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The proximal esophagus is predominantly striated muscle, while the distal esophagus and the remainder of the GI tract contain smooth muscle. A true Zenkers diverticulum may be confused with barium trapped above a cricopharyngeal muscle that has closed before the pharyngeal contraction wave has passed. Multiple co-morbidities at play it seems. Ive talked with team and parents both about aspiration risk and oral feeding aversion. The National Library of Medicine (NLM), on the NIH campus in Bethesda, Maryland, is the world's largest biomedical library and the developer of electronic information services that delivers data to millions of scientists, health professionals and members of the public around the globe, every day. The lingual tonsil is an aggregate of 30 to 100 follicles along the pharyngeal surface of the tongue, extending from the circumvallate papillae to the root of the epiglottis. [QxMD MEDLINE Link]. Brooks, L., Landry, A., Deshpande, A., Marchica, C., Cooley, A., & Raol, N. (2020). See the images below. Normal manometry results show normal esophageal body peristalsis with normal lower esophageal sphincter (LES) pressure and relaxation. Sato Y, Fukudo S. Gastrointestinal symptoms and disorders in patients with eating disorders. The typical picture of achalasia. government site. Circumferential webs appear as ringlike shelves in the cervical esophagus. Several older northern European series showed an association of cervical esophageal webs, iron deficiency anemia, and pharyngeal or esophageal carcinoma. list of sundown towns in new england; jeff mudgett wikipedia. Diagnostic pitfalls and how to avoid them. The coordination of these simultaneously contracting muscle layers produces the motility pattern known as peristalsis. Webs in the distal esophagus have been associated with gastroesophageal reflux disease. When small, the cysts are anterior to the sternocleidomastoid muscle. 1995 Jul;98(7):1154-63. doi: 10.3950/jibiinkoka.98.1154. Any change in the character of dysphagia or bloody discharge in a patient known to have Zenkers diverticulum should suggest a complication. Neck radiographs may show smooth enlargement of the epiglottis and aryepiglottic folds. Results via subsequent VFSS revealed significant improvement in base of tongue movement, pharyngeal pressure generation, and pharyngeal constriction, resulting in efficient movement of the bolus through the pharynx into the esophagus, no nasopharyngeal regurgitation, no aspiration, and near resolution of his pharyngeal dysphagia. When advanced, this condition can lead to such severe dysphagia that malnutrition, weight loss, and dehydration can develop. The loss of nerves along the esophageal body causes aperistalsis, leading to stasis of ingested food and subsequent dilation of the esophagus. Synonym (s): recessus pharyngeus [TA], recessus infundibuliformis, Rosenmller fossa, Rosenmller recess. Some cervical esophageal webs may also be associated with gastroesophageal reflux. With achalasia, the risk of squamous cell carcinoma of the esophagus is higher than that of the general population. [QxMD MEDLINE Link]. Laryngoceles are seen in patients with increased intralaryngeal pressure, such as glass blowers and wind instrument players. 8600 Rockville Pike Anteriorly, there is the larynx, epiglottis, and posterior part of the tongue. Genetics consult? 16-5 ). Pacifier dips in a secure swaddle elevated side lying position would allow for purposeful swallows and motor learning yet reduce risk for airway invasion, given that etiology is not fully clear. [QxMD MEDLINE Link]. The secondary motility disorders, such as scleroderma esophagus or esophageal motility disorder of diabetes, are better understood from the standpoint of the preexisting underlying disorders. Nasal regurgitation was observed during the initial double-contrast swallow. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. The underlying cause of all the primary motility disorders remains elusive. Tertiary contractions are simultaneous, isolated, dysfunctional contractions. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. 16-10 ). Future research should focus on identifying symptom profiles that could lead . [2]. With the partial ganglion cell loss in patients with achalasia, edrophonium (acetylcholine esterase inhibitor) increases LES pressure while atropine (muscarinic antagonist) decreases LES pressure. Barium studies allow detection of more than 95% of structural lesions below the pharyngoesophageal fold. Crit Rev Diagn Imaging 28:133179, 1988. 