Anatomical Location of Cricopharyngeus in Patients with Swallowing Disorder / 中国康复理论与实践

Objective:To further clarify the location of cricopharyngeus in human body. Methods:From September, 2018 to December, 2019, 19 inpatients with swallowing disorders received video fluoroscopic swallowing study (VFSS).The videoes were used to measure the position of cricopharyngeus with Uniweb 4.0 software. Water model simulating the structure of an adult's neck was established to restore the real measurement scene, and obtain the scale ratio between the actual measurement and the computer measurement, then obtain the accurate actual position of the cricopharyngeus. Six adult specimens were dissected. The intersection point of the intended treatment plane and the long axis of cricopharyngeus was taken as the origin, the horizontal axis as X axis, and the sagittal axis as Y axis, to locate the position of cricopharyngeus precisely. Results:Cricopharyngeus was closest to the sixth cervical vertebra. The scaling ratio of the actual measurement obtained from the water model to the computer measurement was about 1∶1.340. The intended treatment plane was closest to the upper edge of the sixth cervical vertebra; on lateral edge of thyroid, cricopharyngeus was (33.47±2.21) mm deep to epidermis, with the angle of (43.37±1.34)° to sagittal axis; and it was (34.59±1.29) mm and (46.32±0.93)° on medial edge of internal jugular vein. Conclusion:The the accurate location of cricopharyngeus in human body has been measured, which can help for the rehabilitation for cricopharyngeal dysfunction.

Effect of electronic moxibustion on activity of parapharyngeal wall in patients with achalasia of cricopharyngeus muscle after stroke based on musculoskeletal ultrasound / 中国针灸

OBJECTIVE@#To observe the clinical effect of electronic moxibustion on dysphagia in patients with achalasia of cricopharyngeus muscle after stroke.@*METHODS@#Sixty patients with dysphagia of achalasia of cricopharyngeus muscle were randomly divided into an observation group and a control group, 30 cases in each group. One patient in the observation group and 2 cases in the control group dropped off. The patients in the control group were treated with routine medical treatment, acupuncture treatment and swallowing rehabilitation training; the patients in the observation group were additionally treated with electronic moxibustion at Lianquan (CV 23), Tiantu (CV 22), Tianding (LI 17) and Futu (LI 18), 30 min each treatment. Both groups were treated 5 times a week for 4 weeks. The musculoskeletal ultrasound (MSUS) was applied to test the activity of parapharyngeal wall and the dysphagia score of Ichiro Fujishima was compared before and after 4-week treatment.@*RESULTS@#After treatment, the activity of the parapharyngeal wall and the dysphagia score of Ichiro Fujishima were increased in both groups (<0.01, <0.05). The changes of activity of parapharyngeal wall and dysphagia score of Ichiro Fujishima in the observation group were greater than the control group (<0.05, <0.01).@*CONCLUSION@#Electronic moxibustion can improve the impaired swallowing function and reconstruct the normal swallowing process.

CT-guided Botulinum Toxin Injection into Cricopharyngeus for Dysphagia after True Bulbar Palsy: a Case Report / 中国康复理论与实践

Objective:To explore the effect of CT-guided Botulinum toxin injection into cricopharynx muscle on dysphagia caused by true bulbar palsy. Methods:A case of dysphagia caused by true bulbar palsy was treated with CT-guided Botulinum toxin injection and its therapeutic effect was reported. Results:The patient had dysphagia after brainstem infarction and was diagnosed as true bulbar palsy. After routine rehabilitation of dysphagia and balloon dilatation, her dysphagia relieved, but reappeared three times. Botulinum toxin was injected into the loop pharynx muscle under the guidance of CT, the clinical effect was remarkable, and no recurrence of the disease appeared in the follow-up. Conclusion:CT-guided Botulinum toxin injection into cricopharyngeus is effective on dysphagia caused by true medullary palsy, and the probability of recurrence is small.

Characteristics of Cricopharyngeal Dysphagia After Ischemic Stroke

OBJECTIVE: To evaluate the characteristics of cricopharyngeal dysfunction (CPD), the frequency, and correlation with a brain lesion in patients with first-ever ischemic stroke, and to provide basic data for developing a therapeutic protocol for dysphagia management. METHODS: We retrospectively reviewed the medical records of a series of subjects post-stroke who underwent a videofluoroscopic swallowing study (VFSS) from January 2009 to December 2015. VFSS images were recorded on videotape and analyzed. CPD was defined as the retention of more than 25% of residue in the pyriform sinus after swallowing. The location of the brain lesion was assessed using magnetic resonance imaging. RESULTS: Among the 262 dysphagic patients with first-ever ischemic stroke, 15 (5.7%) showed CPD on the VFSS. Patients with an infratentorial lesion had a significantly higher proportion of CPD than those with a supratentorial lesion (p=0.003), and lateral medullary infarction was identified as the single independent predictor of CPD (multivariable analysis: odds ratio=19.417; confidence interval, 5.560–67.804; p < 0.0001). Compared to patients without CPD, those with CPD had a significantly prolonged pharyngeal transit time, lower laryngeal elevation, and a higher pharyngeal constriction ratio and functional dysphagia scale score. CONCLUSION: Overall, the results support the notion that an impaired upper esopharyngeal opening is likely related to the specific locations of brain lesions. The association of CPD with lateral medullary infarction can be explained based on the regulation of the pharyngolaryngeal motor system by the motor neurons present in the dorsal nucleus ambiguus. Overall, the results reveal the relation between CPD and the problems in the pharyngeal phase as well as the severity of dysphagia.

