Upper esophageal Sphincter

Question 1

What is the upper esophageal sphincter also known as?

Answer 1

Pharyngeal esophageal segment pharyngeal esophageal junction

Question 2

What is the primary muscle of the UES?

Answer 2

Cricopharyngeus (lower inferior pharyngeal constrictor & superior cuff of esophageal muscle) Cranial nerve 10

Question 3

What allows the UES muscles to relax?

Answer 3

Inhibition of cranial nerve 10

Question 4

What causes the UES to stretch open?

Answer 4

D/t the relationship between the cricoid cartilage & the cricopharyngeus muscle—when laryngeal excursion occurs the attached cricopharyngeus also stretches.

Question 5

Does Mendelssohn help w/ UES opening?

Answer 5

Yes, because by 100 mm traction from the larynx

Question 6

Is it a sphincter?

Answer 6

No, it’s not an anus. It’s a segment- ant is cricoid - not a full ring of muscle.

Question 7

How does UES open?

Answer 7

First inhibit 10 nerve -/relaxation- closed w/ not used- burp vibrates against closed tissue.

Then we want to stretch it
Cricopharyngeus traction- stretch

Duration changes with bolus types

Over emphasis on hyoid bone. It’s the cricoid. 1992 paper causes misinformation hyoid does not cause ues stretching- it just happens at the same time.

Question 8

Best tool?

Answer 8

Modified- can’t see extent of UES opening

Question 9

Physiology/Treatment?

Answer 9

Botox, dilatation d/t inhibition. Laryngeal elevation not often the cause of poor UES opening—

dependent on sensory integration issue.

Duration of opening is most sensitive to bolus type variations 3, 10, 30 ml. Like an automatic sliding door. Oral cavity- is this a big bolus- meta cognitive processing can that help?

Spontaneous recovery— needs to practice thin liquids, ice chips.

Brain derived neurotrophic factor: Lots of environmental experiences needed for error correction