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Pharyngeal reconstruction after total laryngectomy with preservation of phonation.

The goal of pharyngeal reconstruction after laryngectomy is to prevent fistulization and to permit rapid resumption of satisfactory deglutition. Alaryngeal speech acquisition by the traditional method of esophageal speech is effective if insufflation is rapidly learned and tolerated by the pharyngoesophageal segment. Experience with tracheoesophageal phonation revealed an incidence of pharyngoesophageal spasm in 40% of an esophageal speech failure population which prevented useful air flow for speech production. This is related to esophageal distention and reflexive upper esophageal sphincter hypertension. It is suggested that pharyngeal reconstruction after total laryngectomy may permit higher wall tension than is desirable for speech acquisition. The problem of post laryngectomy pharyngoesophageal spasm may be reduced by myotomy of the pharyngeal constrictors with resultant higher air flows in the residual vocal tract for speech. Alterations in the pharyngeal wall tonicity will affect the pitch of the speech and listener acceptability. Recently identification and division of the pharyngeal plexus has produced a similar result in improved phonatory air flows with subjective vocal pitch approximating more normal voices. The above mentioned techniques are readily applied to the laryngectomy procedure and enhance the likelihood of alaryngeal speech acquisition.

Humans↗

Pharyngeal arch patterning in the absence of neural crest.

Pharyngeal arches are a prominent and critical feature of the developing vertebrate head. They constitute a series of bulges within which musculature and skeletal elements form; importantly, these tissues derive from different embryonic cell types [1]. Numerous studies have emphasised the role of the cranial neural crest, from which the skeletal components derive, in patterning the pharyngeal arches [2-4]. It has never been clear, however, whether all arch patterning is completely dependent on this cell type. Here, we show that pharyngeal arch formation is not coupled to the process of crest migration and, furthermore, that pharyngeal arches form, are regionalized and have a sense of identity even in the absence of the neural crest. Thus, vertebrate head morphogenesis can now be seen to be a more complex process than was previously believed and must result from an integration of both neural-crest-dependent and -independent patterning mechanisms. Our results also reflect the fact that the evolutionary origin of pharyngeal segmentation predates that of the neural crest, which is an exclusively vertebrate characteristic.

Animals↗

Origin and evolution of gnathostome dentitions: a question of teeth and pharyngeal denticles in placoderms.

The fossil group Placodermi is the most phylogenetically basal of the clade of jawed vertebrates but lacks a marginal dentition comparable to that of the dentate Chondrichthyes, Acanthodii and Osteichthyes (crown-group Gnathostomata). The teeth of crown-group gnathostomes are part of an ordered dentition replaced from, and patterned by, a dental lamina, exemplified by the elasmobranch model. A dentition recognised by these criteria has been previously judged absent in placoderms, based on structural evidence such as absence of tooth whorls and typical vertebrate dentine. However, evidence for regulated tooth addition in a precise spatiotemporal order can be observed in placoderms, but significantly, only within the group Arthrodira. In these fossils, as in other jawed vertebrates with statodont, non-replacing dentitions, new teeth are added at the ends of rows below the bite, but in line with biting edges of the dentition. The pattern is different on each gnathal bone and probably arises from single odontogenic primordia on each, but tooth rows are arranged in a distinctive placoderm pattern. New teeth are made of regular dentine comparable to that of crown-gnathostomes, formed from a pulp cavity. This differs from semidentine previously described for placoderm gnathalia, a type present in the external dermal tubercles. The Arthrodira is a derived taxon within the Placodermi, hence origin of teeth in placoderms occurs late in the phylogeny and teeth are convergently derived, relative to those of other jawed vertebrates. More basal placoderm taxa adopted other strategies for providing biting surfaces and these vary substantially, but include addition of denticles to the growing gnathal plates, at the margins of pre-existing denticle patches. These alternative strategies and apparent absence of regular dentine have led to previous interpretations that teeth were entirely absent from the placoderm dentition. A consensus view emerged that a dentition, as developed within a dental lamina, is a synapomorphy characterising the clade of crown-group gnathostomes. Recent comparisons between sets of denticle whorls in the pharyngeal region of the jawless fish Loganellia scotica (Thelodonti) and those in sharks suggest homology of these denticle sets on gill arches. Although the placoderm pharyngeal region appears to lack denticles (placoderm gill arches are poorly known), the posterior wall of the pharyngeal cavity, formed by a bony flange termed the postbranchial lamina, is covered in rows of patterned denticle arrays. These arrays differ significantly, both in morphology and arrangement, from those of the denticles located externally on the head and trunkshield plates. Denticles in these arrays are homologous to denticles associated with the gill arches in other crown-gnathostomes, with pattern similarities for order and position of pharyngeal denticles. From their location in the pharynx these are inferred to be under the influence of a cell lineage from endoderm, rather than ectoderm. Tooth sets and tooth whorls in crown-group gnathostomes are suggested to derive from the pharyngeal denticle whorls, at least in sharks, with the patterning mechanisms co-opted to the oral cavity. A comparable co-option is suggested for the Placodermi.

