening tests. Videofluoroscopic examination compared the pharyngeal transit time (PTT), pharyngeal delay time (PDT), and laryngeal elevation delay time (LEDT). Of 175 patients (104 men, 71 women; mean age: 68.6 ± 12.0 years) evaluated, 24 (13.7%) experienced aspiration, significantly prolonging LEDT in swallowing thin liquid. PTT did not differ in swallowing jelly, thickened liquid, or thin liquid among the patients who did not aspirate. However, in two-phase analysis of PTT, performed before and after the jelly passed the epiglottis, the former was significantly prolonged, whereas the latter was significantly shortened. PDT was significantly longer with jelly than with thickened and thin liquids. LEDT was significantly longer in swallowing thin liquids. Apparently, the thin liquid reached the pyriform sinus before maximum laryngeal elevation, posing a risk of laryngeal penetration and aspiration during swallowing. A thicker liquid prolonged the time taken to reach the pyriform sinus, reducing aspiration risk. Moreover, oropharyngeal passage of jelly took longer, triggering the swallowing reflex around the vallecula and allowing the jelly to pass through the hypopharynx after laryngeal closure.