Hypopharynx Region Research Articles

Linear Cephalometric Analysis of Pharynx at the Level of Epiglottis among Snorers and Nonsnorers: A Cross-Sectional Study.

Aim Snoring, which falls within the spectrum of sleep-related breathing disorders, is considered to be one of the common symptoms of airway obstruction. Lateral cephalometric analysis is an effective way of diagnosing airway obstruction by evaluating skeletal and soft tissue abnormalities in patients with sleep-disordered breathing (SDB). The present study was planned to analyze the pharyngeal space among snorers and nonsnorers in the retroglossal region and in the region of hypopharynx at the level of epiglottis. Materials and Methods The present cross-sectional study included a total of 60 individuals who were grouped into snorers and nonsnorers based on their answers for the study questionnaire related to snoring. Digital lateral cephalograms were taken for all maintaining the exposure parameters while Digora software was used for measurements related to the soft tissue parameters. The two significant soft tissue parameters analyzed were the distance of epiglottis from the tip of the soft palate, the retroglossal length, and the distance of posterior pharynx from the tip of the epiglottis, the pharyngeal space. Statistical Analysis The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, Illinois, United States) while paired t -test was used for intergroup analysis. A p -value of < 0.05 was considered statistically significant. Results The mean retroglossal length was found to be 25.52 mm among the snorers and 23.70 mm among the nonsnorers. In case of pharyngeal space, a mean of 8.54 mm was recorded among the snorers whereas among the nonsnorers, the respective mean value of 10.16 mm was observed. Conclusion In the present study, pharyngeal space was found to be less at the level of the tip of epiglottis among the snorers compared with nonsnorers which can be attributed to be one of the significant reasons behind snoring and obstructive sleep apnea syndrome.

Cephalometric Interincisal Angle and Mandibular Variations Among Snorers and Non-Snorers Among North India Population: A Cross Sectional Study

Introduction: Snoring which falls within the spectrum of sleep-related breathing disorders considered to be a common symptom of airway obstruction. Over the years, lateral cephalometric radiography has become one of the standard diagnostic tools to evaluate skeletal and soft tissue abnormalities contributing to obstruction, and have been the most common imaging method in evaluating patients with sleep-disordered breathing (SDB). Aim: To analyze the pharyngeal space in the retroglossal region and the region of hypopharynx at the level of epiglottis as well as its relation with the height and weight of the individuals. Materials And Methods: The study was conducted among 60 participants age 21-50 years and was equally divided into snorers and non-snorers. Lateral cephalogram was taken maintaining the exposure parameters and DIGORA software was used for soft tissue parameters. The parameters analyzed were an interincisal angle, angle of the mandible and height of the ramus. Results: Interincisal angle was found to be more among snorers as compared to non-snorers (p&lt;.05), whereas the angle of the mandible and height of the ramus was found to be less among snorers as compared to non-snorers and was found to be statistically significant.

THE EFFECT OF ISOLATED SEGMENTAL CHIN OSTEOTOMY (SCO) ON THE PHARYNGEAL AIRWAY SPACE

The chin affects facial esthetics and the harmony between frontal and lateral views and is one of the most important anatomic structures of the lower third of the face. Chin osteotomy is aimed at ensuring the harmonization of the facial profile by balancing the size and form of the lower third of the face. It is assumed that the isolated genioplasty surgery will improve the pharyngeal airway space (PAS) by promoting muscle changes, specifically by pulling forward the hyoid bone and decompressing the hypopharynx region. Two patients without obstructive sleep apnea syndrome (OSAS) underwent isolated chin osteotomy for esthetic purposes. Forward movement of the chin by the Pg point was 7 mm in one case and 11 mm in another case. They were evaluated by preoperative and postoperative cone-beam computed tomography scans. The upper airway space was subdivided into retropalatal and retroglossal spaces. After this, the upper airway space was analyzed through the following criteria: 1) three-dimensional, high-altitude, cross-sectional surfaces; 2) transverse and anteroposterior diameter changes. Isolated segmental genioplasty was used after precise virtual planning and resulted in the PAS increase only in one case. There was a relevant correlation between the vertical and horizontal chin change and the hypopharynx. There was an average of a 1.6-fold increase in the total volume of the upper airway space. The retroglossal space was increased 1.5-fold. In another case, there was no relevant correlation between the vertical and horizontal chin change and the PAS. Isolated segmental chin osteotomy provides predictable esthetic results in the correction of different mandible anterior deformities and may contribute to an increased volume and a morphologic airway change. Further studies should be conducted to evaluate the effect of isolated segmental genioplasty on the pharyngeal airway space.

