-
Journal of Oral Rehabilitation Sep 2015Although oropharyngeal and laryngeal structures are essential for swallowing, the three-dimensional (3D) anatomy is not well understood, due in part to limitations of...
Although oropharyngeal and laryngeal structures are essential for swallowing, the three-dimensional (3D) anatomy is not well understood, due in part to limitations of available measuring techniques. This study uses 3D images acquired by 320-row area detector computed tomography ('320-ADCT'), to measure the pharynx and larynx and to investigate the effects of age, gender and height. Fifty-four healthy volunteers (30 male, 24 female, 23-77 years) underwent one single-phase volume scan (0.35 s) with 320-ADCT during resting tidal breathing. Six measurements of the pharynx and two of larynx were performed. Bivariate statistical methods were used to analyse the effects of gender, age and height on these measurements. Length and volume were significantly larger for men than for women for every measurement (P < 0.05) and increased with height (P < 0.05). Multiple regression analysis was performed to understand the interactions of gender, height and age. Gender, height and age each had significant effects on certain values. The volume of the larynx and hypopharynx was significantly affected by height and age. The length of pharynx was associated with gender and age. Length of the vocal folds and distance from the valleculae to the vocal folds were significantly affected by gender (P < 0.05). These results suggest that age, gender and height have independent and interacting effects on the morphology of the pharynx and larynx. Three-dimensional imaging and morphometrics using 320-ADCT are powerful tools for efficiently and reliably observing and measuring the pharynx and larynx.
Topics: Adult; Aged; Aging; Body Height; Deglutition; Epiglottis; Female; Glottis; Healthy Volunteers; Humans; Image Processing, Computer-Assisted; Larynx; Male; Middle Aged; Multidetector Computed Tomography; Pharynx; Reference Values; Sex Characteristics
PubMed: 25892610
DOI: 10.1111/joor.12298 -
Otolaryngologic Clinics of North America Jun 2020Successful palatopharyngoplasty is critical for successful sleep apnea surgery. Traditional uvulopalatopharyngoplasty was primarily excisional, whereas newer techniques,... (Review)
Review
Successful palatopharyngoplasty is critical for successful sleep apnea surgery. Traditional uvulopalatopharyngoplasty was primarily excisional, whereas newer techniques, such as expansion sphincterpharyngoplasty, are more reconstructive. Studies of flow dynamics even demonstrate that the effectiveness of maxillofacial surgery is significantly mediated through stiffening and enlargement of the lateral retropalatal and pharyngeal airway. The current modified technique of uvulopalatopharyngoplasty/expansion sphincteroplasty aims to maximize relocation and tension on the palatopharyngeus muscle, opening the retropalatal airway and the palatal genu, and minimizing tension on the final mucosal closure.
Topics: Endoscopy; Humans; Palate; Pharynx; Phenotype; Plastic Surgery Procedures; Sleep Apnea, Obstructive; Uvula
PubMed: 32334865
DOI: 10.1016/j.otc.2020.02.005 -
BMJ Open Gastroenterology Nov 2023Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation.... (Review)
Review
OBJECTIVE
Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation.
DESIGN
This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches.
RESULTS
The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed.
CONCLUSION
Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.
Topics: Humans; Gastroenterology; Pharynx; Symptom Assessment; Otolaryngology
PubMed: 37996120
DOI: 10.1136/bmjgast-2022-000883 -
Romanian Journal of Morphology and... 2020The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with...
BACKGROUND
The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications.
OBJECTIVES
In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx.
PATIENTS, MATERIALS AND METHODS
Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection - "watchful waiting policy". All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L∕T); shape; lymph node area; central hypodensity; regular∕irregular margins; aspect (homogeneous or not).
RESULTS
US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group - patients treated with CO2 laser - detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases.
CONCLUSIONS
US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).
Topics: Female; Head and Neck Neoplasms; Humans; Larynx; Lymph Nodes; Male; Neoplasm Metastasis; Pharynx; Prospective Studies; Ultrasonography
PubMed: 33544794
DOI: 10.47162/RJME.61.2.12 -
Dysphagia Jun 2024Pharyngeal muscle changes occur in patients with Parkinson's disease and related disorders (PRD); however, the association between the structural alterations in the...
