Autor: Dr. Roberto O. Dantas (SP)
Pharyngeal Swallowing Pressures in the Base-of-Tongue and Hypopharynx Regions Identified With Three-Dimensional Manometry
Pressões faringeas deglutitivas em regiões de base de lingua e hipofaringe identificadas pela manometria tri dimensional.
Sarah P. Rosen, Corinne A. Jones, Timothy M. McCulloch.
Laryngoscope. 2017 Feb 19. Doi: 10.1002/lary.26483.
Objectives: This study aims to use three-dimensional (3D) high-resolution manometry to identify circumferential pressure patterns generated within the asymmetrical base-of-tongue and hypopharynx regions of the pharynx during deglutition.
Study Design: Case series.
Methods: Radial pressures in the regions of interest were evaluated during swallowing events in 12 healthy subjects using 3D high-resolution manometry.
Results: Repeated measures analysis of variance revealed asymmetrical pharyngeal clearance pressures in the base of tongue and hypopharynx regions during swallowing. A significant main effect of direction on pressure was found at the time point of average maximum pressure (P < 0.001) and for pressure integral (P < 0.001), with pressure primarily generated from the posterior direction. An interaction was noted between direction and location when comparing maximum directional pressures, regardless of time (P 50.045), highlighting the differences in anterior pressure production between regions. In contrast to the high posterior pressures produced in the base-of-tongue region, an anteroposterior dominant pressure pattern was observed in the hypopharynx. Pressure waveform complexity in the hypopharynx also is likely attributed to activity in the anterior and posterior directions. Symmetrical pressure generation was observed during intrabolus flow within the hypopharynx.
Conclusion: This study shows that pressure is asymmetrically generated in the base-of-tongue and hypopharynx regions during swallowing of a 10-mL bolus, reflecting the complex anatomy within the pharynx. Understanding of these complex pressure patterns aids in the interpretation of high-resolution manometry and can help guide further study in the clinical assessment and treatment of pharyngeal pathology.
A importância da utilização da manometria de alta resolução na avaliação da motilidade do esôfago já esta demonstrada. Neste trabalho os autores demonstram que também para a faringe este método trás resultados importantes e novos conhecimento da motilidade da faringe. A motilidade da faringe não é tão conhecida quanto a motilidade do esôfago. O método de alta resolução supera as dificuldades até então encontradas, e tende a ser indispensável em futuras avaliações de pacientes com disfagia orofaríngea e manifestações supraesofágicas de refluxo gastroesofágico.