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PubMed1995

The repeatability and variability of electrical impedance tomography indices of pharyngeal transit time in normal adults.

Two electrical impedance tomography (EIT) indices of pharyngeal transit time have been repeatedly measured in 20 normal adults. The time course of change in pharyngeal conductivity whilst swallowing 5, 10 and 20 ml boluses was expressed either as a full width at 20% maximum (FW20) or as a full width at 50% maximum (FW50): the latter could be satisfactorily measured more frequently. Mean coefficients of variation for FW20 and FW50 tended to decrease with increasing bolus volume but this was statistically significant only for FW50 in men. FW20 and FW50 were significantly shorter in men than women and increased with increasing age. FW50 was significantly smaller when larger bolus volumes were swallowed. FW50 was significantly shorter when low-conductivity fluid was used and there was an insignificant trend for it to be longer with electrodes in the highest position. The amplitude of the conductivity change recorded was significantly affected by all factors studied apart from age. If EIT is to be used as a technique for monitoring changes in pharyngeal transit time in patients with neurogenic dysphagia, repeat examinations should be performed under the same conditions and, if possible, large bolus volumes should be used.

Adult↗

PubMed2004

IRI-1, a LIN-15B homologue, interacts with inositol-1,4,5-triphosphate receptors and regulates gonadogenesis, defecation, and pharyngeal pumping in Caenorhabditis elegans.

Inositol-1,4,5-triphosphate receptors (IP(3)Rs) are ligand-gated Ca(2+) channels that control Ca(2+) release from intracellular stores. They are central to a wide range of cellular responses. IP(3)Rs in Caenorhabditis elegans are encoded by a single gene, itr-1, and are widely expressed. Signaling through IP(3) and IP(3)Rs is important in ovulation, control of the defecation cycle, modulation of pharyngeal pumping rate, and embryogenesis. To further elucidate the molecular basis of the diversity of IP(3)R function, we used a yeast two-hybrid screen to search for proteins that interact with ITR-1. We identified an interaction between ITR-1 and IRI-1, a previously uncharacterized protein with homology to LIN-15B. Iri-1 is widely expressed, and its expression overlaps significantly with that of itr-1. In agreement with this observation, iri-1 functions in known itr-1-mediated processes, namely, upregulation of pharyngeal pumping in response to food and control of the defecation cycle. Knockdown of iri-1 in an itr-1 loss-of-function mutant potentiates some of these effects and sheds light on the signaling pathways that control pharyngeal pumping rate. Knockdown of iri-1 expression also results in a sterile, evl phenotype, as a consequence of failures in early Z1/Z4 lineage divisions, such that gonadogenesis is severely disrupted.

Amino Acid Sequence↗

PubMed1986

Significance of pharyngeal colonization with aerobic gram-negative bacilli in elderly institutionalized men.

The prevalence of pharyngeal colonization with aerobic Gram-negative rods was studied on three occasions during one year in 68 elderly males resident on two long-term care wards. For the three surveys, pharyngeal carriage was identified in 43%, 43%, and 37% of residents. Each resident tended to remain either colonized or noncolonized. Pharyngeal colonization was associated with resident incontinence, the development of infection, and increased mortality during the year of observation.

Aerobiosis↗

PubMed1994

Passive protection of mice against group A streptococcal pharyngeal infection by lipoteichoic acid.

Previous studies have shown that lipoteichoic acid (LTA) of group A streptococci plays a central role in the adherence of these organisms to epithelial cells. In this study, intranasal instillation of purified LTA but not deacylated LTA in mice blocked colonization and prevented death after intranasal challenge infection with group A streptococci. Bacteria pretreated with rabbit antisera against LTA also failed to colonize or infect mice after intranasal challenge. In vitro studies showed that LTA and M protein inhibited adherence of type 24 streptococci to mouse pharyngeal cells. Passive intranasal administration of purified type 24 M protein protected mice from death after challenge infection with type 24 streptococci but had no significant effect on pharyngeal colonization. Surface LTA and M protein may mediate adherence of streptococci to mouse pharyngeal cells, and blocking adherence with LTA prevents colonization and infection in this animal model.

