Functional Anatomy Underlying Pharyngeal Swallowing Mechanics and Swallowing Performance Goals

2019 ◽  
Vol 4 (4) ◽  
pp. 648-655
Author(s):  
William G. Pearson ◽  
Jacline V. Griffeth ◽  
Alexis M. Ennis
Keyword(s):  
Functional Anatomy ◽  
Neuromuscular Control ◽  
Upper Esophageal Sphincter ◽  
Performance Goals ◽  
Laryngeal Elevation ◽  
Port Closure ◽  
Swallowing Dysfunction ◽  
Hyoid Movement ◽  
Pharyngeal Swallowing ◽  
Pharyngeal Constriction

Purpose Rehabilitation of pharyngeal swallowing dysfunction requires a thorough understanding of the functional anatomy underlying the performance goals of pharyngeal swallowing. These goals include the safe and efficient transfer of a bolus through the hypopharynx into the esophagus. Penetration or aspiration of a bolus threatens swallowing safety. Bolus residue indicates swallowing inefficiency. Several primary mechanics, or elements of the swallowing mechanism, underlie these performance goals, with some elements contributing to both goals. These primary mechanics include velopharyngeal port closure, hyoid movement, laryngeal elevation, pharyngeal shortening, tongue base retraction, and pharyngeal constriction. Each element of the swallowing mechanism is under neuromuscular control and is therefore, in principle, a potential target for rehabilitation. Secondary mechanics of pharyngeal swallowing, those movements dependent on primary mechanics, include opening the upper esophageal sphincter and epiglottic inversion. Conclusion Understanding the functional anatomy of pharyngeal swallowing underlying swallowing performance goals will facilitate anatomically informed critical thinking in the rehabilitation of pharyngeal swallowing dysfunction.

Epiglottic Position after Cricothyroidotomy: A Comparison with Tracheotomy

1997 ◽  
Vol 106 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Jessica W. Lim ◽  
Patricia Kerman Lerner ◽  
Stephen G. Rothstein
Keyword(s):  
New York ◽  
Medical Center ◽  
Upper Esophageal Sphincter ◽  
Barium Swallow ◽  
New York University ◽  
Laryngeal Elevation ◽  
Posterior Displacement ◽  
Tube Removal ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction

Dysphagia is a known problem in patients with tracheotomy, but its association with cricothyroidotomy is not well studied. The purpose of this study was to evaluate dysphagia in patients with cricothyroidotomy and to determine if there is a reliable indicator of swallowing dysfunction in these patients. A review of charts for patients with modified barium swallow studies conducted at the New York University Medical Center Swallowing Disorders Center yielded three groups of patients: patients with cricothyroidotomy, patients with tracheotomy, and normal patients. There were 8 patients in each group. In all patients in the cricothyroidotomy group, there was a greater impairment of epiglottic displacement, laryngeal elevation, and upper esophageal opening than in the tracheotomy group. This problem with epiglottic displacement produced susceptibility to laryngeal penetration and, in turn, increased the risk of aspiration in those patients with cricothyroidotomy. After cricothyroidotomy tube removal, a return to normal epiglottic movement was observed within 2 months. One mechanism of swallowing dysfunction is impaired posterior displacement of the epiglottis over the glottic aperture. This impaired epiglottic motion appears to be related to restricted laryngeal elevation secondary to tethering of the larynx anteriorly at the site of the cricothyroidotomy. Additionally, we noted a decrease in the opening of the upper esophageal sphincter.

Videofluoroscopic Swallow Study Findings and Correlations in Infancy of Children with Cerebral Palsy

2021 ◽  
pp. 000348942110267
Author(s):  
Amit Narawane ◽  
Christina Rappazzo ◽  
Jean Hawney ◽  
James Eng ◽  
Julina Ongkasuwan
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Demographic Data ◽  
Early Infancy ◽  
Gross Motor ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction ◽  
Swallow Study ◽  
Pharyngeal Swallowing ◽  
Tracheal Aspiration

