1. Dysphagia : Swallowing disorders Professor Magdy Amin RIAD ENT Department Ain shams university

2. Dysphagia : associated symptoms Feeling of lump in throat. Hoarsness of voice. Weight loss. Regurgitation of food. Heartburns or indigestion. Neck mass. Aspiration. Stridor. Cough Oral bleeding Ear pain

3. The Pharynx: Anatomy Continues caudally as the oesophagus. Develops from endodermal lining of the foregut. Fibro muscular tube. Extends from the skull base to cricoid cartilage

4. The Pharynx: Anatomy The Pharyng-oesphageal junction is located about 15 cm from incisors. This junction corresponds to the level of cricopharyngeus sphincter. This is the narrowest and least dilatable part of the alimentary tract (common site for F.B.)

5. The pharynx: functional parts The pharynx opens anteriorly into the nose, the mouth and the larynx. This functionally divides the larynx into 3 parts: 1.Nasopharynx 2.Oropharynx 3.Hypopharynx (Laryngophaynx )

6. The pharynx: functional parts 1.Nasopharynx Opens anteriorly into the nose Above the level of soft palate 1.Oropharynx Opens anteriorly into the oral cavity Below the level of soft palate Above the level of hyoid bone 1.Hypopharynx (Laryngophaynx ) Communicates anteriorly with the larynx Below the level of hyoid Above the level of cricoid cartilage

7. The Pharynx: nerve supply Sensory Motor secretomotor

8. The Pharynx: nerve supply Sensory The pharyngeal branch of sphenopalatine ganglion. The superior laryngeal nerve Motor secretomotor

9. The Pharynx : Lymphatic drainage Upper part of the pharynx Drains to retropharyngeal lymph nodes Lower part of the pharynx Drains to the deep cervical lymph nodes

10. The Pharynx: Histology The pharynx is a fibromuscular tube. The pharyngeal wall has 4 layers. Areolar layer Muscular layer Fibrous layer Mucosal layer

11. The Pharynx: Histology Areolar layer contains the pharyngeal plexus of veins and nerves. Muscular layer Outer circular layer: superior,middle and inferior constrictors Inner longitudinal layer : stylopharyngeus and palatopharyngeus

12. The Pharynx: Histology Fibrous layer The pharyngobasilar fascia, attaches the pharynx to the skull base (medial pterygoid plate, basi-occiput and petrous bone ) Mucosal layer Respiratory epithelium (pseudo stratified columnar ciliated) in PNS Stratified non-keratinizing squamous epithelium for Oropharynx and Hypopharynx.

13. Dysphagia: aetiology Oral disorders Pharyngeal disorders. Oesophageal disorders. CNS disorders / neuromuscular disorders.

14. Dysphagia: clinical features Onset /duration /course Sudden onset F.B Ingestion of caustics CNS lesions caused by vascular incidents

15. Dysphagia: clinical features Acute onset Inflammatory lesions Oropharyngeal ulceration

16. Dysphagia: clinical features Gradual onset Commonest presentation Intrinsic lesions (e.g. tumours, strictures)

17. Dysphagia: clinical features Extrinsic lesions ( e.g. goitre, aortic aneurysm, lymph nodes ) Neuromuscular disorders (e.g. Motor neurone disease, multiple sclerosis, myathenia gravis) Systemic causes (e.g. scleroderma ) Psychosomatic ( e.g. globus pharyngeus )

18. Dysphagia: clinical features Clinical course Regressive Stationary Progressive Intermittent

19. Dysphagia : associated symptoms Feeling of lump in throat. Pharyngo-oesophageal lesions Usually prior to food sticking an dtrue dysphagia Hoarsness of voice. Weight loss. Regurgitation of food. Heartburns or indigestion.

20. Dysphagia : associated symptoms Neck mass. Aspiration. Stridor. Cough Oral bleeding Ear pain