Pharyngeal muscle changes occur in patients with Parkinson's disease and related disorders (PRD); however, the association between the structural alterations in the pharynx and the symptoms of dysphagia remains unclear. We assessed structural changes and contractile forces by measuring pharyngeal wall thickness and width. We aimed to define the pharyngeal measurements and determine their value as diagnostic tools for dysphagia. The pharyngeal wall thickness (PWT), pharyngeal width at rest (PWR), and shortest pharyngeal width at swallowing (PWS) were measured using lateral neck roentgenograms and videofluoroscopic swallowing study. We compared the PWR and PWT between the PRD and control groups using an independent t-test. The Kendall correlation test was performed on the radiological data of the pharynx (PWT, PWR and PWS), dysphagia scales (Penetration-Aspiration scale [PAS] and Dysphagia Outcome and Severity Scale [DOSS]), and Hoehn and Yahr scale (HY scale). The PWT was smaller and the PWR greater in the PRD than in the control group (p < 0.05). The dysphagia scales (PAS and DOSS) were correlated with the radiological data (PWT and PWS) and the HY scale (p < 0.05). The HY scale score also correlated with the PWT (p < 0.05). The optimal cutoff points of the PWT and PWR for predicting aspiration were 4.05 and 16.05 mm in the PRD group, respectively. Using the PWT, PWR and PWS, muscle atrophy and contractile strength of the pharynx can be estimated. The combination of the PWT and PWR can be a simple indicator for predicting swallowing disorders at the bedside.
Topics: Humans; Deglutition Disorders; Parkinson Disease; Male; Pharynx; Female; Aged; Middle Aged; Deglutition; Fluoroscopy; Pharyngeal Muscles; Severity of Illness Index; Radiography; Case-Control Studies; Aged, 80 and over
PubMed: 37902836
DOI: 10.1007/s00455-023-10631-9 -
Current Medical Imaging 2021Obstructive sleep apnea (OSA) is a chronic sleeping disorder. The analysis of the pharynx and its surrounding tissues can play a vital role in understanding the...
BACKGROUND
Obstructive sleep apnea (OSA) is a chronic sleeping disorder. The analysis of the pharynx and its surrounding tissues can play a vital role in understanding the pathogenesis of OSA. Classification of the pharynx is a crucial step in the analysis of OSA.
METHODS
A visual analysis-based classifier is developed to classify the pharynx from MRI datasets. The classification pipeline consists of different stages, including pre-processing to select the initial candidates, extraction of categorical and numerical features to form a multidimensional features space, and a supervised classifier trained by using visual analytics and silhouette coefficient to classify the pharynx.
RESULTS
The pharynx is classified automatically and gives an approximately 86% Jaccard coefficient by evaluating the classifier on different MRI datasets. The expert's knowledge can be utilized to select the optimal features and their corresponding weights during the training phase of the classifier.
CONCLUSION
The proposed classifier is accurate and more efficient in terms of computational cost. It provides additional insight to better understand the influence of different features individually and collectively. It finds its applications in epidemiological studies where large datasets need to be analyzed.
Topics: Humans; Magnetic Resonance Imaging; Pharynx; Research Design; Sleep; Sleep Apnea, Obstructive
PubMed: 33213336
DOI: 10.2174/1573405616666201118143935 -
Swiss Dental Journal Oct 2020This review about extraoral anatomy depicted in cone beam computed tomography describes the pharyngocervical region. Large (≥ 8 × 8 cm) field of views of the maxilla... (Review)
Review
This review about extraoral anatomy depicted in cone beam computed tomography describes the pharyngocervical region. Large (≥ 8 × 8 cm) field of views of the maxilla and/or mandible will inevita-bly depict the pharyngocervical region that com-prises the posterior upper airway, the pharyngeal part of the digestive tract, as well as the cervical segment of the spine. The latter consists of seven cervical vertebrae (C1-C7) with corresponding distinctive features, i.e., the atlas (C1) and the axis (C2). In addition, cervical vertebrae serve as ref-erences for the vertical position of anatomical structures. For instance, C4 is a typical landmark since it generally denotes the level of the chin, of the body of the hyoid bone, of the base of the epiglottis, and of the bifurcation of the common carotid artery, respectively. The pharynx, which is functionally involved in respiration, deglutition, and vocalization, extends from the lower aspect of the skull base to the esophagus. Anatomically, the pharynx is divided into three segments, i.e. the nasopharynx, the oropharynx, and the laryn-gopharynx. All communicate anteriorly with cor-responding cavities, i.e. the nasal cavities, the oral cavity, and the larynx. Although not directly located within the pharyngocervical region, the hyoid bone and the styloid process are also dis-cussed in this review, since both structures are commonly visible on CBCT images of this region.