Swallowing Pressure Variability as a Function of Pharyngeal Region, Bolus Volume, Age, and Sex

Within-individual movement variability occurs in most motor domains. However, it is unknown how pharyngeal swallowing pressure varies in healthy individuals. We hypothesized that: 1) variability would differ among pharyngeal regions; 2) variability would decrease with increased bolus volume; 3) variability would increase with age; and 4) there would be no sex differences. Case series. We used pharyngeal high-resolution manometry to measure swallowing pressure in the following regions: velopharynx, tongue base, hypopharynx, and upper esophageal sphincter. Data were collected from 97 healthy adults (41 male) aged 21 to 89 years during thin liquid swallows: 2 mL, 10 mL, and participant-selected comfortable volume. Pressure variability was measured using coefficient of variation. Repeated measures analysis of variance was used to assess impacts of region, bolus volume, age, and sex on pressure variability. There was a significant region × volume interaction (P < .001) and significant main effect of age (P = .005). Pressures in the hypopharynx region were more variable than all other regions (P ≤ .028), and pressures in the tongue base region were less variable than all other regions (P ≤ .002) except at 2 mL volumes (P = .065). Swallowing pressure variability was significantly different in the velopharynx and upper esophageal sphincter regions, with comfortable volume and 2 mL swallows having greater variability than 10 mL swallows (P ≤ .026). Pressure variability significantly increased with increasing age (P = .002). There were no effects of sex on pressure variability (P ≥ .15). Pharyngeal swallowing pressure variability differs according pharyngeal region, volume, and age but not sex. Abnormal swallowing pressure variability may reflect deviations in motor control in persons with swallowing impairment, and results from this study can be used as normative data for future investigations evaluating swallowing pressure generation. 4 Laryngoscope, 131:E52-E58, 2021.

Evaluation of pain in children submitted to hematopoietic stem cell transplantation

Objective: to evaluate pain in children undergoing transplantation of hematopoietic stem cells. Methods: longitudinal and analytical research with children hospitalized for transplant of hematopoietic stem cells with Faces Pain Scale Revised, every four hours from hospital admission to hospital discharge analyzed with relative/absolute frequency and chi-square test. Results: nine children aged four to nine years old were evaluated, totaling 1,095 ratings 23.4% were reported with some pain score; of these, 38.9% were in hypo pharynx region; 78.8%, moderate pain. The chi-square showed significance between pain scores weeks post-transplantation and pain existence among the analyzed children. Conclusion: although the pain has not affected large proportion of children, moderate and strong pain covered around 80.0% of complaints along the hematopoietic stem cell transplantation process. Thus, it is suggested that the evaluation of pain is one of the signs to be inserted in the protocols of nursing interventions in this context of caring.

Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

Background: In routine medical examination, the hypopharyngeal-esophageal area (HER) is difficult to assess due to its position and anatomical complexity. The purpose of this study was to evaluate the feasibility of a volitional eructation maneuver during transnasal flexible laryngoscopy and its influence on the visibility of the HER. Methods: Twenty healthy volunteers underwent flexible laryngoscopy. Once the larynx was freely visible during laryngoscopy, the subjects were asked to trigger a “burp.” The volitional belching during the study was assisted by drinking a carbonated cold drink. The triggered relaxation of the upper esophageal sphincter along with the widening of the hypopharynx region was recorded and subsequently analyzed frame by frame. Results: Out of 20 volunteers, 16 (80%) were able to volitionally induce an eructation. Significant widening of the hypopharynx region up to the relaxant upper esophageal sphincter could be recorded. The structures were clearly visible in the offline analysis. In 13 (81%) of the 16 subjects who could induce an eructation, the upper esophageal sphincter was partially visible or free for full inspection. Conclusion: The eructation method as a simple physiological function can be used as a complementary method during flexible transnasal endoscopy to enhance visibility of the entire hypopharynx region as well as the upper esophageal sphincter.