Animals↗

Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects.

The oropharyngeal swallow of 10 patients with mild dysphagia at 3 weeks after a cerebrovascular accident (stroke), 10 normal subjects, and 8 neurologically impaired patients with moderate to severe dysphagia was studied videofluorographically to examine the effects of 2 bolus temperatures (room temperature and 33 degrees F), 2 volumes, and 2 viscosities on the durations of pharyngeal stage swallow events and the frequency and nature of oropharyngeal swallowing problems and bolus transit. Normal subjects exhibited significantly longer pharyngeal response times and longer laryngeal elevation only for 1 ml cold liquid. The stroke patients and the 8 significantly dysphagic neurologically impaired patients exhibited very few significant effects of temperature on swallowing disorders or swallow measures. Increases in bolus volume and viscosity decreased pharyngeal delay times in both neurologically impaired patient groups. Stroke patients exhibited significantly longer pharyngeal delay times but shorter pharyngeal response times, laryngeal closure, cricopharyngeal opening, and laryngeal elevation than normal subjects on some bolus volumes and viscosities. Results are discussed in terms of the potentially therapeutic effects of bolus volume and viscosity.

Adolescent↗

Endoscopic stapling for pharyngeal pouch: does it make the cut?

BACKGROUND: Endoscopic stapling to treat pharyngeal pouch is a relatively new technique with the potential to reduce the morbidity associated with the open approach for pharyngeal pouch. Despite enthusiasm for the endoscopic approach there have been no series reported in Australia, and descriptions of outcomes and benefits are currently anecdotal. The aim of the present study was to determine the outcome associated with endoscopic stapling of pharyngeal pouch in an Australian setting. METHODS: All patients admitted for endoscopic stapling for a pharyngeal pouch between 1998 and 2002 by surgeons from the Adelaide and Flinders Universities were identified, and their medical records were reviewed for clinical and operative details. All patients were interviewed by telephone using a structured questionnaire to determine symptom resolution and patient satisfaction. The Likert scale was used to assess the impact of preoperative and postoperative symptoms upon quality of life. RESULTS: A total of 31 patients were identified. The mean age of the group was 75 years (range: 35-91 years) and half the patients had an American Society of Anesthesiologists physical status score of 3 or greater. In four patients the procedure was abandoned; (for three because of inability to pass the diverticuloscope and for one because the pouch was too small). Standard open surgery was undertaken in these patients. Of the 27 procedures completed endoscopically, interview follow up was obtained in 23, at a mean follow up of 17 months (range: 2-68 months). Outcome was very good or excellent in 21 (91%), with significant symptom resolution, reduction in Likert scores and high patient satisfaction. Three patients had previously had pouch surgery and endoscopic stapling was straightforward in these patients. Recurrence of a symptomatic pouch occurred in three patients. There was no significant morbidity related to the procedure. CONCLUSIONS: The early experience of endoscopic stapling for pharyngeal pouch in Adelaide is encouraging. The procedure achieves excellent control of symptoms and can be undertaken with minimal morbidity. Recurrence may be a problem, although repeat endoscopic stapling can be undertaken without difficulty.

Adult↗

Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea.

We measured pharyngeal cross-sectional area and its change with alterations in lung volume in 10 subjects who snored and had obstructive sleep apnea, 6 subjects who snored and did not have obstructive sleep apnea, and 9 subjects who did not snore. Pharyngeal area was measured with use of an acoustic-reflection technique. We found that snorers with and without sleep apnea had a significantly smaller mean (+/- SE) pharyngeal cross-sectional area (4.1 +/- 0.2 and 3.7 +/- 0.9 cm2, respectively) at functional residual capacity than nonsnorers (5.4 +/- 0.5 cm2, P less than 0.025). When lung volume decreased from functional residual capacity to residual volume, both nonsnorers and snorers with sleep apnea had a decrease in pharyngeal area (from 5.4 +/- 0.5 to 4.5 +/- 0.4 cm2 and 4.1 +/- 0.2 to 3.4 +/- 0.2 cm2, respectively), whereas snorers without sleep apnea had no such decrease, suggesting that their pharynxes were less collapsible at low lung volumes. We conclude that snorers with and without sleep apnea have smaller pharyngeal cross-sectional areas than nonsnorers and that snorers with sleep apnea have a further decrease as lung volume falls.

