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Anatomical Variations in Stylopharyngeus Muscle Insertions Suggest Interindividual and Left/Right Differences in Pharyngeal Clearance Function of Elderly Patients: A Cadaveric Study

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Abstract

The stylopharyngeus plays a critical role in the clearance of the piriform recess. We dissected 78 sides of the pharynx from 55 donated cadavers and observed histology of another seven sides of the pharynx from seven cadavers. The stylopharyngeus consistently comprised (1) a descending muscle bundle surrounding the piriform recess and (2) an additional short sheet inserting into the tonsillar bed. Histologically, the former bundle connected to a thick fascia providing the lateral glossoepiglottic fold, extending along the submucosa of the piriform recess, and covering the thyroid cartilage, whereas the latter sheet intermingled with other pharyngeal wall muscles at and near the tonsillar bed. Notably, in 44.4% of female specimens, the additional sheet occupied a greater proportion in cross section than the descending muscle bundle. Given the different directions, the additional sheet seemed to check clearance function of the descending bundle for the piriform recess. Thus, particularly in women, interindividual differences in pharyngeal clearance were likely to depend on whether the additional sheet is strong or weak. Chin down in combination with tilting and rotating the head may represent effective exercises of the stylopharyngeus that could compensate for the disadvantages of additional insertion.

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References

  1. Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in postdeglutition retention in the elderly. Dysphagia 1997;12:63–67.

    Article  PubMed  CAS  Google Scholar 

  2. Olson R, Castell J, Johnston B, Ekberg O, Castell DO. Combined videomanometric identification of abnormalities related to pharyngeal retention. Acad Radiol 1997;4:349–354.

    Article  Google Scholar 

  3. Smith CH, Logemann JA, Colangelo LA, Rademaker AW, Pauloski BR. Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia 1999;14:1–7.

    Article  PubMed  CAS  Google Scholar 

  4. Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, Oschatz E. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol 2002;178:393–398.

    PubMed  Google Scholar 

  5. Kahrilas PJ, Logemann JA. Pharyngeal structure and function. Dysphagia 1993;8:303–307.

    Article  PubMed  CAS  Google Scholar 

  6. Bannister L, Respiratory System. In: Williams PL, Editor. Gray’s Anatomy, 39th ed. London: Churchill & Livingstone, 1995, pp 1627–1682.

  7. Netter FH. Atlas of Human Anatomy, 4th ed. Oxford: Saunders, 2006, p 63.

    Google Scholar 

  8. Seta H, Inada H, Abo M, Sugimoto A, Miyano S. Upper esophageal imaging patterns by videofluoroscopic examination in the anterior-posterior planes: laterality of pharyngoesophageal segment flow. Jpn J Rehabil Med 2004;5:307–312.

    Google Scholar 

  9. Ohkuma R, Fujishima I, Takehara I, Ishii M, Miyono S. Transmucosal surface electromyography of cricopharyngeal muscle using a catheter electrode. Jpn J Rehabil Med 1999;6:410–414.

    Google Scholar 

  10. Masuda Y. Clinical and immunological study of IgA nephropathy before and after tonsillectomy. Acta Otolaryngol (Stockh) Suppl 1988;45:248–255.

    Article  Google Scholar 

  11. Shimada L, Gasser RF. Variations of the pharyngeal raphe. Clin Anat 1988;1:285–294.

    Article  Google Scholar 

  12. Todd TW, Fowler RH. The muscular relationships of the tonsil. Am J Anat 1927;40:355–371.

    Article  Google Scholar 

  13. Moore KL. Clinical Oriented Anatomy, 2nd ed. Baltimore: Williams & Wilkins, 1980, pp 1036–1047.

    Google Scholar 

  14. Hollinshead WH. Anatomy for Surgeons, vol 1, 3rd ed. Philadelphia: Harper & Row, 1982, pp 394–400.

    Google Scholar 

  15. Beasley P. Anatomy of the pharynx and oesophagus. In: Wright D, Editor. Scott-Brown’s Otolaryngology, vol 1, 5th ed. London: Butterworths, 1987, pp 252–271.

