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PubMed2001

The arterial pole of the mouse heart forms from Fgf10-expressing cells in pharyngeal mesoderm.

Development of the arterial pole of the heart is a critical step in cardiogenesis, yet its embryological origin remains obscure. We have analyzed a transgenic mouse line in which beta-galactosidase activity is observed in the embryonic right ventricle and outflow tract of the heart and in contiguous splanchnic and pharyngeal mesoderm. The nlacZ transgene has integrated upstream of the fibroblast growth factor 10 (Fgf10) gene and comparison with the expression pattern of Fgf10 in pharyngeal mesoderm indicates transgene control by Fgf10 regulatory sequences. Dil labeling shows a progressive movement of cells from the pharyngeal arch region into the growing heart tube between embryonic days 8.25 and 10.5. These data suggest that arterial pole myocardium originates outside the classical heart field.

Animals↗

PubMed1998

Pharyngeal pouch following anterior cervical fusion.

A case of an acquired pharyngeal pouch which formed as a consequence of previous anterior cervical fusion is reported. This is a rare cause of pharyngeal pouch formation with only one such case previously reported in the English language literature. In our case adhesions had formed between the posterior pharyngeal wall and the area around the screw used to hold the Senegas plate on the anterior aspect of the fifth to seventh cervical spinal vertebrae.

Cervical Vertebrae↗

PubMed1999

Pharyngeal pouch endoscopic stapling--are post-operative barium swallow radiographs of any value?

Posterior pharyngeal pouch endoscopic stapling has gained increasing popularity among otolaryngologists especially in elderly patients. Post-operative barium swallow appearances can create confusion with the appearance of persistent pouches. We describe our experience in 10 patients, three of whom had external excision with cricopharyngeal myotomy and the remaining seven had endoscopic stapling approach. All three patients who had external excision showed no residual pouch whereas all seven patients who had endoscopic techniques performed showed some residual pouch. We were unsuccessful in our attempt to correlate post-operative symptoms with radiological appearance. Attempts by other radiologists at identifying pre- and post-operative barium swallow radiographs in patients who had endoscopic stapling of pharyngeal pouch were unsuccessful. We conclude that post-operative barium swallow radiography plays no role in determining the success of endoscopic stapling of pharyngeal pouch.

Aged↗

PubMed1999

Free jejunal patch flaps in oral and oro-pharyngeal reconstruction.

Free jejunum has been commonly tubed to provide a reconstructive pharyngeal conduit following pharyngolaryngectomy. It is also common practice to repair small oral and oro-pharyngeal defects with skin-lined flaps i.e. radial free forearm or pectoralis major myocutaneous flap. Free jejunal patch flaps can provide cover for large defects, secrete mucus, tolerate radiotherapy well and do not contract. The operation is associated with a low morbidity and early return of swallowing is feasible. Here we describe the functional results of free jejunal patch flap reconstruction of extensive oral and oro-pharyngeal defects.

Adult↗

PubMed2005

Uvulo-glosso-pharyngeal dimensions in different anteroposterior skeletal patterns.

The aim of this study was to investigate the uvulo-glosso-pharyngeal dimensions in subjects with different anteroposterior jaw relationship. Cephalometric radiograph of 90 subjects (45 females and 45 males, aged 14-17 years) were divided into three groups according to the ANB angle, ie, group 1, skeletal Class I (ANB angle 1-5); group 2, skeletal Class II (ANB angle >5); and group 3, skeletal Class III (ANB angle <1). In addition, each group was divided into two subgroups according to sex. Statistical analysis was undertaken using analysis of variance and least significant difference test. Pearson's Correlation test was also performed. Sex differences were found in Class I and III subjects. No sex differences were detected in Class II subjects. On average, tongue length was significantly shorter in Class III subjects (P < .05), tongue height was reduced in Class II female subjects, the soft palate was thicker in Class III females and the vertical airway length (VAL) was reduced in Class II male subjects (P < .01). In Class II subjects, the hyoid bone was closer to the mandible vertically and to C3 horizontally compared with Class I (P < .01) and Class III (P < .001) male subjects. Anteroposterior skeletal pattern showed a weak, but significant correlation with inferior pharyngeal airway space (R = -0.24, P = .024), vertical position of hyoid bone in relation to mandibular plane (R = -0.26, P = .014), and anteroposterior position of hyoid bone in relation to C3 (R = -0.561, P = .000). In conclusion, uvulo-glosso-pharyngeal dimensions are affected by anteroposterior skeletal pattern.