Adult↗

Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex.

The purpose of this study was to evaluate the effects of double-jaw surgery with counterclockwise rotation of the maxillomandibular complex on the pharyngeal airway space and velopharyngeal anatomy in patients with high occlusal plane facial morphology. Fifty patients (22 men, 28 women) with high occlusal plane facial morphology underwent double-jaw surgery with counterclockwise rotation of the maxillomandibular complex. The patients were divided into 2 groups: group 1, 30 patients (8 men, 22 women) who underwent maxillary and mandibular advancement and group 2, 20 patients (14 men, 6 women) who underwent maxillary advancement and mandibular setback. Presurgery and postsurgery lateral cephalometric radiographs were analyzed to correlate changes in pharyngeal airway space dimensions and velopharyngeal anatomy with maxillary and mandibular positional changes. The calibration showed a more than 0.94 correlation for both intra- and interoperator error. The average follow-up time was 29.6 months in group 1 and 22.2 months in group 2. Mean maxillary surgical change at point A was 4.15 mm in group 1 and 2.5 mm in group 2. Mean mandibular surgical change at the genial tubercles was 7.5 mm in group 1 and -4.95 mm in group 2. After surgery, group 1 patients had an increase in pharyngeal airway space of 47% at the soft palate and 76% at the base of the tongue relative to the amount of mandibular advancement. Group 2 patients had a decrease in pharyngeal airway space of 47% at the soft palate and 65% at the base of the tongue relative to the amount of mandibular setback. Double-jaw surgery with counterclockwise rotation of the maxillomandibular complex significantly affects the pharyngeal airway space and velopharyngeal anatomy in patients with high occlusal plane facial morphology, with both mandibular advancement and setback.

Adolescent↗

Distribution and origin of the intraepithelial nerve fibres in the feline pharyngeal mucosa.

Sensory inputs from the pharynx play an important role in initiation of the swallowing reflex and in feedback control of motor activities. Using an immunohistochemical technique and denervation procedures, we examined the distribution and origin of the intraepithelial nerve fibres in the feline pharyngeal mucosa to clarify the role of the afferent nerve in swallowing. The posterior pillar was very densely innervated, and the posterior and lateral walls of the mesopharynx had a moderate nerve density. In contrast, the base of the tongue, the vallecula, the pharyngeal surface of the epiglottis, and the pyriform sinus had only a few nerve fibres. The epithelium of the rostral and caudal portions of the pharyngeal mucosa were innervated by the glossopharyngeal nerve and superior laryngeal nerve, respectively, with a borderline at the middle level of the epiglottis. A portion of the intraepithelial nerve fibres in the lateral and posterior walls of the mesopharynx originated from the pharyngeal branch of the vagus nerve. It is hypothesized that the intraepithelial nerve fibres that exist in densely innervated areas are related to the initiation of the swallowing reflex induced by stimulation of the pharyngeal mucosa.

Afferent Pathways↗

Evaluation of the viscoelastic properties of pharyngeal tissue.

The viscoelastic properties of the human pharyngeal tissue in tension were evaluated, based on both an experimental protocol-consisting of cyclic load, tensile stress relaxation, and incremental step load tests-and a quasilinear viscoelastic theory. The physical properties of the pharyngeal tissue were evaluated to facilitate the biomechanical modeling of human pharynx. The methodology described has potentially significant clinical importance when one considers engineering a similar type of tissue having the same material properties in the future. Qualitatively, the characteristic features of viscoelastic properties of human pharyngeal tissue were experimentally obtained. Then, the reduced stress relaxation function and the elastic response of the pharyngeal tissue were derived from the experimental results specifically obtained from this tissue, by applying the quasilinear viscoelastic theory. The mathematical expression for analyzing nonlinear viscoelastic properties of human pharyngeal tissue is presented, as is the experimental protocol to evaluate the tissue properties. The characteristic features of the tissue need to be considered when attempting to engineer this tissue equivalent, and the data generated can be utilized to evaluate the function of tissue when it is engineered.

