Abstract
The upper esophageal sphincter (UES) is composed of the cricopharyngeus (CP), the inferior pharyngeal constrictor (IPC), and the most proximal segment of the esophagus and maintains a high pressure zone between pharynx and esophagus. UES opening mechanism during deglutition is multifactorial and includes the combination of neural relaxation of tonically contracted crycopharyngeus muscle, traction forces imparted by the suprahyoid (SH) UES opening muscles, intrabolus pressure generated by the oncoming bolus, and distensibility of the UES musculature [1, 2]. Each of the aforementioned factors involved in UES opening can potentially be modified to compensate for deficiency of others in a compensated state allowing complete pharyngeal clearance; failing to do so results in an uncompensated state, diminished deglutitive UES opening resulting in incomplete pharyngeal clearance, and postdeglutitive residue and potentially postdeglutitive aspiration.
While the end result of this complex mechanism namely UES opening in health and disease has been extensively studied, the relative contribution of each of the components of this mechanism has received less and variable attention. Abnormal UES opening can be classified as primary, namely those due to (1) lack of neural relaxation and (2) abnormal UES distensibility, or it can be secondary namely due to inadequate traction forces imparted on the sphincter by the contraction of SH muscles. This chapter focuses on the latter topic.
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References
Kahrilas PJ, Dodds WJ, Dent J, Logemann JA, Shaker R. Upper esophageal sphincter function during deglutition. Gastroenterology. 1988;95(1):52–62.
Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern M, Lang IM, Brasseur J, Hogan WJ. Opening mechanisms of the upper esophageal sphincter. Am J Physiol. 1989;257:G748–59.
Dodds WJ, Man KM, Cook IJ, Kahrilas PJ, Stewart ET, Kern MK. Influence of bolus volume on swallow-induced hyoid movement in normal subjects. Am J Roentgenol. 1988;150:1307–9.
Gray H, Goss CM. Anatomy of the human body. Philadelphia: Lea & Febiger; 1968.
Cook IJ, Dodds WJ, Dantas RO, Kern MK, Massey BT, Shaker R, et al. Timing of videofluoroscopic, manometric events and bolus transit during the oral and pharyngeal phases of swallowing. Am J Physiol Gastrointest Liver Physiol. 2003;284(6):G933–9.
Mepani R, Antonik S, Massey B, Kern M, Logemann J, Pauloski B, Rademaker A, Easterling C, Shaker R. Augmentation of deglutitive thyrohyoid muscle shortening by the Shaker Exercise. Dysphagia. 2009;24(1):26–31.
Shaker R, Kern M, Bardan E, Taylor A, Stewart ET, Hoffman RG, Arndorfer RC, Hofman C, Bonnevier J. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol. 1997;272:G1518–22.
Kahrilas PJ, Dodds WJ, Dent J, Wyman JB, Hogan WJ, Arndorfer RC. Upper esophageal sphincter function during belching. Gastroenterology. 1986;91:133–40.
McConnell FM, Cerendo D, Jackson RT, Guffin Jr TN. Timing of major events of pharyngeal swallowing. Arch Otolaryngol Head Neck Surg. 1988;114:1413–6.
Kern M, Shaker R, Arndorfer R, Hofmann C. The effect of aging on the cross sectional area of upper esophageal sphincter (UES) opening during swallowing. Gastroenterology. 1994;106:A613.
Shaw DW, Cook IJ, Gabb M, Holloway RH, Simula ME, Panagopoulos V, Dent J. Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing. Am J Physiol. 1995;31:G389–96.
Easterling C, Kern M, Nitschke T, Grande B, Daniels S, Cullen GM, Massey BT, Shaker R. Effect of a novel exercise on swallow function and biomechanics in tube fed cervical dysphagia patients: a preliminary report. Dysphagia. 1999;14:119.
Alfonso M, Ferdjallah M, Shaker R, Wertsch JJ. Electrophysiologic validation of deglutitive UES opening head lift exercise. Gastroenterology. 1998;114:G2942.
Jurell KC, Shaker R, Mazur A, Haig AJ, Wertsch JJ. Spectral analysis to evaluate hyoid muscles involvement in neck exercise. Muscle Nerve. 1996;19:1224.
Jurell KC, Shaker R, Mazur A, Haig AJ, Wertsch JJ. Effect of exercise on upper esophageal sphincter opening muscles: a spectral analysis. Gastroenterology. 1997;112:A757.
Ferdjallah M, Wertsch JJ, Shaker R. Spectral analysis of surface electromyography (EMG) of upper esophageal sphincter opening muscles during head lift exercise. J Rehabil Res Dev. 2000;37:335–40.
Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol. 1991;260:G450–6.
Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–21.
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Easterling, C., Shaker, R. (2013). UES Opening Muscle Dysfunction. In: Shaker, R., Belafsky, P., Postma, G., Easterling, C. (eds) Principles of Deglutition. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3794-9_38
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DOI: https://doi.org/10.1007/978-1-4614-3794-9_38
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