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PubMed1996

Why should we enlarge the pharynx in obstructive sleep apnea?

Patency of the collapsible segment of the pharynx is dependent upon the interplay of anatomic and physiologic factors. The upper airway of the typical patient with obstructive sleep apnea (OSA) is structurally narrowed by fat deposits in the lateral pharyngeal walls. During wakefulness, the upper airway dilator muscles compensate for the structurally reduced pharyngeal size by increasing their activity, thereby pulling the tongue and soft palate forward. As a consequence, the cross-sectional area is relatively preserved, but the shape of the pharynx becomes elliptical along the anteroposterior axis. In the awake patient with OSA, patency of the pharynx is largely dependent upon increased dilator muscle activity. During sleep, the activity of the muscular apparatus of the pharynx decreases causing a critical narrowing. Because anatomic narrowing appears to be a basic feature, enlarging the pharynx should be beneficial, particularly if its lateral diameter can be increased. Whereas facial advancement surgery structurally increases the anteroposterior diameter of the pharynx, thereby accounting for the good results reported with this technique, it is doubtful that uvulopalatopharyngoplasty has a similar effect on either the anter-oposterior or lateral diameters of the pharynx.

Humans↗
PubMed1994

[Capsaicin-induced cough. Tachyphylaxis and the effect of anaesthesia on the pharynx].

We examined the reproducibility of capsaicin-induced cough thresholds and the influence of pharynx anaesthesia used to treat the cough. We performed cough threshold tests on ten patients with bronchial asthma and ten patients with chronic cough. The lowest level of capsaicin-induced cough threshold was defined as ten coughs. Tachyphylaxis in cough thresholds was examined three times at intervals of 30 minutes and 120 minutes after the initial test. We measured cough thresholds before and after pharynx anaesthesia with xylocainbiscus. There was no change in cough thresholds among the three times; nor was them any change in the thresholds before and after pharynx anaesthesia. But in five patients with acute pharyngitis, the cough thresholds after pharynx anaesthesia were greater than before. It was suggested that cough threshold tests had reproducibility 30 minutes and 120 minutes after indicating that tachyphylaxis did not exist. Furthermore it was suggested that pharynx anaesthesia influenced the cough threshold in patients with acute inflammation of the pharynx, but anesthesia had no influence on cough thresholds in patients without acute inflammation of the pharynx.

Adult↗
PubMed2001

Coordination of ges-1 expression between the Caenorhabditis pharynx and intestine.

We have previously shown that the Caenorhabditis elegans gut-specific esterase gene (Ce-ges-1) has the unusual ability to be expressed in different modules of the embryonic digestive tract (anterior pharynx, posterior pharynx, and rectum) depending on sequence elements within the Ce-ges-1 promoter. In the present paper, we analyze the expression of the ges-1 homolog (Cb-ges-1) from the related nematode Caenorhabditis briggsae and show that Cb-ges-1 also has the ability to switch expression between gut and pharynx + rectum. The control of this expression switch centres on a tandem pair of WGATAR sites in the Cb-ges-1 5'-flanking region, just as it does in Ce-ges-1. We use sequence alignments and subsequent deletions to identify a region at the 3'-end of both Ce-ges-1 and Ce-ges-1 that acts as the ges-1 cryptic pharynx enhancer whose activity is revealed by removal of the 5' WGATAR sites. This region contains a conserved binding site for PHA-4 (the C. elegans ortholog of forkhead/HNF3 alpha, beta,gamma factors), which is expressed in all cells of the developing pharynx and a subset of cells of the developing rectum. We propose a model in which the normal expression of ges-1 is controlled by the gut-specific GATA factor ELT-2. We propose that, in the pharynx (and rectum), PHA-4 is normally bound to the ges-1 3'-enhancer sequence but that the activation function of PHA-4 is kept repressed by a (presently unknown) factor binding in the vicinity of the 5' WGATAR sites. We suggest that this control circuitry is maintained in Caenorhabditis because pharyngeal expression of ges-1 is advantageous only under certain developmental or environmental conditions.

Animals↗
PubMed2001

Epimorphic regeneration of the distal part of the planarian pharynx.