Clinical Study on Tongue Acupuncture plus Balloon Dilatation for Deglutition Disorders Due to Achalasia of the Cricopharyngeus Muscle after Cerebral Stroke / 上海针灸杂志

Objective To observe the clinical efficacy of tongue acupuncture plus balloon dilatation in treating deglutition disorders due to achalasia of the cricopharyngeus muscle after cerebral stroke.Method Forty-eight patients with deglutition disorders due to achalasia of the cricopharyngeus muscle after cerebral stroke were randomized into a treatment group and a control group, 24 cases each. The two groups both received conventional rehabilitation training. In addition, the treatment group was given tongue acupuncture plus balloon dilatation, and the control group was by balloon dilatation alone. The two groups were treated once a day, for a total of 4 weeks. The water drinking test score and Standardized Swallowing Assessment (SSA) were evaluated before and after the treatment.Result The water drinking test and SSA scores were significantly changed after the intervention in both groups (P<0.05). After the treatment, the water drinking test and SSA scores in the treatment group were significantly different from those in the control group (P<0.05).Conclusion Tongue needling plus balloon dilatation is an effective approach in treating deglutition disorders due to achalasia of the cricopharyngeus muscle after cerebral stroke.

Effectiveness of Rehabilitative Balloon Swallowing Treatment on Upper Esophageal Sphincter Relaxation and Pharyngeal Motility for Neurogenic Dysphagia

OBJECTIVE: To investigate the relationship between dysphagia severity and opening of the upper esophageal sphincter (UES), and to assess the effect of balloon size on functional improvement after rehabilitative balloon swallowing treatment in patients with severe dysphagia with cricopharyngeus muscle dysfunction (CPD). METHODS: We reviewed videofluoroscopic swallowing studies (VFSS) conducted in the Department of Physical Medicine and Rehabilitation, Myongji Hospital from January through December in 2012. All subjects diagnosed with CPD by VFSS further swallowed a 16-Fr Foley catheter filled with barium sulfate suspension for three to five minutes. We measured the maximum diameter of the balloon that a patient could swallow into the esophagus and subsequently conducted a second VFSS. Then, we applied a statistical technique to correlate the balloon diameter with functional improvement after the balloon treatment. RESULTS: Among 283 inpatients who received VFSS, 21 subjects were diagnosed with CPD. It was observed that the degree of UES opening evaluated by swallowing a catheter balloon had inverse linear correlations with pharyngeal transit time and post-swallow pharyngeal remnant. Videofluoroscopy guided iterative balloon swallowing treatment for three to five minutes, significantly improved the swallowing ability in terms of pharyngeal transit time and pharyngeal remnant (p<0.005 and p<0.001, respectively). Correlation was seen between balloon size and reduction in pharyngeal remnants after balloon treatment (Pearson correlation coefficient R=-0.729, p<0.001), whereas there was no definite relationship between balloon size and improvement in pharyngeal transit time (R=-0.078, p=0.738). CONCLUSION: The maximum size of the balloon that a patient with CPD can swallow possibly indicates the maximum UES opening. The iterative balloon swallowing treatment is safe without the risk of aspiration, and it can be an effective technique to improve both pharyngeal motility and UES relaxation.

Treatment of Cricopharyngeal Dysphagia with Shaker's Head Lift Exercise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cricopharyngeal dysphagia refers to the dysfunction of the upper esophageal sphincter complex, which is composed of the cricopharyngeus, inferior pharyngeal constrictor and the upper segment of the cervical esophagus. Adequate relaxation of the cricopharyngeal muscle in conjunction with anterosuperior excursion of the larynx by suprahyoid muscles and propulsion of food bolus are prerequisite for normal swallow, mechanisms of which, if altered, may result in cricopharyngeal dysfunction. Head lift exercise, first described by Shaker, can be utilized in patients with cricopharyngeal dysphagia by strengthening the suprahyoid musculature and reducing the intrabolus pressure. The objective of this study was to introduce Shaker's head lift exercise in the treatment of cricopharyngeal dysphagia patients. SUBJECTS AND METHOD: Two patients suffering from cricopharyneal dysphagia after receiving skull base surgery were managed with Shaker's head lift exercise and the swallowing function was evaluated with videofluoroscopy. RESULTS: Both patients who had been taught how to perform head lift exercise showed improvement in swallowing function as observed with videofluoroscopy. Aspiration disappeared and both patients were able to take oral diet without the aid of gastrostomy tubes. CONCLUSION: Shaker's head lift exercise enabled oral feeding without aspiration in two patients. This demonstrates that Shaker's head lift exercise can be a promising noninvasive treatment modality in the treatment of cricopharyngeal dysphagia.

Quantitative Analysis of Myosin Heavy Chain (MHC) mRNA expression in Thyropharyngeus muscle and Cricopharyngeus muscle in Rats / 대한이비인후과학회지

BACKGROUNDS: The inferior pharyngeal constrictor muscle (IPC), which consists of the thyropharyngeus (TP) and cricopharyngeus (CP) muscles, plays an important role during deglutition, but their function is different when analysed by radiographic, manometric and electromyographic studies. OBJECTIVES AND MATERIALS: The purpose of this study is to quantify the expression levels of MHC mRNA isoforms (2B, 2X, 2A, 2L, beta-cardiac, neonatal and embryonic) in thyropharyngeus and cricopharyngeus muscles of rats using competitive PCR. RESULTS: The thyropharyngeus muscle was mainly consisted of three fast-twitching MHC isoforms, mostly 2X isoform (85.2%). On the other hand, the cricopharyngeus muscle contained two-third of fast-twitching isoforms(65.1%) and one-third of neonatal MHC(34.9%). CONCLUSIONS: The thyropharyngeus muscle could be characterized as a fast-twitching muscle and the cricopharyngeus muscle is probably considered as a sarcomeric regenerating muscle that is caused by frequently mechanical damage on deglutition.