Head & neck · 2019
Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave.
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May Nelson H, Davidson Kate W, Pearson William G, O'Rourke Ashli K
Аннотация
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.
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.