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The Laryngoscope May 2024Little is known about pharyngeal shortening (PShort) during swallowing. This observational study measured PShort during swallowing in healthy adults and compared it to... (Observational Study)
Observational Study
BACKGROUND
Little is known about pharyngeal shortening (PShort) during swallowing. This observational study measured PShort during swallowing in healthy adults and compared it to patients with swallowing impairments of different aetiologies.
METHODS
275 healthy volunteers (19-99 years) and 75 dysphagic patients (25 with head and neck cancer, 25 with Parkinson's, 25 with stroke) underwent videofluoroscopy. A novel quantitative measure of PShort for 1, 3, and 20 mL thin liquid barium and 3 mL paste boli was determined and compared across age, sex, bolus type and patient cohort.
RESULTS
PShort ranged from 1.05 to 4.41 cm across bolus types with larger displacements for 20 mL (M: 2.52 cm) and paste (M: 2.43 cm) compared with 1 mL (M: 2.36 cm) and 3 mL (M: 2.41 cm). PShort correlated with sex, height, and cohort but not age. Inter-rater reliability for three raters was substantial (intraclass correlation >0.80).
CONCLUSIONS
This novel fluoroscopic measure of PShort is reliable and demonstrates quantitative changes in vertical pharyngeal displacement in healthy and swallow-impaired adults related to sex, size, and bolus type.
LEVEL OF EVIDENCE
3 Laryngoscope, 134:2121-2126, 2024.
Topics: Adult; Humans; Reproducibility of Results; Deglutition Disorders; Deglutition; Pharynx; Fluoroscopy
PubMed: 37916781
DOI: 10.1002/lary.31149 -
Otolaryngology--head and Neck Surgery :... Aug 2023To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We...
OBJECTIVE
To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility.
STUDY DESIGN
Cross-sectional analysis in a prospective cohort.
SETTING
University Hospital.
METHODS
A cross-sectional analysis was conducted in a cohort of consecutive patients from the positive airway pressure (PAP) alternatives clinic who underwent computed tomography (CT) analysis and drug-induced sleep endoscopy for characterization of upper airway collapsibility. PAP titration was used to determine pharyngeal critical pressure (P ) and pharyngeal opening pressure (PhOP). CT metrics included: Transverse maxillary dimensions (interpremolar and intermolar distances) and pharyngeal length (posterior nasal spine to hyoid distance).
RESULTS
The cohort (n = 103) of severe obstructive sleep apnea (Apnea and Hipopnea Index 32.1 ± 21.3 events/h) was predominantly male (71.8%), Caucasian (81.6%), middle-aged (54.4 ± 14.3 years), and obese (body mass index [BMI] = 30.0 ± 4.9 kg/m ). Reduced transverse maxillary dimensions were associated with higher P (intermolar distance: β [95% confidence interval, CI] = -.25 [-0.14, -0.36] cmH O/mm; p = .03) and PhOP (Interpremolar distance: β = -.25 [-0.14, -0.36] cmH O/mm; p = .02). Longer pharyngeal length was also associated with higher P (β = .11 [0.08, 0.14] cmH O/mm, p = .04) and PhOP (β [95% CI] = .06 [0.03, 0.09] cmH O/mm, p = .04). These associations persisted after adjustments for sex, age, height, and BMI.
CONCLUSION
Our results further the concept that skeletal restriction in the transverse dimension and hyoid descent are associated with elevations in pharyngeal collapsibility during sleep, suggesting a role of transverse deficiency in the pathogenesis of airway obstruction.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Prospective Studies; Cross-Sectional Studies; Sleep; Sleep Apnea, Obstructive; Pharynx; Hospitals, University; Continuous Positive Airway Pressure
PubMed: 36939430
DOI: 10.1002/ohn.258 -
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 -
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 -
Current Topics in Developmental Biology 2020The pharyngeal apparatus, a transient embryological structure, includes diverse cells from all three germ layers that ultimately contribute to a variety of adult... (Review)
Review
The pharyngeal apparatus, a transient embryological structure, includes diverse cells from all three germ layers that ultimately contribute to a variety of adult tissues. In particular, pharyngeal endoderm produces cells of the inner ear, palatine tonsils, the thymus, parathyroid and thyroid glands, and ultimobranchial bodies. Each of these structures and organs contribute to vital human physiological processes, including central immune tolerance (thymus) and metabolic homeostasis (parathyroid and thyroid glands, and ultimobranchial bodies). Thus, improper development or damage to pharyngeal endoderm derivatives leads to complicated and severe human maladies, such as autoimmunity, immunodeficiency, hypothyroidism, and/or hypoparathyroidism. To study and treat such diseases, we can utilize human pluripotent stem cells (hPSCs), which differentiate into functionally mature cells in vitro given the proper developmental signals. Here, we discuss current efforts regarding the directed differentiation of hPSCs toward pharyngeal endoderm derivatives. We further discuss model system and therapeutic applications of pharyngeal endoderm cell types produced from hPSCs. Finally, we provide suggestions for improving hPSC differentiation approaches to pharyngeal endoderm derivatives with emphasis on current single cell-omics and 3D culture system technologies.