Adolescent↗

PubMed1989

Electrical activity from the superior pharyngeal constrictor during reflexive and nonreflexive tasks.

The purpose of this investigation was to determine, in a quantitative manner, which, if any, nonswallowing tasks produce significant levels of activation in the superior pharyngeal constrictor muscle of normal human subjects. Bipolar hooked wire electrodes were inserted in the superior pharyngeal constrictor muscle of 15 healthy subjects. Electrode placement was controlled. Each subject performed two reflexive tasks, six voluntary tasks requiring phonation, and four nonspeech voluntary tasks. The electromyogram (EMG) was rectified and integrated. The resulting number was then transformed by taking its natural logarithm. An ANOVA was performed and a linear model was estimated. The magnitude of the EMG activity was related to the location of the electrodes. The largest values were recorded in the lateral-superior placement, followed by the lateral-inferior, medial-inferior and medial-superior. The superior pharyngeal contrictor was found to be a muscle activated primarily during reflexive activity. There was a general trend in the amplitude of EMG activity in relationship to task. Swallowing produced the greatest amount of activity and a gag produced about 60% of the activity produced by the swallow. Two tasks, production of the work /hok/ in which the phoneme /k/ was stressed, and a "modified Valsalva," which was actually a hard /k/ held for several seconds, produced the next greatest level of EMG.

Adult↗

PubMed2000

Pharyngeal colonization prevalence rates for Streptococcus pyogenes and Streptococcus pneumoniae in a respiratory chemoprophylaxis intervention study using azithromycin.

OBJECTIVES: A prospective assessment of the pharyngeal colonization prevalence rates for Streptococcus pyogenes and Streptococcus pneumoniae before and after an azithromycin chemoprophylaxis intervention clinical trial in a cohort of US Marine Corps trainees. In addition, the minimum inhibitory concentrations (MICs) for all streptococcal isolates, for azithromycin, penicillin, erythromycin and cefotaxime are reported. METHODS: Between November 1994 and March 1995, 1108 asymptomatic male US Marine Corps trainees, located in Southern California, were randomly assigned to one of three intervention groups: (1) weekly oral azithromycin, 500 mg (n = 362); (2) 1.2 MU benzathine penicillin G, intramuscularly once (n = 374); or (3) no chemoprophylaxis (n = 372). Subjects provided both a pre- and post-training pharyngeal culture and microbial analysis was conducted to determine the colonization status of each study subject. RESULTS: The pretraining colonization prevalence was 1.2% for S. pneumoniae and 2.4% for S. pyogenes. There was no statistical difference in pretraining prevalence between the three treatment groups for either organism. Post-training pharyngeal cultures revealed an overall prevalence of 1.1% with no difference between treatment arms. However, the overall post-training prevalence of S. pyogenes colonization increased to 4.8%, with the azithromycin group having significant evidence of protection (0.7%) in comparison with the no-treatment group (8.2%). The Etest method demonstrated no significant difference in the MIC50, MIC90, and MIC ranges between pre- and post-training isolates for any of the tested drugs. CONCLUSION: The use of azithromycin as a chemoprophylactic agent to reduce the colonization and subsequent infection of streptococcal respiratory disease among healthy adult male military recruits may be beneficial.

Anti-Bacterial Agents↗

PubMed2002

Development of pharyngeal arch arteries in early mouse embryo.

The formation and transformation of the pharyngeal arch arteries in the mouse embryo, from 8.5 to 13 days of gestation (DG), was observed using scanning electron microscopy of vascular casts and graphic reconstruction of 1-microm serial epoxy-resin sections. Late in 8.5-9DG (12 somites), the paired ventral aortae were connected to the dorsal aortae via a loop anterior to the foregut which we call the 'primitive aortic arch', as in the chick embryo. The primitive aortic arch extended cranio-caudally to be transformed into the primitive internal carotid artery, which in turn gave rise to the primitive maxillary artery and the arteries supplying the brain. The second pharyngeal arch artery (PAA) appeared late in 9-9.5DG (16-17 somites), and the ventral aorta bent dorsolaterally to form the first PAA anterior to the first pharyngeal pouch by early in 9.5-10DG (21-23 somites). The third PAA appeared early in 9.5-10DG (21-23 somites), the fourth late in 9.5-10DG (27-29 somites), and the sixth at 10DG (31-34 somites). By 10.5DG (35-39 somites), the first and second PAAs had been transformed into other arteries, and the third, fourth and sixth PAAs had developed well, though the PAA system still exhibited bilateral symmetry. By 13DG, the right sixth PAA had disappeared, and the remaining PAAs formed an aortic-arch system that was almost of the adult type.