Aged↗

Streptococcal adherence to pharyngeal cells of children with acute rheumatic fever.

The adherence of strains of group A Streptococcus to pharyngeal cells from Egyptian children with acute rheumatic fever (RF) was examined. Nine RF-associated and eight unassociated streptococcal strains were tested in vitro for adherence to pharyngeal cells from 11 patients with acute RF and eight normal subjects. RF-associated streptococcal strains adhered more avidly to pharyngeal cells of patients with acute RF (mean, 11.8 bacteria/cell) than did unassociated strains (mean, 5.9 bacteria/cell; P less than 0.05). The difference in mean adherence could be attributed to certain RF-associated strains. There was no significant difference in adherence when pharyngeal cells from controls were used. Furthermore, one RF-associated streptococcal strain was found to adhere considerably more avidly to pharyngeal cells of patients with RF than to those of controls.

Adolescent↗

Pharyngeal swallowing. The major factor in clearance of esophageal reflux episodes.

OBJECTIVE: This study defined the clearance mechanisms of naturally occurring reflux episodes in normal subjects and patients with gastroesophageal reflux disease. SUMMARY BACKGROUND: Previous studies on acid clearance have been performed in the laboratory setting in supine subjects using acid instillation and stationary motility. The mechanisms of clearance have not been studied using ambulatory pH and motility monitoring. METHODS: A new system capable of monitoring simultaneously for 24 hours pharyngeal pressure, esophageal motility, and pH was used to study the clearance of naturally occurring reflux episodes in 10 normal subjects and 18 patients with gastroesophageal reflux disease. Esophageal contraction waves were classified as primary (i.e., initiated by a pharyngeal swallow) and secondary (i.e., unrelated to a pharyngeal swallow). RESULTS: A total of 1288 reflux episodes were analyzed, during which 2781 contraction waves occurred. Clearance (i.e., restoration of pH to > 4) occurred after primary peristalsis in 83% of reflux episodes. An additional 11% were cleared by pharyngeal swallows without an esophageal body response. Secondary waves were rare and when they occurred, only 19% were peristaltic. Secondary peristalsis cleared only 9 of the 1288 reflux episodes. Patients and normal subjects cleared reflux episodes similarly. Baseline swallowing frequency was 0.87/min during the daytime and increased to 2.59/min (p < 0.01) during daytime reflux episodes. Swallowing frequency in response to nighttime reflux episodes was less (1.42/min; p < 0.05). CONCLUSIONS: Pharyngeal swallowing is the most important mechanism for esophageal acid clearance. Secondary waves are rare, usually disorganized, and unimportant in clearing a reflux episode. During sleep, the mechanisms of clearance are depressed.

Adolescent↗

Effect of pharyngeal stimulation on the motor function of the esophagus and its sphincters.

OBJECTIVE/HYPOTHESIS: Sensory impulses from the pharynx induce contraction of the upper esophageal sphincter (UES), relaxation of the lower esophageal sphincter (LES), and inhibition of peristalsis. To determine 1) the magnitude of UES contractile response to threshold volume of fluid that induces LES relaxation and 2) the effect of rapid pharyngeal air stimulation on LES resting pressure and its concurrent influence on the UES and progression of esophageal peristalsis. METHODS: Eleven healthy volunteers (age, 31 +/- 2 y) were studied by concurrent UES, esophagealbody, and LES manometry. RESULTS: At a threshold volume of 0.3 +/- 0.05 mL, injections of water into the pharynx directed posteriorly, resulted in complete LES relaxation. Duration of these relaxations averaged 19 +/- 1 seconds. In 10 of 11 subjects, these relaxations were accompanied by a simultaneous increase in UES resting tone that averaged 142% +/- 27% above preinjection values. Pharyngeal stimulation by rapid air injection resulted in complete LES relaxation in 8 of the 11 subjects (threshold volume, 14 +/- 6 mL). Five of 8 developed a concurrent mild increase in resting UES pressure (17% +/- 6% above preinjection values) (P < .05). Pharyngeal water injection inhibited the progression of the peristaltic pressure wave at all tested sites and in all subjects, but pharyngeal air injection in only 2 of the 11 studied subjects. CONCLUSIONS: The inhibitory effect of pharyngeal water injection on LES resting pressure is accompanied by a substantial contractile effect on the UES. Although stimulation of the pharynx by rapid air injection may induce LES relaxation, its inhibitory effect on esophageal peristalsis and stimulatory effect on UES pressure are negligible compared with that of water injection.

