Transection Of Muscle Research Articles

Surgical approaches for thoracic outlet decompression in the treatment of thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is a controversial and uncommon syndrome. Three different diagnoses can be made based on the compressed structure: arterial TOS, venous TOS, and neurogenic TOS. Diagnosing TOS, especially neurogenic TOS, remains difficult since a single diagnostic tool does not exist. Although this resulted in a lot of confusion, standardization of care and outcome improved daily care practice measures in the last decade. Current treatment algorithms consist of both conservative and surgical treatment approaches, which should be chosen depending on the type of TOS and extend of the complaints. Surgical treatment of TOS is performed via thoracic outlet decompression (TOD). TOD surgery includes complete resection of the first rib (cartilage to cartilage), transection of the scalene muscles and complete neurolysis/venolysis or arteriolysis. Four different approaches can be chosen for TOD surgery: the transaxillary (TA), supraclavicular (SC), paraclavicular (PC), and infraclavicular (IC) approach. The TA, SC, and PC approach can be used for every form of TOS. However, the PC approach is mostly used for treating venous TOS. The IC approach has no role in treating neurogenic or arterial TOS and is only used for venous TOS. Every approach has its own benefits and limitations and literature does not agree on what approach is best. Therefore, the used surgical approach for TOD should be based on the surgeon's preference and experience. The aim of this review is to present an overview of the diagnostic pathway and provide an in-depth description of the surgical approach in each form of TOS.

Re-Examination of the Maxillary Vestibular Approach with Emphasis on Facial Mimetic Muscle Preservation.

The standard Keen's or the maxillary vestibular incision allows direct access to the zygomatico-maxillary complex with inadvertent transection of the facial muscles and more laborious visualisation of the zygoma. We describe modifications to the vestibular and Keen's technique, based on identification and re-orientation of the facial muscles as well as utilisation of anatomical gaps between the facial mimetic muscles. Our modifications are based on the principle of facial mimetic muscle identification, preservation and re-orientation to near normal anatomy.

Traumatic transection of inferior rectus muscle: technique for exploration and repair

This video article may be viewed at jaapos.org.We present a technique for exploring, identifying, and repairing an acutely transected inferior rectus muscle. A 9-month-old girl presented emergently at the Hospital for Sick Children, Toronto, after an unwitnessed fall from a bed. She was bleeding from her left eye, and her parents reported that she might have struck her eye on the sharp edge of a plastic toy. The patient had an inferior conjunctival laceration and new-onset left hypertropia.

Lateral Approach in Thyroidectomy- a Comparative Study

Introduction: To enter the thyroid gland, the lateral "backdoor" technique (LA) uses the same central neck incision as the anterior border of the sternocleidomastoid (SCM) and strap muscles. Typically, this treatment is done to redo thyroid surgery. The results of the two procedures were compared in people who were having their first conventional thyroidectomy. Methods: A case-control study was undertaken on 30 people who received a routine open thyroidectomy from January 1, 2018 to December 31, 2019. The first 15 patients were given MA, then another 15 were given LA. All patients received 10 mL of 1 percent Marcaine infiltration before the neck incision was closed. Basic demographic data, surgery time, incision length, gland weight, strap muscle transection required, and complications were all recorded. The study excluded thyroid revision surgery and minimally invasive thyroid surgery. Results: Demographics, surgery time, gland weight, and incisional length did not differ significantly. The LA group experienced significantly reduced post-operative pain. 5 patients (11%) in the MA group required horizontal transection of strap muscles to remove large goitres, compared to 1 patient (2.2%) in the LA group. In neither group, there were any major issues. Conclusion: The LA approach is equally safe as the midline surgery, with a similar surgical time and substantially lower pain levels. By avoiding midline separation and suturing of strap muscles, it reduces the need for strap muscle transection to remove large goitres.