Objectives: Cerebral palsy (CP) in infants can affect global motor function and lead to swallowing difficulties. This study aims to characterize oral and pharyngeal swallowing dynamics in infancy of patients later diagnosed with CP and to determine if swallow study performance in early infancy is associated with later CP severity and characteristics. Methods: This is a retrospective chart review of infants who underwent videofluoroscopic swallow studies (VFSS) between 6/2008 and 10/2018 at a tertiary children’s hospital, and were later diagnosed with CP. Demographic data, CP characteristics and metrics, and VFSS findings were collected and analyzed. Results: There were 66 patients included in this study. The average age at the time of VFSS was 4 months (range: 0.3-12 months), 42% of patients were female, and 50% of patients were born premature. In our sample, 86% of patients presented with oral dysphagia, and 76% with pharyngeal dysphagia. Laryngeal penetration in isolation was seen in 39% of patients, and tracheal aspiration was seen in 38% of patients. Of these tracheal aspiration events, 64% were silent. At the time of VFSS, 58% of patients had a nasogastric tube, 12% had a gastrostomy tube, and 3% had a prior hospitalization for pneumonia. Rates of penetration and aspiration in early infancy did not consistently correlate with prematurity, type of CP (spastic, non-spastic, or mixed), degree of paralysis (quadriplegic, hemiplegic, or diplegic), or severity of Gross Motor Function Classification System (GMFCS) score. Conclusion: While there was not a consistent correlation of swallowing dynamics in infancy with later gross motor categorizations of CP, the results of this retrospective review highlight the essential role of early clinical and videofluoroscopic swallowing evaluations to identify oral and pharyngeal swallowing dysfunction in this patient population.

scholarly journals The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmed Nagy ◽  
Sonja M. Molfenter ◽  
Melanie Péladeau-Pigeon ◽  
Shauna Stokely ◽  
Catriona M. Steele
Keyword(s):  
Peak Velocity ◽  
Upper Esophageal Sphincter ◽  
Healthy Population ◽  
Bolus Volume ◽  
Velocity Increase ◽  
Movement Distance ◽  
Hyoid Movement ◽  
Laryngeal Vestibule ◽  
Esophageal Sphincter ◽  
Liquid Bolus

Hyoid movement in swallowing is biomechanically linked to closure of the laryngeal vestibule for airway protection and to opening of the upper esophageal sphincter. Studies suggest that the range of hyoid movement is highly variable in the healthy population. However, other aspects of hyoid movement such as velocity remain relatively unexplored. In this study, we analyze data from a sample of 20 healthy young participants (10 male) to determine whether hyoid movement distance, duration, velocity, and peak velocity vary systematically with increases in thin liquid bolus volume from 5 to 20 mL. The temporal correspondence between peak hyoid velocity and laryngeal vestibule closure was also examined. The results show that maximum hyoid position and peak velocity increase significantly for 20 mL bolus volumes compared to smaller volumes, and that the timing of peak velocity is closely linked to achieving laryngeal vestibule closure. This suggests that generating hyoid movements with increased power is a strategy for handling larger volumes.

Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave

Head & Neck ◽  
2019 ◽  
Vol 42 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Nelson H. May ◽  
Kate W. Davidson ◽  
William G. Pearson ◽  
Ashli K. O'Rourke
Keyword(s):  
Pressure Wave ◽  
Upper Esophageal Sphincter ◽  
Sphincter Pressure ◽  
Esophageal Sphincter ◽  
Pharyngeal Swallowing

scholarly journals Relating neuromuscular control to functional anatomy of limb muscles in extant archosaurs

2019 ◽  
Vol 280 (5) ◽  
pp. 666-680 ◽  
Author(s):  
Andrew R. Cuff ◽  
Monica A. Daley ◽  
Krijn B. Michel ◽  
Vivian R. Allen ◽  
Luis Pardon Lamas ◽  
...  
Keyword(s):  
Functional Anatomy ◽  
Neuromuscular Control ◽  
Limb Muscles

Upper esophageal sphincter impedance as a marker of sphincter opening diameter

2012 ◽  
Vol 302 (9) ◽  
pp. G909-G913 ◽  
Author(s):  
Taher I. Omari ◽  
Lara Ferris ◽  
Eddy Dejaeger ◽  
Jan Tack ◽  
Dirk Vanbeckevoort ◽  
...  
Keyword(s):  
Risk Index ◽  
Upper Esophageal Sphincter ◽  
Aim Analysis ◽  
Luminal Diameter ◽  
High Resolution Manometry ◽  
Swallowing Dysfunction ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Swallow Function