The totipotent stem cells called neoblasts seem to be concerned with the remarkable regeneration ability of planarians. However, the pharynx is able to regenerate after the amputation of its distal part, in spite of a lack of neoblasts in the pharynx. The process of regeneration has been referred to as morphallaxis, based on conventional histochemical observations. We examined it again immuno-histochemically using anti-Dugesia japonica proliferating cell nuclear antigen (DjPCNA) antibody for neoblasts and anti-D. japonica myosin heavy chain-A (DjMHC-A) antibody for pharynx muscle fibers. This immuno-histochemical study, together with observations of the regeneration process of planarians irradiated with X-rays in particular regions, revealed that after the amputation, neoblasts from outside the pharynx entered that organ, moved through the mesenchyme of the pharynx to the wounded area, and differentiated into the cells that had been lost there. We show here that the regeneration after amputation of the distal part of the pharynx is an 'epimorphic' process.

Animals↗
PubMed2005

Ultrasound evaluation of the normal fetal pharynx.

OBJECTIVE: To obtain normative data for fetal pharyngeal diameter and to investigate the ability to visualize pharynx at different gestational ages during routine prenatal sonography. METHODS: Sonographic studies were performed in 292 consecutive pregnant women. The diameters of the pharynx were measured and our ability to visualize pharynx was evaluated at different gestational ages. RESULTS: Sonographic measurements of the pharyngeal diameter were obtained in 153 of the 292 fetuses. The diameter of the pharynx increased from a mean of 4.5+/-0.53 mm at 16 weeks to 9.1+/-1.72 mm at 36 weeks. Pharyngeal diameters showed a significant positive relationship with advancing gestational age (p<0.0001, R2=0.571). The differences in visualization among different gestational age groups were found to be significant (p<0.05 by Chi-Square). CONCLUSION: This study reports normative data for fetal pharyngeal diameter. Pharyngeal measurements were similar to previous reports in the literature. Our success in visualizing the pharynx was best between 21 and 30 weeks of gestation. This period might be the optimum time for evaluating fetal pharynx.

Female↗
PubMed2000

Nasal mupirocin treatment of pharynx-colonized methicillin resistant Staphylococcus aureus: preliminary study with 10 carrier infants.

BACKGROUND: Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in infants has become a serious concern and a new means of preventing the transmission of MRSA in the community needs to be considered. METHODS: We performed nasal mupirocin treatment on 10 infants who were MRSA-positive either in the nose or the pharynx and evaluated the effect of mupirocin on the eradication of MRSA. RESULTS: Eradication of MRSA from the nose was successful in two cases and eradication from the pharynx in six (66.6%) of nine cases. The number of treatments required to achieve eradication varied; within three courses for nose carriers and from one to seven courses for pharynx carriers. Eradication was unsuccessful even after five to seven treatments in three pharynx-limited carriers. CONCLUSIONS: These data suggest that the effect of nasal mupirocin treatment on pharynx-colonized MRSA is limited and that repetitive treatment is necessary in some cases. However, in view of the possibility of preferential pharyngeal colonization of Staphylococcus aureus in infancy, nasal mupirocin treatment deserves further evaluation for eradication not only of nose- but also of pharynx-colonized MRSA.

Administration, Intranasal↗
PubMed1994

Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients.

PURPOSE: The authors correlated the radiographic evaluation and 24-hour pH monitoring of the pharynx and the esophagus in patients with globus pharyngeus. MATERIALS AND METHODS: Radiographic examination of the pharynx of 22 patients (13 women and nine men, aged 23-73 years [mean, 47 years]) included videofluoroscopy and static radiography. Twenty-four-hour double-probe pH monitoring of the pharynx (abnormal, pH < 4) and esophagus (abnormal, 6% or more total acid exposure) was performed in all patients. RESULTS: Radiographic results were normal in 17 patients; results were abnormal in five, with four having pharyngeal dysfunction and one showing a persistent cricopharyngeal impression. Zenker diverticulum was not seen. Results at pH monitoring of the pharynx and esophagus were normal in 20 and 18 of the 22 patients, respectively. In four of five patients with abnormal radiographic studies of the pharynx, results of pharyngeal pH monitoring were normal. CONCLUSION: Most patients with globus pharyngeus had normal results at pH monitoring and radiographic examination of the pharynx.

