Article

Anatomy, physiology and pathophysiology of dysphagia. Acta

Department of Medicine, Northwestern University, Chicago, Illinois.
Acta oto-rhino-laryngologica Belgica (Impact Factor: 0.43). 02/1994; 48(2):97-117.
Source: PubMed

ABSTRACT

This is a review paper examining the pathogenesis of oropharyngeal dysphagia. Pharyngeal anatomy and physiology are discussed along with a detailed description of the neuronal architecture and function of the medullary swallowing center. The oropharyngeal swallow is then examined in biomechanical terms emphasizing that the swallow is comprised of several elements (velopharyngeal closure, upper esophageal sphincter opening, closure of the laryngeal vestibule, tongue loading, tongue pulsion and pharyngeal clearance) each of which can be compromised, causing dysphagia. The key modality for evaluating patients with oropharyngeal dysphagia is the videofluoroscopic swallowing study which is analyzed according to the efficacy with which these functional elements of the swallow are accomplished. Specific therapy can then be addressed toward correcting dysfunctional elements.

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    • "In the human, the anterior and posterior tonsillar pillars and the posterior pharyngeal wall (Pommerenk, 1928; Doty, 1968; Goyal and Cobb, 1981) are the most sensitive areas for initiation of the pharyngeal phase of swallowing. Several investigators believed that the swallowing reflex is mainly triggered from the IX nerve (Levine, 1988; Kahrilas, 1994). "
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    ABSTRACT: To date, the details of human sensory innervation to the pharynx and upper airway have not been demonstrated. In this study, a single human oro- and laryngopharynx obtained from autopsy was processed with a whole-mount nerve staining technique, Sihler's stain, to determine its entire sensory nerve supply. The Sihler's stain rendered all mucosa and soft tissue translucent while counterstaining nerves. The stained specimen was then dissected and the nerves were traced from their origins to the terminal branches. It was found that the sensory innervation of the human pharynx is organized into discrete primary branches that innervate specific areas, although these areas are often connected by small neural anastomoses. The density of innervation varied, with some areas receiving almost no identifiable nerve supply (e.g., posterior wall of the hypopharynx) and certain areas contained much higher density of sensory nerves: the posterior tonsillar pillars; the laryngeal surface of the epiglottis; and the postcricoid and arytenoid regions. The posterior tonsillar pillar was innervated by a dense plexus formed by the pharyngeal branches of the IX and X nerves. The epiglottis was densely innervated by the internal superior laryngeal nerve (ISLN) and IX nerve. Finally, the arytenoid and postcricoid regions were innervated by the ISLN. The postcricoid region had higher density of innervation than the arytenoid area. The use of the Sihler's stain allowed the entire sensory nerve supply of the pharyngeal areas in a human to be demonstrated for the first time. The areas of dense sensory innervation are the same areas that are known to be the most sensitive for triggering reflex swallowing or glottic protection. The data would be useful for further understanding swallowing reflex and guiding sensory reinnervation of the pharynx to treat neurogenic dysphagia and aspiration disorders. Anat Rec 258:406–420, 2000. © 2000 Wiley-Liss, Inc.
    Full-text · Article · Apr 2000 · The Anatomical Record
  • [Show abstract] [Hide abstract]
    ABSTRACT: To date, the details of human sensory innervation to the pharynx and upper airway have not been demonstrated. In this study, a single human oro- and laryngopharynx obtained from autopsy was processed with a whole-mount nerve staining technique, Sihler's stain, to determine its entire sensory nerve supply. The Sihler's stain rendered all mucosa and soft tissue translucent while counterstaining nerves. The stained specimen was then dissected and the nerves were traced from their origins to the terminal branches. It was found that the sensory innervation of the human pharynx is organized into discrete primary branches that innervate specific areas, although these areas are often connected by small neural anastomoses. The density of innervation varied, with some areas receiving almost no identifiable nerve supply (e.g., posterior wall of the hypopharynx) and certain areas contained much higher density of sensory nerves: the posterior tonsillar pillars; the laryngeal surface of the epiglottis; and the postcricoid and arytenoid regions. The posterior tonsillar pillar was innervated by a dense plexus formed by the pharyngeal branches of the IX and X nerves. The epiglottis was densely innervated by the internal superior laryngeal nerve (ISLN) and IX nerve. Finally, the arytenoid and postcricoid regions were innervated by the ISLN. The postcricoid region had higher density of innervation than the arytenoid area. The use of the Sihler's stain allowed the entire sensory nerve supply of the pharyngeal areas in a human to be demonstrated for the first time. The areas of dense sensory innervation are the same areas that are known to be the most sensitive for triggering reflex swallowing or glottic protection. The data would be useful for further understanding swallowing reflex and guiding sensory reinnervation of the pharynx to treat neurogenic dysphagia and aspiration disorders.
    No preview · Article · May 2000 · The Anatomical Record
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    ABSTRACT: The assessment and management of dysphagia is a rapidly growing part of speech pathology clinical practice for both adult and paediatric populations, yet there is limited information available regarding the epidemiology of dysphagia. Very few studies have defined the characteristics of the disorder, its incidence/prevalence in various populations, the natural history of the disorder or the relative risks, comorbidities and outcomes associated with dysphagia. The current paper will identify some fundamental questions that as yet remain unanswered and highlight areas of future research that are required in order for us to have a better understanding of dysphagia and inform assessment and management. In conclusion, the authors propose an epidemiological framework and highlight information needs in the field of dysphagia. This framework urges future dysphagia research to be informed and underpinned by sound epidemiological principles.
    No preview · Article · Jan 2005 · International Journal of Speech-Language Pathology
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