Posterior Pharynx Research Articles

The combined pharyngeal flap and palate pushback procedure: Improvements in technique

Experience with the combined pharyngeal flap and palate pushback operation (Dibbell et al., 1965; Bucholz et al., 1967; Weber et al., 1970) has confirmed that palate surgery in older children-particularly in children or adults who have had previous palate surgery-is associated with more bleeding than the primary palate repair in infants. A simple reversal of the customary sequence of the procedure (not unique, we are sure, to this centre) has reduced blood loss and simplified the operation. After the mouth gag has been placed, the palate and posterior pharynx are injected

Retropharyngeal parathyroid adenoma.

To the Editor.— The patient described below had the rare finding of a parathyroid adenoma with hemorrhage presenting as a retropharyngeal mass. The clinical picture, with fever and leukocytosis, suggested the diagnosis of a retropharyngeal abscess. Report of a Case.— A 50-year-old obese woman was admitted to the Memphis Naval Hospital with a three-day history of increasing dysphagia. For the 36 hours prior to admission the patient had been unable to swallow her own secretions and had taken nothing by mouth. The patient denied trauma or ingestion of a foreign body. There was no pertinent medical history. The temperature was 38.6 C. Generalized cervical swelling with mild tenderness in each supraclavicular area was present, and there was a mild right otitis externa. The throat showed ecchymosis of the posterior pharynx, without fluctuation. The white blood cell count was 15,400/cu mm, with 78% neutrophils, 20% lymphocytes, and 2% monocytes. The calcium

Induced Emesis—A Questionable Procedure for the Treatment of Acute Poisoning

The effectiveness of various methods of inducing emesis in poisoning cases is reviewed. The risks involved in mechanical stimulation of the posterior pharynx following distension of the stomach with aqueous fluid are discussed. The oral administration of dry mustard powder, table salt, copper sulfate, zinc sulfate, tartar emetic and ipecac syrup, and the parenteral administration of apomorphine as emetics are discussed. It is concluded that some means for inducing vomiting are ineffective and others are of questionable reliability. The oral administration of activated charcoal may serve as an alternative to induced emesis in the treatment of poisoning.

Management of by Prolonged

A simple method of providing protracted airway patency for infants with the Pierre Robin syndrome is nasoesophageal intubation with a small caliber soft plastic catheter. This prevents development of the high posterior pharyngeal negative pressures which are caused by repeated swallowing and sucking and which may pull the tongue into the posterior pharynx to produce airway obstruction. The nasoesophageal tube may be inserted quickly as an emergency measure and may be replaced easily if dislodged. It may be used for several weeks, or months, during which time some infants will grow sufficiently to obviate the need for tongue traction procedures, which are associated with moderately high risk during the neonatal period. More severe cases of Pierre Robin syndrome may require eventual employment of a lip-tongue adhesion when the child is old enough to tolerate the procedure with lower risk.

A New Device for Exposure of the Oropharynx

A NEW gag for use in tonsillectomy and adenoidectomy is similar in design to the Davis and McIvor type devices, and accepts the tongue retractors used in these gags. The most significant and revolutionary difference is the provision of a hinge where the bow attaches to the channel. The effect of this hinge is to enable the tongue depressor to pivot in its relation to the bow. This allows two positional adjustments that are not available on any other mouth gag. First, the tongue depressor can be inserted into the mouth to any depth desired, obviating the need for a large variety of tongue depressors of different lengths. Second, the tongue depressor may be angled by use of the pivot to depress the base of the tongue, considerably improving the exposure of the posterior pharynx. The hinge is provided with a notched ratchet and a pawl that locks the hinge

Carcinoma of the posterior pharyngeal wall

Of forty-eight patients with cancer of the posterior pharynx seen between 1937 and 1970 none was salvaged before 1951, and an occasional cure was obtained between 1952 and 1960. During the most recent decade, however, vertical pharyngotomy as the initial excisional surgery provided a cure rate of 62.5 per cent; four of the five survivors are alive more than four years after operation.

The pharyngeal bone musculature of the carp, Cyprinus carpio.

