Among the VFSSs, those showing pharyngeal stasis by mechanical obstruction due to cervical osteophytes were selected for inclusion in this study. Lateral pharyngeal pouches are extremely common, and the frequency of their occurrence increases with age. Leonard DS, Broe P. Oesophageal achalasia: an argument for primary surgical management. Some diseases with diffuse mucous membrane ulceration affect the pharynx. Furthermore, the examination can detect coexisting structural lesions (e.g., prominent cricopharyngeal muscle, Zenkers diverticulum, web, stricture) that may be difficult to circumvent safely at endoscopy. Rarely, pedunculated lesions (e.g., papillomas, lipomas, fibrovascular polyps) may be coughed up into the mouth or may cause sudden death through asphyxiation. Barium studies of the pharynx are usually of limited value in patients with acute sore throat caused by viral, bacterial, or fungal infection. Four outpouchings from the pharynx grow to meet the branchial clefts. The pharyngeal outpouchings are of endodermal origin and are termed branchial pouches. being unable to chew food properly. Sonnenberg A. anthony coaxum football coach; overflow shelter wichita, ks; what does the green leaf mean on parkrun results Inflammatory disorders of the pharynx or gastroesophageal reflux can alter pharyngeal elevation, epiglottic tilt, or closure of the vocal cords and laryngeal vestibule. Gravesen FH, Gregersen H, Arendt-Nielsen L, Drewes AM. Some background: He is an ex 33-weeker, now 39+5. Clinical and manometric course of nonspecific esophageal motility disorders. [QxMD MEDLINE Link]. Webs appear radiographically as 1- to 2-mm wide, shelflike filling defects along the anterior wall of the hypopharynx or cervical esophagus ( Fig. Motility is preserved at the proximal striated muscle portion of the esophagus. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. However, in the setting of a normal MRI with normal motor development, other etiologies need to be explored. "When the results of the oropharyngeal exam and the esophagram were combined, esophageal stasis in isolation was the most common finding at all complaint locations, with the exception of patients who complained of stasis in the cervical and thoracic esophagus where the most common finding was no stasis." "Pharyngeal stasis in isolation . 16-4 ). These poorly differentiated or undifferentiated tumors spread rapidly to the entire supraglottic region and pre-epiglottic space. 2012 Mar. Ulcerative lesions may deeply penetrate the tongue and valleculae and invade the pre-epiglottic space ( Fig. The coordination of these simultaneously contracting muscle layers produces the motility pattern known as peristalsis. He also gets very constipated. Diagnostic pitfalls and how to avoid them. The term comes from the oropharynx, the location in the back of the throat, and dysphagia, which means disordered swallowing. Cross-sectional imaging studies are the examinations of choice for showing spread of tumor into the submucosa, intrinsic muscles, tissues extrinsic to the pharynx, and regional lymph nodes. Diverticula appear on frontal views as saccular protrusions that have narrow necks (see Fig. Neck radiographs may show smooth enlargement of the epiglottis and aryepiglottic folds. Search google scholar for this article by my colleague and friend, Laura Brooks, which may or may not be pertinent, pending your further assessment and refection. Pharyngeal phase problems include -having a hard time starting a swallow -getting food or liquid into your airway, called aspiration -having some food or liquid stay in your throat after you've swallowed, called residue. The 5-year survival rate varies from 76% for patients with localized tumors to 10% to 20% for patients with cervical lymph node metastases. Head Neck. Radiographically, the diverticula are persistent, barium-filled sacs of various sizes connected to a bulging lateral hypopharyngeal wall by a narrow neck ( Fig. Response to amyl nitrate, with disappearance of the spasm on esophagram. Although the tests of association and correlation of the stasis variable did not present significance, it is . Tonsillar tumors may spread to the soft palate, base of the tongue, and posterior pharyngeal wall. A frontal view shows loss of the normal contour of the left piriform sinus. Pathologically, a unilocular cyst is lined by keratinizing, stratified, squamous epithelium and is filled with desquamated keratinaceous debris. Please confirm that you would like to log out of Medscape. They are usually unilateral. Enter your email address to subscribe to this blog and receive notifications of new posts by email. The pharynx is the site of common illnesses, including