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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.
Head and Neck Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Warrenkevin Henderson, Hannah Jacobson, Noelle Purcell, Kylar Wiltz
In one neonate with trisomy 13, the right posterior belly of the digastricus split and sent a deep bundle to stylopharyngeus (Colacino and Pettersen 1978). In another neonate with trisomy 13, stylopharyngeus was doubled bilaterally (Pettersen et al. 1979). The extra muscles coursed transversely to the superior pharyngeal constrictor and inserted just lateral to the pharyngeal raphe. In a boy with trisomy 13q, an extra stylopharyngeus muscle was present on the left side and inserted deep into hyoglossus (Pettersen 1979). In an infant with trisomy 18, an abnormal belly of stylopharyngeus coursed posteriorly behind the styloid process and inserted over the superficial surface of the superior constrictor (Bersu and Ramirez-Castro 1977). Stylopharyngeus was absent in a fetus with craniorachischisis (Alghamdi et al. 2017).
Rhinolaryngoscopy for the Allergist
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jerald W Koepke, William K Dolen
Anterior bony protrusions (osteophytes) from the vertebral bodies behind the posterior pharyngeal wall can cause obstruction; mucus that collects on these projections can lead to chronic pharyngeal symptoms. The pulsations of a carotid aneurysm might be noted on examination of the oropharynx. Cobblestoning of the mucosa (Fig. 11.10) results from hypertrophy of lymphoid tissue and is a sign of upstream inflammatory reaction. One of the most striking abnormalities of the pharyngeal walls is spasm of the pharyngeal constrictor muscles associated with anxiety or chemical irritation of the upper airway. The patient complaining of a tight throat may indeed have a tight throat; this might be difficult to understand on direct pharyngeal examination and the symptoms and signs might otherwise be confused with those of asthma.
Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study
Published in International Journal of Speech-Language Pathology, 2022
Increased pressure with effortful swallowing was observed at the level of the velopharynx, mesopharynx and hypopharynx. This global pressure increase aligns with previous research (Takasaki, Umeki, Hara, Kumagami, & Takahashi, 2011) and indicates that effortful swallowing does not simply increase tongue base retraction, but increases contraction of the superior and inferior pharyngeal constrictor muscles. Effortful swallowing was found to significantly increase UOS RT when compared with non-effortful swallowing in adults with dysphagia. This finding is significant since the aim of the effortful swallow is to increase pharyngeal pressure to generate greater pharyngeal force to propel the bolus through the pharynx into the oesophagus (O’Rourke et al., 2014). Alongside greater pharyngeal force, prolonged UOS RT can assist with improving pharyngeal bolus clearance (Hind, Nicosia, Roecker, Carnes, & Robbins, 2001). These findings suggest that the effortful swallow does more than increase tongue base to posterior pharyngeal wall contact in people with dysphagia.
Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients
Published in Logopedics Phoniatrics Vocology, 2021
Chiara Mezzedimi, Enza Vinci, Fabio Giannini, Serena Cocca
Phonation induces a significant increase in upper esophageal sphincter (UES) pressure. This UES pressure increase is significantly higher than that of the stomach, esophagus, and lower esophageal sphincter (LES), indicating the existence of a phonation-induced UES contractile reflex. The UES pressure generated by activation of this reflex is influenced by sex [19]. The upper esophageal sphincter is comprised of the cricopharyngeal muscles (CPM), inferior pharyngeal constrictor, and the proximal cervical esophagus. CPM is controlled by medulla, thus medullary infarction may result in a failed relaxation of UES. According to Kang SH et al. [20], the occurrence of the upper esophageal sphincter (UES) dysfuction might be the first step, which in turns affect the swallowing process, resulting in pharyngo-esophageal dyssynergia, and so dysphagia.
A comparison of swallow-related submandibular contraction amplitude and duration in people with Parkinson’s disease and healthy controls
Published in International Journal of Speech-Language Pathology, 2021
Julie Kim, Christopher R. Watts
Parkinson’s disease (PD) leads to physiological impairments in the voluntary and involuntary (e.g. reflexive) actions of swallowing muscles. Oropharyngeal dysphagia occurs in more than 80% of the PD population across the progressive stages of the disease (Kalf, de Swart, Bloem, & Munneke, 2012; Pfeiffer, 2011; Simons, 2017). Pharyngeal stage swallowing impairments in PD range from delayed onset of pharyngeal stage activity, dysmotility of the pharyngeal constrictor muscles, poor base of tongue retraction, impaired laryngeal closure, and reduced opening diameter of the upper oesophageal sphincter (Leopold & Kagel, 1996; Nagaya, Kachi, Yamada, & Igata, 1998; Nilsson, Ekberg, Olsson, & Hindfelt, 1996). Numerous studies have also suggested that hyolaryngeal excursion is impaired secondary to PD (Ertekin et al., 2002; Leopold & Kagel, 1997b; Nagaya et al., 1998; Suttrup & Warnecke, 2016). Collectively these physiological impairments result in vallecular, pharyngeal wall, and/or pyriform sinus residue, in addition to laryngeal penetration with or without aspiration (Leopold & Kagel, 1997a; Suttrup & Warnecke, 2016).