MendelsohnManöver

The Mendelsohn maneuver is a swallowing therapy technique used in dysphagia rehabilitation to improve the efficiency of the swallow by prolonging the elevation of the larynx during the swallow and thereby extending opening of the upper esophageal sphincter (UES). It is named after its developer within the field of speech-language pathology and is commonly employed by clinicians working with patients who have swallow impairment.

Mechanism and purpose: During a normal swallow, the larynx elevates and then returns to rest as the bolus passes through the pharynx. In the Mendelsohn maneuver, the patient is trained to hold the larynx in its elevated position for several seconds after initiating the swallow. This voluntary plateau aims to prolong cricopharyngeal opening, improve bolus clearance, and reduce pharyngeal residue and the risk of penetration or aspiration.

Technique: The patient swallows a small amount of food or liquid, then, at the peak of laryngeal elevation, maintains the elevated position by sustaining the muscles that lift the larynx for a few seconds before continuing to swallow or finishing the swallow. Practitioners typically guide the patient through practice repetitions and integrate the maneuver into a broader therapy program, with gradual progression and cues.

Indications and limitations: It is commonly used for oropharyngeal dysphagia due to reduced laryngeal elevation or impaired UES opening, such as after stroke, traumatic brain injury, neurodegenerative disease, or certain cancer treatments. Contraindications include inability to follow instructions, significant neck pain or instability, or conditions where prolonged elevation poses risk. Evidence regarding functional outcomes is mixed, but the technique remains a standard option within individualized dysphagia rehabilitation plans.