Lymphatic drainage of the nasal fossae and nasopharynx: preliminary anatomical and radiological study with clinical implications

Background.

The lymphatic pathways of the nasal cavity are of enormous clinical importance. To date there has been no accurate radiographic record of these pathways.

Methods.

Four halves of the head and neck from 2 fresh human cadavers were studied.

Results.

The capillary network arises from the mucous membrane of the atrium, the turbinates, the floor of the nasal cavity, and the nasopharynx. They drain into the lateral pharyngeal and retropharyngeal lymph nodes. There is 1 lymphatic communication at the junction of the lateral posterior wall of the turbinates and the nasopharynx and another communication between 2 groups of lymph nodes situated between the origin of the facial artery and the bifurcation of the carotid artery.

Conclusions.

A rich avalvular lymph capillary network exists in the mucous membrane and 2 major lymph collecting vessels course through the parapharyngeal space to multiple first tier lymph nodes. © 2008 Wiley Periodicals, Inc. Head Neck, 2009     

A prospective study of tobacco and alcohol use as risk factors for pharyngeal carcinomas in Singapore Chinese

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare disease in most populations; however, in areas of Southeast Asia and North Africa and in the Arctic, undifferentiated NPC is the most frequent pharyngeal malignancy. Although smoking and alcohol have been established firmly as synergistic risk factors for other pharyngeal carcinomas, previous studies on the association between these risk factors and NPC have not been consistent. Therefore, the authors analyzed this relation in a cohort of Singapore Chinese, which is a population with a high incidence of NPC. METHODS: From 1993 to 1998, a population-based cohort of 61,320 Singapore Chinese ages 45 years to 74 years who were free of cancer completed a comprehensive interview on living conditions and dietary and lifestyle factors. By linkage to Singapore population-based registries, the cohort was followed through 2005, and cancer occurrence was determined. The relative risk of NPC and other oropharyngeal carcinomas in the cohort was investigated by using a Cox proportional hazards model. RESULTS: In total, 173 NPCs and 75 other oropharyngeal carcinomas were observed during 601,879 person-years of follow-up. Smoking for >40 years was associated with a doubled risk of NPC (relative risk, 2.0; 95% confidence interval, 1.2-3.3), whereas smoking intensity, age at smoking initiation, and alcohol consumption were not associated with NPC risk. In contrast, smoking duration, smoking intensity, age at smoking initiation, and alcohol consumption all were associated with an increased risk of other oropharyngeal carcinoma (P for trend, <.0001). CONCLUSIONS: Smoking and alcohol influenced the risk of NPC and other oropharyngeal carcinomas differently in a high-incidence NPC population. Long-term smoking was a risk factor for NPC, but alcohol consumption was not.     

Neuromuscular compartments and fiber‐type regionalization in the human inferior pharyngeal constrictor muscle

The inferior pharyngeal constrictor (IPC) muscle functions during swallowing, respiration, and vocalization. The most‐caudal portion of the IPC is believed to be part of the functional upper esophageal sphincter (UES). We hypothesized that the caudal fibers of the human IPC may have enzyme‐histochemical characteristics similar to those of the cricopharyngeus muscle, a major component of the UES. In this study, human IPC muscles obtained from autopsy were studied using Sihler's stain to examine innervation patterns, and using myofibrillar ATPase, NADH tetrazolium reductase (NADH‐TR), and succinic dehydrogenase (SDH) techniques to investigate the distribution and oxidative capacity of the slow‐ (type I) and fast‐ (type II) twitch fibers in the muscle. The results showed that the human IPC consists of at least two neuromuscular compartments (NMCs): rostral and caudal. Each of the NMCs was innervated by a separate nerve branch derived from the pharyngeal branch of the vagus nerve. The rostral NMC is faster (39% type I, 61% type II) than the caudal NMC (70% type I, 30% type II). In addition, two histochemically‐delineated fiber layers were identified in the human IPC: a slow inner layer (SIL) with predominantly type I fibers (66%), and a fast outer layer (FOL) with predominantly type II fibers (62%) (P < 0.01). However, the dimensions of both fiber layers and proportions of the muscle fiber types varied with the NMCs. Specifically, the ratio of the thickness of the SIL to FOL was ～2:1 for the caudal NMC and ～1:2 for the rostral NMC, respectively. In the SIL the type I fibers accounted for 84% for the caudal NMC and 69% and 44% for the lower and upper portions of the rostral NMC. In contrast, the type II fibers in the FOL accounted for 46% for the caudal NMC and 67% and 74% for the lower and upper portions of the rostral NMC, respectively (P < 0.01). The caudal NMC of the IPC shared histochemical characteristics with the cricopharyngeus muscle, in that it contained predominantly slow oxidative fibers. Overall, the caudal NMC and the SIL in the IPC had high NADH‐TR and SDH activities. However, different patterns of oxidative enzyme activity were identified in both type I and type II fibers. This study provided histochemical evidence for the concept that the caudal NMC within the IPC contributes to the functional UES. In addition, the two histochemically‐defined fiber layers in the IPC may be a specialized adaptation in humans to enable different upper‐airway functions during respiration, swallowing, and speech. Anat Rec 264:367–377, 2001. © 2001 Wiley‐Liss, Inc.     