16-12 ). The LES pressure tracing is at the level of the sleeve (tracing 6). Please confirm that you would like to log out of Medscape. Initial results of diagnostic endoscopy may be negative. Low peristaltic amplitudes normally occur at the transition zone between the striated and smooth muscle portions; however, the peristalsis is uninterrupted. The incidence of esophageal dysmotility appears to increased in patients with spinal cord injury (SCI). The muscle is oriented in 2 perpendicular opposing layers: an inner circular layer and an outer longitudinal layer, known collectively as the muscularis propria. Int J Mol Sci. (From Levine MS, Rubesin SE: Radio-logic investigation of dysphagia. Achalasia manometry picture Note the nonrelaxing lower esophageal sphincter (LES) and the absence of esophageal body peristalsis. He also gets very constipated. On lateral radiographs, the base of the tongue may seem to protrude posteriorly. Transient or persistent protrusions of the anterolateral cervical esophagus into the Killian-Jamieson space are termed lateral cervical esophageal pouches or diverticula, respectively. J Stroke Cerebrovasc Dis. "When the results of the oropharyngeal exam and the esophagram were combined, esophageal stasis in isolation was the most common finding at all complaint locations, with the exception of patients who complained of stasis in the cervical and thoracic esophagus where the most common finding was no stasis." "Pharyngeal stasis in isolation . A barium examination can also be used to rule out a second primary lesion in the esophagus. Hypertrophy of the lingual tonsil frequently occurs after puberty, as a compensatory response after tonsillectomy, or as a nonspecific response to allergies or repeated infection. Barium is retained in the right and left lateral pharyngeal pouches (, Spot radiograph of the pharynx obtained with patient in a left posterior oblique position shows a thin, 1.5-cm barium-filled track (. The use of endoscopy and magnetic resonance imaging (MRI) may help exclude malignancy. Epub 2021 Feb 20. Muller M, Eckardt AJ, Gopel B, Eckardt VF. Muscles of the oral cavity, pharynx, and cervical esophagus are of the striated variety. Function Anatomy Conditions and Disorders Care Frequently Asked Questions Overview What is the pharynx? 16-14 ). On double-contrast frontal views in which a modified Valsalva maneuver is performed, the pouches are seen as hemispheric, barium-coated protrusions above the notch in the lateral pharyngeal wall. Radiographic findings in pharyngeal carcinoma. Primary esophageal motility disorders are idiopathic in nature, but postviral, infectious, environmental, and genetic factors have been hypothesized. Timing of events during deglutition after chemoradiation therapy for oropharyngeal carcinoma. endstream endobj 224 0 obj <> endobj 225 0 obj <> endobj 226 0 obj <>stream Dis Esophagus. Motility is preserved at the proximal striated muscle portion of the esophagus. However, tumor-like cysts of various histologic types are not uncommonly seen in the pharynx. Most patients with Killian-Jamieson diverticula are asymptomatic, but some may complain of dysphagia or regurgitation. Whether gastroesophageal reflux predisposes patients with a large Killian dehiscence to the formation of Zenkers diverticulum is unknown. 22(2):226-30. Occasionally, a deeply infiltrating, primarily submucosal lesion may be manifested by subtle asymmetric enlargement of the tongue base. Almost all patients (>95%) are moderate to heavy abusers of alcohol and tobacco or have a tumor related to herpes virus. Radiographic description of this phenomenon has been called presbyesophagus. Most patients with cervical esophageal webs are asymptomatic. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. X./X"spGO>'R3? Current clinical approach to achalasia. However, barium studies may reveal enlargement of the aryepiglottic fold with a smooth overlying mucosa. The incidence of achalasia is 1-3 case per 100,000 population per year. The upper anterolateral pharyngeal wall is poorly supported in the region of the posterior and superior portions of the thyrohyoid membrane. Velopharyngeal insufficiency (VPI) is when the soft palate does not close tightly against the back of the throat, leading to air coming out the nose (characterized by hypernasality and/or nasal air emission) during speech. coordinated stasis The idea, proposed in 1992 by Gordon Baird, that certain groups of species remain unaltered for tens of millions of years, then experience an episode of rapid extinction and the formation of new species. Other signs and symptoms include nasal obstruction, epistaxis, pain, headache, and damage to the fifth cranial nerve. I like to start with the whys to guide intervention options. The response to amyl nitrate (a smooth muscle relaxant), with partial relaxation of the lower esophageal sphincter (LES), allows some