Animals↗

PubMed1992

Influence of cefpirome on pharyngeal and faecal flora after single and multiple intravenous administrations of cefpirome to healthy volunteers.

The effect of single and multiple 2 g doses of i.v. cefpirome on pharyngeal and faecal flora was studied in ten male volunteers. There was no effect on pharyngeal flora. After a single dose, cefpirome had no effect on faecal flora but numbers of Escherichia coli were reduced below the detection limit during multiple dose treatment. No strains of Clostridium difficile were selected in this study and only a slight increase in the numbers of Candida spp. were found. Cefpirome, therefore, has little, if any, effect on faecal or pharyngeal flora.

Adult↗

PubMed2005

Evolution and development of the chordates: collagen and pharyngeal cartilage.

Chordates evolved a unique body plan within deuterostomes and are considered to share five morphological characters, a muscular postanal tail, a notochord, a dorsal neural tube, an endostyle, and pharyngeal gill slits. The phylum Chordata typically includes three subphyla, Cephalochordata, Vertebrata, and Tunicata, the last showing a chordate body plan only as a larva. Hemichordates, in contrast, have pharyngeal gill slits, an endostyle, and a postanal tail but appear to lack a notochord and dorsal neural tube. Because hemichordates are the sister group of echinoderms, the morphological features shared with the chordates must have been present in the deuterostome ancestor. No extant echinoderms share any of the chordate features, so presumably they have lost these structures evolutionarily. We review the development of chordate characters in hemichordates and present new data characterizing the pharyngeal gill slits and their cartilaginous gill bars. We show that hemichordate gill bars contain collagen and proteoglycans but are acellular. Hemichordates and cephalochordates, or lancelets, show strong similarities in their gill bars, suggesting that an acellular cartilage may have preceded cellular cartilage in deuterostomes. Our evidence suggests that the deuterostome ancestor was a benthic worm with gill slits and acellular gill cartilages.

Animals↗

PubMed1989

Changes in the pharyngeal airway in relation to extension of the head.

In a sample of 20 adults the associations between cervical lordosis, craniocervical inclination, position of the hyoid bone and cross-sectional dimensions of the pharyngeal airway were studied. Lateral skull radiographs were obtained in natural head posture and also at 20 degrees extension with the subjects' teeth in the intercuspal position. Cervical lordosis was measured from the second to the sixth vertebra and the position of the hyoid bone was calculated in horizontal and vertical directions. The dimensions of the free airway were measured between the dorsal tongue surface and the posterior pharyngeal wall and at the level of the second and fourth vertebra. A change from natural head posture to 20 degrees extension resulted in an increase in cervical lordosis and craniocervical inclination, changed position of the hyoid bone and increased cross-sectional dimensions of the pharyngeal airway. The changes in lordosis produced by changing natural head posture to 20 degrees extension showed significant correlations with the size of changed craniocervical inclination and free airway.

Adult↗

PubMed1999

Pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position with the intubating versus the standard laryngeal mask airway.

BACKGROUND: The tube of the intubating laryngeal mask (ILM) is more rigid than the standard laryngeal mask airway (LMA), and the authors have tested the hypothesis that pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position are different when the two devices are compared. METHODS: Twenty anesthetized, paralyzed adults were randomly allocated to receive either the LMA or ILM for airway management. Microchip sensors were attached to the size 5 LMA or ILM at locations corresponding to the pyriform fossa, hypopharynx, base of tongue, posterior pharynx, and distal and proximal oropharynx. Mucosal pressures, airway sealing pressures, and fiberoptic positioning were recorded during inflation of the cuff from 0 to 40 ml in 10-ml increments. RESULTS: Airway sealing pressures were higher for the ILM (30 vs. 23 cm H2O), but epiglottic downfolding was more common (56% vs. 26%). Pharyngeal mucosal pressures were much higher for the ILM at five of six locations. Mean mucosal pressures in the distal oropharynx for the ILM were always greater than 157 cm H2O, regardless of cuff volume. There was no correlation between mucosal pressures and airway sealing pressures at any location for the LMA, but there was a correlation at three of six locations for the ILM. CONCLUSIONS: The ILM provides a more effective seal than the LMA, but pharyngeal mucosal pressures are higher and always exceed capillary perfusion pressure. The ILM is unsuitable for use as a routine airway and should be removed after its use as an airway intubator.