sore throat and tonsillitis. Killian-Jamieson diverticula can be bilateral or unilateral. Symptoms attributed to lymphoid hyperplasia of the lingual tonsil include throat discomfort, a globus sensation, and dysphagia. Effect of orthognathic surgery on pharyngeal airway space: a cephalometric evaluation using dolphin imaging software/Avaliacao cefalometrica do espaco aereo faringeo apos cirurgia ortognatica por meio do . This can cause speech that is difficult to understand. ASHA / What is a swallowing disorder? Crit Rev Diagn Imaging 28:133179, 1988. list of sundown towns in new england; jeff mudgett wikipedia. Overall low energy and alertness for his age. These disorders may manifest as oral stasis of food, inability to initiate a swallow, premature spillage. Patients with lateral pharyngeal pouches usually have no symptoms. Initial results of diagnostic endoscopy may be negative. Branchial ridges (arches) lie between the branchial clefts. Farmer's Empowerment through knowledge management. In contrast, saccular cysts of the aryepiglottic folds arise from the mucus-secreting glands of the appendix of the laryngeal ventricle and are filled with mucoid secretions. It carries air, food and fluid down from the nose and mouth. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow. MRI brain? The inferior constrictor muscle is composed of the thyropharyngeal and cricopharyngeal muscles. Webs are thin mucosal folds usually located along the anterior wall of the lower hypopharynx and proximal cervical esophagus. In patients with known pharyngeal cancer, a contrast examination is of value to assist in planning proper work-up and therapy. Nodules of tumor may spread to the palatine tonsil, valleculae, or pharyngoepiglottic fold. He was eventually diagnosed with a posterior tongue tie and underwent a frenulectomy. Laryngoceles are seen in patients with increased intralaryngeal pressure, such as glass blowers and wind instrument players. 99>X5W0k|KkzvD7\Q{*{[Vs* @Lid{ EM>;"t1wDZ. If you log out, you will be required to enter your username and password the next time you visit. Patients with benign tumors of the base of the tongue may be asymptomatic or may complain of throat irritation or dysphagia. 18(7):[QxMD MEDLINE Link]. The thyropharyngeal muscle arises from the lateral ala of the thyroid cartilage; it courses laterally and posteriorly to merge with its counterpart from the opposite side in a raphe in the posterior pharyngeal wall. Clipboard, Search History, and several other advanced features are temporarily unavailable. [QxMD MEDLINE Link]. Transient or persistent protrusions of the anterolateral cervical esophagus into the Killian-Jamieson space are termed lateral cervical esophageal pouches or diverticula, respectively. [QxMD MEDLINE Link]. With severe luminal narrowing, dysphagia may result, especially in patients with circumferential cervical esophageal webs. However, no studies to date have shown convincing evidence that surveillance is worthwhile. Most patients with Killian-Jamieson diverticula are asymptomatic, but some may complain of dysphagia or regurgitation. Barium may also be trapped above early closure of the upper cervical esophagus. Chest pain is, in fact, a more common complaint that may precipitate emergency room visits and cardiologic evaluations. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow. Timing of events during deglutition after chemoradiation therapy for oropharyngeal carcinoma. Most patients with squamous cell carcinoma are 50 to 70 years of age. Retention cyst at the base of the tongue. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . Eric A Gaumnitz, MD Professor of Medicine, Division of Gastroenterology, University of Wisconsin School of Medicine; Program Director, Gastroenterology and Hepatology Fellowship, University of Wisconsin School of Medicine and Public Health; Director, Motility Unit, University of Wisconsin Hospitals Dis Esophagus. of dysfunction of deglutition (DOSS), the presence of food stasis (Eisenhuber scale), laryngeal penetration and laryngotracheal aspiration (PAS) and oral and pharyngeal transit time were evaluated . Scarring may cause distortion of the pharyngeal contours. sharing sensitive information, make sure youre on a federal The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Small or predominantly submucosal lesions may be hidden in the valleculae or the recess between the tongue and tonsil (glossotonsillar recess). Webs in the distal esophagus have been associated with gastroesophageal reflux disease. A person with cricopharyngeal dysfunction may experience: a feeling of having something stuck in their throat difficulty swallowing. ), Partially obstructing cervical esophageal web. Advanced achalasia can lead to malnutrition, dehydration, and aspiration. cess. Wondering about work of breathing, swallow-breathe interface with both pacifier dips and/or clinical observation of PO feeding. If the dilation extends above the thyroid cartilage and through the thyrohyoid membrane, the sac is termed external laryngocele. Inflammatory disorders of the pharynx or gastroesophageal reflux can alter pharyngeal elevation, epiglottic tilt, or closure of the vocal cords and laryngeal vestibule. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Muller M, Eckardt AJ, Gopel B, Eckardt VF. This association was termed Plummer-Vinson syndrome or Paterson-Kelly syndrome. Benign tumors arising from the minor mucoserous salivary glands are usually seen in the oropharynx in the region of the soft palate and base of the tongue. Therapeutic procedures and operations are associated with a small but significant risk of mortality and morbidity. [QxMD MEDLINE Link]. The 5-year survival rate is approximately 40%. persistent drooling of saliva. Medical team is very supportive of therapy. 16-18 ). 22(2):226-30. Can dysphagia be cured by surgery? endstream endobj 227 0 obj <>stream They are usually composed of normal epithelium and lamina propria. new hanover high school football roster; st mary's glacier camping colorado; espn 2025 basketball rankings; is february 11 2022 a federal holiday; janae from sweetie pies: new baby; lahat may hangganan quotes; Branchial pouch sinuses or fistulas are tracts that extend from the pharynx and end blindly in the soft tissues of the neck (sinus) or extend to the skin (fistulas). Likely at risk for bolus mis-direction from below (refluxate), d/t what sounds like proximal hypotonia that could make timely effective response to retrograde flow from the esophageal body unreliable. A small plaquelike or ulcerative lesion can easily be missed on barium or endoscopic studies but can be detected on MRI or CT studies. The relationship between the mouth of the Zenkers diverticulum and prominent cricopharyngeus is demonstrated. This redundant mucosa has been termed the postcricoid defect and was previously attributed to a venous plexus in this region. All the etiologies that I mentioned, in isolation or in combination, could play a part in the diffuse pharyngeal stasis/residue observed, which is worrisome for bolus mis-direction during the course of a true feeding. Esophageal stasis was the most common finding regardless of complaint location. These pouches and diverticula are relatively common and may be confused radiographically with Zenkers diverticulum. 16-17 ). If saccular dilation of the appendix is confined by the thyroid cartilage, it is termed an internal laryngocele. I^0FLIP TuY}Oy_2z>fus^`oNd gu!yooo;z\_(/Bvd0:+r _ h'9#@#BttG2z.xhEQ}@In2V1bGln^0;huVH^ gY'`V|f-2cm"aoEa;8oX41C?~kNG0{a.9~\}Le =W Disclaimer. Hoarseness occurs primarily in patients with laryngeal carcinoma, supraglottic carcinoma, or carcinoma of the medial piriform sinus infiltrating the arytenoid cartilage or cricoarytenoid joint. The dysmorphic features stand out as worrisome, and often craniofacial and cardiac variants like an ASD can co-occur. 37(12):1210-9. 2018 Jul;66(7):543-549. doi: 10.1007/s00106-017-0365-5. The underlying cause of all the primary motility disorders remains elusive. Achalasia affects both sexes in equal numbers. Esophageal motility disorders discussed in this article include the following: Spastic esophageal motility disorders, including diffuse esophageal spasm (DES), nutcracker esophagus, and hypertensive LES, Nonspecific esophageal motility disorder (inefficient esophageal motility disorder), Secondary esophageal motility disorders related to scleroderma, diabetes mellitus, alcohol consumption, psychiatric disorders, and presbyesophagus. Results Dysphagia evaluation was completed in 301 patients with complaints of bolus stasis. 2013 Jun. Multiple co-morbidities at play it seems. 233 0 obj <>/Filter/FlateDecode/ID[<9925DAB172E4C04EAA11C856BA143EA3>]/Index[223 23]/Info 222 0 R/Length 65/Prev 694135/Root 224 0 R/Size 246/Type/XRef/W[1 2 1]>>stream Barium studies reveal the size, extent, and inferior limit of pharyngeal tumors and the degree of functional impairment. Benign cartilaginous tumors involving the pharynx (chondromas) usually arise from the posterior lamina of the cricoid cartilage. Nutcracker esophagus is the most common motility disorder (>40% of all motility disorders diagnosed), but it is the most controversial in significance. Food or stomach acid backing up into the throat. Manometry may reveal elevated LES pressure greater than 40 mm Hg in more than 60% of patients; however, hypertensive LES is not universal