Anterior prompt for debridement and myoplasty femoral neck and head osteomyelitis

The known anterior prompts to the femoral neck are non-traumatic, but they exclude the possibility of myoplasty and are not large enough for intra-articular sequestrectomy.Objective. The aim of the study was to develop an anterior prompt to the hip joint for sequestrectomy with myoplasty.Materials and research methods. For surgery neck and head of the hip osteomyelitis we perform a semi-oval incision in the projection of the femoral head, from the anterior spines of the ilium we cut off the tendons of the sartorius and rectus head of the quadriceps femoris muscles. An operating field is formed, which allows sequestrectomy to be performed. Plasty of the osteomyelitis cavity is performed with the proximal parts of the two anterior ileofemoral muscles. The operating field, if necessary, can be increased by temporary transection of the lumbar-iliac muscle tendon.Research results. The key to the anterior surgical prompt to the hip joint is the sartorius and rectus head of the quadriceps. The length of the surgical wound reaches 17–22 cm, and the width is 16–18 cm. With the mobilized proximal part of the sartorius muscle, we fill the entire bone cavity in the neck and head of the femur. Of the 12 operated patients, 11 (91.7 ± 7.6 %) had a stable long-term remission.Conclusion. The proposed approach is less traumatic and allows you to operate at an angle of about 90°. It complements the advantages of the known anterior prompts and is devoid of their disadvantages.

Peroral endoscopic myotomy and septotomy for Zenker diverticulum.

Zenker diverticulum (ZD) is the most common hypopharyngeal diverticulum seen often in septuagenarian and octogenarian males. Oropharyngeal dysphagia is the most common presenting symptom. Treatment of ZD has been advancing with the introduction of a wide variety of accessory devices, primarily focusing on obliteration of the septum by complete transection of the cricopharyngeus muscle to recreate the common cavity and restore normal pharyngo-esophageal bolus outflow. This review aimed to provide an overview of the various surgical and endoscopic treatment options for ZD, while focusing specifically on Zenker peroral endoscopic myotomy.

Proposal of New Key Step in Lateral Approach Thyroidectomy in Light of Comparison of Surgical Outcomes of Medial versus Lateral Approach Thyroidectomy: A Randomised Controlled Study.

Objective Thyroid surgery has travelled a long path, from a surgery which once was considered deemed to fail and even led to death, to the current time when newer techniques are being tested to make the incision smaller and smaller. The aim of our study is to give a precise detailed stepwise description of medial and lateral surgical approach with the anatomical basis and to compare their feasibility and safety. Methods 104 cases presenting with thyroid swelling in the Department of Otorhinolaryngology, Assam Medical College Dibrugarh from January 1, 2019, to December 31, 2019, were selected and randomisation was done based on day of admission from OPD. Basic demographic data, preoperative diagnosis, operative time, blood loss, need for transection of strap muscles, and complications were recorded. Result The distribution of thyroid cases according to age ranged from 17 to 81 years. The prevalence of thyroid disorders was the highest (37.5%) in the age group of 31–40 yrs. Of a total of 104 thyroid cases, 49 were colloid goitre, 24 were multinodular goitre, 9 were follicular neoplasm category 4, 4 were papillary thyroid carcinoma, 2 were follicular neoplasm category 3, and 3 were follicular neoplasm category 5. Conclusion Out of the two approaches, lateral approach thyroidectomy showed better results with fewer complications. A single structure (superior belly of omohyoid) can be used as a guide to preserving all vital structures related to the thyroid gland.

The evolution of operative access in lung surgery.

In modern surgical practice, considerable attention is paid to reducing surgical trauma and reducing the incidence of postoperative complications, which has a direct impact on the duration of hospitalization and patient recovery. In chest surgery, this problem is most significant, since to perform small interventions on the lungs and pleura, a wide thoracotomy was required with the transection of the chest muscles and the separation of the ribs. The article describes modern minimally invasive approaches used in lung surgery. Particular attention is paid to the role of video-assisted surgical interventions in the surgical treatment of non-small cell lung cancer. The results of traditional multiport thoracoscopic lung resections were compared with standard open thoracotomy. The advantages and possible disadvantages of various options for video-assisted surgical interventions on the lungs are described.

Introduction of a new key step in lateral approach thyroidectomy: a randomised prospective study on thirty patients

