By Gulchin A. Ergun, Peter J. Kahrilas (auth.), Roy C. Orlando MD (eds.)
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B, The soft palate is now elevated toward the tip of the scope, and the superior constrictors are adducted toward the midline. These two events have sealed the nasopharynx during a swallow. The opening of the eustachian tubes is seen bilaterally. C, With the endoscope just entering the proximal region of the nasopharynx, the posterior pharyngeal wall is seen at 6 o'clock, the soft palate and uvula are visible at 12 o'clock, and the lateral pharyngeal wall is seen bilaterally. The lateral diameter of the pharynx is significantly larger than its anteroposterior diameter.
G,H, Examples of electro myographic recordings from the mylohyoid-geniohyoid muscle group (MH), inferior pharyngeal constrictor (I C), and CP muscle for a healthy patient (panel G) and a patient with CP achalasia (panel H) during dry swallow. (continued on next page) FIGURE sw MH l IC CP 2 0 H 3 4 5 Time, s 2-14. CONTINUED Note that the MH and IC do not exhibit any tone before swallowing, whereas the CP muscle maintains a basal tone during resting. In the normal control subject, swallowing results in transient inhibition of CP tone, myoelectrical activity of the MH group, and the inferior constrictors.
A, Normal larynx. Note the lack of interarytenoid edema, secretions, and erythema. B, Laryngopharyngeal reflux disease. Interarytenoid edema is seen, with thick secretions over the vocal folds and loss of vascular markings. C, Reinke's edema. This condition denotes mucoid, gelatinous fluid in the superficial layer of the lamina propria (Reinke's space). Note the associated interarytenoid edema and erythema, as well as the obliteration of mucosal vascularity by the edema. Reinke's edema is commonly associated with cigarette smoking, voice abuse, and SEGERD; it may also be associated with hypothyroidism.
Atlas of Esophageal Diseases by Gulchin A. Ergun, Peter J. Kahrilas (auth.), Roy C. Orlando MD (eds.)