Adult↗
PubMed2002

Mechanical properties of the passive pharynx in Vietnamese pot-bellied pigs. I. Statics.

The static mechanical properties of the passive pharynx were investigated in Vietnamese pot-bellied pigs by using an isolated upper airway preparation. During general anesthesia and neuromuscular blockade, cross-sectional area (A) of the pharynx was measured while airway pressure (Paw) was held at various pressures in the absence of airflow. The static A-Paw relationship was measured during application of 0, 1, and 2 cm of caudal tracheal displacement. Relative to humans, closing pressures (Pclose) of the pig pharynx were very low (-15 to -35 cmH(2)O). Tracheal displacement significantly decreased compliance of the hypopharynx (from 0.074 +/- 0.02 cm(2)/cmH(2)O with no displacement to 0.052 +/- 0.01 cm(2)/cmH(2)O with 2 cm of displacement) and decreased Pclose of the oropharynx (from -18.2 +/- 9.9 cmH(2)O to -24.1 +/- 10.5 and -28.7 +/- 12.3 cmH(2)O with 1 and 2 cm of displacement, respectively). Tracheal displacement did not affect A of the pharyngeal segments. In conclusion, tracheal displacement decreased collapsibility of the passive pharynx. The pharynx of the pot-bellied pig is structurally more resistant to collapse than the human pharynx.

Anatomy, Cross-Sectional↗
PubMed1996

Functional abnormalities of the pharynx: a prospective analysis of radiographic abnormalities relative to age and symptoms.

PURPOSE: To determine the prevalence and severity of functional abnormalities of the pharynx relative to patient age and symptoms. MATERIALS AND METHODS: Radiographic evaluation of the pharynx was performed in 110 consecutive outpatients aged 19-84 years old who had no previous surgery of the larynx, pharynx, or esophagus. Each patient completed a symptom data sheet, and we reviewed medical records to determine the main indication for each examination. Videofluoroscopy and static filming in frontal and lateral positions were done with 20-ml barium boluses. We then evaluated functional abnormalities and classified abnormal findings by type and severity. RESULTS: We categorized patients by age into three groups: less than 40 years old (n=31), between 40 and 60 years old (n =42), and greater than 60 years old (n=37). We found a significant increase in the prevalence (23%, 36%, 57%, respectively) and severity of functional abnormalities of the pharynx in older patients (p < .05). Laryngeal penetration, aspiration, pharyngeal stasis, and cricopharyngeal bar were the main abnormalities found in the two older groups. However, we found no correlation between functional abnormalities of the pharynx and symptoms and indications (p > .05). CONCLUSION: Functional abnormalities of the pharynx increased in prevalence and severity with age. Often these findings were not related to specific pharyngeal symptoms and must be interpreted cautiously in older patients.

Adult↗
PubMed2003

[Factors influencing pharynx' and pharyngoesophageal sphincter's morphology and their function after total laryngectomy].

The usefulness of the videolaryngoscopy in patients after total laryngectomy/laryngopharyngectomy was discussed. They serve for: a) evaluation of the pharynx and of the pharyngoesophageal sphincter (pes) morphology, b) prognosis of the esophageal speech developing. In the study videolaryngoscopy was done in 82 patients (7 female and 75 male). In 62 of them total laryngectomy was done (among them in 50/62--with standard pharynx suture, in 9/62--with the pes plasty, and 3/62--with simple pes myotomy). In 20 case of laryngopharyngectomies--4/20 standard pharynx suture was done, 12/20 were reconstructed with tongue flap, 3/20--with pes plasty, and in 1/20 simple myotomy was performed. The investigations were carried out between 1 to 36 months after total laryngectomy and 24 month after laryngopharyngectomy. The analysis of the videolaryngoscopy imagings revealed that the pharynx and pes morphology after laryngectomy/laryngopharyngectomy (shape, thickness of the mucose, weakened wall peristalsis, secretion retention, lack or presence of the pes relaxation at the time of examination) correlates with the rest pressure in the pes area, measured by Seeman's method and with the occurrence of the esophageal speech mastering. The most significant changes in morphology and function of the pharynx (irregular shape, weakened wall peristalsis, retention of secretion) as well as the highest pressure in the area (5.1 +/- 3.33 kPa-38 +/- 25 mm Hg) was found after pharyngolaryngectomy. The shape of the pharynx in all the patients after laryngectomy with plasty or simple myotomy of the pes was regular, with thin and smooth mucosa while the rest pressure was low (3.0 +/- 1.18 kPa(-)+/- 22.5 +/- 8.8 mm Hg). In the analyzed material at the rest pressure in the sphincter area from 0.7 to 4kPa (from 5 to 30 mm Hg), 93% (41/44) of the patients have mastered the esophageal speech. It was stressed that videolaryngoscopy is entirely sufficient for the approximate assessment of the rest pressure in the pes area and prognosis of the esophageal speech development process.

