Martin W. Donner

Anatomy and physiology of the pharynx

Radiographic evaluation of the passage of a bolus from the mouth through the pharynx into the esophagus is based upon identification of specific anatomical landmarks and the integrated motion accomplished by the oral and pharyngeal muscles during swallowing. Twenty-six muscles and 6 cranial nerves must be coordinated to enable the safe performance of the complex physiological task of transporting liquids and firm food from the mouth into the esophagus. The following discussion and illustrations of pharyngeal anatomy and physiology are pertinent to an understanding of normal swallowing function.

Adaptation, compensation, and decompensation of the pharyngeal swallow

Under normal circumstances, the act of swallowing adjusts to varying demands of different bolus characteristics and different head and neck postures. When the swallowing mechanism is impaired by disease, adjustment is essential to compensate for the impairment and allow swallowing. Evidence of adjustment can be demonstrated by cineradiography which provides important clues to the presence of underlying disease. When adjustment to disease is inadequate, swallowing decompensates. In this case, gross changes in swallowing performance are evident from clinical evaluation and cineradiography.

Serial and cineradioangiographic visualization of maternal circulation in the primate (hemochorial) placenta

Abstract The maternal circulation of the hemochorial placenta common to man and the higher primates has been studied by serial and cineradioangiography. This technique has confirmed the validity of the circulatory hypothesis derived from previous anatomic and physiologic studies. 1. Maternal blood enters the intervillous space from the endometrial spiral arterioles in discrete, relatively high-pressure, funnel-shaped streams. 2. Inflow of blood is curtailed or abolished during uterine contractions. 3. The endometrial spiral arterioles act independently of one another. Not all of them are patent and discharging blood into the intervillous space simultaneously. 4. Several factors appear to be responsible for regulation of blood flow into the intervillous space: intrauterine pressure, the pattern of uterine contractility, the contour of the individual contraction wave, and those factors which act specifically upon arteriolar walls. 5. Attention is called to the nonhomogeneity of the blood in the intervillous space.

A COMPARISON OF CLINICAL MEASUREMENTS OF GASTROESOPHAGEAL REFLUX

To determine which diagnostic procedures best correlate with a history of gastroesophageal reflux, 50 subjects (29 with and 21 without symptoms) were studied. All underwent evaluation by esophageal acid perfusion, pH probe determination of gastroesophageal reflux of acid, measurement of mean resting lower esophageal sphincter pressure, and cineradiography after swallows of neutral and acid barium. The acid perfusion test and pH probe correlated most closely with symptoms of gastroesophageal reflux while the resting lower esophageal sphincter pressure and acid barium swallows correlated less well.

Neuromuscular Disorders Affecting the Pharynx: Cineradiographic Analysis

A review of the results of cineradiographic examinations of the pharynx in patients with neurologic and muscular disorders has been undertaken. Many of the radiographic signs of pharyngeal dysfunction occur in more than one neurologic condition. However, localized areas of involvement can be identified. In many instances characteristic radiographic manifestations help to diagnose a single disease. Technical advantages of continuous filming or tape recording in the analysis of swallowing suggest its routine use in clinical evaluation.

Pharyngoesophageal interrelationships: observations and working concepts

Simultaneous disorders of the pharynx and esophagus are so frequent that the complete swallowing chain should be examined in all patients with dysphagia. Data are presented to support the concept that such simultaneous disorders represent related phenomena; the mechanism involves changes in cricopharyngeal function seen radiographically as cricopharyngeal prominence. If neurologic disease has been excluded, cricopharyngeal prominence may be the clue to esophageal disease. When cricopharyngeal prominence is found during dynamic imaging of the pharynx, intensive examination of the esophagus and a search for signs of compensation or decompensation in the pharynx should be undertaken.

Acid-Barium Swallows in the Radiographic Evaluation of Clinical Esophagitis

Heartburn, substernal discomfort, regurgitation, and chest pain are frequent complaints of patients under clinical evaluation (1, 2, 7, 9). Many times these symptoms are nonspecific, and radiological help is sought to distinguish their esophageal origin from cardiac or musculoskeletal disorders (3, 5, 11). In the past, this identification has often been difficult unless a scarred, deformed, and ulcerated esophagus demonstrated the end stage of chronic esophagitis or unless frequent episodes of free gastroesophageal reflux were observed during fluoroscopy (3, 5). One of the most crucial questions in this regard has been the clinical significance of a small sliding hiatus hernia or a lower esophageal ring detected radiologically (7, 9). Previous manometric studies have shown that acid perfusion of the esophagus induces abnormal esophageal motility in patients with clinical esophagitis (1, 2, 4, 8, 10). This information has been used to develop a simple effective method for the radiological diagnosis of pept...

Dynamic imaging of the pharynx

The technique of dynamic imaging of the pharynx and some supplementary maneuvers which can be tailored to the individual patients needs are discussed in detail. An approach to the analysis of normal and abnormal swallowing studies is presented.

Vagal Reflexes Referred from the Upper Aerodigestive Tract: An Infrequently Recognized Cause of Common Cardiorespiratory Responses

OBJECTIVE To review the physiologic basis for normal and abnormal vagal reflexes arising from the pharynx, larynx, and esophagus, as well as the relevance of vagal reflexes to the pathogenesis of such clinically common cardiorespiratory responses as bradycardia, tachycardia, dysrhythmia, coronary angiospasm, bronchospasm, laryngospasm, prolonged apnea, and singultus (hiccups). DATA SOURCES Pertinent articles and reviews were identified through a MEDLINE search (April 1966 to October 1991). Older studies and others not identified in the MEDLINE search were found through a manual search of the bibliographies of the retrieved articles. STUDY SELECTION Experimental studies in both humans and animals, as well as case series and single case reports, were selected for evaluation and citation. In instances where a similar phenomenon was described in multiple independent reports, only studies that provided a novel finding or interpretation were cited. More authoritative book chapters and peer-reviewed summaries were also cited in support of commonly accepted principles. DATA EXTRACTION AND SYNTHESIS Most of the clinical data are derived from case reports and small case series and are therefore anecdotal; equal weight was given to all such studies. Reports of conflicting observations or interpretations were clearly identified and were cited without exception. CONCLUSIONS Stimulation of the upper aerodigestive tract can lead to clinically significant cardiorespiratory responses. Although the prevalence of and risk factors for such responses have not been established, we suggest that a pharyngeal, a laryngeal, or an esophageal source for abnormal cardiorespiratory responses be sought whenever a detailed clinical evaluation fails to reveal a cause, particularly when there are concurrent symptoms or signs of upper aerodigestive tract disease, such as dysphagia or gastroesophageal reflux.

Normal and Abnormal Swallowing

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