Methods for measuring swallowing pressure variability using high-resolution manometry.

Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3 - 10 consecutive swallows had no overall difference in variability, but sets of 2 swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.

Three-Dimensional Tomographic Analysis of the Dimensions of the Nasal Cavity and Nasal and Upper Pharyngeal Airway Space in Subjects Submitted to Surgically Assisted Rapid Maxillary Expansion

The main objective of the surgically assisted rapid maxillary expansion (SARME) is to increase the transversal dimension of the upper dental arch in individuals with maxillary atresia. Its effects are not restricted to the maxilla, also acting on the nasal cavity and pharyngeal airway. The present study aimed to evaluate the occurrence of dimensional changes in the nasal cavity and nasal and upper pharyngeal airway space in individuals submitted to surgically assisted maxillary expansion using 2 different osteotomies. Nasal and pharyngeal airway space structures were analyzed by pre-and post-operative cone beam computed tomography scans of 29 adult subjects submitted to surgically assisted maxillary expansion. Volumetric measurement of the nasal and upper pharyngeal airway and linear measurements of the nasal cavity were performed using Dolphin Imaging 11.7 software. The data were tabulated and submitted to statistical analysis by ANOVA analysis of variance and Tukey test (p <0.05). The results showed that both osteotomies were effective in correcting transverse maxillary deficiency and presented similar effects on the nasal cavity and pharyngeal air space, the pharyngeal air space presented increased volume also in the hypopharynx region, which allowed to conclude that the EMCA promotes an increase in the floor width of the nasal cavity after expansion, and, consequently, increase in volume of the nasal cavity itself and nasal airway space, as well as pharyngeal air space.

Residents' journal review

Residents' journal review

Pharyngeal swallowing pressures in the base-of-tongue and hypopharynx regions identified with three-dimensional manometry.

This study aims to use three-dimensional (3D) high-resolution manometry to identify circumferential pressure patterns generated within the asymmetrical base-of-tongue and hypopharynx regions of the pharynx during deglutition. Case series. Radial pressures in the regions of interest were evaluated during swallowing events in 12 healthy subjects using 3D high-resolution manometry. Repeated measures analysis of variance revealed asymmetrical pharyngeal clearance pressures in the base-of-tongue and hypopharynx regions during swallowing. A significant main effect of direction on pressure was found at the time point of average maximum pressure (P < 0.001) and for pressure integral (P < 0.001), with pressure primarily generated from the posterior direction. An interaction was noted between direction and location when comparing maximum directional pressures, regardless of time (P =0.045), highlighting the differences in anterior pressure production between regions. In contrast to the high posterior pressures produced in the base-of-tongue region, an anteroposterior dominant pressure pattern was observed in the hypopharynx. Pressure waveform complexity in the hypopharynx also is likely attributed to activity in the anterior and posterior directions. Symmetrical pressure generation was observed during intrabolus flow within the hypopharynx. This study shows that pressure is asymmetrically generated in the base-of-tongue and hypopharynx regions during swallowing of a 10-mL bolus, reflecting the complex anatomy within the pharynx. Understanding of these complex pressure patterns aids in the interpretation of high-resolution manometry and can help guide further study in the clinical assessment and treatment of pharyngeal pathology. 4. Laryngoscope, 127:1989-1995, 2017.

Pharyngeal Pressure and Timing During Bolus Transit.