<p class="abstract"><strong>Background:</strong> The school of Bilroth in Vienna started modern thyroid surgeries in 1860s.<sup>1</sup> Thyroidectomy was associated with high mortality, recurrent laryngeal nerve injuries and tetany. One and a half century down the timeline, complications still occur. Although, in experienced hands, the thyroid surgeries performed today are associated with minimal mortality and morbidity. Lateral approach thyroidectomy is a commonly practiced approach with fewer complications. We carried out a study to assess the efficacy, safety and advantages of lateral approach thyroidectomy with a new key step.</p><p class="abstract"><strong>Methods:</strong> A prospective study was performed on thirty patients undergoing conventional open thyroidectomy from January to July 2019 at a tertiary care hospital in north east India. All patients underwent open thyroidectomy via lateral approach in which identifying superior belly of omohyoid was considered a key step of surgery. Basic demographic data, preoperative diagnosis, operative time, blood loss, need for transection of strap muscles and complications were recorded. </p><p class="abstract"><strong>Results:</strong> There were no intra-operative complications, without the need to cut strap muscles or sacrifice superior belly of omohyoid in any case. Voice change was seen in one case, improved after steroid administration. One case developed tetany after total thyroidectomy managed with calcium supplements.</p><p class="abstract"><strong>Conclusions:</strong> Results suggested that lateral approach of thyroidectomy is a quick and safe technique where identification of superior belly of omohyoid considered as our key step, enabled easy delivery of superior pole of thyroid and facilitates easy identification and preservation of vital structures; thus, causing least morbid sequelae.</p>

Maylard’s incision: how to make an easy incision for complex pelvic abdominal surgery

The video aims to show the Maylard technique, an extended transverse incision characterized by bilateral ligation of the deep inferior epigastric vessels and transection of the anterior rectus abdominis muscles.[1][1]...

Curcumin and Nanocurcumin Oral Supplementation Improve Muscle Healing in a Rat Model of Surgical Muscle Laceration.

To compare the effects of curcumin and nanocurcumin oral supplementation on the muscle healing rate of an animal model of surgical muscle laceration. Thirty-two male adult rats were randomly divided into sham, control, curcumin, and nanocurcumin groups. Partial transection of the gastrocnemius muscle was made in the right limb of the control and treatment groups. The sham and control groups received normal saline, curcumin group received 500 mg/kg of curcumin and nanocurcumin group received 100 mg curcumin-loaded nanomicelles orally every day. They euthanized two weeks later and the specimens were stained by hematoxylin-eosin (H&E) and Masson's trichrome methods. Aspartate transaminase (AST) and creatine phosphokinase(CPK) were measured in blood samples. The percentage of collagen fibers in the nanocurcumin group was significantly lesser than the control and curcumin groups (p<0.001). Muscle fiber regeneration in the treatment groups was significantly higher than the control group (p<0.001). The blood vessels of the nanocurcumin group were significantly more than other groups (p<0.001). Plasma AST had a significant difference in the control group compared to the sham and nanocurcumin groups (p=0.026). The plasma CPK level of the control group was also significantly higher than other groups (p<0.001). In conclusion, although oral curcumin supplementation has little effects because of its poor bioavailability, embedding it in nanoparticles could enhance its systemic effects in promoting the muscle healing process.

Lower Vestibular Incision: A Modified Technique of Dissection.

Exposure to anterior mandible via conventional approach by either cervicular or vestibular incision is normally carried out for trauma or orthognathic surgery. Transection of mentalis muscle and reposition of the muscle is a key step. This prevents post-operative lip ptosis. A modified dissection technique is presented in the article to identify the bilateral mentalis muscles at its insertion and isolate it in order to preserve it if feasible for access or to transect it after demarcating so that it can be reoriented in its native position. The modified method is an anatomically direct functional approach to the anterior mandible.

Intercostal nerve protection to prevent post-thoracotomy pain.

Posterolateral thoracotomy is a commonly used surgical approach to access thoracic structures for non-cardiac surgery. This incision involves transection of major muscles and retraction of ribs against resistance. In spite of “effective” postoperative analgesic measures including epidural analgesia or patient controlled analgesia, many patients have considerable acute and chronic postoperative pain which may lead to increased post-operative complications, especially pulmonary complications, increased consumption of analgesics, prolonged hospital stay and delayed functional recovery (1).

