Cortical representation of swallowing in normal adults: Functional implications

Objective: Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects. Study Design: Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques. Methods: Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross-correlation analysis. One-way and two-way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence. Results: Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks. Conclusions: Activation of the primary motor and somatosensory cortices, as well as other sensory-motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.