Relative contribution of various airway protective mechanisms to prevention of aspiration during swallowing

Deglutitive airway protective mechanisms include glottal closure, epiglottal descent, and anterosuperior displacement of the larynx. Aspiration of swallowed material may occur during the pre-, intra-, or postpharyngeal phase of swallowing. Our objectives were to determine the relative contribution o...

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Bibliographic Details
Published in:American journal of physiology: Gastrointestinal and liver physiology 2003-06, Vol.284 (6), p.G933-G939
Main Authors: Medda, Bidyut K, Kern, Mark, Ren, Junlong, Xie, Pengyan, Ulualp, Seckin O, Lang, Ivan M, Shaker, Reza
Format: Article
Language:English
Subjects:
Animals
Cats
Cricoid Cartilage - physiology
Deglutition - physiology
Epiglottis - physiology
Epiglottis - surgery
Esophagus - diagnostic imaging
Esophagus - physiology
Female
Hyoid Bone - physiology
Inhalation - physiology
Male
Pharynx - physiology
Radiography
Thyroid Cartilage - physiology
Trachea - diagnostic imaging
Trachea - physiology
Vocal Cords - physiology
Vocal Cords - surgery
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Summary:Deglutitive airway protective mechanisms include glottal closure, epiglottal descent, and anterosuperior displacement of the larynx. Aspiration of swallowed material may occur during the pre-, intra-, or postpharyngeal phase of swallowing. Our objectives were to determine the relative contribution of the airway protective mechanisms during each phase of swallow in 14 decerebrated cats before and after suprahyoid myotomy, epiglottectomy, and unilateral cordectomy. After myotomy, superior excursions of the hyoid, thyroid, and cricoid cartilages and anteroposterior diameter of maximum upper esophageal spincter (UES) opening were significantly diminished, but the incidence of pharyngeal residue significantly increased (P < 0.05). No aspiration was observed in the predeglutitive period. After myotomy, the incidence of aspiration significantly increased in both intra- and postdeglutitive periods. Epiglottectomy did not alter aspiration incidence, but unilateral cordectomy resulted in a 100% incidence of intra- and postdeglutitive aspiration. In conclusion, glottal closure constitutes the primary mechanism for prevention of intra- and postdeglutitive aspiration, but laryngeal elevation may assist this function. Bolus pulsion without laryngeal distraction can open the UES, but at risk of aspiration due to decreased pharyngeal clearance. The epiglottis provides no apparent airway protection during any phase of swallowing.
ISSN:0193-1857
1522-1547
DOI:10.1152/ajpgi.00395.2002