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

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.
Deglutition ; Electric Impedance ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Esophagus ; Gastroesophageal Reflux ; Gastrointestinal Contents ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Hypersensitivity ; Manometry ; Mucous Membrane ; Peristalsis ; Pharmaceutical Preparations ; Phenobarbital ; Prevalence ; Proton Pump Inhibitors ; Relaxation ; Upper Gastrointestinal Tract

An anterior cervical osteophyte is one of the causes of dysphagia. Surgical treatment is one of the treatment options available, and previous studies have suggested that it is an immediate and effective treatment. This paper reports a case of temporarily aggravated dysphagia after surgical treatment in a patient with anterior cervical osteophyte. A 75-year-old male complained of dysphagia for one year. A videofluoroscopic swallowing study (VFSS) revealed anterior cervical osteophytes at the C3 and C4 level, which resulted in decreased epiglottic folding and partial obstruction of the bolus passage. After he underwent osteophytectomy and anterior fixation, the post-operative VFSS showed an aggravation of dysphagia with prevertebral soft tissue edema. The major cause of dysphagia was attributed to the limitation of movement of the posterior pharyngeal wall and upper esophageal sphincter due to the increased prevertebral soft tissue thickness. In conclusion, surgery should be considered when a severe dysphagia is persistent after adequate conservative treatment in patients with dysphagia due to anterior cervical osteophytes, and patients at high risk of postoperative dysphagia might require swallowing rehabilitation.
Aged ; Cervical Vertebrae ; Deglutition ; Deglutition Disorders ; Edema ; Esophageal Sphincter, Upper ; Female ; Fluoroscopy ; Humans ; Male ; Osteophyte ; Rehabilitation

PURPOSE: The aim is to study the dependence of deformable based auto-segmentation of head and neck organs-at-risks (OAR) on anatomy matching for a single atlas based system and generate an acceptable set of contours. METHODS: A sample of ten patients in neutral neck position and three atlas sets consisting of ten patients each in different head and neck positions were utilized to generate three scenarios representing poor, average and perfect anatomy matching respectively and auto-segmentation was carried out for each scenario. Brainstem, larynx, mandible, cervical oesophagus, oral cavity, pharyngeal muscles, parotids, spinal cord, and trachea were the structures selected for the study. Automatic and oncologist reference contours were compared using the dice similarity index (DSI), Hausdroff distance and variation in the centre of mass (COM). RESULTS: The mean DSI scores for brainstem was good irrespective of the anatomy matching scenarios. The scores for mandible, oral cavity, larynx, parotids, spinal cord, and trachea were unacceptable with poor matching but improved with enhanced bony matching whereas cervical oesophagus and pharyngeal muscles had less than acceptable scores for even perfect matching scenario. HD value and variation in COM decreased with better matching for all the structures. CONCLUSION: Improved anatomy matching resulted in better segmentation. At least a similar setup can help generate an acceptable set of automatic contours in systems employing single atlas method. Automatic contours from average matching scenario were acceptable for most structures. Importance should be given to head and neck position during atlas generation for a single atlas based system.
Brain Stem ; Head and Neck Neoplasms ; Head ; Humans ; Larynx ; Mandible ; Methods ; Mouth ; Neck ; Organs at Risk ; Pharyngeal Muscles ; Radiotherapy ; Spinal Cord ; Trachea

The prevalence of people presenting with fish bone foreign body (FFB) is high in Asian countries, including Korea, and coastal areas around the world. Pointed linear-shaped FFBs are common in the oral cavity and upper esophageal sphincter, whereas large flat bones are more common FFBs in the esophagus. If the FFB is not found on endoscopy, residual foreign body sensation or embedded FFB is possible. In such cases, CT is helpful. However, in the case of totally embedded FFB, not only preoperative diagnosis but also localization during operation or surgery is important. If these are not performed, the initial incision site or operation method would be difficult to determine. For this purpose, no standard guideline has been established yet. We report a case of upper esophageal sphincter-embedded FFB diagnosed using CT rather than endoscopy. The bone was successfully localized using conventional ultrasonography during the operation and then removed surgically.
Asian Continental Ancestry Group ; Diagnosis ; Endoscopy ; Esophageal Sphincter, Upper ; Esophagus ; Foreign Bodies ; Humans ; Korea ; Methods ; Mouth ; Pharynx ; Prevalence ; Sensation ; Ultrasonography

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

Killian-Jamieson diverticulum is a permanent protrusion of anterolateral proximal esophagus through anatomically weak muscular gap, known as Killian-Jamieson area, into adjacent area. During a routine educational dissection, we found a well-defined lateral diverticulum just inferior to the transverse fibers of the cricopharyngeus muscle in a Korean male cadaver. It had a dimension of 1.8×1.4×1.0 cm with two types of epithelial cells, stratified squamous and simple cuboidal to low-columnar epithelium, and attenuated and haphazardly arranged muscle fibers. No epithelial dysplasia or malignant transformation was identified except ulcerative changes. Although Killian-Jamieson diverticulum is a very rare disease, clinicopathological aspects should be considered.
Cadaver* ; Diverticulum* ; Epithelial Cells ; Epithelium ; Esophagus ; Humans ; Male ; Pharyngeal Muscles ; Rare Diseases ; Ulcer

Suprahyoid muscles play an important role in normal swallowing by providing muscle contractions involved in airway protection and upper esophageal sphincter opening. However, these muscles can be weakened by neurological disease or aging, which can result in pharyngeal dysphagia. Therefore, strengthening of the suprahyoid muscles is a clinically important treatment. In addition, it is important to know exactly how and which method is optimal. Many therapeutic exercise methods have been reported to strengthen the suprahyoid muscles, and new methods related to this have recently been reported. Therefore, this study will briefly summarize the representative traditional methods and the recently reported, relatively new methods for strengthening the suprahyoid muscles.
Aging ; Deglutition ; Deglutition Disorders ; Esophageal Sphincter, Upper ; Exercise ; Methods ; Muscle Contraction ; Muscles ; Rehabilitation

Prolonged intubation is known to bring on postextubation dysphagia (PED) in some patients. We have noted that there were some studies to investigate specific type and pattern of PED, which showed large variety of different swallowing abnormalities as mechanisms of PED that are multifactorial. There are several options of treatment in accordance with the management of these abnormalities. A botulinum toxin (BoT) injection into the upper esophageal sphincter (UES) can improve swallowing functions for patients with this disorder, by working to help the muscle relax. In this case, the conventional treatment was not effective in patients with PED, whereas the BoT injection made a great improvement for these patients. This study suggests that the UES pathology could be the main cause of PED.
Botulinum Toxins* ; Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Humans ; Intubation ; Intubation, Intratracheal ; Pathology

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