Topics: Cell Differentiation; Cell Lineage; Cell Proliferation; Cells, Cultured; Endoderm; Humans; Pharynx; Pluripotent Stem Cells
PubMed: 32220297
DOI: 10.1016/bs.ctdb.2020.01.004 -
BMJ Case Reports Nov 2022
Topics: Humans; Hypopharynx; Pharynx; Nose; Dentures; Otolaryngology
PubMed: 36379622
DOI: 10.1136/bcr-2021-248487 -
Journal of Fish Biology Dec 2020Activin A belongs to the superfamily of transforming growth factor-β and plays an important role in hormone regulation and tissue development. However, few research...
Activin A belongs to the superfamily of transforming growth factor-β and plays an important role in hormone regulation and tissue development. However, few research studies have been conducted on the effect of activin A on feeding organs in fish. In this study, the zebrafish (Danio rerio) larvae were treated with 1 ng ml activin A for 8 days continuously. The haematoxylin and eosin (H&E) staining section results revealed that the transverse inner diameter of the pharynx and oesophagus significantly increased on the third and eighth days after treatment compared with the control group (P < 0.05). On the eighth day, the cross-sectional area of the pharyngeal muscle increased by 8638 μm compared to the control group (P < 0.05). The RNA in situ hybridization results also showed that the expression of skeletal muscle-specific genes (myog and myod) was significantly increased in pharyngeal muscle on the eighth day. Furthermore, the qRT-PCR results showed the expression of gh gene was significantly increased on the eighth day (P < 0.05). At the same time, more larvae in activin A group were able to feed larger brine shrimp (Artemia) than in the control group on the eighth day. In conclusion, activin A could affect feeding by promoting the inner diameter and muscle development of the pharynx and oesophagus in zebrafish larvae. This study is the first to report that the development of the pharynx and oesophagus can directly affect food intake in fish larvae, which provides a theoretical basis for the study of food intake of fish at an early stage.
Topics: Activins; Animals; Artemia; Esophagus; Gene Expression Regulation, Developmental; In Situ Hybridization; Inhibin-beta Subunits; Muscle Development; Pharynx; Zebrafish
PubMed: 32785965
DOI: 10.1111/jfb.14493 -
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 -
ELife Feb 2020Khoomei is a unique singing style originating from the republic of Tuva in central Asia. Singers produce two pitches simultaneously: a booming low-frequency rumble...
Khoomei is a unique singing style originating from the republic of Tuva in central Asia. Singers produce two pitches simultaneously: a booming low-frequency rumble alongside a hovering high-pitched whistle-like tone. The biomechanics of this biphonation are not well-understood. Here, we use sound analysis, dynamic magnetic resonance imaging, and vocal tract modeling to demonstrate how biphonation is achieved by modulating vocal tract morphology. Tuvan singers show remarkable control in shaping their vocal tract to narrowly focus the harmonics (or overtones) emanating from their vocal cords. The biphonic sound is a combination of the fundamental pitch and a focused filter state, which is at the higher pitch (1-2 kHz) and formed by merging two formants, thereby greatly enhancing sound-production in a very narrow frequency range. Most importantly, we demonstrate that this biphonation is a phenomenon arising from linear filtering rather than from a nonlinear source.
Topics: Audiovisual Aids; Humans; Magnetic Resonance Imaging; Pharynx; Russia; Singing
PubMed: 32048990
DOI: 10.7554/eLife.50476