barium to pass through it into the stomach. Catherine Shaker Seminars: Formula One Style in Austin! Esophageal motility disorders are not uncommon in gastroenterology. Lymphoid hyperplasia of the base of the tongue. Lateral Pharyngeal Pouches and Diverticula, Branchial Cleft Cysts, Branchial Cleft Fistulas, and Branchial Pouch Sinuses, Lateral Cervical Esophageal Pouches and Diverticula, Lymphoid Hyperplasia of the Lingual and Palatine Tonsils, Surgery for Tongue and Oropharyngeal Cancers, Surgery for Zenkers Diverticulum and Pharyngeal Pouches. pharyngeal: [adjective] relating to or located or produced in the region of the pharynx. Cricopharyngeal dysfunction is most common in older adults. Esophagram of a 65-year-old man with rapid-onset dysphagia over 1 year. Radiographically, an exophytic lesion appears as a polypoid mass projecting into the oropharyngeal air space. Cervical nodal metastases are seen in one third to one half of patients. A referred earache may occur, especially when nasopharyngeal tumors block the eustachian tube. surefire led conversion head; bayou club houston membership fees. Barium may also be trapped above early closure of the upper cervical esophagus. 2010 Feb. 22(2):142-9, e46-7. Significant acid reflux might lead to disabling symptoms, caused by reflux or its complications. Reassurance is important in patients with spastic motility disorders, especially in the setting of noncardiac chest pain. 99>X5W0k|KkzvD7\Q{*{[Vs* @Lid{ EM>;"t1wDZ. Retention cyst at the base of the tongue. Among the anomalies seen in SCI patients weretype II achalasia (12%), type III achalasia (4%), esophagogastric junction outflow obstruction (20%), hypercontractile esophagus (4%), and peristaltic abnormalities (weak peristalsis with small or large defects or frequent failed peristalsis) (48%). Many nasopharyngeal squamous cell cancers are undifferentiated tumors, and many have a reactive lymphoid stroma. Abdullah Fayyad, MD, MBBS is a member of the following medical societies: American Gastroenterological AssociationDisclosure: Nothing to disclose. If it is not neurologic, could it be anatomic? The relationship between gastroesophageal reflux disease and Zenkers diverticulum is also controversial. 16-1 ). The pharynx is the site of common illnesses, including sore throat and tonsillitis. The degree of ganglion cell loss parallels the disease duration such that, at 10 years, ganglion cells are likely completely absent. At the LES, the loss of inhibitory nerves is demonstrated by loss of nitric oxide synthase and vasoactive intestinal peptide (VIP) immunohistochemistry staining. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. The pouches are usually bilateral. Benign cartilaginous tumors involving the pharynx (chondromas) usually arise from the posterior lamina of the cricoid cartilage. Ineffective esophageal motility (IEM): the old-new frontier in esophagology. [QxMD MEDLINE Link]. When decreased base of tongue movement, impaired pharyngeal pressure generation, and presence of pharyngeal residue are noted during a VFSS, a neurologic etiology can be suspected. Approximately 50% of patients develop cervical nodal metastases. Although acute epiglottitis usually affects children between 3 and 6 years of age, it occasionally causes severe stridor and sore throat in adults. Pharyngeal airway changes in Class III patients treated with double jaw orthognathic surgery-maxillary advancement and mandibular setback. [QxMD MEDLINE Link]. If unilateral, the diverticula are usually found on the left side of the proximal cervical esophagus. The clinical presentation of a motility disorder is varied, but, classically, dysphagia and chest pain are reported. An ulcerated lesion appears as an irregular barium collection disrupting the expected contour of the base of the tongue. Webs also should not be confused with a prominent cricopharyngeal muscle, which appears as a round, broad-based protrusion from the posterior pharyngeal wall at the level of the pharyngoesophageal segment. MeSH The webs protrude to various depths into the esophageal lumen. 16-11 ). Esophageal motility disorders are less common than mechanical and inflammatory diseases affecting the esophagus, such as reflux esophagitis, peptic strictures, and mucosal rings. 