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Sokol and associates studied simultaneous cineradiography and manometric activity of the pharynx and hypopharynx in asymptomatic subjects using continuous perfusion techniques.1 • At rest, the resting pressures in the pharyngeal cavity are equal to atmospheric pressure. In Figure 2-1 Segmental activation of the muscles forming the upper, middle, and lower pharyngeal constrictors. (From Doty, R.W., andBosma, J.F.: Electromyographic activity of pharyngeal muscles during swallowing. J. Neurophysiol., 19:44, 1956, with permission.)

Figure 2-2 Pharyngeal contraction. A powerful single-peak contraction is produced with a duration of 0.4 second. This wave progresses at a speed of 9 to 25 cm/sec. (DS, dry swallow.)

Figure 2-3 Relationship of the pharyngoesophageal high-pressure zone to the spine. (From Sokol, E.M., Hellmann, P., Wolf, B.S., et al.: Simultaneous cineradiography and manometric study of the pharynx, hypopharynx and cervical esophagus. Gastroenterology, 51:560, 1566, with permission.)

Figure 2-5 The high-pressure zone of the upper esophageal sphincter is caused by continuous active contraction of the cricopharyngeus muscle. (DS, dry swallow.)

Figure 2-4 Asymmetry of the upper esophageal sphincter. (A, anterior; L, left; LA, left anterior; LP, left posterior; P, posterior; R, right; RA, right anterior; RP, right posterior.) (From Winans, C.S.: Thepharyngoesophageal closure mechanism: A manometric study. Gastroenterology, 63:768, 1972, with permission.)

Figure 2-5 The high-pressure zone of the upper esophageal sphincter is caused by continuous active contraction of the cricopharyngeus muscle. (DS, dry swallow.)

n. During the rapid single contraction of the pharynx (13 cm), the high-pressure zone of the upper esophageal sphincter (18 cm) falls to ambient pressure. Passage of the contraction in the hypopharynx closes the sphincter, and the wave continues into the cervical esophagus (23 cm). (DS, dry swallow.)

Figure 2-7 Control mechanisms of the esophageal body and lower esophageal sphincter. A, Intrinsic nervous plexuses of the esophagus. B, Intrinsic and extrinsic innervation of the esophagus. (LES, lower esophageal sphincter.) (From Castell, D.O.: The Esophagus. Boston, Little, Brown, 1992, with permission.)

Figure 2-8 Esophageal contractions. The primary wave is a normal contraction in response to voluntary swallowing. Secondary waves are normal peristaltic contractions occurring in response to distention or irritation. Tertiary waves are nonpropulsive contractions; they occur spontaneously or in response to swallowing. (WS, wet swallow.)

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Constipation Prescription

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