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PubMed1998

Pharyngeal localizations of branchial cysts.

Two cases with unusual pharyngeal localizations of branchial cysts medial to the great neck vessels and pharyngeal constrictor muscle are presented. The authors reviewed the theories of origin of the branchial cysts and the surgical treatment options. In their first case the transoral approach was chosen. Because of previous unsuccessful attempts at surgical treatment, the pharyngeal cyst was extremely adherent to adjacent tissue with much scar tissue, and it was very difficult to remove. As a result of this disappointing operation, an external neck exploration was indicated in the second patient. Histological examinations confirmed that the excised cysts were branchial in both cases.

Adult↗

PubMed1985

Reconstructive options for pharyngeal and/or cervical esophageal defects.

Reconstruction of the pharynx and or cervical esophagus continues to represent a formidable challenge for the head and neck oncologic surgeon. An analysis was made of 40 patients undergoing pharyngeal and/or esophageal reconstruction. The majority of these reconstructions were sometimes used in combination with skin grafts and even regional skin flaps. Those patients undergoing complete pharyngeal-esophageal reconstruction using a myocutaneous flap with soft Silastic stenting will be discussed as to the potential value of this technique. This article addresses the author's preference for particular reconstructive techniques (ie, skin graft v flap) as it relates to anatomic areas in the pharynx and esophagus. The study concludes that the myocutaneous flaps can be effectively and successfully used for the one-stage reconstruction of subtotal pharyngeal-esophageal defects. However, the reconstruction of total pharyngeal-esophageal defects continues to be a problem area, with only moderate success achieved with the techniques described.

Eating↗

PubMed1999

Morphological analysis of the pharyngeal jaws in two populations of Lebias fasciata Valenciennes, 1821 (Teleostei: Cyprinodontidae).

The study of the pharyngeal jaws in two geographically isolated Italian populations of Lebias fasciata indicated the presence of two phenotypes: the Adriatic phenotype with a large ceratobranchial V and upper and lower pharyngeal jaws bearing few large teeth and the Sicilian phenotype with a smaller ceratobranchial V and pharyngeal jaws with smaller and more numerous teeth. The morphological variations of pharyngeal jaws should be interpreted as a result of the geographical isolation of these two populations.

Animals↗

PubMed2005

Surgical interventions for pharyngeal pouch.

BACKGROUND: A pharyngeal pouch is an out-pouching or pocket that develops from the posterior wall of the pharynx just above the entrance to the oesophagus (gullet). Pouches may give rise to difficulty in swallowing, sensation of a lump in the throat or of food sticking in the throat and may lead to troublesome regurgitation of food. Food may enter the pouch rather than passing down the oesophagus and this and regurgitation may result in weight loss, hoarseness of voice and/or recurrent chest infections. The management of patients with a pharyngeal pouch may be either conservative or surgical. The surgical management can be further divided into two broad categories: endoscopic and open procedures. In the first half of the twentieth century an open surgical approach to the pouch was most frequently used, and remains common in some parts of the world. In recent decades endoscopic procedures (where the approach is made through the mouth) have become popular. The superiority of one approach over another has yet to be clearly demonstrated. OBJECTIVES: To assess the effectiveness and safety of open and endoscopic surgical procedures for the management of a pharyngeal pouch. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2004, MEDLINE (1966 to 2004) and EMBASE (1974 to 2004). Reference lists of all identified trials and previous reviews were searched for additional trials. Further electronic searches for key authors identified were made. There were no language restrictions. The date of the last search was September 2004. SELECTION CRITERIA: We sought to identify all randomised controlled trials (RCTs) comparing two or more interventions. DATA COLLECTION AND ANALYSIS: Three reviewers assessed the eligibility of trials for inclusion in the review, based on pre-determined criteria. MAIN RESULTS: No trials were identified which fulfilled the criteria. AUTHORS' CONCLUSIONS: There is no evidence from high quality randomised controlled trials to demonstrate the effectiveness of endoscopic compared with open procedures for pharyngeal pouch. There is no good evidence to establish whether one endoscopic procedure is superior to another.

