Ultrasound Study of the Submentonian Musculature and Its Relationship in Dysphagia

Thickness of the submental muscles

A measurement of the thickness of the digastric muscles will be performed, which will range from the upper to the lower fascial limit of the muscular belly, in its thickest territory and perpendicular to the superficial fascia of the mylohyoid muscle. The measurement of the thickness of the mylohyoid musculature will be carried out in two locations: (1) immediately below the measurement obtained for the left digastric muscle, between the limits of the superficial and deep fascia that surround it and (2) in its central raphe. The measurement of the thickness of the geniohyoid and genioglossus muscles will be carried out in their most central location, with a perpendicular line drawn from the raphe of the mylohyoid to the inferior fascia of the tongue. Finally, the thickness of the tongue will be made from the lower to the upper fascial edge, on the same line drawn for the genihyoid and Genioglossal muscles.

Hyolaryngeal displacement

the convex probe will be used, placed longitudinally along the midline that follows the arrangement of the throat and the prominence of the thyroid cartilage. Two hyperechoic lines will be located, separated from each other, corresponding to the hyoid bone (cranial) and the most superior aspect of the ossification of the thyroid cartilage (caudal), which offer a posterior acoustic shadow artifact. 3 repetitions of a swallowing maneuver of a bolus of 3mL of water will be requested, with a rest interval of 1 to 2 minutes. These maneuvers will be recorded in video format for subsequent analysis with Image J Software (v 1.37; National Institutes of Health, Rockville, MD, USA). Each video will be analyzed frame by frame, selecting the most representative of the distances "a" (distance at rest) and "b" (maximum hyolaryngeal approximation). The result of this variable will be expressed in centimeters (cm) and % of approximation.

Muscle strength

Medical Research Council (MRC) Scale: this is a valid and reliable measure of the level of global muscle strength, widely used in the context of critically ill patients. It consists of 6 manual tests rated 0 (total absence of contraction) and 5 (preserved muscle capacity) applied bilaterally on different muscle groups of the upper and lower extremity, including: shoulder abduction, elbow flexion, wrist extension, flexion hip, knee extension and ankle dorsiflexion.

Functional Status

Functional Status Score for the ICU Scale (FSS-UCI): allows the evaluation of 5 basic functional tasks both in the critically ill patient and in the patient admitted to the ward and after being discharged from the hospital, which include: turning, transfer from supine to sitting, sitting at the edge of the bed, transferring from sitting to standing and walking. The minimum value is 0 (non functional) and the maximum value is 7 (very functional)

Swallowing function

Volume-Viscosity Swallow Test Scale (VVS-T): The VVS-T scale is a valid and reliable method for the detection of dysphagia, consisting of a protocol designed to maintain the safety and effectiveness of the patient's swallowing and directing the detection of silent bronchial aspiration episodes. Evaluates 3 types of texture with different viscosity (liquid texture -water-, nectar and pudding) at 3 volumes (5mL, 10mL and 20mL) to detect signs associated with safety (tone of voice, cough or desaturation) and with the effectiveness of swallowing (lip seal, oral residue, fractional swallow or pharyngeal residue).

Swallowing function

Functional Oral Intake Scale (FOIS): the FOIS scale is currently one of the clinical tools for the evaluation of swallowing most accepted by scientific literature. It offers 7 levels of functionality (minimum value is 0 (non functional and maxim value is 7, very functional) in decreasing order of severity, divided into several blocks depending on the type of feeding (oral exclusively or dependent on alternative feeding).