Mano-videoendoscopic assessment in the evaluation of the pharyngeal contraction and upper esophageal sphincter function in dysphagic patients

Karaho, Takehiro; Nakajima, Junko; Satoh, Tetsuya; Kawahara, Keisuke; Nakayama, Tsuneyoshi; Kohno, Naoyuki

doi:10.1016/j.anl.2016.08.004

Cited by 7 publications

(10 citation statements)

References 16 publications

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“…Consistent with our results, Fukushima et al indicated involvement of the RLN and pharyngeal branch of the vagus nerve in decreased UES pressure during swallowing (6). Karaho et al reported that a drop in UES pressure, which indicates a gap between the resting pressure and the nadir of the pressure, was the most useful parameter for predicting UES opening in humans (10). There are two hypotheses for the reduced negative UES pressure during swallowing following Bi-RLNx: 1) decreased resting UES pressure and 2) change in the laryngeal elevation.…”

Section: Discussionsupporting

confidence: 91%

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Tsujimura

Suzuki

Yoshihara

et al. 2018

Journal of Applied Physiology

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Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

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Section: Discussionsupporting

confidence: 91%

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Tsujimura

Suzuki

Yoshihara

et al. 2018

Journal of Applied Physiology

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“…The present study is clinically relevant, because it provides useful information on the UES opening during swallowing. In general, the UES opening has been considered as a passive event, because it occurs as a result of the elevation of the hyolaryngeal complex and of the relaxation of the cricopharyngeal part of the inferior constrictor [2,[7][8][9][10][11]. Our findings revealed that the palatopharyngeus spread across the inner surface of the cricopharyngeal part of the inferior constrictor, and it is connected to the cricopharyngeal part of the inferior constrictor thorough a dense connective tissue (Fig.…”

Section: Discussionmentioning

confidence: 69%

“…The opening of the upper esophageal sphincter (UES), which is located on the cricopharyngeal part of the inferior constrictor and the uppermost part of the esophagus [1][2][3][4], is one of the essential events required for proper swallowing [5,6]. In general, the UES opening occurs as a result of the elevation of the hyolaryngeal complex and the relaxation of the cricopharyngeal part of the inferior constrictor [2,[7][8][9][10][11]. Therefore, the mechanism of the UES opening has been considered a passive event, and a few studies have focused on whether any anatomical structures directly act on the UES opening.…”

Section: Introductionmentioning

confidence: 99%

Anatomy of inferior end of palatopharyngeus: its contribution to upper esophageal sphincter opening

Fukino

Tsutsumi

Nimura

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose The palatopharyngeus is one of the longitudinal pharyngeal muscles which contributes to swallowing. It is reported that the palatopharyngeus has muscle bundles in various directions and with attachment sites, and each muscle bundle has a specific function. Although previous reports suggest that the palatopharyngeus is partly interlaced with some parts of the inferior constrictor, the precise relationship remains unclear. The purpose of this study was to examine the precise manner of the connection between the palatopharyngeus and inferior constrictor, and to examine the histological characteristics of this connection. Methods We examined 15 halves of nine heads from Japanese cadavers (average age: 76.1 years); 12 halves, macroscopically, and three halves, histologically. Results Our observation suggests that the palatopharyngeus spreads radially on the inner aspect of the pharyngeal wall. The most inferior portion of the palatopharyngeus extended to the inner surface of the cricopharyngeal part of the inferior constrictor. Histological analysis showed that the inferior end of the palatopharyngeus continued into the dense connective tissue located at the level of the cricoid cartilage. The dense connective tissue not only covered the inner surface of the inferior constrictor but also entered its muscle bundles and enveloped them. Conclusion Therefore, the palatopharyngeus interlaced the cricopharyngeal part of the inferior constrictor through the dense connective tissues. The findings of this study show that the palatopharyngeus may act on the upper esophageal sphincter directly and help in its opening with the aid of the pulling forces in the superolateral direction.

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“…Multiple factors influence the UES opening, in which the cholinergic contractions of UES, as well as pressure in the pharynx and esophagus, may become involved [36,37]. The UES residual pressure and UES relaxation duration reflect the status of UES during swallowing.…”

Section: Discussionmentioning

confidence: 99%

The Biomechanical Characteristics of Swallowing in Tracheostomized Patients with Aspiration following Acquired Brain Injury: A Cross-Sectional Study

et al. 2023

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Objectives: Investigate the biomechanical characteristics in tracheostomized patients with aspiration following acquired brain injury (ABI) and further explore the relationship between the biomechanical characteristics and aspiration. Methods: This is a single-center cross-sectional study. The tracheostomized patients with aspiration following ABI and age-matched healthy controls were recruited. The biomechanical characteristics, including velopharynx (VP) maximal pressure, tongue base (TB) maximal pressure, upper esophageal sphincter (UES) residual pressure, UES relaxation duration, and subglottic pressure, were examined by high-resolution manometry and computational fluid dynamics simulation analysis. The penetration–aspiration scale (PAS) score was evaluated by a videofluoroscopic swallowing study. Results: Fifteen healthy subjects and fifteen tracheostomized patients with aspiration following ABI were included. The decreased VP maximal pressure, increased UES residual pressure, and shortened UES relaxation duration were found in the patient group compared with the control group (p < 0.05). Furthermore, the subglottic pressure significantly decreased in patients (p < 0.05), while no significant difference was found in TB maximal pressure between groups (p > 0.05). In addition, in the patient group, VP maximal pressure (rs = −0.439; p = 0.015), UES relaxation duration (rs = −0.532; p = 0.002), and the subglottic pressure (rs = −0.775; p < 0.001) were negatively correlated with the PAS score, while UES residual pressure (rs = 0.807; p < 0.001) was positively correlated with the PAS score (p < 0.05), the correlation between TB maximal pressure and PAS score (rs = −0.315; p = 0.090) did not reach statistical significance. Conclusions: The biomechanical characteristics in tracheostomized patients with aspiration following ABI might manifest as decreased VP maximal pressure and subglottic pressure, increased UES residual pressure, and shortened UES relaxation duration, in which VP maximal pressure, UES relaxation duration, subglottic pressure, and UES residual pressure were correlated with aspiration.

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Mano-videoendoscopic assessment in the evaluation of the pharyngeal contraction and upper esophageal sphincter function in dysphagic patients

Cited by 7 publications

References 16 publications

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Anatomy of inferior end of palatopharyngeus: its contribution to upper esophageal sphincter opening

The Biomechanical Characteristics of Swallowing in Tracheostomized Patients with Aspiration following Acquired Brain Injury: A Cross-Sectional Study

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