The measurement of the physical extent of opening of the upper esophageal sphincter (UES) during bolus swallowing has to date relied on videofluoroscopy. Theoretically luminal impedance measured during bolus flow should be influenced by luminal diameter. In this study, we measured the UES nadir impedance (lowest value of impedance) during bolus swallowing and assessed it as a potential correlate of UES diameter that can be determined nonradiologically. In 40 patients with dysphagia, bolus swallowing of liquids, semisolids, and solids was recorded with manometry, impedance, and videofluoroscopy. During swallows, the UES opening diameter (in the lateral fluoroscopic view) was measured and compared with automated impedance manometry (AIM)-derived swallow function variables and UES nadir impedance as well as high-resolution manometry-derived UES relaxation pressure variables. Of all measured variables, UES nadir impedance was the most strongly correlated with UES opening diameter. Narrower diameter correlated with higher impedance ( r = −0.478, P < 0.001). Patients with <10 mm, 10–14 mm (normal), and ≥15 mm UES diameter had average UES nadir impedances of 498 ± 39 Ohms, 369 ± 31 Ohms, and 293 ± 17 Ohms, respectively (ANOVA P = 0.005). A higher swallow risk index, indicative of poor pharyngeal swallow function, was associated with narrower UES diameter and higher UES nadir impedance during swallowing. In contrast, UES relaxation pressure variables were not significantly altered in relation to UES diameter. We concluded that the UES nadir impedance correlates with opening diameter of the UES during bolus flow. This variable, when combined with other pharyngeal AIM analysis variables, may allow characterization of the pathophysiology of swallowing dysfunction.

S169 – Radiation-Associated Dysphagia with Nasopharyngeal Carcinoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P132-P133
Author(s):  
Jeremy D. Meier ◽  
Rebecca Leonard ◽  
D Gregory Farwell ◽  
Peter C Belafsky
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Average Duration ◽  
Clinical Database ◽  
Swallowing Function ◽  
Age And Gender ◽  
Swallowing Dysfunction ◽  
And Gender ◽  
Maximal Average ◽  
Pharyngeal Constriction ◽  
Normal Controls

Objectives We have observed that patients with dysphagia after radiotherapy (RT) for nasopharyngeal carcinoma (NPC) have substantially worse swallowing function than patients treated with RT of other sub-sites. The purpose of this investigation was to describe swallowing dysfunction after RT for NPC and compare swallowing parameters to patients receiving RT for cancer from another site. Methods Fluoroscopic swallowing data of persons with dysphagia after RT for NPC was abstracted from a clinical database. Objective swallowing parameters were compared to age- and gender-matched normal controls and to cancer stage-matched patients treated with RT for oropharyngeal cancer (OPC). Results 13 patients with NPC were compared to 13 controls and 13 patients with OPC. The average duration from RT to fluoroscopic study was 74 months for NPC and 24 months for OPC (p=.06). 62% of NPC and 47% of OPC were gastrostomy tube-dependent. 92% of NPC patients aspirated or penetrated compared to 62% of OPC patients. The maximal average tolerated bolus was 10.6cc for NPC and 22.2cc for OPC (p<.02). Mean hyolaryngeal elevation was 4.02 (±1.27) for normals, 2.96 (±0.86) for OPC, and 2.45 (± 1.17) for NPC (p<.01). Opening of the pharyngoesophageal segment was lower than normal in both NPC and OPC. Pharyngeal constriction was 0.08 (±0.09) for normals, 0.40 (±0.24) for OPC and 0.45 (±0.27) for NPC (p<.001). Conclusions The data suggest that patients with dysphagia after radiotherapy for NPC present at a later date, have significantly less hyolaryngeal elevation, have weaker pharyngeal constriction, and cannot tolerate as large a bolus as patients treated with radiotherapy for OPC.

S118 – Study of Pharyngeal Swallowing by High-resolution Manometry

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P116-P117
Author(s):  
Kenji Takasaki ◽  
Umeki Hiroshi ◽  
Kaori Enatsu ◽  
Fujinobu Tanaka ◽  
Hidetaka Kumagami ◽  
...  
Keyword(s):  
High Resolution ◽  
Normal Values ◽  
Upper Esophageal Sphincter ◽  
Cervical Esophagus ◽  
High Resolution Manometry ◽  
Maximum Value ◽  
Physiological Information ◽  
Asymptomatic Adult ◽  
Esophageal Sphincter ◽  
Pharyngeal Swallowing

Objectives This study aimed to demonstrate the feasibility of a novel high-resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Methods 33 asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above-mentioned points of pressure were also measured. Results The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid-point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively. Conclusions The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.

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