Diverticulum↗

PubMed2001

Patterning the pharyngeal arches.

The presence of a muscularised pharynx with skeletal support is a fundamental vertebrate characteristic. Developmentally, the pharynx arises from the pharyngeal arches on either side of the head of vertebrate embryos. The development of the pharyngeal arches is complex involving a number of disparate embryonic populations, ectoderm, endoderm, neural crest and mesoderm, which must be co-ordinated to generate the components and overall identity of each of the arches. Previous studies suggested that it is the neural crest that plays a pivotal role in patterning the pharyngeal arches. It is now also becoming clear, however, that there are crest-independent patterning mechanisms. Therefore, pharyngeal arch patterning is more complex than was previously believed and there must be an integration of crest-dependent and -independent patterning mechanisms. BioEssays 23:54-61, 2001.

Animals↗

PubMed2005

XTbx1 is a transcriptional activator involved in head and pharyngeal arch development in Xenopus laevis.

The development of pharyngeal arch derivatives in mouse and zebrafish embryos depends on the activity of the transcription factor Tbx1. We cloned the Xenopus laevis orthologue of Tbx1 (XTbx1) and show that the pattern of expression is similar to that in other vertebrate species. Zygotic transcripts are first detected shortly after the mid-blastula transition and are localized to the presumptive mesoderm at mid-gastrula stages. XTbx1 expression persists in the lateral plate mesoderm at neurula stages and is found in the pharyngeal arches and otic vesicles from early tail bud stages onward. We demonstrate that XTbx1 is a transcriptional activator and that this trans-activation requires the C-terminal region of the protein. A dominant interfering mutant of XTbx1 disrupts the development of Xenopus head structures and pharyngeal arch derivatives. Lineage labeling reveals a requirement for XTbx1 function in cells that contribute to the pharyngeal mesoderm and for fgf8 expression.

Animals↗

PubMed2003

Placoderm fishes, pharyngeal denticles, and the vertebrate dentition.

The correlation of the origin of teeth with jaws in vertebrate history has recently been challenged with an alternative to the canonical view of teeth deriving from separate skin denticles. This alternative proposes that organized denticle whorls on the pharyngeal (gill) arches in the fossil jawless fish Loganellia are precursors to tooth families developing from a dental lamina along the jaw, such as those occurring in sharks, acanthodians, and bony fishes. This not only indicates that homologs of tooth families were present, but also illustrates that they possessed the relevant developmental controls, prior to the evolution of jaws. However, in the Placodermi, a phylogenetically basal group of jawed fishes, the state of pharyngeal denticles is poorly known, tooth whorls are absent, and the presence of teeth homologous to those in extant jawed fishes (Chondrichthyes + Osteichthyes) is controversial. Thus, placoderms would seem to provide little evidence for the early evolution of dentitions, or of denticle whorls, or tooth families, at the base of the clade of jawed fishes. However, organized denticles do occur at the rear of the placoderm gill chamber, but are associated with the postbranchial lamina of the anterior trunkshield, assumed to be part of the dermal cover. Significantly, these denticles have a different organization and morphology relative to the external dermal trunkshield tubercles. We propose that they represent a denticulate part of the visceral skeleton, under the influence of pharyngeal patterning controls comparable to those for pharyngeal denticles in other jawed vertebrates and Loganellia.

Animals↗

PubMed2005

Role of a FMRFamide-like family of neuropeptides in the pharyngeal nervous system of Caenorhabditis elegans.