AbstractThe carp, Cyprinus carpio, was found to have eight pairs of muscles inserting on the pharyngeal bones. These were the levator arcus branchialis V, retractor os pharyngeus superioris, retractor os pharyngeus inferioris, cleithropharyngeus superficialis, cleithropharyngeus profundus, coracobranchialis posterior, transversus ventralis V and subarcualis rectus communis. Complete morphological descriptions of the muscles are given along with relevant osteological information. The pharyngeal muscles function in mastication by moving the bones and their attached teeth against the chewing pad so that crushing and grinding of food occurs during occlusion. In addition, certain pharyngeal bone muscles enlarge the lumen of the posterior pharynx thereby admitting food to the region of the teeth and chewing pad. The homologies of some of these muscles are considered along with the historical details pertinent to the establishment of a suitable nomenclature for the pharyngeal bone muscles.

Ultrastructure of the feeding apparatus of the nematode Trichodorus christiei

The ultrastructure of the feeding apparatus, as well as the stoma and the pharynx, of Trichodorus christiei Allen, a vector of tobacco rattle virus, was studied by electron microscopy. The stomatal opening is triradiate. The stomatal lumen, which extends to the pharynx, is lined by the outer body wall cuticle. The feeding apparatus consists of two parts, an outer spear and a fine inner spear. The anterior half of the outer part, appearing in the stomatal and the anterior pharyngeal lumens, consists of solid cuticle in its apical region. The posterior half fuses to the dorsal cuticle of the posterior pharynx. Ih the middle region of the outer spear, the dorsal side of the spear has an oblique opening. Through this opening, the anterior half of the inner spear is inserted into the anterior outer spear. The pharynx is mostly composed of muscle cells containing both thin and thick myofilaments, approximately 80 A and 220 A in diameter, respectively. The pharyngeal muscles attach to the dorsal surface of the posterior half of the outer spear, thus enabling its protrusion. The food can pass continuously from the stomatal opening to the esophagus through the stomatal and the pharyngeal lumens.

A comparison of changes in pulmonary flow resistance in healthy volunteers acutely exposed to SO-2 by mouth and by nose.

On separate occasions, healthy male volunteers were exposed either by nose or by mouth to one of two concentrations of sulphur dioxide, 15 and 28 p.p.m. Exposure to SO₂ lasted 10 minutes. Pulmonary flow resistance (R1) was measured by the oesophageal catheter method, and the lung volume was measured by a modification of the gas-compression method; when SO₂ was administered by nose, nasal flow resistance (Rn) was measured by means of a catheter placed in the posterior pharynx. The increase in R1 was greater when SO₂ was administered by mouth than when it was administered by nose. Similarly, irritative symptoms of the posterior pharynx and chest were more common during exposure by mouth. These findings suggest that the mouth is less effective than the nose as an absorptive surface for SO₂.

Acute lymphonodular pharyngitis

A previously imdescribed acute infectious viral disorder, characterized principally by lesions in the posterior pharynx, but occasionally elsewhere, is presented and illustrated. Evidence indicates that a strain of Coxsackie A 10 virus is the etiologic agent responsible for the infection in this outbreak.

Pharyngeal Tooth Replacement in Semotilus atromaculatus and Clinostomus elongatus, Two Species of Cyprinid Fishes

T ELEOST fishes usually have five pairs of branchial arches, four of which bear gillrakers medially and gill lamellae laterally. Typically each arch consists of a hypobranchial, ceratobranchial, epibranchial and pharyngobranchial. Some marine and freshwater fishes have various branchial arches or parts of arches modified for tooth attachment. As a rule this modification is associated with the reduction or loss of teeth on the jaws. Cyprinid fishes, lacking teeth on the jaws, have a well developed dentition on the modified fifth branchial The fifth arches in all Cyprinidae are represented by hypertrophied ceratobranchials, sickle shaped in appearance and joined at their ventral ends by a ligament which in older fish may ossify. They are located in the floor of the posterior pharynx, anterior to its junction with the esophagus and are usually referred to as the 'pharyngeal arches. The shape of the pharyngeal teeth varies widely between the species and various classifications of tooth forms have been proposed. One of the earliest major studies of pharyngeal teeth was that of Heckel (1842) who described thirteen forms under four major divisions. His major divisions were: (1) concave, (2) aggregated, (3) recurved with grinding surfaces, and (4) recurved without grinding surfaces. The most recent comprehensive study of the pharyngeal arches and their teeth is that of Chu (1935). He refers the teeth of cyprinids to three principal categories: compressed, depressed, and conical. The compressed teeth are further divided into six types while the depressed and conical teeth are each divided into three types. Heterodont dentition characterizes a few cyprinids such as the goldfish (Carassius) and the carp (Cyprinus), in which the first tooth is conical while the remainder are compressed (goldfish) or flat and ridged (carp). The forms of teeth are correlated with the feeding. habits of the species. In carnivorous cyprinids the teeth are pointed and slightly hooked so as to function primarily for holding and swallowing the prey. In herbivorous and omnivorous species a grinding surface is present for titurating the food. Some mollusc-eating minnows likewise have grinding molariform teeth.