Animals↗

PubMedDate not supplied

AmphiFoxE4, an amphioxus winged helix/forkhead gene encoding a protein closely related to vertebrate thyroid transcription factor-2: expression during pharyngeal development.

The full-length sequence and developmental expression of amphioxus AmphiFoxE4 are described. Transcripts of the gene are first detected in the pharyngeal endoderm, where the club-shaped gland is forming and subsequently in the definitive gland itself. AmphiFoxE4 is closely related to vertebrate genes encoding the thyroid-specific transcription factor-2 (TTF2), which plays an early developmental role in the morphogenesis of the thyroid gland and a later role in hormone-mediated control of thyroid function. In amphioxus, AmphiFoxE4 expression is not thyroid specific because the club-shaped gland, the only structure expressing the gene, is not homologous to the vertebrate thyroid; instead, the thyroid homologue of amphioxus is a specialized region of the pharyngeal endoderm called the endostyle. We propose that (a) the pharynx of an amphioxus-like ancestor of the vertebrates included a club-shaped gland that expressed FoxE4 as well as an endostyle that did not, and (b) the club-shaped gland soon disappeared in the vertebrate line of descent but (c) not before there was a homeogenetic transfer of FoxE4 expression from the club-shaped gland to the nearby endostyle. Such a transfer could have provided part of the genetic program enabling the endostyle to separate from the pharyngeal endoderm and migrate away as the rudiment of the thyroid gland.

Amino Acid Sequence↗

PubMed1998

The prevalence of chronic Chlamydia pneumoniae infection as detected by polymerase chain reaction in pharyngeal samples from patients with ischaemic heart disease.

AIMS: Cross-sectional serological studies have suggested an association between ischaemic heart disease and infections from Chlamydia pneumoniae and Helicobacter pylori. We therefore sought to find out if patients with ischaemic heart disease had an increased prevalence of C. pneumoniae in the pharynx. As the course of the C. pneumoniae infection remains unclear, both acute and follow-up samples were taken and compared with antibody levels. METHODS AND RESULTS: We studied 282 patients with ischaemic heart disease. One hundred and two subjects without history or symptoms of ischaemic heart disease served as controls. Pharyngeal specimens for polymerase chain reaction detection of C. pneumoniae, and blood samples for C. pneumoniae and H. pylori antibody detection, were collected. In patients with positive polymerase chain reaction or C. pneumoniae IgA titres > or = 32, indicating current infection, convalescent samples were taken at least 6 weeks later. An immunofluorescent antigen detection test was used to confirm the presence of C. pneumoniae elementary bodies in specimens found to be polymerase chain reaction positive. The prevalence of positive polymerase chain reaction tests was 36% among patients and 22% among controls (P<0.05). Forty-seven percent of patients with positive polymerase chain reaction remained positive in the convalescent test. Elevated C. pneumoniae IgG titres > or = 512 were found in 39% of patients and 26% of the controls (P<0.05). IgA titres > or = 32 were found in 46% of the patients and 44% of the controls (ns). Antibody titres remained largely unchanged at convalescent testing. Two patients and none of the controls had IgM titres > 16. There was no link between positive H. pylori serology and positive C. pneumoniae polymerase chain reaction tests. CONCLUSIONS: The high prevalence and persistence of positive pharyngeal C. pneumoniae polymerase chain reaction and elevated antibody titres in patients with ischaemic heart disease indicate a chronic infection. The pharyngeal presence of C. pneumoniae might contribute to a low grade inflammatory activation or be a source for further spread of the bacteria to atherosclerotic vessels.

Adolescent↗

PubMed1996

Inhibition of progressing primary esophageal peristalsis by pharyngeal water stimulation in humans.

BACKGROUND & AIMS: Sensory impulses initiated from the pharynx exert differing effects on the deglutitive apparatus. They have an inhibitory effect on the lower esophageal sphincter but an excitatory effect on the upper esophageal sphincter. The aim of this study was to systematically investigate the effect of pharyngeal sensory impulses evoked by water stimulation on the progressing esophageal peristalsis. METHODS: Sixteen healthy young volunteers were studied in the supine position. The presence of normal peristalsis was verified. Esophageal peristalsis was recorded 3, 6, 9, 12, 15, and 18 cm above the lower esophageal sphincter. Pharyngeal stimulation was performed by injecting a predetermined threshold volume into the pharynx 2 cm above the upper esophageal sphincter, directed posteriorly. The injections were timed to coincide with the arrival of the peristaltic wave induced by dry swallows at respective recording sites. RESULTS: Injection of the threshold volume (0.5 +/- 0.1 mL) stopped the progression of peristalsis at both the striated and smooth muscle esophagus. Topical pharyngeal anesthesia blocked this inhibitory effect (P < 0.01). CONCLUSIONS: Sensory impulses initiated from the pharynx evoked by water injection inhibit the progression of primary esophageal peristalsis. Although the clinical significance of these findings is not determined, they may explain the mechanism of some of the failed esophageal peristalsis.

