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Dysphagia and Aspiration
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The majority of patients with a reversible neurological deficit tend to show recovery within a few months, and it is the practice in most units to manage these patients with tracheostomies and feeding tubes, although this may be far from ideal. There are therefore very few indications for reversible procedures. Dysphagia with mild aspiration due to dysfunction of the cricopharyngeus muscle, weakness of the hemilarynx, or reduced pharyngeal constrictor activity can usually be managed with a cricopharyngeal myotomy or vocal cord medialisation with or without excision of the redundant pharyngeal mucosa. Laryngeal or laryngohyoid suspension may be considered in more severe cases.
Care
Published in Henry J. Woodford, Essential Geriatrics, 2022
A range of cognitive, motor and sensory components are required for safe swallowing. The process of swallowing can be divided into phases.Oral phase: chewing and mixing with saliva. The bolus of food is moved backwards in the mouth by the tongue.Pharyngeal phase: there is closure of the velopharynx (to block off the nasal cavity) and the larynx (by an upward and anterior movement). The epiglottis prevents food from entering the airway. There is pharyngeal peristalsis to aid the transit. The food passes the cricopharyngeal muscle to enter the oesophagus.Oesophageal phase: transport to the stomach by peristalsis.
Saliva, Swallowing, and Lower Oesophageal Sphincter
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The pharynx is an incomplete tube enclosed by three constrictor muscles. The cricopharyngeus muscle is an important component of the inferior constrictor and acts as an upper oesophageal sphincter that keeps the oesophageal inlet closed, except during swallowing. The cricopharyngeus muscle is supplied by the recurrent and external laryngeal nerves. The other striated muscles are supplied by the pharyngeal branch of the vagus nerve, and the mucosa is supplied by the glossopharyngeal nerve.
Current status and advances in esophageal drug delivery technology: influence of physiological, pathophysiological and pharmaceutical factors
Published in Drug Delivery, 2023
Ai Wei Lim, Nicholas J. Talley, Marjorie M. Walker, Gert Storm, Susan Hua
The esophagus is a part of the gastrointestinal tract (GI tract) that connects the pharynx to the stomach. It is a hollow, muscular channel that delivers swallowed food bolus to the stomach. The thickness of the esophageal wall in healthy individuals varies depending on the section of the esophagus, with the largest wall thickness during esophageal contraction of 4.70 mm (95%CI: 4.44-4.95) and during esophageal dilation of 2.11 mm (95%CI: 2.00-2.23) (Xia et al., 2009). The esophagus begins at the upper esophageal sphincter that is formed by the cricopharyngeal muscle and ends with the lower esophageal sphincter, which is surrounded by the crural diaphragm (Standring, 2020). While the average length of the esophagus in an adult is between 23 to 25 cm, the length in children at birth varies between 8 to 10 cm (Standring, 2020; Scott-Brown et al., 2008). The esophagus is lined with non-keratinized squamous epithelium in humans and the muscular elements are smooth muscle (Standring, 2020).
Clinical pearls and promising therapies in myositis
Published in Expert Review of Clinical Immunology, 2023
Caoilfhionn M. Connolly, Julie J. Paik
Sporadic inclusion body myositis (IBM) is the most common cause of myopathy in patients over the age of 50 [104,105]. Unlike other IIM, it has a male predominance [106]. Despite its prevalence, it remains poorly recognized, largely owing to the insidious onset of symptoms. IBM is characterized by asymmetric weakness affecting both proximal and distal muscle groups, with prominent distal involvement. Patients may present with reduced hand grip or dexterity (finger flexor weakness), frequent falls in the setting of knee buckling (knee extensor weakness), or foot drop (ankle dorsiflexor weakness) [107]. Dysphagia, due to cricopharyngeal muscle involvement, is common and can precede the onset of extremity weakness [108]. Facial weakness and difficulty closing eyes can rarely be present. Weakness is typically painless, and patients may also note loss of muscle mass, particularly of the quadriceps or ventral forearm or quadriceps. Involvement is typically asymmetric [107]. Recently, a study found that female and Black
Botulinum toxin A injection using ultrasound combined with balloon guidance for the treatment of cricopharyngeal dysphagia: analysis of 21 cases
Published in Scandinavian Journal of Gastroenterology, 2022
Lielie Zhu, Jiajun Chen, Xiangzhi Shao, Xinyu Pu, Jinyihui Zheng, Jiacheng Zhang, Xinming Wu, Dengchong Wu
As part of the upper oesophageal sphincter (UES), normally, the cricopharyngeal muscle maintains tension and contraction during breathing, preventing air from entering the oesophagus and protecting the airway from retrograde reflux from the stomach [1–3]. During swallowing, food is pushed from the mouth to the pharynx under the contraction of masticatory muscles, tongue muscles and pharyngeal muscles; then, the hyoid–laryngeal complex moves upwards and forwards, and the cricopharyngeal muscle relaxes physiologically to allow food to pass through [38]. This swallowing motor sequence is regulated by the medulla oblongata swallowing central pattern generator (CPG) [39]. Brain lesions of many causes, especially brainstem stroke, could damage this regulatory mechanism, which then cannot distribute the swallowing impulse to the relevant motor nucleus, resulting in cricopharyngeal muscle achalasia [38,39]. Therefore, patients with stroke were selected as the participants in this study, which has important clinical significance because of its high incidence and the high incidence of cricopharyngeal muscle achalasia after stroke [5–7,23]. In addition, with good administration, stroke can reach a relatively stable clinical state compared with other progressive neurogenic or neuromuscular diseases, which might hinder patients from gaining permanent therapeutic effects.