2009 Apr. Racial differences in the incidence of achalasia and other esophageal motility disorders have not been established. Diffuse residue, hard to quantify as it varied throughout the study, but definitely not a littleenough that poses a risk for aspiration post-swallow/as feeding continues. Hoarseness occurs primarily in patients with laryngeal carcinoma, supraglottic carcinoma, or carcinoma of the medial piriform sinus infiltrating the arytenoid cartilage or cricoarytenoid joint. External and internal laryngoceles do not fill with barium on pharyngograms. Outcomes of treatment for achalasia depend on manometric subtype. Dig Dis Sci. new hanover high school football roster; st mary's glacier camping colorado; espn 2025 basketball rankings; is february 11 2022 a federal holiday; janae from sweetie pies: new baby; lahat may hangganan quotes; The primary role is to clear the esophagus of retained food or any gastroesophageal refluxate. MRI brain? Small or predominantly submucosal lesions may be hidden in the valleculae or the recess between the tongue and tonsil (glossotonsillar recess). This barium, trapped between downwardly progressing pharyngeal contraction and the cricopharyngeal muscle, is termed a pseudo-Zenkers diverticulum ( Fig. [Full Text]. The pathophysiology of the primary esophageal motility disorders is poorly defined, with the exception of achalasia. Her paper is one I reference with neonatologists and intensivists when indicated. Before entertaining a diagnosis of a motility disorder, first and foremost, the physician must evaluate for a mechanical obstructing lesion. c)IG}$EolC9f/6y8xr|}uBQ^hJ\|J}01`c55# fX"cr4Fe"?zp8k$i?NrMqjnvVu^5TUfVrGMZWI/];^gAC]Hq$6)\~|ounXx2 f(E^4ikb Qh/#GH+;&*~7ka<2( \ In DES, muscular hypertrophy or hyperplasia has been described in the distal two thirds of the esophagus. What we know so far suggests a poor prognosis for being a full PO feeder at time of d/c from the NICU and the etiology(ies) is/are unlikely to resolve in the short term, given multiple complex co-morbidities, as yet not fully determined. Long-term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18-year single-centre experience. Ulcerative lesions may deeply penetrate the tongue and valleculae and invade the pre-epiglottic space ( Fig. The neck of the Zenkers diverticulum can be very broad during swallowing. The pathogenesis is not well documented, but chronic mucosal irritation is incriminated. The pharyngeal wall consists of overlapping superior middle and inferior constrictors on its posterior aspects and sides. The relationship between the mouth of the Zenkers diverticulum and prominent cricopharyngeus is demonstrated. o Can protude into pharynx and cause pharyngeal stasis. j=e,e)_E)g4Hv[IO^SiwLev`h-`` F b6 fAtXA k``eD*wd:PW0+ bQp2082a>7 :JF' {v on@d o=g 'AExrIcJ k Branchial pouch sinuses arise from the tonsillar fossa (second pouch), upper anterolateral piriform fossa (third pouch), or lower anterolateral piriform sinus (fourth pouch; Fig. With severe lymphoid hyperplasia of the base of the tongue, the nodules may extend into the valleculae, along the lingual surface of the epiglottis, or even into the upper hypopharynx. 110(7):967-77; quiz 978. Aryepiglottic fold nodules or mass lesions may cause dysphonia or respiratory symptoms such as stridor. Oropharyngeal dysphagia is a medical condition that causes a disruption or delay in swallowing. [2] In a study of12 patients with paraplegia (level of injury between T4-T12), 13 patients with tetraplegia (level of injury between C5-C7), and 14 able-bodied individuals, Radulovic et al found 21 of the 25 patients (84%) with SCI had at least one esophageal motility anomaly compared to 1 of 14 able-bodied subjects (7%). When I read your post with such clear clinical and radiologic presentation, the possible etiologies/questions that popped in my mind as I read your post were: hypotonia (constipation, lethargy, oral-motor disintegrity understood thus far; wonder about postural control and movement patterns, sensory-moor function include trunk and head/neck), extra esophageal reflux (nasal congestion, lax pharyngeal constrictors, perhaps postural hypotonia), poor posterior driving force of tongue (often correlated with hypotonia, poor pressure generation to help achieve UES relaxation and opening, posterior tongue tie and/or mandibular hypoplasia.seems at times ENTs miss that). Webs appear radiographically as 1- to 2-mm wide, shelflike filling defects along the anterior wall of the hypopharynx or cervical esophagus ( Fig. Could Intermittent Fasting Improve GERD Symptoms? This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis in the throat. These webs are thought to be normal variants in the valleculae and piriform sinuses. A combination of internal and external laryngocele is termed a mixed laryngocele. 16-7 ). Most of these tumors are keratinizing squamous cell carcinomas. 16-18 ). In addition, anxiety states may also play a role in some patients. Epub 2021 Feb 5. 