Adult↗

PubMed2002

The influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures with the esophageal tracheal combitube.

BACKGROUND: The authors determined the influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures for the esophageal tracheal combitube. METHODS: Twenty fresh cadavers were studied. Microchip sensors were attached to the anterior, lateral, and posterior surfaces of the distal and proximal cuffs of the small adult esophageal tracheal combitube. Mucosal pressure for the proximal cuff in the pharynx was measured at 0- to 100-ml cuff volume in 10-ml increments, and for the distal cuff in the esophagus and trachea were measured at 0- to 20-ml cuff volume in 2-ml increments. The proximal cuff volume to form an oropharyngeal seal of 30 cm H2O was determined. In addition, mucosal pressures for the proximal cuff in the pharynx were measured in four awake volunteers with topical anesthesia. RESULTS: There was an increase in mucosal pressure in the trachea, esophagus, and pharynx at all cuff locations with increasing volume (all: P < 0.001). Pharyngeal mucosal pressures were highest posteriorly (50-ml cuff volume: 99 +/- 62 cm H2O; 100-ml cuff volume: 255 +/- 161 cm H2O). Esophageal mucosal pressures were highest posteriorly (10-ml cuff volume: 108 +/- 55 cm H2O; 20-ml cuff volume: 269 +/- 133 cm H2O). Tracheal mucosal pressures were highest anteriorly (10-ml cuff volume: 98 +/- 53 cm H2O; 20-ml cuff volume: 236 +/- 139 cm H2O). The proximal cuff volume to obtain an oropharyngeal seal of 30 cm H2O was 47 +/- 12 ml. Pharyngeal mucosal pressures were similar for cadavers and awake volunteers. CONCLUSION: We conclude that mucosal pressures for the esophageal tracheal combitube increase with cuff volume, are highest where the cuff is adjacent to rigid anatomic structures, and potentially exceed mucosal perfusion pressure even when cuff volumes are limited to achieving an oropharyngeal seal of 30 cm H2O.

Adult↗

PubMed2005

Sniffing position improves pharyngeal airway patency in anesthetized patients with obstructive sleep apnea.

BACKGROUND: Appropriate bag-and-mask ventilation with patent airway is mandatory during induction of general anesthesia. Although the sniffing neck position is a traditionally recommended head and neck position during this critical period, knowledge of the influences of this position on the pharyngeal airway patency is still inadequate. METHODS: Total muscle paralysis was induced with general anesthesia in 12 patients with obstructive sleep apnea, eliminating neuromuscular factors contributing to pharyngeal patency. The cross-sectional area of the pharynx was measured endoscopically at different static airway pressures. Comparison of static pressure-area plot between the neutral and sniffing neck positions allowed assessment of the influence of the neck position change on the mechanical properties of the pharynx. RESULTS: The static pressure-area curves of the sniffing position were above those of neutral neck position, with increasing maximum cross-sectional area and decreasing the closing pressure at both retropalatal and retroglossal airways. The beneficial effects of the sniffing position were greater in obstructive sleep apnea patients with higher closing pressure and smaller body mass index. CONCLUSIONS: Sniffing position structurally improves maintenance of the passive pharyngeal airway in patients with obstructive sleep apnea and may be beneficial for both mask ventilation and tracheal intubation during anesthesia induction.

Adult↗

PubMed1983

Lining the superiorly based pharyngeal flap.