Adult↗

PubMed1999

Pharyngeal pH monitoring in patients with posterior laryngitis.

OBJECTIVE: To evaluate the diagnostic value of 3-site 24-hour ambulatory pH monitoring in patients with posterior laryngitis (PL) and the prevalence of esophageal abnormalities in this patient group. METHODS: Twenty patients with PL and 17 healthy volunteers were studied as controls. Control subjects had transnasal esophagogastroduodenoscopy (T-EGD) and ambulatory pH monitoring. Patients underwent T-EGD, ambulatory pH monitoring, and barium esophagram. RESULTS: T-EGD documented no abnormality in controls. Esophagitis was present in 2 PL patients, and hiatal hernia in 3. Ambulatory pH monitoring showed that 15 PL patients and 2 controls exhibited pharyngeal acid reflux. Barium esophagram documented gastroesophageal reflux in 5 PL patients. However, none of these barium reflux events reached the pharynx. All PL patients with barium esophagram evidence of gastroesophageal reflux also showed pharyngeal acid reflux by pH monitoring. CONCLUSION: Pharyngeal acid reflux is more prevalent in patients with PL than in healthy controls. Patients with PL infrequently have esophageal sequelae of reflux disease. Ambulatory 24-hour simultaneous 3-site pharyngoesophageal pH monitoring detects gastroesophagopharyngeal acid reflux events in most patients with PL.

Adolescent↗

PubMed1996

[Ventilation via a transnasally placed pharyngeal tube. Comparison with mask ventilation].

OBJECTIVE: The present prospective study was designed to investigate the respiratory function during ventilation via a tube inserted through the nose into the pharynx. Results were compared with respiratory parameters measured during conventional mask ventilation in the same patients. METHODS: 20 ASA physical status I-II patients were studied after approval by the local Ethics Committee. Anaesthesia was induced with alfentanil 15 micrograms/kg and propofol 2.5-3.0 mg/kg and maintained with propofol, 12-15 mg/kg/h. Patients were ventilated via a facemask with oxygen and a tidal volume of approximately 8ml/kg (measurement A). After insertion of a tube (I.D. 7.0-7.5 mm) through the nostril into the pharynx ventilation was repeated in the same manner (measurement B). To secure airway seal a second person closed the patient's mouth and exerted cricoid pressure. Following neuromuscular blockade with suxamethonium (1.5 mg/kg) respiratory parameters were measured again (C). Measurements included pulse oximetry and side stream spirometry with continuous collection of the following data: airway pressure, inspired and expired tidal volume, dynamic compliance, expired volume in one second, inspiratory and expiratory oxygen and carbon dioxide concentration. Pressure-volume and flow-volume loops were displayed continuously. RESULTS: Ventilation via facial mask or via pharyngeal tube with and without relaxation showed normal endtidal FECO2. The mean values were 4.5 +/- 0.7%, 4.8 +/- 0.4% and 4.6 +/- 0.7%, respectively. Mean oxygen saturation exceeded 98% in each period. Leakage during mask ventilation was 59.3 +/- 65.5 mL and decreased to 40.5 +/- 62.1 mL with the pharyngeal tube, whereas relaxation resulted in a significant increase to 92.3 75.0 mL. Compliance (Cdyn) and expired volume in one second (V 1.0) did not change significantly during the entire period of measurement. CONCLUSION: The use of a pharyngeally placed tube proved adequate compared to conventional mask ventilation in 20 patients without underlying airway disease.

Adolescent↗

PubMed1994

[Lateral pharyngeal diverticulum as a cause of superior laryngeal nerve neuralgia].