PS01.200: OPEN IVOR LEWIS ESOPHAGECTOMY WITH AN AGGRESSIVE UPPER MEDIASTINAL LYMPH NODE DISSECTION

Abstract Background The Ivor Lewis procedure consists of open subtotal esophagectomy and intrathoracic esophago-gastric anastomosis. Though this procedure is open surgery, it can minimize the risk of anastomotic leakage. This procedure combined with aggressive upper mediastinal lymph node dissection could achieve satisfactory short-term and long-term outcomes. Methods The cases with middle or lower thoracic cancer without metastasis at the cervical area are subjected to this Ivor Lewis procedure. To evade the demerit of thoracotomy, we have employed 1) the 3-field lymphadenectomy in selective patients, 2) the vertical muscle-sparing thoracotomy without transection of muscles and ribs, 3) paravertebral block for postoperative pain. Results A total of 246 patients who underwent subtotal esophagectomy (2011.1–2016.12) were analyzed for short-time postoperative outcomes. In 135 patients of the Ivor-Lewis group, prevalence of anastomotic leakage, anastomotic stricture recurrent nerve palsy and the morbidity, defined as Clavien-Dindo classification 2 or further, was 0%, 0.7% and 21% respectively. On the other hand, the incidence of these increased significantly in 111 patients who underwent cervical anastomosis, 10%, 6.3% and 47% respectively. Though Ivor-Lewis was open surgery, 83% patients in the Ivor Lewis group achieved 30 m walking at the ward within postoperative day 2 and the median length of postoperative hospital stay was 16 days (10–83). The survival according to our therapeutic strategy was analyzed in 352 patients who underwent subtotal esophagectomy for thoracic esophageal cancer (2002.1–2012.12). The overall survival was 82.5/83.5/52.1/50.0/32.1% for stage0/I/II/III/IVa (JES10th). The solitary cervical lymph node recurrence was diagnosed in 5 patients of Ivor-Lewis group, but 4 of the patient could be cured by additional cervical lymph node dissection. Conclusion Discussion: Intrathoracic anastomosis could minimize the risk of anastomotic leakage, and consequently the total complication rate could be reduced. The strategy that the cervical lymphadenectomy is performed only through the thoracic cavity in the selected patients was acceptable because of our survival data. Conclusion: Using our Ivor-Lewis procedure for the patients with thoracic esophageal cancer, even the open operation can minimize the risk of complication. Out therapeutic strategy could achieve satisfactory survival results. Disclosure All authors have declared no conflicts of interest.

Challenging Management of Double Vision After Functional Endoscopic Sinus Surgery—A Series of 6 Cases

To present 6 cases of orbital trauma, diplopia and strabismus after functional endoscopic sinus surgery (FESS). Retrospective observational case series. The medical charts of suitable patients were reviewed for information on medical examination, imaging studies, the type of corrective surgery, and surgical outcomes. All patients with diplopia and strabismus after undergoing FESS who were treated or consulted at our institution between 2008 and 2017 were included. The presence and extent of strabismus and double vision at the end of follow-up. Six patients complained of diplopia after FESS; all of them had proven orbital trauma. In Cases 1-5, patients suffered medial rectus (MR) muscle transection and subsequent exotropia. Their prognosis was guarded despite prompt surgical intervention, and ranged from large exotropia when direct recovery of the MR was attempted, to primary gaze orthotropia but with minimal adduction capacity, during which vertical recti transposition was attempted. Patient 6 sustained transient diplopia, although all of his extraocular muscles appeared intact on imaging. His eye position and movement were completely resolved with conservative measures only. Our experience was that immediate recovery procedures to reattach the muscle in cases with proven transection of the MR muscle are futile, and that definitive corrective strabismus surgery (ie, vertical muscle transposition) has a better chance to achieve favorable results.

The lateral “backdoor” approach to open thyroid surgery: A comparative study

The traditionally taught technique for conventional open thyroidectomy is via a midline splitting of the strap muscles following a skin crease neck incision - midline approach (MA). The lateral "backdoor" approach (LA) uses the same central neck incision but approaches the thyroid gland between the anterior border of sternocleidomastoid (SCM) and strap muscles. This technique is usually reserved for re-do thyroid surgery. We compared the results of the two approaches in patients undergoing conventional thyroidectomy for the first time. A case-control study was performed on 90 patients undergoing conventional open thyroidectomy from 2012 to 2014. The first 45 patients underwent MA and subsequent 45 patients underwent LA. All patients were given 10ml of 1% Marcaine infiltration into the neck incision before closure. Basic demographic data, operative time, incision length, weight of gland, need for transection of strap muscles and complications were recorded. Revision thyroid surgery and minimally invasive thyroid operations were excluded. The demographics, operative timing, gland weight and incisional length showed no significant difference. Post-operative pain was significantly lower in the LA group. 5 patients (11%) in MA group needed horizontal transection of strap muscles to extract large goitres compared to 1 patient (2.2%) in the LA group. No major complications occurred in either group. The LA method is as safe as the midline technique with comparable operative time and significantly lower pain scores. It avoids midline separation and suturing of strap muscles and reduces the need for strap muscle transection to removal large goitres.