The nervous system of C. elegans has a remarkable abundance of flp genes encoding FMRFamide-like (FLP) neuropeptides. To provide insight into the physiological relevance of this neuropeptide diversity, we have tested more than 30 FLPs (encoded by 23 flps) for bioactivity on C. elegans pharynx. Eleven flp genes encode peptides that inhibit pharyngeal activity, while eight flp genes encode peptides that are excitatory. Three potent peptides (inhibitory, FLP-13A, APEASPFIRFamide; excitatory, FLP-17A, KSAFVRFamide; excitatory, FLP-17B, KSQYIRFamide) are encoded by flp genes, which, according to reporter gene constructs, are expressed in pharyngeal motoneurons. Thus, they may act through receptors localized on the pharyngeal muscle. The two other potent peptides, FLP-8 (excitatory AF1, KNEFIRFamide,) and FLP-11A (inhibitory, AMRNALVRFamide), appear to be expressed in extrapharyngeal neurons and are therefore likely to act either indirectly or as neurohormones. Intriguingly, a single neuron can express peptides that have potent but opposing biological activity in the pharynx. Only five flp genes encode neuropeptides that have no observable effect on the pharynx, but none of these have shown reporter gene expression in the pharyngeal nervous system. To examine the roles of multiple peptides produced from single precursors, a comparison was made between the bioactivity of different neuropeptides for five flp genes (flp-3, flp-13, flp-14, flp-17, and flp-18). For all but one gene (flp-14), the effects of peptides encoded by the same gene were similar. Overall, this study demonstrates the impressive neurochemical complexity of the simple circuit that regulates feeding in the nematode, C. elegans.

Action Potentials↗

PubMed2002

Zebrafish hox paralogue group 2 genes function redundantly as selector genes to pattern the second pharyngeal arch.

The pharyngeal arches are one of the defining features of the vertebrates, with the first arch forming the mandibles of the jaw and the second forming jaw support structures. The cartilaginous elements of each arch are formed from separate migratory neural crest cell streams, which derive from the dorsal aspect of the neural tube. The second and more posterior crest streams are characterized by specific Hox gene expression. The zebrafish has a larger overall number of Hox genes than the tetrapod vertebrates, as the result of a duplication event in its lineage. However, in both zebrafish and mouse, there are just two members of Hox paralogue group 2 (PG2): Hoxa2 and Hoxb2. Here, we show that morpholino-mediated "knock-down" of both zebrafish Hox PG2 genes results in major defects in second pharyngeal arch cartilages, involving replacement of ventral elements with a mirror-image duplication of first arch structures, and accompanying changes to pharyngeal musculature. In the mouse, null mutants of Hoxa2 have revealed that this single Hox gene is required for normal second arch patterning. By contrast, loss-of-function of either zebrafish Hox PG2 gene individually has no phenotypic consequence, showing that these two genes function redundantly to confer proper pattern to the second pharyngeal arch. We have also used hoxb1a mis-expression to induce localized ectopic expression of zebrafish Hox PG2 genes in the first arch; using this strategy, we find that ectopic expression of either Hox PG2 gene can confer second arch identity onto first arch structures, suggesting that the zebrafish Hox PG2 genes act as "selector genes."

Animals↗

PubMed2000

Attachment of Moraxella catarrhalis occurs to the positively charged domains of pharyngeal epithelial cells.

Attachment of bacteria to host cells is the initial step in the pathogenesis of infection. Several factors, such as hydrophobicity, surface electric charge, and van der Waals force, are considered to be responsible for the attachment step. However, it is not clear why bacteria and epithelial cells, both of which possess a negative surface charge, do not repel one another. In the present study, we used Moraxella catarrhalis and pharyngeal epithelial cells to study the surface charges of structures involved in the attachment. By atomic force microscopy (AFM) equipped with surface potential spectroscopy, it was found that the cell surface microplicae have a positive charge of 30.1+/-3.6 mV (mean+/-SE). The depressions between the microplicae have a negative surface charge of 43.5+/-4.0 mV. Using cationic ferritin and electron microscopy (EM) we confirmed that the depressions between the microplicae have a negative charge. By AFM and by using cationic ferritin with EM, it was found that the net surface charge of the bacterial cells is negative. By both AFM and EM, it was found that the bacterial cells attach to the microplicae of the pharyngeal epithelial cell. Our work confirmed the general belief that both kinds of cells do have a net negative charge. We conclude that there are positively and negatively charged domains on the surface of human pharyngeal epithelial cells. M. catarrhalis evidently attaches to the positively charged domain (i.e. microplicae) of pharyngeal epithelial cells.