Choristoma of the nasopharynx in a newborn infant.

IN A PERUSAL of the literature, no case of choristoma in the nasopharynx of an infant could be found. However, Baum * has seen a tiny lesion in one case, that of an older child. Choristoma removed from the nasopharynx of an infant. <h3>REPORT OF A CASE</h3> G. M., born April 28, 1953, was a full-term 7-lb. 4-oz. (3,290 gm.) infant. The mother was Rh-negative, the infant Rh-positive. Delivery was by Caesarean section at term because of cephalopelvic disproportion. Routine physical examination of the infant was without abnormal findings, except that there seemed to be an obstruction to both nasal breathing and swallowing. Feeding through a nasal tube was necessary. The infant was seen on the fourth day by the department of otolaryngology. By raising the soft palate, we found a grayish movable mass lying against the posterior pharynx. Removal was thought necessary to allow normal breathing and feeding. Aspiration was

Intussusception in infancy and childhood

A detailed analysis is given of thirty-five patients from The New York Hospital pavilion service who were treated for intussusception in seventeen years from 1932 to 1949. The deaths are recorded in table form. The fact that in the majority of cases symptoms occurred ten or more hours before the patient was admitted to the hospital proves that neither the general public nor the general practitioner are making the diagnosis early enough to assure a successful operation. The mortality can hardly be lowered without earlier diagnosis and admission to a surgical service. A number of patients had a history of recent respiratory infections (34.2 per cent) or injection of the posterior pharynx on their admission examination. Mesenteric nodes were found to be enlarged at operation in 40 per cent of the cases. However, no definite relationship between these findings could be established. The large majority of cases (thirty) were successfully treated with “milking.” In one case it required twenty minutes to reduce the intussusception by this means. Patience and gentle handling of the bowel are essential if this method is to be successful. The New York Hospital series differs in no way from other reports in that the mortality after resection was very high. Only by avoiding the necessity of resection by early diagnosis and prompt operation can this high mortality rate be lowered. As long as the intussusception can be reduced by milking, the death rate can be kept down to around 6.7 per cent.

THE DIGESTIVE TRACT OF CARASSIUS AURATUS

1. The digestive tube of Carassius auratus closely resembles that of Campostoma anonsalum (Rafinesque).2. Study of the gross structure brought out the following characteristics: the posterior pharynx possesses pharyngeal teeth which bite on a dorsal horny pad; a dorsal diverticulum leading to the pneumatic duct extends from the short oesophagus; the oesophagus opens directly into an expanded part of the intestine, the intestinal bulb; a circular sphincter marks the boundary between oesophagus and intestinal bulb; the intestine proper does not show the extreme coiling of Campostoma but is considerably longer than that of Fundulus; it leads into the rectum.3. The walls of the entire tract possess a tunica mucosa, tunica muscularis and tunica serosa. Absence of a muscularis mucosae prevents the determination of a distinct submucosa.4. Epithelium of the pharynx is stratified with numerous mucous cells in the superficial layer. At the intestinal sphincter, there is an abrupt change to the simple columnar epith...