The Effect of Adipose-derived Mesenchymal Stem Cells on Healing of Massive Chronic Rotator Cuff Tear in Rodent Model

Objectives:Mesenchymal stem cells (MSCs) may promote restoration of the structure and function of the injured tendon-bone interface of the healing rotator cuff following repair. As compared to acute tears, chronic massive rotator cuff tears are a challenging healing microenvironment, with degenerative changes present in the muscle, tendon, and bone. Therefore, the purpose of this study was to explore the efficacy of MSCs in restoring the tendon-bone interface following repair of massive chronic rotator cuff tears in a rodent model.Methods:Adipose-derived mesenchymal stem cells (ADSCs) were isolated from inguinal fat of adult Lewis rats (n= 8) and expanded to passage 2 (P2). To induce degenerative changes in a rat modeling a massive chronic rotator cuff tear, the supraspinatus and infraspinatus tendons were transected bilaterally near their bony insertion and the corresponding muscle bellies were injected with 2.5 U botulinum toxin A (botox). Eight weeks later, tendons were repaired with or without augmentation at the tendon-bone interface. In particular, there were 5 groups ; (1) no repair (defect), (2) repair, (3) repair + fibrin, (4) repair + fibrin + ADSCs, (5) repair + fibrin + ADSCs + TGF-β3 (n=12 shoulders per condition). An equivalent cohort of animals received acute tendon transection (without botox injection) and immediate repair with or without augmentation. At 4 weeks following repair, animals were euthanized and the shoulders were harvested for analysis of bone morphometry, histology, and mechanical properties. Bone morphometry of the humeral head including; bone mineral density, bone volume percentage, and trabeculae number, thickness, and spacing was determined using micro-computed tomography. Statistical analyses included 2-way ANOVA with Tukey post-hoc tests. Analyses of histology and mechanical properties are ongoing.Results:ADSCs at P2 demonstrated a spindle-shaped morphology and were capable of forming colonies (Fig. 1A) and undergoing trilineage differentiation (Fig. 1B). Compared to healthy and acutely injured shoulders, muscles in the chronic condition exhibited atrophy, fibrosis, and fatty infiltration, with corresponding reductions in wet weights (Fig. 1C). All groups in the acute and chronic conditions possessed significantly reduced bone mineral density and bone volume percentage compared to healthy controls (p < 0.05), while only groups in the chronic condition exhibited compromised trabecular number and spacing. (p < 0.05). Augmentation of repairs with ADSCs (with or without TGF-β3) in the chronic condition significantly increased bone mineral density over defect controls (p < 0.05).Conclusion:Two-tendon transection and chemical paralysis of rotator cuff muscles in a rodent model mimics the degenerative changes seen in human shoulders, including decrements in bone quality. The efficacy of ADSCs in restoring structure and function of the tendon-bone interface likely depends on tear chronicity and size and may have greater benefit in chronic tears, as suggested by improvements in parameters of bone morphometry. This study will help further clarify the involvement of adult stem cell therapy in enhancing healing of the rotator cuff enthesis in the setting of degenerative tissue. Future studies would investigate the potential of adult stem cells to promote muscle regeneration in chronic rotator cuff tears and augment structural healing at the enthesis.

The Role of Cremaster Muscle as a Cause of Ascending Testis after Inguinal Hernia/Hydrocele Repair

Background Ascending testis (AT) is one of the rare but serious complication that may occurs following inguinal hernia/hydrocele repair. We aimed to review our more than 7 years’ experience and discuss the possible mechanism through which the AT possibly occurs following inguinal hernia/hydrocele repair. Materials and Methods A retrospective analysis of 7,212 boys who had undergone inguinal hernia/hydrocele repair between March 2009 and April 2016 was conducted. Exclusion criteria were: undescended testis, misdiagnosed AT, and retractile testis. Two types of surgical procedures were performed based on the medical records: (1) transection of the hernia sac and processus vaginalisalone and (2) isolation of the vas deferens and testicular vessels and a global transection of the remaining structures. Subsequently, post-operative incidence of AT was compared across variables extracted from the medical records. Results Sixteen (0.22%) patients were diagnosed with AT post operatively. AT incidence after inguinal hernia/hydrocele repair was reported in approximately 0.19% of the entire patient sample (in the 8491 hernia/hydrocele repairs). Comparison of AT incidence with the age at initial operation showed significant increase at the age of one year or less (P =0.017). In addition, AT incidence was significantly higher in the patients for whom only the sac/processus vaginalis was transected rather than the patients who underwent hernia/hydrocele repair with isolation of the vas deferens and testicular vessels (0.06% vs. 0.27%, respectively, P =0.023). Other subgroup analyses remained non-significant. Conclusion We conclude that transection of the cremaster muscle might decrease the incidence of ascending testis following inguinal hernia/ hydrocele repair.

