Nelson H May1, Kate W Davidson2, William G Pearson3,4, Ashli K O'Rourke5. 1. Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina. 2. Speech Language Pathologist, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina. 3. Department of Cellular Biology & Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia. 4. Department of Otolaryngology, Medical College of Georgia at Augusta University, Augusta, Georgia. 5. Department of Otolaryngology-Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina.
Abstract
BACKGROUND: Opening of the upper esophageal sphincter (UES) is a critical element of swallowing. Understanding the functional pharyngeal anatomy during UES opening would be clinically useful for dysphagia evaluation and treatment. METHODS: Simultaneous high-resolution pharyngeal manometry and videofluoroscopy (VFS) videos for 18 nondysphagic subjects were evaluated. UES pressure readings were segmented into six pressure phases, including a poorly understood pre-relaxation contraction. Anatomic landmarks were tracked in VFS imaging and evaluated morphometrically to determine the movement of key swallowing structures within each UES pressure phase. RESULTS: There were significant differences in pharyngeal mechanics by UES pressure stage (range of D-values = 1.7-2.2, P < .0001). The soft palate maximally elevates during the pre-relaxation contraction of the UES. Early during UES relaxation, the hyolaryngeal complex and pharyngeal structures maximally elevate and pharyngeal structures constrict around the bolus. CONCLUSION: The mechanics underlying the UES pressure wave suggest generation of a sealed pharyngeal cavity, possibly integral to pharyngeal pressure generation and bolus propulsion.
BACKGROUND: Opening of the upper esophageal sphincter (UES) is a critical element of swallowing. Understanding the functional pharyngeal anatomy during UES opening would be clinically useful for dysphagia evaluation and treatment. METHODS: Simultaneous high-resolution pharyngeal manometry and videofluoroscopy (VFS) videos for 18 nondysphagic subjects were evaluated. UES pressure readings were segmented into six pressure phases, including a poorly understood pre-relaxation contraction. Anatomic landmarks were tracked in VFS imaging and evaluated morphometrically to determine the movement of key swallowing structures within each UES pressure phase. RESULTS: There were significant differences in pharyngeal mechanics by UES pressure stage (range of D-values = 1.7-2.2, P < .0001). The soft palate maximally elevates during the pre-relaxation contraction of the UES. Early during UES relaxation, the hyolaryngeal complex and pharyngeal structures maximally elevate and pharyngeal structures constrict around the bolus. CONCLUSION: The mechanics underlying the UES pressure wave suggest generation of a sealed pharyngeal cavity, possibly integral to pharyngeal pressure generation and bolus propulsion.
Authors: Nicole M Rogus-Pulia; Corinne A Jones; Angela L Forgues; Jason Orne; Cameron L Macdonald; Nadine P Connor; Timothy M McCulloch Journal: Am J Speech Lang Pathol Date: 2020-06-23 Impact factor: 2.408
Authors: Mistyka S Schar; Taher I Omari; Charmaine M Woods; Charles Cock; Sebastian H Doeltgen; Ching Li Chai-Coetzer; Danny J Eckert; Theodore Athanasiadis; Eng H Ooi Journal: J Clin Sleep Med Date: 2022-04-01 Impact factor: 4.062
Authors: Mistyka S Schar; Taher I Omari; Charmaine M Woods; Lara F Ferris; Sebastian H Doeltgen; Kurt Lushington; Anna Kontos; Theodore Athanasiadis; Charles Cock; Ching-Li Chai Coetzer; Danny J Eckert; Eng H Ooi Journal: J Clin Sleep Med Date: 2021-09-01 Impact factor: 4.324