Adult↗

Sleep apnea following a pharyngeal flap: a feared complication.

Pharyngeal flaps are often used to correct velopharyngeal insufficiency. They produce a permanent partial obstruction of the velopharyngeal space. Respiratory obstruction and obstructive sleep apnea have been reported following this surgery. We undertook a study to find out the incidence of sleep apnea associated with pharyngeal flap surgery. Forty-one children (aged 2 to 22 years) admitted for a pharyngeal flap underwent a polysomnographic recording prior to their surgery. One child with Steinert's disease showed some episodes of obstructive apnea, and the surgery was canceled. Forty children underwent pharyngeal flap surgery, and polysomnography with continuous arterial saturation was repeated following surgery. Postoperative polysomnograms were normal in 26 patients (65 percent) and abnormal in 14 patients (35 percent). Among the 14 abnormal patients, we found 6 with obstructive apneas, 6 with central apneas, and 2 with both central and obstructive apneas. Ten of the 14 abnormal patients were restudied in the following months. Eight children had normal recordings, while 2 had central apneas. The 4 patients who declined a follow-up recording had no clinical symptoms of respiratory difficulty when sleeping. Of the 2 children with abnormal recordings on long-term follow-up, 1 is asymptomatic, while the second has persistent snoring, nocturnal awakening, sweating, and daytime lethargy. A section of his flap has been recommended. Independent analysis of arterial oxygen saturation revealed that the percentage of time with a saturation of less than 90 percent identifies patients with clinically significant apneas. Our data show that significant sleep apneas following pharyngeal flaps may not be as frequent or permanent as previously reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

High correlation between the bacterial species in denture plaque and pharyngeal microflora.

OBJECTIVES: The morbidity and mortality of the dependent elderly that result from aspiration pneumonia are recognized as a major geriatric health problem. Most cases of bacterial pneumonia are initiated following colonization or superinfection of the pharynx by pathogenic bacteria, followed by aspiration of pharyngeal contents. A recent study revealed that bacteria, that commonly cause respiratory infection, colonized the dentures of dependent elderly. This suggests that denture plaque may function as a reservoir of potential respiratory pathogens to facilitate colonization on the pharynx. The purpose of this study was to determine the possible correlation between denture and pharyngeal microflora. STUDY DESIGN: The denture and pharyngeal bacterial flora of 50 dependent elderly were examined, and the microorganisms identified by culturing. The agreement between the bacterial species in denture plaque and pharyngeal microflora was investigated using the Kappa method. RESULTS: The microorganism species on the dentures and pharyngeal mucosa of the subjects had an agreement rate of 68.5%. The agreement rate for each of the bacterial species of the dentures and pharynx was also demonstrated to be high. CONCLUSIONS: Dentures should be considered an important reservoir of organisations which could colonise the pharynx, and the importance of controlling denture plaque for the prevention of aspiration pneumonia cannot be overemphasized.

Aged↗

Immunoglobulins to group A streptococcal surface molecules decrease adherence to and invasion of human pharyngeal cells.

The M protein is one of the most important virulence factors of group A streptococci (Streptococcus pyogenes) and may play an important role in the first steps of streptococcal infection. Since acute pharyngitis is a frequently occurring infectious disease caused by these bacteria, we wished to know whether antibodies to the M protein or other surface components inhibit adherence and internalization of streptococci to pharyngeal cells. We investigated the role of whole human secretory immunoglobulin A (sIgA), M6 protein-specific sIgA, and M6 protein-specific serum IgG in the inhibition of streptococcal adherence and internalization to cultured human pharyngeal cells. S. pyogenes D471, which produces a type 6 M protein (M+), and its isogenic M-negative (M-) derivative JRS75 were tested. Purified whole sIgA, M protein-specific sIgA, and sIgA preabsorbed with M protein were able to decrease significantly the adherence of streptococci to pharyngeal cells. Purified IgG against the M6 protein did not diminish the attachment of streptococci to the pharyngeal cells but did reduce internalization. Thus, our data suggest that secretory IgA may play a key role in preventing streptococcal infection at mucosal surfaces by blocking adherence while affinity-purified anti-M protein-specific IgG blocks epitopes responsible for invasion.