Cyclooxygenase-2 inhibitor celecoxib attenuates joint contracture following immobilization in rat knees.

BackgroundThe aim of this study is to clarify the following two points: First, whether a cyclooxygenase-2 mediated pathway is involved in the formation of immobilization-induced joint contracture and, second, the effectiveness of oral administration of non-steroidal anti-inflammatory drug celecoxib (CBX) for the prevention of myogenic and arthrogenic contracture following immobilization in a rat model.MethodsThirty male rats were randomly divided into three groups: immobilization (Im), Im + CBX, and control (n = 10 each). External fixation immobilized the right knee joint of Im and Im + CBX groups in flexion for 3 weeks. 50 mg/kg of CBX was administrated daily to the Im + CBX group during this period. The passive range of motion (ROM) of knee joints was measured before and after transection of knee flexor muscles and myogenic and arthrogenic ROM restrictions were calculated. The semitendinosus muscles and knee joints were investigated histologically to elucidate factors responsible for contracture.ResultsMyogenic ROM restrictions were exhibited both in Im and Im + CBX groups (44 ± 5 and 36 ± 8 °, respectively), but restrictions significantly decreased in the Im + CBX group compared to the Im group. Significant reductions of the muscle length ratios (Rt/Lt) and sarcomere number ratios (Rt/Lt) in knee flexor semitendinosus muscle, which are responsible for myogenic contracture, were also seen both in Im group (92 ± 5 and 92 ± 4 %, respectively) and Im + CBX group (97 ± 3 and 97 ± 3 %, respectively), but were inhibited by CBX administration (P < 0.05). Im and Im + CBX groups exhibited arthrogenic ROM restrictions with no significant differences (82 ± 3 and 83 ± 5 °, respectively). Posterior synovial length shortening and pathological changes (hemorrhage in joint cavities and capsule edema) in the knee joints were comparable between Im and Im + CBX groups.ConclusionsOral administration of celecoxib partially reduced myogenic ROM restriction concomitantly with knee flexor muscle shortening following immobilization. These results imply that inflammation and nociception are involved in myogenic contracture formation independently of joint immobilization, and that CBX is effective in preventing joint contracture following immobilization in rats.

Differential effects of respiratory and electrical stimulation-induced dilator muscle contraction on mechanical properties of the pharynx in the pig.

Respiratory stimulation (RS) during sleep often fails to discontinue flow limitation, whereas electrical stimulation (ES) of the hypoglossus (HG) nerve frequently prevents obstruction. The present work compares the effects of RS and HG-ES on pharyngeal mechanics and the relative contribution of tongue muscles and thoracic forces to pharyngeal patency. We determined the pressure-area relationship of the collapsible segment of the pharynx in anesthetized pigs under the following three conditions: baseline (BL), RS induced by partial obstruction of the tracheostomy tube, and HG-ES. Parameters were obtained also after transection of the neck muscles and the trachea (NMT) and after additional bilateral HG transection (HGT). In addition, we measured the force produced by in situ isolated geniohyoid (GH) during RS and HG-ES. Intense RS was recognized by large negative intrathoracic pressures and triggered high phasic genioglossus and GH EMG activity. GH contraction produced during maximal RS less than a quarter of the force obtained during HG-ES. The major finding of the study was that RS and ES differed in the mechanism by which they stabilized the pharynx: RS lowered the pressure-area slope, i.e., reduced pharyngeal compliance (14.1 ± 2.9 to 9.2 ± 1.9 mm(2)/cmH2O, P < 0.01). HG-ES shifted the slope toward lower pressures, i.e., lowered the calculated extraluminal pressure (17.4 ± 5.8 to 9.2 ± 7.4 cmH2O, P < 0.01). Changes during RS and HG-ES were not affected by NMT, but the effect of RS decreased significantly after HGT. In conclusion, HG-ES and RS affect the pharyngeal site of collapse differently. Tongue muscle contraction contributes to pharyngeal stiffening during RS.