Adult↗

PubMed2002

Assessment of pharyngeal sensitivity to mechanical stimuli using psychophysical and electrophysiological techniques.

The investigation was aimed to assess pharyngeal sensitivity by means of intensity ratings and event-related potentials (ERPs) to mechanical stimulation. Twenty healthy subjects participated (14 female, mean age 23.6 years). Both intensity ratings and ERP were obtained in response to three intensities of mechanical stimuli (air puffs) applied to the nasal cavity or the pharynx. Test-retest reliability was investigated for two sessions performed on different days. The study provided the following: (1) intensity ratings of nasal or pharyngeal stimuli increased with increasing stimulus intensity (P < 0.001); (2) they also exhibited a significant test-retest reliability (r </= 0.78) which was best for higher stimulus intensities; (3) ERP amplitudes increased and latencies shortened with increasing stimulus intensity (factor 'intensity': P < 0.013); (4) test-retest reliability was best at centro-frontal recording sites where significant correlations were found for both ERP amplitudes and latencies; (5) ERP to pharyngeal stimulation correlated significantly with perceived stimulus intensity (e.g., latency N1 at Cz: r = -0.73, P = 0.001). In conclusion, mechanical stimulation of the pharynx can be applied to reliably elicit ERPs which are related to both stimulus intensity and intensity ratings. This model may be useful in the investigation of cough-related changes in pharyngeal sensitivity.

Adult↗

PubMed2001

High laryngeal mask airway pressures resulting from nitrous oxide do not increase pharyngeal mucosal injury in dogs.

PURPOSE: During general anesthesia, nitrous oxide (N2O) diffuses rapidly into the air-filled laryngeal mask airway (LMA) cuff, increasing intracuff pressure. There is no clear correlation between LMA intracuff pressure and pressure on the pharynx. We have studied the effects of high LMA intracuff pressures secondary to N2O on the pharyngeal mucosa of dogs. METHODS: Sixteen mongrel dogs were randomly allocated to two groups: G1 (intracuff volume, 30 mL; n=8) breathed a mixture of O2 (l L x min(-1)) and air (l L x min(-1)) and G2 (intracuff volume, 30 mL; n=8) a mixture of O2 (l L x min(-1)) and N2O (l L x min(-1)). Anesthesia was induced and maintained with pentobarbitone. LMA cuff pressure was measured at zero (control), 30, 60, 90 and 120 min after #4 LMA insertion. The dogs were sacrificed, and biopsy specimens from seven predetermined areas of the pharynx in contact with the LMA cuff were collected for light (LM) and scanning electron microscopic (SEM) examination by a blinded observer. RESULTS: LMA intracuff pressure decreased with time in G1 (P <0.001) and increased in G2 (P <0.001). There was a significant difference between the groups (P <0.001). In both groups, the LM study showed a normal epithelium covering the pharyngeal mucosa and mild congestion in the subepithelial layer. There were no differences between the groups (P >0.10) or among the areas sampled (P >0.05). In both groups, the SEM study showed a normal pharyngeal mucosa with mild superficial desquamation. Few specimens in G1 and G2 showed more intense epithelial desquamation. CONCLUSION: High LMA intracuff pressures produced by N2O do not increase pharyngeal mucosal injury in dogs.

Anesthetics, Inhalation↗

PubMed2005

Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults.