Developing a mucosal flap to line the nasal surface of a superiorly based pharyngeal flap can present technical difficulties, particularly in the scarred and immobile soft palate. Employing the technique described, the forward attachment of the pharyngeal flap to the nasal surface is made through a long, horizontal incision high in the soft palate. The dissection of the nasal lining is started at this point and carried posteriorly to provide a single broad mucosal flap, hinged near the margin of the velum, and turned backward to line the raw area of the pharyngeal flap. This minor variation in technique has made the operative procedure easier to perform, resulting in fewer complications.

Cleft Palate↗

PubMed1985

A method for lining the superiorly based pharyngeal flap.

The development of a mucosal flap as a lining for a superiorly based pharyngeal flap has undergone many modifications. The technique described herein uses tissue from the nasal surface of the soft palate with its base at the uvula. Its ease of construction is based on the adaptive use of modern vascular instruments. Since 1979 a total of 32 pharyngeal flaps have been lined in this manner. The results, as determined by a trained speech pathologist and the use of the oral panendoscope, have been quite good. This method offers a number of advantages, including the ability to line the pharyngeal flap with a shortened soft palate or one that is difficult to mobilize due to scarring, no through-and-through incision into the soft palate, and no exposed raw surfaces that can contribute to recurrence of velopharyngeal incompetence.

Adult↗

PubMed2003

Speech benefits of posterior pharyngeal flap are preserved after surgical flap division for obstructive sleep apnea: experience with division of 12 flaps.

Attachment of a posterior pharyngeal flap is commonly performed for the surgical management of velopharyngeal insufficiency. Obstructive sleep apnea has been found to occur in as many as 38% of patients undergoing posterior pharyngeal flap attachment. Often, this is temporary in the early postoperative period. When it occurs later after surgery, however, it can require active treatment. Many patients improve with the use of nighttime nasal C-PAP. Those patients who do not improve sufficiently with nasal C-PAP may require surgical flap division. We report surgical flap division in 12 such patients. All patients had preoperative and postoperative perceptual speech evaluations, and most had preoperative and postoperative pressure flow studies. In 11 of the 12 patients who underwent surgical flap division, velopharyngeal function did not deteriorate. We hypothesized that the persistence of the speech improvement in those patients is either secondary to the bulk of tissue from the flap, which remains in the posterior pharyngeal wall and provides a pad to assist with velopharyngeal closure, or is secondary to the speech mechanisms that the patients learned with the flap in place and were able to continue even after flap division.

Adolescent↗

PubMed1985

Aerodynamic assessment of the results of pharyngeal flap surgery: a preliminary investigation.

Voice-quality (i.e., nasality) judgments are commonly used to evaluate the results of pharyngeal flap surgery. However, these are subjective judgments of questionable validity and reliability. This project was designed to systematically evaluate the outcome of pharyngeal flap surgery utilizing objective, quantifiable physiologic (pressure-flow) information. Thirty-one patients who had undergone pharyngeal flap surgery were selected. Pressure-flow measurements and perceptual judgments of speech were obtained following surgery. Results indicated that using pressure-flow criteria, only 52 percent of the outcomes were considered successful. Results also indicated that 35 percent of the cases were characterized by substantial nasopharyngeal airway obstruction. In the present study, these findings, along with the related perceptual phenomenon of denasality, were considered unsuccessful. Finally, results suggest that aerodynamic measurements can be used to assess other surgical techniques designed to correct velopharyngeal insufficiency.

Adolescent↗

PubMed1987

Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep.

The effect of von Langenbeck palatoplasty and pharyngeal flap surgery on upper airway obstruction during sleep was studied by obtaining polysomnographic sleep studies on 10 patients undergoing each procedure at 1 to 2 days prior to surgery, 2 to 3 days postoperatively, and approximately 3 months postoperatively. The effects of von Langenbeck palatoplasty on sleep-related upper airway obstruction were usually minimal and clinically insignificant, whereas severe obstructive sleep apnea was present in all but one of the patients undergoing pharyngeal flap surgery at 2 to 3 days postoperatively. In most patients the upper airway obstruction was resolved at the 3-month postoperative sleep study. These data suggest that palatoplasty carries with it a very slight risk of upper airway obstruction, whereas pharyngeal flap surgery has as a very frequent concomitant the occurrence of severe obstructive sleep apnea in the immediate postoperative period.

