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

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

OBJECTIVE: To compare the videofluoroscopic findings between the patients with lateral medullary infarct and middle cerebral artery infarct and to investigate specific findings relevant to lateral medullary infarct. METHOD: Among patients with stroke taking videofluoroscopic study for swallowing problems, thirteen patients had a lesion in lateral medulla in imaging study and twenty-six patients in middle cerebral arterial territory. The findings of videofluoroscopic study on two groups were analyzed and compared. RESULTS: In oral phase, the ability of mastication and bolus formation were better in lateral medullary group. In pharyngeal phase, lateral medullary group revealed significantly impaired triggering of pharyngeal reflex, impaired laryngeal elevation, larger amount of residual materials, repeated swallow, delayed pharyngeal transit time, weaker pharyngeal muscle contraction, and poorer upper esophageal sphincter relaxation. Inadequate relaxation of upper esophageal sphincter was most significant factor in indicating the possibility of lateral medullary infarct (positive predictability 90.0%). Inadequate triggering of pharyngeal swallow indicated least possibility of lateral medullary infarct (negative predictability 92.3%). CONCLUSION: Lateral medullary group has the characteristics of more impaired pharyngeal function and better oral function during swallowing than middle cerebral artery group in videofluoroscopic study. Inadequate upper esophageal relaxation and triggering of pharyngeal swallow are the most predictive for lateral medullary infarct.
Deglutition ; Esophageal Sphincter, Upper ; Gagging ; Humans ; Mastication ; Middle Cerebral Artery* ; Pharyngeal Muscles ; Relaxation ; Stroke

BACKGROUND AND OBJECTIVES: Cricopharyngeal dysphagia refers to the dysfunction of the upper esophageal sphincter complex, which is composed of the cricopharyngeus, inferior pharyngeal constrictor and the upper segment of the cervical esophagus. Adequate relaxation of the cricopharyngeal muscle in conjunction with anterosuperior excursion of the larynx by suprahyoid muscles and propulsion of food bolus are prerequisite for normal swallow, mechanisms of which, if altered, may result in cricopharyngeal dysfunction. Head lift exercise, first described by Shaker, can be utilized in patients with cricopharyngeal dysphagia by strengthening the suprahyoid musculature and reducing the intrabolus pressure. The objective of this study was to introduce Shaker's head lift exercise in the treatment of cricopharyngeal dysphagia patients. SUBJECTS AND METHOD: Two patients suffering from cricopharyneal dysphagia after receiving skull base surgery were managed with Shaker's head lift exercise and the swallowing function was evaluated with videofluoroscopy. RESULTS: Both patients who had been taught how to perform head lift exercise showed improvement in swallowing function as observed with videofluoroscopy. Aspiration disappeared and both patients were able to take oral diet without the aid of gastrostomy tubes. CONCLUSION: Shaker's head lift exercise enabled oral feeding without aspiration in two patients. This demonstrates that Shaker's head lift exercise can be a promising noninvasive treatment modality in the treatment of cricopharyngeal dysphagia.
Deglutition ; Deglutition Disorders* ; Diet ; Esophageal Sphincter, Upper ; Esophagus ; Fluoroscopy ; Gastrostomy ; Head* ; Humans ; Larynx ; Muscles ; Pharyngeal Muscles ; Relaxation ; Skull Base

OBJECTIVE: To investigate the relationship between dysphagia severity and opening of the upper esophageal sphincter (UES), and to assess the effect of balloon size on functional improvement after rehabilitative balloon swallowing treatment in patients with severe dysphagia with cricopharyngeus muscle dysfunction (CPD). METHODS: We reviewed videofluoroscopic swallowing studies (VFSS) conducted in the Department of Physical Medicine and Rehabilitation, Myongji Hospital from January through December in 2012. All subjects diagnosed with CPD by VFSS further swallowed a 16-Fr Foley catheter filled with barium sulfate suspension for three to five minutes. We measured the maximum diameter of the balloon that a patient could swallow into the esophagus and subsequently conducted a second VFSS. Then, we applied a statistical technique to correlate the balloon diameter with functional improvement after the balloon treatment. RESULTS: Among 283 inpatients who received VFSS, 21 subjects were diagnosed with CPD. It was observed that the degree of UES opening evaluated by swallowing a catheter balloon had inverse linear correlations with pharyngeal transit time and post-swallow pharyngeal remnant. Videofluoroscopy guided iterative balloon swallowing treatment for three to five minutes, significantly improved the swallowing ability in terms of pharyngeal transit time and pharyngeal remnant (p<0.005 and p<0.001, respectively). Correlation was seen between balloon size and reduction in pharyngeal remnants after balloon treatment (Pearson correlation coefficient R=-0.729, p<0.001), whereas there was no definite relationship between balloon size and improvement in pharyngeal transit time (R=-0.078, p=0.738). CONCLUSION: The maximum size of the balloon that a patient with CPD can swallow possibly indicates the maximum UES opening. The iterative balloon swallowing treatment is safe without the risk of aspiration, and it can be an effective technique to improve both pharyngeal motility and UES relaxation.
Barium Sulfate ; Catheters ; Deglutition Disorders* ; Deglutition* ; Esophageal Sphincter, Upper* ; Esophagus ; Humans ; Inpatients ; Pharyngeal Muscles ; Physical and Rehabilitation Medicine ; Relaxation*