NASOPHARYNGEAL ULCERATION RESULTING FROM PRESSURE NECROSIS

In this article we report a case of ulceration of the posterior pharynx caused by pressure necrosis due to a sharp-pointed anterior tubercle of the atlas. REPORT OF A CASE E. B., a 17 year old white girl, was referred to us from another city on Nov. 27, 1937, with the complaint of spitting up blood-streaked sputum. The history was that she awoke one morning in October 1937 with a sore throat, which gave her little concern until forty-eight hours later, when she was noticeably worse and hoarse. The school nurse found that there was some blood in the back of the throat and put her under the care of a local physician. He noted that she had a temperature in the afternoon of from 99.5 to 101 F. (mouth) and had her confined to bed, but while in bed she had no fever. She was suspected to have tuberculosis,

Status Thymico-lymphaticus: Acute Edema of Lungs

Reading the June, 1930, issue of Radiology (page 605), I was much interested in H. P. Doub's editorial entitled “The Problem of Enlarged Thymus.” Because of the wide diversity of opinion relative to thymic symptoms and studies of that gland, the following report may be of interest. The case came under my observation in November, 1928, while I was Director of the X-ray Department of the United Hospital, Port Chester, New York. The patient was a supposedly normal child four months of age, without a history of previous illness. While his mother was out of the room, in another part of the house, he was left in his crib alone, any abnormal condition being unsuspected. Upon his mother's return she found him cyanotic and practically moribund. Dr. R. A. Higgons, of Port Chester, was called immediately, but by the time he arrived the child was dead. The supposition is that the child became frightened because of his mother's absence from the room. The following is the autopsy report made by Dr. Margaret Loder, pathologist of the United Hospital, Port Chester, New York: “Body is that of a male child, normally developed, particularly large and fat for the age (four months). Testicles descended normally. A few small glands are palpable in the left inguinal region, and one fairly large gland in the right cervical region (anterior). Ear drums appear normal. Frothy material is oozing from both nostrils. “Chest.—Thymus gland is enormously hypertrophied, measuring 80 × 70 × 30 mm. and weighing 50 grams. Central portions of both lateral lobes show some liquefaction necrosis. Gland covers the aorta, trachea, and bronchi, and comes clown well over the pericardium. Both lungs show marked edema throughout. The same material that was seen coming from the nostrils oozes from the larger bronchi. There is no obstruction in the bronchi, trachea, or posterior pharynx. Thoracic nodes are not enlarged. Heart appears normal; chambers are empty. “Abdomen.—Lymph nodes are enlarged throughout the mesentery, which enlargement appears to be due to a simple hyperplasia, and there is apparently no necrosis of these glands. Other organs appear normal. “Extremities and genitalia.—Normal. “Diagnosis. — Status thymico-lymphaticus: acute edema of lungs.” In my paper entitled “Studies of the Thymus, with Roentgen Findings” (Am. Jour. Roentgenol. and Rad. Ther., March, 1929, XXI, 256), I reported the death of a child four years of age who died suddenly in primary anesthesia. The autopsy findings were as follows: status lymphaticus, the thymus gland weighing 35 grams. No previous X-ray examination of this patient's chest had been made. There is every reason to believe that many cases of sudden death occur in which autopsy findings are not obtained.

A case of primary tuberculosis of the fauces, posterior pharynx and palatal and lingual tonsils, cured by tuberculin injection

A case of primary tuberculosis of the fauces, posterior pharynx and palatal and lingual tonsils, cured by tuberculin injection

MALIGNANT DIPHTHERIA AND THE IMMUNIZING POWER OF ANTITOXIN.

History. —C. M., male, aged 13, developed diphtheria which was diagnosed as such April 11. On the afternoon of April 10, though the throat was most carefully examined, no membrane could be discovered. The following morning, however, it covered the tonsils, posterior pharynx, uvula and nasal cavity. The attack was apparently a most malignant one, cultures of pure growth of the Klebs-Loeffler bacillus being made from swabs of the nose and throat. On the night of April 12, the patient, while in a critical condition, was kissed by the three other children in the family and also by his parents; this in the face of severe opposition on the part of the attending physicians. The patient died April 13, having previously received 60,000 units of diphtheria antitoxin. The rest of the family developed diphtheria on April 13 and 14, 3 of the 5 members having received on April 11, 500