or required for the manometric diagnosis. [2]. The loss of nerves along the esophageal body causes aperistalsis, leading to stasis of ingested food and subsequent dilation of the esophagus. Associated complications, including strictures, Barrett esophagus, and adenocarcinoma of the esophagus, are the concern. Radiographic description of this phenomenon has been called presbyesophagus. No documented abnormalities exist regarding the distribution of myenteric neurons in patients diagnosed with spastic motility disorders of the esophageal body, but diffuse fragmentation of vagal filaments, increased endoneural collagen, and mitochondrial fragmentation are described. FOIA Signs and symptoms associated with dysphagia can include: Pain while swallowing. Pharyngeal definition, of, relating to, or situated near the pharynx. Sato Y, Fukudo S. Gastrointestinal symptoms and disorders in patients with eating disorders. Schlottmann F, Patti MG. Primary esophageal motility disorders: beyond achalasia. gopuff warehouse address; barts health nhs trust canary wharf; The exception is the . Patients with complaints of bolus stasis in the throat (i.e., pharynx and cervical esophagus) were less accurate at localizing bolus stasis than patients with complaints in the thoracic esophagus (p < .001). A barium examination can also be used to rule out a second primary lesion in the esophagus. Radiographic findings in pharyngeal carcinoma. 2017 Jun 30. Possible complications, therapeutic options, expected outcomes, and dietary modifications should be explained. These webs are thought to be normal variants in the valleculae and piriform sinuses. coughing or choking when eating or drinking. There are no skeletal structures in the fourth pharyngeal arch. Squamous cell carcinoma of the right palatine tonsil. [QxMD MEDLINE Link]. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. The Killian-Jamieson space is a triangular area of weakness in the cervical esophagus just below the cricopharyngeal muscle. The .gov means its official. No reliable information for other motility disorders exists. Abstract: Ankyloglossia, or tongue tie, and its impact on the oral phase of feeding has been studied and debated for decades. Hoarseness. [High-resolution manometry of pharyngeal swallowing dynamics]. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. HNO. Webs may be confused radiographically with redundant mucosa in the anterior wall of the pharyngoesophageal segment at the level of the cricoid cartilage. Has there been a neuro consult? Catherine Shaker Swallowing and Feeding Seminars, Research Corner: Infant and maternal factors associated with attainment of full oral feeding (FOF) in premature infants. Partial obstruction is suggested by a jet phenomenon or by dilation of the esophagus or pharynx proximal to the web (see Fig. The esophagus functions solely to deliver food from the mouth to the stomach where the process of digestion can begin. Abdullah Fayyad, MD, MBBS is a member of the following medical societies: American Gastroenterological AssociationDisclosure: Nothing to disclose. Dig Dis Sci. He also has a high palate and often is nasally congested. Whether or not symptomatic relief is achieved, the prognosis in patients with spastic esophageal motility disorders is favorable. endstream endobj 224 0 obj <> endobj 225 0 obj <> endobj 226 0 obj <>stream Muscle wall thickening has been described in patients who are asymptomatic and, conversely, has been absent in some patients with typical symptoms and manometric findings. The cricopharyngeal muscle has no midline raphe. Nihon Jibiinkoka Gakkai Kaiho. Gastroenterology. The 2023 edition of ICD-10-CM J39.2 became effective on October 1, 2022. 2021 Dec;36(6):1063-1071. doi: 10.1007/s00455-020-10239-3. [QxMD MEDLINE Link]. Most of these patients have recurrent aphthous stomatitis and oropharyngeal ulceration. 16-16 ). Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. A second branchial cleft cyst is found at the level of the hyoid bone, deep to the sternocleidomastoid muscle. However, any asymmetrically distributed coarse nodularity or mass must be viewed with suspicion. Incomplete opening and early closure of the cricopharyngeal muscle, and early closure of the upper cervical esophagus, have been associated with gastroesophageal reflux disease. 