Topics: Cone-Beam Computed Tomography; Hyoid Bone; Mandible; Pharynx; Spiral Cone-Beam Computed Tomography
PubMed: 33021766
DOI: 10.61872/sdj-2020-10-01 -
BMJ Case Reports Nov 2022
Topics: Humans; Hypopharynx; Pharynx; Nose; Dentures; Otolaryngology
PubMed: 36379622
DOI: 10.1136/bcr-2021-248487 -
European Journal of Radiology Jul 2016Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific... (Review)
Review
Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific tendinitis of the longus colli muscle. These conditions should be managed by different specialties; beginning with care in the emergency room, physicians from orthopedics, pediatrics, otolaryngology, and oncology are in charge of the treatment. Since these diseases demonstrate similar fluid collections in the RPS on computed tomography (CT) and magnetic resonance imaging (MRI), the radiologist's diagnosis based on the characteristic imaging findings is very important to identify the primary disease. Also, since some of the diseases require immediate surgical intervention to avoid life-threatening mediastinitis or airway obstruction, radiologists must distinguish these diseases correctly and provide recommendations for their management to physicians. Understanding clinical features and imaging findings of these fluid collections in the RPS is crucial for the best care.
Topics: Body Fluids; Emergencies; Humans; Magnetic Resonance Imaging; Pharyngeal Diseases; Pharynx; Tomography, X-Ray Computed
PubMed: 27235871
DOI: 10.1016/j.ejrad.2016.04.001 -
Journal of Anatomy Aug 2021Solitary chemosensory cells and chemosensory cell clusters are distributed in the pharynx and larynx. In the present study, the morphology and reflexogenic function of...
Solitary chemosensory cells and chemosensory cell clusters are distributed in the pharynx and larynx. In the present study, the morphology and reflexogenic function of solitary chemosensory cells and chemosensory cell clusters in the nasal cavity and pharynx were examined using immunofluorescence for GNAT3 and electrophysiology. In the nasal cavity, GNAT3-immunoreactive solitary chemosensory cells were widely distributed in the nasal mucosa, particularly in the cranial region near the nostrils. Solitary chemosensory cells were also observed in the nasopharynx. Solitary chemosensory cells in the nasopharyngeal cavity were barrel like or slender in shape with long lateral processes within the epithelial layer to attach surrounding ciliated epithelial cells. Chemosensory cell clusters containing GNAT3-immunoreactive cells were also detected in the pharynx. GNAT3-immunoreactive cells gathered with SNAP25-immunoreactive cells in chemosensory clusters. GNAT3-immunoreactive chemosensory cells were in close contact with a few SP- or CGRP-immunoreactive nerve endings. In the pharynx, GNAT3-immunoreactive chemosensory cells were also attached to P2X3-immunoreactive nerve endings. Physiologically, the perfusion of 10 mM quinine hydrochloride (QHCl) solution induced ventilatory depression. The QHCl-induced reflex was diminished by bilateral section of the glossopharyngeal nerve, suggesting autonomic reflex were evoked by chemosensory cells in pharynx but not in nasal mucosa. The present results indicate that complex shape of nasopharyngeal solitary chemosensory cells may contribute to intercellular communication, and pharyngeal chemosensory cells may play a role in respiratory depression.
Topics: Animals; Capsaicin; Chemoreceptor Cells; Male; Nasal Cavity; Nasal Mucosa; Pharynx; Quinine; Rats, Wistar; Transducin; Rats
PubMed: 33677835
DOI: 10.1111/joa.13424