2016 Apr 30. Dysphagia is the medical term for swallowing difficulties. A wide variety of benign tumors occur in the pharynx. These contractions are nonperistaltic, have no known physiologic role, and are observed with increased frequency in elderly people. A person with cricopharyngeal dysfunction may experience: a feeling of having something stuck in their throat difficulty swallowing. The 5-year survival rate varies from 76% for patients with localized tumors to 10% to 20% for patients with cervical lymph node metastases. 16-16 ). Anatomically, the circular muscle layer at the LES is thickened, but, microscopically, individual muscle cells are grossly normal. Rarely, pedunculated lesions (e.g., papillomas, lipomas, fibrovascular polyps) may be coughed up into the mouth or may cause sudden death through asphyxiation. The predominant neuropathologic process of achalasia involves the loss of ganglion cells from the wall of the esophagus, starting at the LES and developing proximally. Praveen K Roy, MD, MSc is a member of the following medical societies: Alaska State Medical Association, American Gastroenterological AssociationDisclosure: Nothing to disclose. Problem-Solving with Catherine: Adenoid Hypertrophy and Pediatric Dysphagia, Problem-Solving: New infant referral but limited experience, Problem-Solving with Catherine: 3-month-old with TEF and Vocal Cord Paralysis, Lifelong Learners Join Catherine in Houston, State-of-the-Art NICU Practice: Catherine Shaker and Suzanne Thoyre. He also has a high palate and often is nasally congested. [QxMD MEDLINE Link]. Carcinoma arises in less than 1% of patients with Zenkers diverticulum, but it is usually fatal. 18(7):[QxMD MEDLINE Link]. Inflammation-induced dysmotility may result in laryngeal penetration and stasis. A dynamic examination reveals a higher percentage of webs than spot images alone. Recent hearing test indicates possible sensorineural loss, but they want to re-do it. Manometry demonstrates diffuse esophageal spasm with simultaneous contractions of the esophagus observed throughout the tracing. Because such a strong association exists between head and neck squamous cell carcinoma and esophageal carcinoma, a major goal of a preoperative radiologic study is to rule out a synchronous primary esophageal cancer. The most common benign lesions are retention cysts of the valleculae or aryepiglottic folds. The motor learning from the pacifier dips would keep him learning but minimize risk. Some webs show inflammatory changes. Bethesda, MD 20894, Web Policies Clin J Gastroenterol. They include sore throat, dysphagia, and odynophagia. Abstract: Ankyloglossia, or tongue tie, and its impact on the oral phase of feeding has been studied and debated for decades. The complications of Zenkers diverticulum include bronchitis, bronchiectasis, lung abscess, diverticulitis, ulceration, fistula formation, and carcinoma. Philadelphia, WB Saunders, 1992. 16-4 ). Neurological disorders affecting oral, pharyngeal . Squamous cell carcinoma usually develops several years after the diagnosis of achalasia. The thyropharyngeal muscle arises from the lateral ala of the thyroid cartilage; it courses laterally and posteriorly to merge with its counterpart from the opposite side in a raphe in the posterior pharyngeal wall. When large, the cysts may extend posteriorly to the sternocleidomastoid muscle, displacing the carotid sheath. for stability and/or r/t tethered oral tissues, r/t mild mandibular hypoplasia). PMC At the time of diagnosis, the esophagus usually is dilated, and the tumor is advanced. With severe ulceration, amputation of the uvula and tip of the epiglottis may be observed radiographically. The quiet cry may suggest retracted tongue (? Gatto AR, Cola PC, da Silva RG, Ribeiro PW, Spadotto AA, Henry MAAC. anthony coaxum football coach; overflow shelter wichita, ks; what does the green leaf mean on parkrun results Neurogastroenterol Motil. Some diseases with diffuse mucous membrane ulceration affect the pharynx. During swallowing, Zenkers diverticulum appears as a posterior bulging of the lowermost hypopharyngeal wall above an anteriorly protruding pharyngoesophageal segment (cricopharyngeal muscle; Fig. Is there any particular intervention improving pharyngeal clearance with the swallow. This redundant mucosa has been termed the postcricoid defect and was previously attributed to a venous plexus in this region. Life expectancy is not affected, and weight loss is rare. Nasopharyngeal squamous cell carcinoma occurs at a relatively young age, with 20% of patients being younger than 30 years. If you log out, you will be required to enter your username and password the next time you visit. 