An Anatomical Protrusion Exists on the Posterior Hypopharyngeal Wall in Some Elderly Cadavers

Abstract

Dysfunction of the cricopharyngeus is a common cause for dysphagia in the elderly and results in the appearance of the cricopharyngeal bar on a barium swallow radiological examination. However, manometrically normal relaxation of the cricopharyngeus has been observed in patients with a permanent cricopharyngeal bar, which implies that some structural changes may occur in the pharyngoesophageal wall. The aim of this study was to examine the macro-microscopic morphological features in the posterior hypopharyngeal wall of elderly human cadavers. Using dissection, histology, and E12 sheet plastination methods, we examined 31 human cadavers (15 females and 16 males; age 60-97 years with a mean of 77 years). We found that about one-third of the cadavers (29%, 9 out of 31) had an anatomical cricopharyngeal protrusion on the posterior hypopharyngeal wall. The protrusion presented two different appearances: a transverse ridge (2 females and 4 males, age 60-91 years) and a tongue-like fold (1 female and 2 males, age 71-86 years). The existence of the anatomical protrusion in the elderly cadaver suggests that such a structural change may become a physical barrier to affect the normal deglutition in the living elderly and should be carefully considered when interpreting radiological and manometrical examinations and with the management of dysphagia.