OBJECTIVE: To summarize the diagnostic and therapeutic experience of primary cricopharyngeal achalasia and introduce new operandi modus. METHOD: Report the two cases we treated in 2008 and integrate published literature, and approach its diagnostic and therapeutic experience and make use of new operandi modus. RESULT: The diagnosis of primary cricopharyngeal achalasia is difficult, and we must apply exclusive diagnosis according to the examinations of fibrolaryngoscopy, esophagoscopy and barium meal et al. CONCLUSION Surgical treatment is the best option. Partial resection of cricopharyngeal muscle and upper esophageal ring-shaped muscle is superior to simple cricopharyngeal myotomy.
Aged ; Esophageal Achalasia ; diagnosis ; surgery ; Female ; Humans ; Middle Aged ; Pharyngeal Diseases ; diagnosis ; surgery ; Pharyngeal Muscles ; physiopathology

Cleft Palate ; Humans ; Palate, Soft ; Pharyngeal Muscles ; Pharynx ; Velopharyngeal Insufficiency

We examined pharyngeal nerve courses in paraffin-embedded sagittal sections from 10 human fetuses, at 25-35 weeks of gestation, by using S100 protein immunohistochemical analysis. After diverging from the glossopharyngeal and vagus nerves at the level of the hyoid bone, the pharyngeal nerves entered the constrictor pharyngis medius muscle, then turned upward and ran superiorly and medially through the constrictor pharyngis superior muscle, to reach either the levator veli palatini muscle or the palatopharyngeus muscle. None of the nerves showed a tendency to run along the posterior surface of the pharyngeal muscles. Therefore, the pharyngeal nerve plexus in adults may become established by exposure of the fetal intramuscular nerves to the posterior aspect of the pharyngeal wall because of muscle degeneration and the subsequent rearrangement of the topographical relationship between the muscles that occurs after birth.
Adult ; Fetus ; Glossopharyngeal Nerve ; Humans ; Hyoid Bone ; Muscles ; Parturition ; Pharyngeal Muscles ; Pregnancy ; Vagus Nerve

BACKGROUND AND OBJECTIVES: Pharyngoesophageal musculature plays an important role in swallowing, and prevents aspiration and supraesophageal reflux. These muscles are closed during the resting state and opens with swallowing to allow the passage of food. In this study, the histochemical characteristics of the upper esophageal sphincter muscles in human were investigated. MATERIALS AND METHODS: Muscle samples from the inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle and sternocleidomastoid (SCM) muscle were obtained from the healthy portion of nine laryngectomized specimen. We used the H&E staining for identifying the gross anatomy of these muscles, and the myofibrillar ATPase staining and the NADH-TR staining for differentiating the muscle fiber type. RESULTS: Analysis of the muscle fiber types of the upper esophageal sphincter muscle revealed a predominance of type I in the cricopharyngeus (78.9%) and the upper esophageal muscle (85.2%), and type II in the inferior pharyngeal constrictor muscle (80%). In the SCM muscle, the percentage of each fiber type was almost the same. The proportion of oxidative fibers within these muscles correlated well to that of the type I fibers. CONCLUSION: The distribution of the type I fibers tended to be higher in the upper esophageal muscle than in the inferior pharyngeal constrictor. These findings about fiber types represents well the physiological features of each muscle, i.e. the inferior pharyngeal constrictors are capable of short rapid contraction and the upper esophageal muscles are capable of slow rhythmic movement.
Adenosine Triphosphatases ; Deglutition ; Esophageal Sphincter, Upper* ; Histocytochemistry ; Humans* ; Muscles ; Pharyngeal Muscles

Although dysphagia is an important health problem and one of the determinants of quality of life in patients with dementia, the neurophysiologic changes of dysphagia in dementia have not been fully uncovered, yet. we investigated the changes of strength of tongue lip and pharyngeal muscles in patients with dementia. This study included 30 subjects with dementia. In all subjects, clinical assessments consisted of the Iowa Oral Performance Instrument (IOPI) for tongue and lip, surface electromyography (sEMG) with Vital stim plus on suprahyoid muscles, the Mini-Mental State Examination, and Clinical Dementia Rating (CDR) scales. All subjects were classified into 3 groups according to severity; CDR 1, 2, and 3. There was no difference between IOPI and sEMG among all 3 groups. The values of tongue and lip IOPI from all 3 dementia groups were significantly lower than values of control. The comparisons for values of tongue and lip IOPI among 3 dementia group were not different from each other. The sEMG of suprahyoid muscles were not different between all 3 dementia groups and control. These findings are supportive of dysphagia therapy for oral phase would be beneficial for the restoration of swallowing function in patients with dementia and dysphagia.
Deglutition ; Deglutition Disorders ; Dementia ; Electromyography ; Humans ; Iowa ; Lip ; Muscles ; Pharyngeal Muscles ; Quality of Life ; Tongue ; Weights and Measures

The pathogenesis and mechanism of obstructive sleep apnea (OSA) has been under investigation for over 25 years, but its etiology and mechanism remains elusive. Skeletal (maxillary and/or mandibular hypoplasia or retrodisplacement, inferior displacement of hyoid) and soft tissue (increased volume of soft tissue, adenotonsillar hypertrophy, macroglossia, thickened lateral pharyngeal walls) factors, pharyngeal compliance (increased), pharyngeal muscle factors (impaired strength and endurance of pharyngeal dilators and fixators), sensory factors (impaired mechanoreceptor sensitivity, impaired pharyngeal dilator reflexes), respiratory control system factors (unstable respiratory control) and so on facilitate collapse upper airway. Therefore, OSA may be a heterogeneous disorder, rather than a single disease entity and various pathogenic factors contribute to the OSA varies person to person. As a result, patients may respond to different therapeutic approaches based on the predominant abnormality leading to the sleep disordered breathing.
Compliance ; Humans ; Hypertrophy ; Macroglossia ; Mechanoreceptors ; Pharyngeal Muscles ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive*