Superior laryngeal neuralgia was first described at the turn of the century by Avellis. In absence of accompanying disease in the organs adjacent to the nerve, idiopathic neuralgia is the most likely diagnosis. A 63-year-old man presented with left superior laryngeal neuralgia. Endoscopy revealed no pathological findings. Barium examination of the pharynx applying a modified Valsalva's manoeuvre revealed a small (0.5 cm) lateral pharyngeal diverticulum. 21 months after successful surgical removal the patient remains symptom-free. In the case of a 65-year old woman with left superior laryngeal neuralgia, barium examination revealed a lateral pharyngeal diverticulum at the same position between the hyoid-bone and the upper margin of the thyroid cartilage. The symptoms disappeared spontaneously. This is the first case of this particular kind of lateral pharyngeal diverticulum described in the literature. The explanation for the obstinate superior laryngeal neuralgia caused by such a small diverticulum must be sought in its immediate neighborhood to the superior laryngeal nerve.

Aged↗

PubMed2001

Evaluation of topical pharyngeal anesthesia for upper endoscopy including factors associated with patient tolerance.

BACKGROUND: Topical pharyngeal anesthesia is generally used as a pretreatment for upper endoscopy. However its efficacy has not been established. METHODS: A randomized double-blind placebo-controlled study was undertaken. Subjects were 201 patients who underwent upper endoscopy and gave informed consent. Relative risks (RR) of patient discomfort were calculated for pharyngeal anesthesia, anxiety, and other potential confounding factors by using logistic regression analyses. RESULTS: The RR of patient discomfort on intubation was 0.56 for the anesthesia versus the placebo group (95% CI, 0.31-1.01). RR was higher in patients aged 39 or younger than in those 40 or over (RR = 2.22, 95% CI, 1.04-4.74). With subgroup analysis in those examinees less than 40 years old, the RR of patient discomfort was 0.21 for the topical anesthesia (95% CI, 0.04-0.99) versus the placebo group and 4.93 for patients undergoing upper endoscopy for the first time (95% CI, 1.13-21.60). In the first-time patients, the RR was lower in the topical anesthesia than in the placebo group (RR = 0.20; 95% CI, 0.04-0.93); it was higher in patients with a trait-anxiety score higher by 10 points than in those with a lower score (RR = 3.35, 95% CI, 1.01-11.15). With the Bonferroni correction for multiple testing of data, statistical significance is indicated by a CI of 97.5% in the subgroup analyses. CONCLUSIONS: Topical pharyngeal anesthesia appears to be effective in patients less than 40 years old and in those undergoing the procedure for the first time. A high trait-anxiety score could be a predictor of discomfort in first-time examinees.

Adult↗

PubMed2002

Long-term results of endoscopic stapling diverticulotomy for pharyngeal pouches.

OBJECTIVE: The aim of the present study was to evaluate the long-term success of endoscopic stapling as a primary procedure for the treatment of pharyngeal pouches. METHODS: This study is a retrospective case review of 25 patients with pharyngeal pouches treated by endoscopic stapling (23 stapled, 2 abandoned) over a 4-year period (1994 to 1998) at a University teaching hospital in the United Kingdom. Outcome measures used were relief of symptoms over a long-term follow-up of 2 to 5 years. RESULTS: Of the 25 patients analyzed, 12 patients (48%) have remained asymptomatic after their initial stapling. Eight patients (32%) were relieved of their symptoms after revision stapling. The overall long-term success rate for endoscopic stapling was 80% (20 of 25 patients) CONCLUSION: Reduced morbidity and few complications in the elderly make endoscopic stapling a favored primary technique of treating pharyngeal pouches. Open surgery is recommended only in healthy patients with very large pouches.

Aged↗

PubMed2002

Sex differences in genioglossus muscle response to changes in pharyngeal resistance.

The genioglossus (GG) muscle's response to partial oropharyngeal occlusion was studied in age-matched, healthy awake men (n = 16) and women (n = 15). A miniature balloon was placed in the retroglossal pharynx, and the GG's electromyographic (EMG) reflexive response was evaluated in different body postures. We assumed that inflating the pharyngeal balloon and changing the body posture from upright to supine would increase pharyngeal airway resistance. Our hypothesis was that the change in airway resistance would elicit a different response in the GG muscle depending on sex. Our results showed that GG activity during natural breathing was higher in women than in men. GG EMG activity did not change upon inflation of the balloon in women. In contrast, when the balloon was inflated in the men, the GG's basal activity increased (P <.01) in both the upright and the supine positions. Women appeared to show a higher GG baseline EMG activity during spontaneous breathing at rest, while men were more responsive to the partial occlusion of the pharyngeal airway.

Adult↗

PubMed1998

Persistent dysphagia after laser uvulopalatoplasty: a videoradiographic study of pharyngeal function.

In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

Adult↗