Adult↗
PubMed2006

[Repair of pharynx with acellular dermal matrix].

OBJECTIVE: To evaluate the clinical use of acellular dermal matrix (ADM) in the repair of pharynx. METHOD: From June 2003 to December 2004, 18 cases of laryngopharyngeal carcinoma or oropharyngeal carcinoma accepted treatment of surgery. Four of them had the tumor in the place of posterior wall of laryngopharynx or oropharynx. In the operation, the tumor was resected and the function of larynx was reserved, reconstruction of the posterior wall of laryngopharynx or oropharynx was made with ADM. Three of them had normal function of vocal cords and the tumor was in the place of posterior wall of pharynx and lateral wall of piriform fossa. These patients accepted resection of the tumor and the larynx was reserved. ADM was sutured to the prevertebral fascia to repair the pharynx, reinforcement was made with sternocleidomastoid muscle then. The other 11 patients had the tumor in the pharynx and cervico-esophagus and the vocal cords were fixed. These cases accepted total resection of the larynx and laryngopharynx. ADM was sutured to the prevertebral fascia to repair the posterior wall of laryngopharynx, musculo-cutaneous flap of pectoralis major muscle was made to repair the anterior and lateral walls. All these 18 patients accepted radiotherapy after the operation, the dosage was 60-70 Gy. RESULTS: Among all these 18 cases, no rejection of ADM or formation of pharynx fistula happened after the operation. The allograft became normal mucosa finally. Two patients had subcutaneous infection. After the treatment of dressing change and antibiotics, the wound healing was satisfying. All the 18 patients had resumption of oral diet finally but 3 of them had light mis-swallowing. Seven patients whose larynx were reserved had the trachea cannula pulled out The follow-up periods after the operation lasted 12 months to 30 months. The middle follow-up period was 19. 38 months. Neither rejection nor scar formation of the allograft happened. The follow-up of 11 patients lasted more than 18 months, 3 of them had relapse of tumor. After the second operation 1 patient was still alive and 2 patients died of distant metastasis. CONCLUSION: ADM can be easily obtained. Its histocompatibility were perfect The operative procedure were easy to perform. The complications of donor part can be totally avoided. The combined use of ADM and musculo-cutaneous flap of pectoralis major muscle or other neck tissue was safe and effective in the reconstruction of pharynx.

Aged↗
PubMed2001

Neuroglandular synapses in the pharynx of the sea anemone Aiptasia pallida (Cnidaria, Anthozoa).

Scanning and transmission electron microscopy of the pharynx of the sea anemone Aiptasia pallida revealed a heavily ciliated epidermis and two types of gland cells not known previously to be innervated. By tracing serial cross sections of the pharynx, we located and characterized two types of neuroglandular synapses (i.e., those having clear vesicles and those with dense-cored vesicles). The diameters of the vesicles at each synapse were averaged; clear vesicles ranged from 70 to 103 nm in diameter and were observed at synapses to both mucous and zymogenic gland cells. Dense-cored vesicles ranged from 53 to 85 nm in diameter and were observed at synapses to two mucous gland cells. One mucous gland cell had three neuroglandular synapses, one with clear vesicles and two with dense-cored vesicles. The occurrence of either clear or dense-cored vesicles at neuroglandular synapses suggests that at least two types of neurotransmitter substances control the secretion of mucus in the sea anemone pharynx. To date, only clear vesicles have been observed at a neurozymogenic gland cell synapse in the pharynx. No evidence of immunoreactivity to phenylethanolamine-N-methyl transferase was observed at neuroglandular synapses, suggesting that adrenaline is not a transmitter in the pharynx of A. pallida.