Determining intrabolus pressure (IBP) at the upper esophageal sphincter (UES) and in the esophagus has given compelling evidence that IBP can be a predictor for swallowing dysfunction. Studies have looked most superiorly at the low hypopharynx region but there has been no inquiry into what IBP measures throughout the entire pharynx can tell us. We present a study to describe the pressures within and surrounding the moving bolus throughout the pharynx and into the UES. Simultaneous high-resolution manometry (HRM) and videofluoroscopy were performed in ten healthy subjects swallowing ten 10mL thin-liquid barium boluses. Three events surrounding bolus movement were tracked via videofluoroscopy, and two additional events were found using manometric measures. As the bolus passes through the pharynx, low pressure is created at and below the head of the bolus. A modest pressure increase is seen as the bolus passes through the pharynx, and finally, high pressure is observed at the bolus tail, followed by an even larger pressure generation of a clearance event. HRM allows for greater resolution in data collection in the pharynx and in this study, aided in identifying semi-unique characteristics around the hypopharynx and the UES which are consistent with the complex anatomy of the regions and the transition of the UES from active closure to relaxed opening. In the future, additional studies designed to look at aged and diseased populations may lead to better understanding of disease etiology, and treatment options.

The curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleep apnea hypopnea syndrome and its influencing factors

Objective:To observe the clinical curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleepapnea hypopnea syndrome (OSAHS) and to explore the related influencing factors. Method:The cross-sectional area of the narrowest plane in the nasopharyngeal region, velopharyngealregion, glossopharyngeal region, and hypopharynx region were measured using Spiral CT combined with Müller's experiment and computer processing system. All the elderly patients were administered with proton pump inhibitors (rabeprazole sodium, 20 mg/d) and domperidone tablets (10 mg×3/d) for 3 months. After treatment, repeat tests were performed to evaluate the therapeutic effects. Result:Before and after 3 months of treatment, significant difference was found in the total number of reflux, total reflux time, reflux symptom index and reflux symptoms scale (P<0.05), however, there's no significant difference in respiratory disorder index (P>0.05). After 3 months treatment, the cross-sectional area of those four structural regions was increased in different degrees in the patients with reduced OSAHS. However, no significant changes in the cross sectional area was observed in the patients with unchanged OSAHS. Conclusion:Anti-reflux therapy has curative effect in only 60% of the elderly patients with laryngopharyngeal reflux and OSAHS. In addition to the laryngopharyngeal reflux disease, age, BMI and medical history might be the reasons that lead to the failure of the improvement in the other 40% of the elderly patients.

Pituitary Metastases from Follicular Thyroid Carcinoma

Metastatic carcinomas to the pituitary gland are uncommon, occurring in only 1% of the pituitary masses. They often originate from breast or lung carcinomas and may resemble a nonfunctioning pituitary adenoma both clinically and radiologically. Here we describe a patient with pituitary metastasis from follicular thyroid carcinoma and discuss the unique features of these lesions. A 45-year-old woman was admitted to the emergency rescue room of our hospital with a 2-month history of progressive headache and blurred vision. Evaluation revealed right eye amaurosis, with a mild abducens and oculomotor palsy. Pituitary magnetic resonance imaging showed a mass that was hypo-intense in T1-weighted and hyper-intense in T2-weighted-images, located from the sphenoid sinus up to chiasmatic cisterns, raising and deflecting the optic chiasm, down to hypopharynx region, and distorting the cavernous sinuses. No evidence of anterior or posterior hypopituitarism was recorded. The immediate trans-sphenoidal surgery was uncomplicated with partial improvement of the visual fields and headache. Histopathology revealed a metastasis with well-differentiated follicular thyroid architecture. Total thyroidectomy and lymph node dissection was performed with a final histopathological diagnosis of follicular thyroid carcinoma. Subsequently, her headache became more severe. 131-I ablation treatments were performed 15 days and 12 months after thyroidectomy with decrease in headache and a decline in serum thyroglobulin levels. Pituitary metastases from thyroid carcinoma are very uncommon. As this patient illustrates, they tend to produce symptoms relating to space-occupying expansion in the parasellar region rather than to those due to destruction of the pituitary gland. Although rare, pituitary metastases caused by thyroid malignancy should be considered in patients with expanding parasellar lesions if they have thyroid cancer or uncharacterized thyroid diseases. They are unlikely to be amenable to complete resection and should be considered for 131-I treatment, perhaps avoiding the need for extensive neurological surgery.