从《伤寒论》太阳病篇谈咽干症的治法

《伤寒论》除了在少阴病篇有甘草汤、桔梗汤等专门治疗咽部疾病的专方之外,其他各篇均未单独对咽部疾病进行论述,通过对太阳病篇中涉及到咽部干燥症的条文的详细解读,来揭示其隐藏的关于咽干症的一系列治则和治法。     

Evidence for recurrent laryngeal nerve contribution in motor innervation of the human cricopharyngeal muscle.

OBJECTIVE: To study the functional motor nerve supply of the upper esophageal sphincter in humans. STUDY DESIGN: Intraoperative electromyographic study. METHODS: The contribution of the recurrent laryngeal nerve and the pharyngeal plexus in the motor nerve innervation of the cricopharyngeal muscle and the inferior pharyngeal constrictor muscle was examined intraoperatively. RESULTS: Electromyography showed that there is a considerable overlap in the innervation of the cricopharyngeal muscle and the inferior pharyngeal constrictor muscle. The recurrent laryngeal nerve functionally contributes to the motor innervation of the cricopharyngeal muscle in all patients and contributes to the motor innervation of the inferior pharyngeal constrictor muscle in most patients. The pharyngeal plexus functionally contributes to the motor innervation of the inferior pharyngeal constrictor muscle but does not always contribute to the motor innervation of the cricopharyngeal muscle. CONCLUSIONS: This is the first report which provides evidence that the recurrent laryngeal nerve functionally contributes to the motor innervation of the cricopharyngeal and inferior pharyngeal constrictor muscle. Furthermore, this study shows that intraoperative electromyography in humans is a feasible method to analyze the physiology of the motor innervation of the upper esophageal sphincter.     

下咽癌连续大切片的病理学观察

目的:探讨下咽癌不同类型与其浸润部位。方法:对7例下咽癌进行连续大切片,常规石蜡切片,HE、 Mallory三色染色法,光镜观察。结果:不同类型下咽癌浸润部位有一定差别。结论:对下咽癌浸润范围的 研究对于手术范围确定和保留喉功能非常重要。     

Aberrant Ascending Pharyngeal Artery Mimicking a Partially Occluded Internal Carotid Artery

Doppler sonography has become a primary imaging modality for the diagnosis of carotid arterial stenosis. Carotid stenting for a severely stenotic but not completely occluded carotid artery is becoming an alternative to carotid endarterectomy in selected groups of patients. The authors discuss a case of complete occlusion of the internal carotid artery associated with an ipsilateral aberrant ascending pharyngeal artery originating from the proximal internal carotid artery, which mimicked a stenotic internal carotid artery on sonography. Meticulous Doppler sonographic examination may provide clues for this extraordinary condition, yet angiography is indicated for a definite diagnosis.     

Tumours of the posterior pharyngeal wall: the use of the platysma flap

Posterior pharyngeal wall tumours are infrequent neoplasms with a very poor prognosis. The 5 year survival rate ranges from 3% to 32%. Most authors agree that the treatment of choice is surgery with post-operative radiotherapy. The results of treatment of 36 patients (tumour excision plus bilateral neck dissection and post-operative radiotherapy) in which the posterior pharyngeal wall defect was closed with a platysma myocutaneous flap were compared with other forms of repair (13 patients). The 5 year survival rate was 17.2% in the whole group. Laryngeal voice was achieved in 79% of patients having a platysma flap reconstruction. The platysma myocutaneous flap is very satisfactory for the repair of the posterior pharyngeal wall as it is easy to perform, it is oncologically safe and its functional results match well with other forms of reconstruction, with the advantage of laryngeal preservation.     

三种唇腭裂修复术对唇腭裂患者语音恢复影响研究

目的:探讨三种唇腭裂修复术对语音恢复的影响.方法:选择65例唇腭裂患者,随机分为反向双Z术组、咽后壁瓣成形术组、腭因肌瓣术组,观察吹水泡时间、软腭抬高角度α0、腭最高点与咽后壁的最短距离d(mm)、语音清晰.结果:三组患者术后吹水泡时间、软腭抬高角度α0、腭最高点与咽后壁的最短距离d(mm)、语音清晰度均明显优于术前(P＜0.05),组间比较无显著性特征(P＞0.05).结论:手术方式是恢复唇腭裂患者语音的最佳选择,三项检查是评价腭音闭合不全的有效手段.     

Bolus propulsive activity of the tongue in dysphagic cancer patients

Videofluoroscopic recordings were analyzed for liquid swallows in dysphagic patients with cancer involving the pharynx. Temporal measurements were made for the tongue stripping action in relation to velar and hyoid function. Dysphagic subjects as a group displayed an altered sequence of activity compared to normal controls, with the onset of stripping occurring after velar closure. Tongue stripping action and hyoid movement appeared to be time-locked to a greater extent than tongue stripping and velar closure. Duration of the stripping gesture was longer in dysphagic patients than in normal controls.