8600 Rockville Pike MRI is the method of choice for evaluating tumors of the nasopharynx. The diverticula are lined by nonkeratinizing squamous epithelium surrounded by loose areolar connective tissue, with many vascular spaces. what is pharyngeal stasis. Gatto AR, Cola PC, da Silva RG, Ribeiro PW, Spadotto AA, Henry MAAC. Any change in the character of dysphagia or bloody discharge in a patient known to have Zenkers diverticulum should suggest a complication. The LES pressure tracing is at the level of the sleeve (tracing 6). What causes VPI? World J Gastroenterol. Rohof WO, Salvador R, Annese V, et al. Esophageal motility disorders, excluding achalasia, lack population-based studies. PMC [QxMD MEDLINE Link]. As a result, pending further data, they might consider a G-Tube with a Nissen (to optimize airway protection and more safely buy him time for response to therapy and evolution to guide the differential), instead of home NG, which would have its own attendant sequelae. 2009 Apr. Because such a strong association exists between head and neck squamous cell carcinoma and esophageal carcinoma, a major goal of a preoperative radiologic study is to rule out a synchronous primary esophageal cancer. Praveen K Roy, MD, MSc Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine Most patients are asymptomatic and in the fifth to sixth decade of life. 16-15 ). National Library of Medicine 30(3):1-5. No nasopharyngeal regurgitation that I recall. Squamous cell carcinomas represent 90% of malignant lesions involving the oropharynx and hypopharynx. 2013 Apr. Epub 2021 Feb 5. Current clinical approach to achalasia. A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry. Inflammation-induced dysmotility may result in laryngeal penetration and stasis. Complications of botulinum toxin injections for treatment of esophageal motility disorders. Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Israeli Medical AssociationDisclosure: Received grant/research funds from Takeda Pharmaceuticals for conducting research; Received consulting fee from Takeda Pharmaceuticals for consulting; Received honoraria from Takeda Pharmaceuticals for speaking and teaching; Received consulting fee from Vecta for consulting; Received consulting fee from XenoPort for consulting; Received honoraria from Eisai for speaking and teaching; Received grant/research funds from Wyeth Pharmaceuticals for conducting research; Received grant/research funds f. Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine. Efficient transport by the esophagus requires a coordinated, sequential motility pattern that propels food from above and clears acid and bile reflux from below. At the time of diagnosis, the esophagus usually is dilated, and the tumor is advanced. Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. Purpose The purpose of this article was to determine whether patients who complain of bolus stasis are accurate at localizing bolus stasis as measured by a videofluoroscopic swallowing study with an esophagram. The secondary peristaltic wave is induced by esophageal distension from the retained bolus, refluxed material, or swallowed air. Inflammation-induced dysmotility may result in laryngeal penetration and stasis. A true Zenkers diverticulum may be confused with barium trapped above a cricopharyngeal muscle that has closed before the pharyngeal contraction wave has passed. This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis in the throat. The junction of the ala of the thyroid cartilage and thyrohyoid membrane is seen on frontal views as a notch in the lateral pharyngeal wall. Frontal view shows large, smooth-surfaced, round to ovoid nodules (. With severe lymphoid hyperplasia of the base of the tongue, the nodules may extend into the valleculae, along the lingual surface of the epiglottis, or even into the upper hypopharynx. Variable amounts of inflammatory cells have been described within the myenteric plexus along with the disappearing nerves. Occasionally, a deeply infiltrating, primarily submucosal lesion may be manifested by subtle asymmetric enlargement of the tongue base. Oropharyngeal dysphagia is a medical condition that causes a disruption or delay in swallowing. A referred earache may occur, especially when nasopharyngeal tumors block the eustachian tube. We put him on an oral rest for now. Increased incidence of both esophageal squamous cell and adenocarcinoma is observed in patients with long-standing achalasia. After swallowing, barium in the diverticulum is regurgitated into the hypopharynx. The fourth pharyngeal arch forms the laryngeal cartilages, muscles of the soft palate and pharynx, part of the subclavian artery and the arch of the aorta. The cricopharyngeal muscle constitutes the lower portion of the inferior constrictor muscle, arising from the lateral cricoid cartilage to encircle the lowermost hypopharynx. 