Idiopathic cricopharyngeal achalasia is a rare condition that produces oropharyngeal dysphagia. It is caused by spasm of the cricopharyngeus and inability to relax with swallowing. A prominent muscle bar at the upper esophageal sphincter is a typical finding of the esophagogram. Cricopharyngeal myotomy is the treatment of choice. We report a case of cricopharyngeal myotomy for 61-year-old female patient.
Deglutition ; Deglutition Disorders ; Esophageal Achalasia* ; Esophageal Sphincter, Upper ; Female ; Humans ; Middle Aged ; Pharyngeal Muscles ; Spasm

An overlap syndrome is a combination of major features of more than one connective tissue diseases which is presented in the same patient. An overlap syndrome of rheumatoid arthritis (RA) and polymyositis (PM) which involved the upper pharyngeal muscle has not been reported in Korea. Herein, we report a rare case of a patient with a long-history RA presenting proximal muscle weakness and swallowing difficulty, who was successfully treated with a high-dose of corticosteroid, azathioprine and tacrolimus.
Arthritis, Rheumatoid ; Azathioprine ; Connective Tissue Diseases ; Deglutition ; Humans ; Korea ; Muscle Weakness ; Pharyngeal Muscles ; Polymyositis ; Tacrolimus

OBJECTIVE: To observe the histopathologic and morphological changes of palatopharyngeal soft tissues in patients with different degrees of obstructive sleep apnea hypopnea syndrome (OSAHS) patients. METHOD: Thirty-eight male OSAHS patients were divided into 3 groups according to AHI, namely mild group (n = 10), moderate group (n = 13),and severe group (n = 15). The soft palate tissues with partial palatopharyngeal arch and palatoglossal arch tissues were obtained from surgery and processed with conventional paraffin embedding. The sections were stained by HE and observed under a light microscope. The histological quantitative changes of the specimens were measured by analyzing the constituent ratios of glandular tissue, fat tissue and interstitial elements. Statistical analysis was performed. RESULT: 1) Optical microscope showed that (100 times), as the aggravation of the OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis, accompanied by liquefied degeneration of basal cell; The mucous membrane and submucosal connective tissue contain a certain number of lymphocytes infiltration. The mucosa and submucosal layer of loose connective tissue contain inflammatory cells and a lot of fat vacuoles can be observed; The soft palate mucous acini have inconsistent and irregular shape, among which there are a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini with dark stained cytoplasm; The palatoglossal muscle and palatopharyngeus muscle fibers can't be identified with disordered arrangement of structure, showing pleomorphic changes including swelling, atrophy and degeneration. Some of elastic fibers were disrupted and a lot of fat cells infiltration was observed. (2) The constituent ratios of the three kinds of tissues in soft palate from different degrees of OSAHS patients show that quantitative changes of glandular tissue and interstitial elements among the mild, moderate and severe OSAHS group patients exhibit statistically significant differences (P < 0.05). The constituent ratio of vascular components between mild and severe groups and that between moderate and severe groups exhibit statistically significant differences (P < 0.05). The constituent ratio changes of vascular components between mild and moderate groups show no statistically significant difference (P > 0.05). CONCLUSION With the rising of severity of OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis. Between acinar cell we could see a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini. Muscle fibers of palatopharyngeal tissue have pleomorphic changes of swelling, atrophy and degeneration.
Adult ; Humans ; Male ; Middle Aged ; Palate, Soft ; pathology ; Pharyngeal Muscles ; pathology ; Sleep Apnea, Obstructive ; classification ; pathology

BACKGROUND AND OBJECTIVES: Pain is one of the most troublesome discomfort accompanying tonsillectomy. Pharyngeal muscle spasm is one of the causes of post-tonsillectomy pain. We investigated the effect of an oral central muscle relaxant agent (chlorophenesin carbamate: CPC) on post-tonsillectomy pain. MATERIALS AND METHOD: Thirty adult patients undergoing tonsillectomy were included in this study. Basic pain control per oral administration consisted of 3.0 g/day (t.i.d.) salicylsalicylic acid and intramuscular injection of 5 mg diclofenac sodium (DCF) on demand. The patient population was divided into CPC group (n=15) and control group (n=15) randomly. CPC Group (n=15) received additional oral ingestion of 375 mg (t.i.d.) CPC for 7 days after operation. Pain assesment was peformed using visual analogue scale (VAS) at rest and while swallowing at the first (POD1) and seventh (POD7) day of the operation. Pain relief score (PRS) is the difference between VAS at POD1 and POD7. The number of injection of DCF was compared also. RESULTS: VAS of CPC group and the control at POD1 were 1.9+/-1.7/4.8+/-2.3 (rest/swallowing) and 2.8+/-1.6/5.2+/-1.9, respectively. VAS of CPC group and the control at POD7 were 1.5+/-1.8/3.4+/-1.9 and 1.8+/-1.3/3.5+/-1.5, respectively. The VAS scores of the two groups at POD1 and POD7 are not significantly different. The PRS of CPC group and the control group were 1.7+/-0.7/1.4+/-1.4 (rest/swallowing) and 1.0+/-1.0/1.6+/-1.2 (rest/swallowing), respectively. No significant difference in PRS was observed between the two study groups. The number of injection of DCF between the two groups is not significantly different. CONCLUSION: No significant benefit is found for the use of oral muscle relaxant agent after tonsillectomy.
Administration, Oral ; Adult ; Deglutition ; Diclofenac ; Eating ; Equidae ; Humans ; Injections, Intramuscular ; Pharyngeal Muscles ; Spasm ; Tonsillectomy