Adolescent↗

PubMed1999

Prefabricated free jejunal transfer: a new reconstructive technique for high pharyngeal defects.

A new method that uses a prefabricated free jejunal transfer has been applied to three cancer patients with pharyngoesophageal defects with a high pharyngeal deficit extending up to the nasopharynx. In this method, the jejunum harvested in the usual manner is divided into two segments with a single vascular pedicle. Its distal segment is used to reconstruct the cervical esophagus, and its proximal segment is turned over to create a mucosal patch to cover the high pharyngeal defects. The two segments are then co-apted in a side-by-side anastomosis. The esophagus can be reconstructed in a naturally straight shape without a curved portion or blind loop formation, thus leading to good swallowing function. In our series, all grafts survived well and there was no complication directly related to jejunal transfer. All patients could tolerate a soft diet without difficulty. This method is easy to perform and applicable to any shape or size of very high pharyngeal defects that cannot be reconstructed properly by other methods. Although patients with an advanced hypopharyngeal cancer usually have a poor prognosis, this technique allows a better quality of life for a probable short life span.

Aged↗

PubMedDate not supplied

Rapid detection of Chlamydia trachomatis in conjunctival, pharyngeal, and urethral specimens with a new polymerase chain reaction assay.

GOAL OF THIS STUDY: The Amplicor polymerase chain reaction (PCR) assay for the detection of Chlamydia trachomatis (Roche Molecular Systems, Branchburg, NJ) was evaluated on conjunctival, pharyngeal, and urethral swabs. STUDY DESIGN: A total of 515 conjunctival, pharyngeal, and urethral swabs. The reference system was culture with McCoy cells in shell vials with fluorescent immunostaining. One swab was used for both cell culture and the molecular assay. Initial storage took place in 2-SP medium. After transfer to Amplicor specimen transport medium the molecular assay was done using the Amplicor Chlamydia trachomatis amplification and detection kits. RESULTS: The total positive rate was 6.6%. Specificity of culture was 100%. The evaluated molecular assay gave a specificity of 99.8%. Sensitivities of PCR and culture were 100% and 85.3%, respectively. CONCLUSIONS: Because of the high sensitivity, specificity, and ease of use, the molecular assay was found to be a good alternative to culture for detection of C. trachomatis in conjunctival, pharyngeal, and urethral specimens.

Adolescent↗

PubMed2002

A 10-year review of perioperative complications in pharyngeal flap surgery.

A 10-year retrospective study was undertaken to investigate perioperative complications in pharyngeal flap surgery in one institution using inferiorly and superiorly based flaps. In this fashion the current practice of surgical technique based on local findings and perioperative care, through regular monitoring by experienced nurses on the ward, was evaluated for adequacy. The charts of 275 patients who had 287 pharyngeal flap procedures were studied. Demographics, type and duration of operation, associated procedures, surgeon, anesthetist, duration of hospital stay, associated medical conditions, and perioperative complications such as bleeding, respiratory insufficiency, or flap dehiscence were evaluated. In this series a total complication rate of 6 percent was found, with 2.4 percent early (<6 weeks) and 3.8 percent late (>6 weeks) complications. Only two patients (0.7 percent) had postoperative bleeding requiring reoperation, and one patient (0.3 percent) needed reintubation. The most frequent complication was flap dehiscence in nine patients (3.1 percent), which occurred early in three and late in six. Pharyngeal flap surgery can be performed safely with very few complications provided the correct experience and infrastructure are present. Careful surgery, in conjunction with adequate anesthesia and postoperative monitoring, makes these procedures safe and rewarding.

Adolescent↗