Animals↗

Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function.

Effect of aging, bolus volume, temperature, and consistency on the pharyngeal peristalsis, as well as the effect of aging on the upper esophageal sphincter (UES) resting pressure and its response to esophageal distension by air and balloon, were studied in 14 young and 12 healthy elderly volunteers. In both age groups there was no significant volume or temperature effect on amplitude, duration, or velocity of the pharyngeal peristalsis. Compared with water swallows, mashed potato swallows resulted in a significant increase in the amplitude and duration of the hypopharyngeal peristaltic pressure wave (P < 0.05). For water swallows, the amplitude and duration of the peristaltic pressure wave in the hypopharynx were significantly increased in the elderly compared with the young group (P < 0.01). UES resting pressure in the elderly measured 43 +/- 5 (SE) mmHg and was significantly less than that of the young (71 +/- 8 mmHg; P < 0.01). Magnitude of the UES pressure decrease because of esophageal distension by air, as well as magnitude of its pressure increase because of esophageal balloon distension, was similar among young and elderly. 1) Contrary to common expectations, the parameters of the pharyngeal peristaltic pressure wave do not deteriorate in the elderly in their seventh and eighth decade. 2) Compared with the young, hypopharyngeal pressure wave amplitude and duration are significantly increased in the elderly. This increase could be caused by an adaptation response to a pharyngeal outflow compromise. 3) Pharyngeal peristaltic pressure wave amplitude and duration, but not its velocity, are modulated by the bolus consistency. This modulatory mechanism is preserved in the elderly. 4) Although UES resting pressure is significantly decreased in the elderly, its pressure response to esophageal distension by air and balloon is preserved.

Adult↗

Pharyngeal swallowing elicited by fluid infusion: role of volition and vallecular containment.

Nonalimentary swallows minimize aspiration by clearing accumulated fluid from the pharynx. This study aimed to define 1) the pharyngeal sensory field to elicit swallowing and 2) the effect of infusion rate, volition, taste, and temperature on pharyngeal swallows. Test solutions were directed into the valleculae at 6.5, 11.5, and 32 ml/min through a catheter in eight healthy volunteers. Deglutition was signaled with electromyography and electroglottography. Spatial distribution of infusate before swallowing was studied using videofluoroscopy coupled with a video timer. Volitional control was assessed with rapid or restrained swallows. Pharyngeal swallow latency decreased as the instillation rate increased, was potently modified with volition, and was unchanged by infusate taste or temperature. Water infusion into the valleculae did not trigger pharyngeal swallowing until liquids overflowed and reached the aryepiglottic folds or pyriform sinuses. The variation in swallow latency among flow rates was mainly due to the duration of liquid containment within the valleculae. This suggests that the valleculae act to contain pharyngeal secretions and residue and prevent aspiration by diverting their contents around the larynx before swallowing.

Adult↗

Measurement of pharyngeal cross-sectional area by finite element analysis.

A noninvasive measurement of pharyngeal cross-sectional area (CSA) during sleep would be advantageous for research studies. We hypothesized that CSA could be calculated from the measured pharyngeal pressure and flow by finite element analysis (FEA). The retropalatal airway was visualized by using a fiber-optic scope to obtain the measured CSA (mCSA). Flow was measured with a pneumotachometer, and pharyngeal pressure was measured with a pressure catheter at the palatal rim. FEA was performed as follows: by using a three-dimensional image of the upper airway, a mesh of finite elements was created. Specialized software was used to allow the simultaneous calculation of velocity and area for each element by using the measured pressure and flow. In the development phase, 677 simultaneous measurements of CSA, pressure, and flow from one subject during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep were entered into the software to determine a series of equations, based on the continuity and momentum equations, that could calculate the CSA (cCSA). In the validation phase, the final equations were used to calculate the CSA from 1,767 simultaneous measurements of pressure and flow obtained during wakefulness, NREM, and REM sleep from 14 subjects. In both phases, mCSA and cCSA were compared by Bland-Altman analysis. For development breaths, the mean difference between mCSA and cCSA was 0.0 mm2 (95% CI, -0.1, 0.1 mm2). For NREM validation breaths, the mean difference between mCSA and cCSA was 1.1 mm2 (95% CI 1.3, 1.5 mm2). Pharyngeal CSA can be accurately calculated from measured pharyngeal pressure and flow by FEA.

Anatomy, Cross-Sectional↗