Animals↗
PubMed2001

Early morphogenesis of the Caenorhabditis elegans pharynx.

We investigated the cellular behaviors that accompany the early stages of pharyngeal morphogenesis in Caenorhabditis elegans. The embryonic pharynx develops from a ball of cells into a linear tube connected anteriorly to the buccal cavity and posteriorly to the midgut. By using GFP reporters localized to discrete subcellular regions, we show that pharyngeal morphogenesis can be divided into three stages: (1) lengthening of the nascent pharyngeal lumen by reorientation of apicobasal polarity of anterior pharyngeal cells ("Reorientation"), (2) formation of an epithelium by the buccal cavity cells, which mechanically couples the buccal cavity to the pharynx and anterior epidermis ("Epithelialization"), and (3) a concomitant movement of the pharynx anteriorly and the epidermis of the mouth posteriorly to bring the pharynx, buccal cavity, and mouth into close apposition ("Contraction"). Several models can account for these cellular behaviors, and we distinguish between them by physically or genetically ablating cells within the digestive tract. These studies provide the first description of how the pharynx primordium develops into an epithelial tube, and reveal that pharyngeal morphogenesis resembles aspects of mammalian kidney tubulogenesis.

Animals↗
PubMed1992

Effect of a catheter in the pharynx on the frequency of transient lower esophageal sphincter relaxations.

Transient relaxation of the lower esophageal sphincter (LES) is observed fairly frequently during prolonged continuous monitoring of the LES. The aim of this study was to test whether the presence of a catheter in the pharynx through the stimulation of mechanoreceptors may induce transient LES relaxation. LES and esophageal pressure recordings were obtained for 1 hour in six subjects with a manometric catheter placed via a gastrostomy tube. Swallowing was monitored by submental electromyographic recording. Additional recordings were obtained in these subjects with a catheter placed in the pharynx for 1 additional hour. Transient LES relaxations were recorded in both study periods, i.e., with and without a catheter in the pharynx. The frequency of transient LES relaxations was significantly higher in the presence of manometric catheters in the pharynx (6.4 +/- 2.2 vs. 2.0 +/- 1.1 total LES relaxations). The frequency of transient LES relaxation during the first and second hour after placement of the manometric catheter in a group of seven healthy subjects was not significant different. It is concluded that the pharynx is one of the sites that may mediate the induction of transient LES relaxation.

Aged↗
PubMed2000

Planaria FoxA (HNF3) homologue is specifically expressed in the pharynx-forming cells.

We have isolated a planarian Forkhead box A (FoxA, a new name for a gene group containing HNF3 alpha,beta,gamma)-related gene, DjFoxA, and examined its spatial and temporal distribution in both intact and regenerating planarians by in situ hybridization. In intact worms, DjFoxA is specifically expressed in the cells participating in pharynx development in the region surrounding the pharynx, which is located in the central portion of the body. During regeneration, DjFoxA-positive cells appear in the pharynx-forming region and migrate to the midline to form a pharynx rudiment. These results suggest that DjFoxA is specifically expressed in the cells participating in pharynx formation and has an evolutionarily conserved function in digestive tract formation.

Amino Acid Sequence↗
PubMed1997

Identification of chemical synapses in the pharynx of Caenorhabditis elegans.

The rhythmic contraction of the Caenorhabditis elegans pharynx is unique in that the network of 12 neurons, including two M3 neurons, that regulate the contraction is known. The neurotransmitters secreted by these cells, and the target cells responding to these chemical signals, are not known. Here, we describe an approach to obtain this missing information and use the M3 cells as an example. Electrical recordings (electropharyngeograms) were used in conjunction with temporally and spatially defined application of neurotransmitters via photolysis of inactive, photolabile precursors. To illustrate the technique we used pharyngeal preparations in which the two M3 neurons are intact and preparations in which they were removed by laser irradiation. Removal of M3 neurons results in the loss of the small negative peaks in the electropharyngeograms and an increase in time during which the pharynx remains contracted. We demonstrate that the application of glutamate by photolysis of caged glutamate to a pharynx from which the two M3 neurons were removed produces effects similar to those observed before removal of the M3 neurons. In control experiments, photolytic release from photolabile precursors of carbamoylcholine, a stable and well characterized analog of acetylcholine, or of gamma-aminobutyric acid, from photolabile precursors did not have this effect. The response depended on the amount of glutamate released. By reducing the size of the photolytic beam, glutamate was released at several different locations of the pharynx. Two areas of the pharynx mainly respond to the application of glutamate; one corresponds to the pm4 muscle cells in the metacorpus, and the other to the junction between muscle cells pm5 in the isthmus and pm6 in the terminal bulb.