2009 Aug. 54(8):1680-5. Future research should focus on identifying symptom profiles that could lead to targeted swallowing evaluations based on patient history and complaint. Am J Gastroenterol. The dysmorphic features stand out as worrisome, and often craniofacial and cardiac variants like an ASD can co-occur. Branchial pouch sinuses or fistulas are tracts that extend from the pharynx and end blindly in the soft tissues of the neck (sinus) or extend to the skin (fistulas). A lateral pharyngeal diverticulum is a protrusion of nonkeratinizing squamous mucosa originating in the pharynx. Muscle wall thickening has been described in patients who are asymptomatic and, conversely, has been absent in some patients with typical symptoms and manometric findings. We explored four different methods, namely, the visuoperceptual Would you like email updates of new search results? Nutcracker esophagus is the most common motility disorder (>40% of all motility disorders diagnosed), but it is the most controversial in significance. Other diseases of pharynx. Inability to swallow. cess. Barium studies of the pharynx are usually of limited value in patients with acute sore throat caused by viral, bacterial, or fungal infection. Neurological disorders aff Esophageal stasis was the most common finding regardless of complaint location. Reasons for the swallow study were bedside symptoms of desaturations during oral feeding at ~37 weeks PMA and a steady decline in his oral intake & feeding cues. 2013 Apr. World J Gastroenterol. The cause and clinical significance of webs are controversial. After swallowing, barium in the diverticulum is regurgitated into the hypopharynx. They should be well informed about its lifelong nature. 2012 Mar. A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry. Clinical and manometric course of nonspecific esophageal motility disorders. Manometry may reveal elevated LES pressure greater than 40 mm Hg in more than 60% of patients; however, hypertensive LES is not universal or required for the manometric diagnosis. Zenkers diverticulum is usually found in older patients who have dysphagia, regurgitation of undigested food, halitosis, choking, hoarseness, or a neck mass. The longitudinal muscle is responsible for shortening the esophagus, while the circular muscle forms lumen-occluding ring contractions. Esophageal motility disorders may occur as manifestations of systemic diseases, referred to as secondary motility disorders. Unable to load your collection due to an error, Unable to load your delegates due to an error. ASHA / Pharyngeal Phase Bolus. Esophageal stasis was the most common finding regardless of complaint location. Search google scholar for this article by my colleague and friend, Laura Brooks, which may or may not be pertinent, pending your further assessment and refection. This website also contains material copyrighted by 3rd parties. American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, American College of Physicians-American Society of Internal Medicine. Head Neck. Only rarely is a pedunculated polypoid lesion (e.g., papilloma, fibrovascular polyp) seen. Scintigraphy also had good sensitivity in detecting penetration and/or aspiration in VFS. persistent drooling of saliva. ASHA / What is a swallowing disorder? Signs and symptoms associated with dysphagia can include: Pain while swallowing. What causes VPI? The inferior constrictor muscle is composed of the thyropharyngeal and cricopharyngeal muscles. Although esophagram shows a typical picture of achalasia, this patient had adenocarcinoma of the gastroesophageal junction. 16-6 ). The risk factors, age of presentation, and histologic type are more varied than those of the typical squamous cell carcinoma of the oropharynx and hypopharynx. The measurements of premature pharyngeal entry, pharyngeal transit time, and postswallow pharyngeal stasis by scintigraphy were correlated with those of VFS. J Neurogastroenterol Motil. HU6?Q However, the postcricoid defect is probably related to redundancy of the mucosal and submucosal tissue in this area. Some patients are asymptomatic but present with a palpable neck mass. Nodules of tumor may spread to the palatine tonsil, valleculae, or pharyngoepiglottic fold. Branchial ridges (arches) lie between the branchial clefts. Cross-sectional imaging studies are the examinations of choice for showing spread of tumor into the submucosa, intrinsic muscles, tissues extrinsic to the pharynx, and regional lymph nodes. This work supports a comprehensive evaluation of both the . [QxMD MEDLINE Link]. Regardless of its underlying histologic characteristics, a benign pharyngeal tumor usually appears radiographically as a smooth, round, sharply circumscribed mass en face and as a hemispheric line with abrupt angulation in profile (see Figs. Possible complications, therapeutic options, expected outcomes, and dietary modifications should be explained. Sonnenberg A. being unable to chew food properly. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.