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AGA technical review on management of oropharyngeal dysphagia
Ian J. Cook, Peter J. Kahrilas Gastroenterology Volume 116, Issue 2, Pages (February 1999) DOI: /S (99) Copyright © 1999 American Gastroenterological Association Terms and Conditions
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Fig. 1 Sagittal view of the pharynx. At rest, the nasopharynx is in continuity with the oropharyx and the hypopharynx communicates freely with the trachea. Note that the esophagus is collapsed and closed, with the UES situated posterior to the cricoid cartilage. Gastroenterology , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions
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Fig. 2 The oropharyngeal swallow as imaged by videofluoroscopy and reconstructed in three dimensions with computer graphics. From left to right, each horizontally arranged group of images contains the three-dimensional reconstruction of the pharyngeal cavity and surrounding structures, the lateral radiographic appearance of the pharynx during a 10-mL barium swallow, the corresponding posterior-anterior radiographic appearance, and a magnified view of the hypopharynx at the time indicated at the left. Time 0.00 is the instant of UES opening; the entire sequence of events transpires within 1 second. The metal sphere under the chin is used to correlate among images. In the magnified hypopharyngeal reconstructions, 1 is the epiglottis, 2 is the laryngeal vestibule, 3 is the arytenoid cartilage, 4 is the esophagus, and 4' is the pyriform sinus after closure of the UES. Note the importance of laryngeal elevation during the pharyngeal reconfiguration and synchrony of UES opening with laryngeal vestibule closure. Gastroenterology , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions
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Fig. 3 Time line showing volume-induced modifications in the timing of events within the pharyngeal swallow. Each horizontal bar depicts the period during which one of the oropharyngeal valves is in a swallowing configuration as opposed to a respiratory configuration. Events at the onset and offset of pharyngeal reconfiguration bear a fixed time relationship to each other, regardless of swallow bolus volume. The stereotypy of these phases is demonstrated by referencing of onset events from time 0 counting forward and of offset events from time 0' counting forward or backward. This timing scheme defines the volume-dependent middle portion of the time line (black), which has a value of 0 for 1-mL swallows and 0.2 seconds for 20-mL swallows. Reprinted with permission.27 Gastroenterology , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions
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