This study characterized the vertical position of the bolus head at the onset of the pharyngeal swallow in healthy older adults. Lateral-view videofluoroscopic (VF) images were obtained from ten healthy volunteers (age-71.6 +/- 7.5 years, mean+/- SD) as they swallowed 5-cc thin liquid barium aliquots. For each swallow, the bolus head and several anatomic landmarks were digitally recorded from the image in which pharyngeal swallow-related hyoid bone elevation began. Vertical distance between the bolus head and the intersection of the tongue base and mandibular ramus (TMI) was computed. Bolus head position at swallow onset ranged from 47.4-mm above to 34.9-mm below the TMI (2.2 +/- 14.4-mm, mean +/- SD). Although the bolus head was below the level of the TMI for the majority of swallows, neither penetration nor aspiration occurred. For individual subjects, mean bolus head position ranged from 25.8 +/- 5.0-mm above to 15.5 +/- 6.5-mm below the TMI. Whereas five of ten subjects initiated the pharyngeal swallow with the bolus head consistently above or consistently below the TMI, five subjects initiated swallowing with the bolus head either above or below the TMI across trials. Older adults commonly initiate thin-liquid swallows with the bolus head well below the TMI without associated penetration or aspiration. Thus, bolus position alone does not differentiate between normal and pathologic swallowing within the healthy elderly. Bolus position at pharyngeal swallow onset can vary substantially from trial to trial within an individual, suggesting that the triggering of swallowing depends on multiple influences.

Aged↗

PubMed2006

The influence of orolingual pressure on the timing of pharyngeal pressure events.

This study explored the influence of two methods of effortful swallow execution on the timing of pharyngeal pressure events. Participants were asked to either emphasize or minimize tongue-to-palate contact during performance of the maneuver. Twenty healthy participants were evaluated using concurrent submental surface electromyography (sEMG), orolingual manometry, and pharyngeal manometry. Each subject performed three repetitions of three counterbalanced tasks (noneffortful dry swallows, effortful dry swallows with tongue-to-palate emphasis, and effortful dry swallows with tongue-to-palate de-emphasis). Four variables were measured: Onset Lag vs. sEMG Peak, Peak Lag vs. sEMG Peak, Total Duration, and Percent Rise Time to Peak. Compared to noneffortful swallows, the effortful swallow task elicited significantly earlier onsets and peaks of pharyngeal pressures relative to the submental sEMG peak. Total pressure event durations were greater and rise times were significantly shorter. When comparing the two methods of effortful swallow execution, a longer latency to peak proximal pharyngeal pressure was found in the tongue-to-palate emphasis condition. These results support the interpretation that the effortful swallow maneuver involves generation of higher velocity bolus driving forces that propel the bolus into and through the pharynx with greater efficiency and that pressure is then sustained to facilitate more complete bolus clearance.

Adult↗

PubMed1991

Radial and longitudinal asymmetry of human pharyngeal pressures during swallowing.

Radial asymmetry of upper esophageal sphincter resting pressure has been previously described; however, neither radial nor longitudinal asymmetry of pharyngeal pressures has been demonstrated. The authors used a specially designed intraluminal transducer catheter (Konigsberg; Konigsberg Instruments, Pasadena, CA) with four solid-state transducers separated by 3 cm and oriented circumferentially at 90 degrees intervals to measure pharyngeal pressures. Two wet swallows at each 1-cm interval along the length of the pharynx were measured in 12 normal volunteers (10 male, 2 female; mean age, 38 years). Pressure data were collected on-line by an Apple IIe microcomputer (Apple Computer Inc., Cupertino, CA) at 100 Hz and analyzed for both radial and longitudinal asymmetry. Significant (P less than 0.05) longitudinal asymmetry was shown in all positions except right lateral. Radial asymmetry was present for the first 4 cm only, with anterior and posterior pressures significantly (P less than 0.05) higher than lateral pressures. It was concluded that pharyngeal pressure responses show both axial and longitudinal asymmetry in the distal pharynx. Awareness of transducer position and orientation is essential in the evaluation of pharyngeal pressures.

Adult↗

PubMed1992

Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening.