208(6):1035-44. Neurogastroenterol Motil. Among the anomalies seen in SCI patients weretype II achalasia (12%), type III achalasia (4%), esophagogastric junction outflow obstruction (20%), hypercontractile esophagus (4%), and peristaltic abnormalities (weak peristalsis with small or large defects or frequent failed peristalsis) (48%). The body of the esophagus is similarly composed of 2 muscle types. Growth Disorders: 7 Cases of a Developing Problem, Trending Clinical Topic: Intermittent Fasting. Lymphoid hyperplasia of the base of the tongue. These protrusions are commonly found in those who have increased intrapharyngeal pressure (e.g., wind instrument players, glass blowers, people with severe sneezing episodes). This is an example of pseudoachalasia, which reinforces the absolute need for esophagogastroduodenoscopy (EGD) in patients with radiologic diagnosis of achalasia. However, barium studies may reveal enlargement of the aryepiglottic fold with a smooth overlying mucosa. On frontal views, pouches appear as small, round, or ovoid protrusions of the lateral upper esophageal wall that are filled late during swallowing and that empty after swallowing. The mid esophagus contains a graded transition of striated and smooth muscle types. None of the clinical or physiologic behaviors can be attributed strictly to being born preterm, though preterm birth would increase risk for co-morbidities. The National Library of Medicine (NLM), on the NIH campus in Bethesda, Maryland, is the world's largest biomedical library and the developer of electronic information services that delivers data to millions of scientists, health professionals and members of the public around the globe, every day. Familial clustering is observed, but a genetic relationship is not established. The use of endoscopy and magnetic resonance imaging (MRI) may help exclude malignancy. Tumors of various histologic types tend to occur at specific locations in the pharynx. The radiologist carefully searches for spread to the nasal cavity, sinuses, and cranial base, especially for cranial nerve involvement. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTc0NzgzLW92ZXJ2aWV3. 15(32):3969-75. 16-7 ) and do not empty as quickly after swallowing. The radiologist may be the first physician to suggest a diagnosis of pharyngeal carcinoma ( Fig. The webs protrude to various depths into the esophageal lumen. The primary role is to clear the esophagus of retained food or any gastroesophageal refluxate. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. Patients with second branchial cleft cysts usually present between the ages of 10 and 40 years with a painless or fluctuant mass in the upper neck along the upper third of the anterior border of the sternocleidomastoid muscle. The pathogenesis of Zenkers diverticulum is as controversial as the muscular anatomy. Eur J Pediatr. Some pharyngeal and cervical esophageal webs are associated with diseases that cause inflammation and scarring, such as epidermolysis bullosa or benign mucous membrane pemphigoid. V4IQ){lP E 2015 Jul. pharyngeal: [adjective] relating to or located or produced in the region of the pharynx. The first branchial cleft forms the external auditory meatus. Severe ulceration with subsequent scarring may also be caused by lye ingestion ( Fig. In contrast, the neck of Zenkers diverticulum is on the posterior hypopharyngeal wall, and the sac extends inferiorly behind the cervical esophagus. On frontal radiographs obtained in patients with lymphoid hyperplasia, multiple smooth, round, or ovoid nodules are symmetrically distributed over the surface of the base of the tongue ( Fig. [Temporal and spatial pattern analysis of pharyngeal swallowing in patients with abnormal sensation in the throat]. In addition, anxiety states may also play a role in some patients. Surgeon. Physiologic characteristics of achalasia are additionally useful in assisting with establishing the diagnosis through chemical challenge testing. UES opened for a portion of the bolus to pass through, pharyngeal stripping was not great. They are also known as Killian-Jamieson pouches or Killian-Jamieson diverticula . However, the impact of posterior tongue ties on the pharyngeal phase of swallowing is not well documented in the literature. Esophageal dysmotility develops as the smooth muscle of the esophagus is replaced by scar tissue, gradually leading to progressive loss of peristalsis and a weakening of LES. The measurements of premature pharyngeal entry, pharyngeal transit time, and postswallow pharyngeal stasis by scintigraphy were correlated with those of VFS. Results via subsequent VFSS revealed significant improvement in base of tongue movement, pharyngeal pressure generation, and pharyngeal constriction, resulting in efficient movement of the bolus through the pharynx into the esophagus, no nasopharyngeal regurgitation, no aspiration, and near resolution of his pharyngeal dysphagia.