Animals↗
PubMed1999

Pharyngeal mucosal pressure and perfusion: a fiberoptic evaluation of the posterior pharynx in anesthetized adult patients with a modified cuffed oropharyngeal airway.

BACKGROUND: Pharyngeal airway devices can exert substantial pressures against the pharyngeal mucosa. The authors assess the relation between pharyngeal mucosal perfusion and directly measured mucosal pressure (MP) in the posterior pharynx using a fiberoptic technique with a modified cuffed oropharyngeal airway (COPA). The authors also measure in vivo intracuff pressure (CP), airway sealing pressure and MP at four locations using an unmodified COPA. METHODS: Twenty adult patients, American Society of Anesthesiologists status I or II, undergoing general anesthesia were allocated randomly to receive either (1) a COPA with a millimeter microchip sensor fixed on the external cuff surface to record distal posterior pharyngeal MP or (2) a COPA with a fiberoptic scope inserted inside the cuff to record digitized images of the distal posterior pharyngeal mucosa. MP and digitized images were obtained at the same location over an in vivo CP range of 10-160 cm H2O in 10- to 20-cm H2O increments. The digitized images were scored according to blood vessel caliber and mucosal color by two investigators blinded to MP and CP. In an additional 20 matched patients, in vivo CP, airway sealing pressure, and MP was measured at four different cuff locations (corresponding to the anterior, lateral, and posterior pharynx and the distal oropharynx) with increasing cuff volume. RESULTS: Blood vessel caliber and mucosal color was normal in all patients when the mean mucosal pressure was 17 cm H2O. Blood vessel caliber was first reduced when the mean mucosal pressure was 34 cm H2O. There was a progressive incremental reduction in blood vessel caliber and mucosal color when the mean mucosal pressure increased from 34 to 80 cm H2O (P < or = 0.05). Complete blood vessel collapse and mucosal paling first occurred with the mean mucosal pressure was 73 cm H2O and was present in 90% of patients when the mean mucosal pressure was 80 cm H2O. Mean MP was always higher in the posterior pharynx compared with the other locations when the cuff volume was 20 ml or greater (P < 0.001). In vivo CP is an excellent predictor of mucosal pressure. Mean (95% confidence interval [CI]) MP in the posterior pharynx was 35 (5-67) and 78 (50-109) cm H2O when the airway sealing pressure was 10 (6-16) and 17 (13-21) cm H2O respectively. CONCLUSION: Pharyngeal mucosal perfusion is reduced progressively in the posterior pharynx when MP is increased from 34 to 80 cm H2O with the COPA. CP provides reliable information about MP and should be less than 120 cm H2O to prevent mucosal ischemia.

Adult↗
PubMed1976

The pharynx of Caenorhabditis elegans.

The anatomy of the pharynx of Caenorhabditis elegans has been reconstructed from electron micrographs of serial sections. The pharynx is used for pumping food into the gut, and is composed of 34 muscle cells, 9 marginal cells, 9 epithelial cells, 5 gland cells and 20 neurones. Three regions of specialization in the cuticle lining of the pharyngeal lumen may aid in the accumulation of food particles. A basement membrane isolates the pharynx from the rest of the animal, making the pharyngeal nervous system a nearly self-contained unit which is composed primarily of five classes of motor neurones and six classes of interneurones. Three other classes have also been described, which by their morphology appear to be neurosecretory and motor, motor and interneuronal, and lastly one pair that only innervates three of the marginal cells. Some classes of neurone have free endings just under the cuticle lining the lumen of the pharynx, suggesting that these are mechano- or proprio-receptive endings. The connectivity of these neurones has been described at the level of individual synaptic regions, and after combining this information with video taped observations of the pharynx pumping, some interpretations of how these neurones function have been offered.

Animals↗