Pharyngeal coordination, sphincter opening, and flow pressures during swallowing were investigated in patients with pharyngeal (Zenker's) diverticula. Fourteen patients with diverticula and 9 healthy age-matched controls were studied using simultaneous videoradiography and manometry. Pharyngeal and upper esophageal sphincter pressures were recorded by a perfused side hole/sleeve assembly. Temporal relationships among swallowing events, extent of sphincter opening during swallowing, and intrabolus pressure during bolus passage across the sphincter were measured. The timing among pharyngeal contraction and sphincter relaxation, opening, and closure did not differ between patients and controls. Sphincter opening was significantly reduced in patients compared with controls in sagittal (P = 0.0003) and transverse (P = 0.005) planes. Manometric sphincter relaxation was normal in patients. Intrabolus pressure was significantly greater in patients than in controls (P = 0.001). It is concluded that Zenker's diverticulum is a disorder of diminished upper esophageal sphincter opening that is not caused by pharyngosphincteric incoordination or failed sphincter relaxation. Incomplete sphincter opening is likely to cause dysphagia. Increased hypopharyngeal pressures during swallowing are probably important in the pathogenesis of the diverticulum.

Aged↗

PubMed1993

Shape, volume, and content of the deglutitive pharyngeal chamber imaged by ultrafast computerized tomography.

BACKGROUND: Conventional radiographic techniques image only the silhouettes of the deglutitive pharyngeal chamber. This study aimed to accurately image the horizontal plane shape and content of the pharynx during swallowing. METHODS: Dynamic computerized tomography images of the pharynx were obtained at the rate of 17 per second during swallowing. Multiple adjacent levels were imaged in eight subjects and a single level was scanned in four subjects during swallows of varied volume. Images were analyzed for area, volume, and the bolus fraction of the deglutitive pharyngeal chamber. RESULTS: The deglutitive chamber enlarged to approximately 24 mL (during tongue loading) compared with a preswallow pharyngeal volume averaging 15 mL. Throughout the 10 mL swallows, the bolus occupied less than 30% of the lumen regardless of axial level. The bolus fraction of the deglutitive chamber increased with swallow volume, as did the dimensions of the upper esophageal sphincter and the bolus velocity through the upper esophageal sphincter. CONCLUSIONS: The deglutitive pharyngeal chamber was typically approximately 15 mL > the bolus volume, implying that an obligatory 15 mL of air was swallowed under these test conditions. Most swallowed air originated as air trapped within the pharynx and larynx as the oropharynx was sealed from above and below.

Adult↗

PubMedDate not supplied

A preoperative sleep study with nasal airway occlusion in pharyngeal flap surgery.

PURPOSE: Obstructive sleep apnea is a major complication of pharyngeal flap surgery. The purpose of the present study is to predict preoperatively the risk of upper airway obstruction after surgery. MATERIAL AND METHODS: We performed an overnight sleep study preoperatively and postoperatively in 16 pediatric patients considered for pharyngeal flap surgery. Preoperative sleep study was done for two nights, once in normal breathing condition and once with complete nasal occlusion by packing of nostril with tampon gauze. RESULTS: In preoperative sleep recordings in normal breathing condition, all subjects had a normal apnea hypopnea index (AHI) less than 5/h. In preoperative recording with complete nasal occlusion, five patients exceeded 5/h in AHI. In particular, for two patients who had AHI higher than 15/h, we gave up a surgery in one case and performed pharyngeal flap operation for the other following a tracheotomy for severe disturbance of oral breathing. The remaining 14 subjects underwent surgery without airway obstructive complications. There was strong correlation between preoperative AHI with nasal tampon gauze and AHI at two weeks postoperatively (r = 0.88 P < .0001). There was no significant correlation between preoperative AHI in normal breathing condition and postoperative AHI (P > .05). CONCLUSIONS: These results exhibit preoperative sleep study with complete nasal airway occlusion represent postoperative breathing condition well during early postoperative period. Preoperative sleep study with complete nasal airway occlusion with nasal tampons could be useful for predicting the risk of upper airway obstruction secondary to pharyngeal flap surgery.

Child↗