The role of cricopharyngeus muscle in pharyngoesophageal disorders

Goyal, Raj K.; Martin, Sandra B.; Shapiro, Jo; Spechler, Stuart J.

doi:10.1007/bf01354547

Cited by 82 publications

(52 citation statements)

References 29 publications

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“…Too often, the terminology only reflects this horizontal part of the cricopharyngeal muscle. Therefore, we agree with Goyal et al that hypopharyngeal dysphagia generally refers to the 'pharyngoesophageal sphincter dysfunction,' which is a better term for 'cricopharyngeal dysfunction' [6].…”

Section: Discussionmentioning

confidence: 41%

“…Because of the laryngeal elevation and anatomical relation of the cricopharyngeal muscle to the cricoid cartilage, the measured region moves cephalad to the manometry probe. Also, Goyal et al claim that there is a disparity between the anatomical location of the cricopharyngeal muscle and the manometric high-pressure zone of the pharyngoesophageal sphincter [6]. The highest pressure zone is above the level of the cricopharyngeal muscle and varies according to phonation, respiration and head posture.…”

Section: Discussionmentioning

confidence: 99%

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Botulinum toxin for dysphagia due to cricopharyngeal dysfunction

Moerman

Callier

Dick

et al. 2002

European Archives of Oto-Rhino-Laryngology

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Botulinum injection in the cricopharyngeal muscle has not yet been described thoroughly. In reviewing the literature, only 24 cases were found in which botulinum injection was used to treat cricopharyngeal dysfunction. We want to add another four cases and discuss specific indications and necessary pre-treatment examinations. Depending on the patient's history and the clinical findings, botulinum injection may be performed. Manometry and videofluoroscopy are not mandatory. The type of functional pathology defines whether botulinum toxin will be a definite treatment or a temporary relief.

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Botulinum toxin for dysphagia due to cricopharyngeal dysfunction

Moerman

Callier

Dick

et al. 2002

European Archives of Oto-Rhino-Laryngology

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“…Aberrant histological and histochemical features such as internalized muscle, ragged red crescents, splits, and nemaline rods were originally considered to be abnormal but are now known to characterize normal CPM tissue [2]. These are unique features that are not found in the adjacent muscles [1]. The different amounts of versican and fibronectin in the CPM endomysium are probably related to specific features of this muscle, particularly because versican and fibronectin are proteins involved in regulatory cell signaling.…”

Section: Discussionmentioning

confidence: 96%

“…It remains closed and prevents air from entering the gastrointestinal tract during inspiration, protects the airway from refluxing material from the esophagus, and opens during swallowing, belching, and vomiting [1]. This elasticity may be attributable to the muscle's structure, which includes the extracellular matrix (ECM), sarcolemma, and muscular tissue [2].…”

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confidence: 99%

Extracellular Matrix Composition of the Cricopharyngeus Muscle

et al. 2011

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The aim of this study was to analyze the presence and distribution of total collagen, type I and type III collagen, elastic fibers, fibronectin, and versican in the endomysium of cricopharyngeus muscles from adults of various ages. The study was a cross-sectional analysis of human cricopharyngeus muscles. Twenty-seven muscles obtained from autopsies of men and women ranging in age from 28 to 92 years were analyzed with the Picrosirius method, oxidized Weigert resorcin-fuchsin, immunohistochemistry, and image analysis. Collagen had the highest density among the analyzed components. Elastic fibers surrounded each muscle cell; they were aligned longitudinally by their long axis and associated with traversing fibers, thereby forming a fiber network with embedded muscle cells. The fibronectin and versican contents varied widely among the specimens. We found no statistically significant differences between the proportion of extracellular matrix (ECM) components and factors such as gender and race. We conclude that the higher proportion of type I and type III collagen is compatible with the cricopharyngeus muscle's sphincteric behavior, and the arrangement of the elastic fibers may also contribute to the muscle's elasticity. We found no statistically significant correlation between the ECM components and age.

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“…Therefore, the IPC (Asoh and Goyal, 1978) and upper esophagus (Zaino et al, 1970) adjacent to the cricopharyngeus muscle are also thought to be contributors to the UES. A recent review of the literature concerning the relationship between the pharyngeal muscles and the UES suggests that the cricopharyngeus muscle may not be the major muscle of the UES (Goyal et al, 1993). We hypothesized that if the IPC, cricopharyngeus muscle, and upper esophagus are the muscles responsible for the high-pressure zone of the UES, they may have similar distribution patterns of the muscle fiber types.…”

mentioning

confidence: 96%

Neuromuscular compartments and fiber‐type regionalization in the human inferior pharyngeal constrictor muscle

Sanders

2001

Anat. Rec.

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The inferior pharyngeal constrictor (IPC) muscle functions during swallowing, respiration, and vocalization. The most-caudal portion of the IPC is believed to be part of the functional upper esophageal sphincter (UES). We hypothesized that the caudal fibers of the human IPC may have enzyme-histochemical characteristics similar to those of the cricopharyngeus muscle, a major component of the UES. In this study, human IPC muscles obtained from autopsy were studied using Sihler's stain to examine innervation patterns, and using myofibrillar ATPase, NADH tetrazolium reductase (NADH-TR), and succinic dehydrogenase (SDH) techniques to investigate the distribution and oxidative capacity of the slow-(type I) and fast-(type II) twitch fibers in the muscle. The results showed that the human IPC consists of at least two neuromuscular compartments (NMCs): rostral and caudal. Each of the NMCs was innervated by a separate nerve branch derived from the pharyngeal branch of the vagus nerve. The rostral NMC is faster (39% type I, 61% type II) than the caudal NMC (70% type I, 30% type II). In addition, two histochemically-delineated fiber layers were identified in the human IPC: a slow inner layer (SIL) with predominantly type I fibers (66%), and a fast outer layer (FOL) with predominantly type II fibers (62%) (P Ͻ 0.01). However, the dimensions of both fiber layers and proportions of the muscle fiber types varied with the NMCs. Specifically, the ratio of the thickness of the SIL to FOL was ϳ2:1 for the caudal NMC and ϳ1:2 for the rostral NMC, respectively. In the SIL the type I fibers accounted for 84% for the caudal NMC and 69% and 44% for the lower and upper portions of the rostral NMC. In contrast, the type II fibers in the FOL accounted for 46% for the caudal NMC and 67% and 74% for the lower and upper portions of the rostral NMC, respectively (P Ͻ 0.01). The caudal NMC of the IPC shared histochemical characteristics with the cricopharyngeus muscle, in that it contained predominantly slow oxidative fibers. Overall, the caudal NMC and the SIL in the IPC had high NADH-TR and SDH activities. However, different patterns of oxidative enzyme activity were identified in both type I and type II fibers. This study provided histochemical evidence for the concept that the caudal NMC within the IPC contributes to the functional UES. In addition, the two histochemically-defined fiber layers in the IPC may be a specialized adaptation in humans to enable different upper-airway functions during respiration, swallowing, and speech. Anat

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The role of cricopharyngeus muscle in pharyngoesophageal disorders

Cited by 82 publications

References 29 publications

Botulinum toxin for dysphagia due to cricopharyngeal dysfunction

Botulinum toxin for dysphagia due to cricopharyngeal dysfunction

Extracellular Matrix Composition of the Cricopharyngeus Muscle

Neuromuscular compartments and fiber‐type regionalization in the human inferior pharyngeal constrictor muscle

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