    Google Scholar 

  16. Ohtsuka K, Tomita H, Murakami G. Anatomy of the tonsillar bed: topographical relationship between the palatine tonsil and the lingual branch of the glossopharyngeal nerve. Acta Otolaryngol Suppl 2002;546:99–109.

    Article  PubMed  Google Scholar 

  17. Ekberg O. Posture of the head and pharyngeal swallowing. Acta Radiol Diagn (Stockh) 1986;6:691–696.

    Google Scholar 

  18. Logemann JA, Kahrilas PJ, Kobara M, Vakil NB. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil 1989;70:767–771.

    PubMed  CAS  Google Scholar 

  19. Logemann JA. The role of exercise programs for dysphagia patients. Dysphagia 2005;20:139–140.

    Article  PubMed  Google Scholar 

  20. Welch MV, Logemann JA, Rademaker AW, Kahrilas PJ. Changes in pharyngeal dimensions effected by chin tuck. Arch Phys Med Rehabil 1993;74:178–181.

    PubMed  CAS  Google Scholar 

  21. Shanahan TK, Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Chin-down posture effect on aspiration in dysphagic patients. Arch Phys Med Rehabil 1993;74:736–739.

    Article  PubMed  CAS  Google Scholar 

  22. Shaker R, Kern M, Bardan E, Taylor A, Stewart ET, Hoffmann RG. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol 1997;272:G1518–G1522.

    PubMed  CAS  Google Scholar 

  23. Ertekin C, Keskin A, Kiylioglu N, Kirazli Y, On AY, Tarlaci S, Aydogdu I. The effect of head and neck positions on oropharyngeal swallowing: A clinical and electrophysiologic study. Arch Phys Med Rehabil 2001;82:1255–1260.

    Article  PubMed  CAS  Google Scholar 

  24. Lewin JS, Hebert TM, Putnam JB Jr, DuBrow RA. Experience with the chin tuck maneuver in postesophagectomy aspirators. Dysphagia 2001;16:216–219.

    Article  PubMed  CAS  Google Scholar 

  25. Büllow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia 2001;16:190–195.

    Article  Google Scholar 

  26. Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and maintaining isometric and isokinetic goals of the Shaker exercise. Dysphagia 2005;20:133–138.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to Professor Toshihiko Yajima, Department of Oral Anatomy, Health Science University of Hokkaido; Professor Shigemitsu Yoshida, Department of Oral Anatomy, Hokkaido University School of Dentistry; and Professor Shigetaka Yoshida, Department of Anatomy, Asahikawa Medical University School of Medicine, for their permission to use their materials.

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Authors and Affiliations

  1. Department of Physiotherapy, Bunkyo University School of Human Science, 196-1 Kogane-cho, Eniwa, Hokkaido, 061-1408, Japan

    Han Meng & Shigenori Miyamoto

  2. Division of Internal Medicine and Rehabilitation, Iwamizawa Kojinkai Hospital, 297-13 Shibunncho, Iwamizawa, Hokkaido, 068–0833, Japan

    Gen Murakami

  3. Department of Anatomy, Sapporo Medical University, School of Medicine, South 1 West 17, Chuo-ku, Sapporo, Hokkaido, 060–8557, Japan

    Daisuke Suzuki

Authors
  1. Han Meng
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  2. Gen Murakami
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  3. Daisuke Suzuki
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  4. Shigenori Miyamoto
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Corresponding author

Correspondence to Daisuke Suzuki.

Additional information

This work was performed at the Department of Anatomy, Sapporo Medical University, School of Medicine, Sapporo, Japan.

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Meng, H., Murakami, G., Suzuki, D. et al. Anatomical Variations in Stylopharyngeus Muscle Insertions Suggest Interindividual and Left/Right Differences in Pharyngeal Clearance Function of Elderly Patients: A Cadaveric Study. Dysphagia 23, 251–257 (2008). https://doi.org/10.1007/s00455-007-9131-2

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  • DOI: https://doi.org/10.1007/s00455-007-9131-2

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