BACKGROUND AND OBJECTIVES: Total laryngectomy is usually used for patients with advanced laryngeal cancer, and causes injuries to hypopharyngeal mucosa, cricopharyngeal muscle, pharyngeal constrictor muscle. These damages induce postoperative swallowing difficulties, although accurate and objective data have not been reported. The purpose of this study is to evaluate the changes and functional difficulties of swallowing mechanism in patients with total laryngectomy by manometric analysis. MATERIALS AND METHODS: We used station pull-through technique in two groups. The study group consisted of 11 total laryngectomized patients, and the control group consisted of 10 cases. We measured resting pressure, length, pressure after relaxation of UES (upper esophageal sphincter), and pharyngeal pressure. And 5 parameters were analyzed for coordination of hypopharynx and UES during swallowing. RESULTS: In the study group, the resting pressure, the maximal pressure after relaxation, and the length of UES was 36.3+/-10.5 mmHg, 149.8+/-14.6 mmHg, and 3.4+/-0.8 cm respectively. In the control group, the results was 34.9+/-9.6 mmHg, 85.5+/-12.3 mmHg, 2.2+/-0.6 cm respectively. The pharyngeal pressure was 81.8+/-10.1 mmHg in the study group, and 67.1+/-12.3 mmHg in the control group. The interval of pharyngeal constriction was 3.0+/-0.23 sec in the study group and 0.49+/-0.04 sec in the control group. The interval of UES relaxation was 2.43+/-0.14 sec in the study group and 0.99+/-0.03 sec in the control group. CONCLUSION: Manometric analysis showed higher pressure of the pharynx and UES in the total laryngectomized patients than in the normal adults. And there was a failure in the coordination between pharyngeal constriction and UES relaxation.
Adult ; Constriction ; Deglutition ; Esophageal Sphincter, Upper* ; Humans ; Hypopharynx ; Laryngeal Neoplasms ; Laryngectomy ; Mucous Membrane ; Pharyngeal Muscles ; Pharynx* ; Relaxation

Videofluoroscopic swallowing study (VFSS) used for the diagnosis of dysphagia has limitations in objectively assessing the contractility of the pharyngeal muscle or the degree of the upper esophageal sphincter relaxation. With a manometer, however, it is possible to objectively assess the pressure changes in the pharynx caused by pharyngeal muscle contraction during swallowing or upper esophageal sphincter relaxation, hence remedying the limitations of VFSS. The following case report describes a patient diagnosed with lateral medullar infarction presenting a 52-year-old male who had dysphagia. We suggested that the manometer could be used to assess the specific site of dysfunction in patients with dysphagia complementing the limitations of VFSS. We also found that repetitive transcranial magnetic stimulation was effective in treating patients refractory to traditional dysphagia rehabilitation.
Complement System Proteins ; Deglutition ; Deglutition Disorders* ; Diagnosis* ; Esophageal Sphincter, Upper ; Humans ; Infarction ; Male ; Manometry* ; Middle Aged ; Pharyngeal Muscles ; Pharynx ; Rehabilitation ; Relaxation ; Transcranial Magnetic Stimulation*

OBJECTIVE: To evaluate the characteristics of cricopharyngeal dysfunction (CPD), the frequency, and correlation with a brain lesion in patients with first-ever ischemic stroke, and to provide basic data for developing a therapeutic protocol for dysphagia management. METHODS: We retrospectively reviewed the medical records of a series of subjects post-stroke who underwent a videofluoroscopic swallowing study (VFSS) from January 2009 to December 2015. VFSS images were recorded on videotape and analyzed. CPD was defined as the retention of more than 25% of residue in the pyriform sinus after swallowing. The location of the brain lesion was assessed using magnetic resonance imaging. RESULTS: Among the 262 dysphagic patients with first-ever ischemic stroke, 15 (5.7%) showed CPD on the VFSS. Patients with an infratentorial lesion had a significantly higher proportion of CPD than those with a supratentorial lesion (p=0.003), and lateral medullary infarction was identified as the single independent predictor of CPD (multivariable analysis: odds ratio=19.417; confidence interval, 5.560–67.804; p < 0.0001). Compared to patients without CPD, those with CPD had a significantly prolonged pharyngeal transit time, lower laryngeal elevation, and a higher pharyngeal constriction ratio and functional dysphagia scale score. CONCLUSION: Overall, the results support the notion that an impaired upper esopharyngeal opening is likely related to the specific locations of brain lesions. The association of CPD with lateral medullary infarction can be explained based on the regulation of the pharyngolaryngeal motor system by the motor neurons present in the dorsal nucleus ambiguus. Overall, the results reveal the relation between CPD and the problems in the pharyngeal phase as well as the severity of dysphagia.
Brain ; Constriction ; Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Humans ; Infarction ; Magnetic Resonance Imaging ; Medical Records ; Medulla Oblongata ; Motor Neurons ; Pharyngeal Muscles ; Pyriform Sinus ; Retrospective Studies ; Stroke* ; Videotape Recording

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