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Am J Physiol Gastrointest Liver Physiol (January 15, 2003). doi:10.1152/ajpgi.00395.2002
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Submitted on September 12, 2002
Accepted on January 13, 2003

RELATIVE CONTRIBUTION OF VARIOUS AIRWAY PROTECTIVE MECHANISMS TO PREVENTION OF ASPIRATION DURING SWALLOWING

Bidyut K. Medda1, Mark Kern1, Junlong Ren1, Pengyan Xie2, Seckin O. Ulualp1, Ivan M. Lang1, and Reza Shaker1*

1 MCW Dysphagia Institute and Division of Gastroenterology and Hepatology, Departments of Medicine, Radiology and Otolaryngology and Human Communication Sciences, The Medical College of Wisconsin, Milwaukee, WI, USA
2 Department of Gastroenterology, Peking University First Hospital, Peking, China

* To whom correspondence should be addressed. E-mail: rshaker{at}mcw.edu.

Deglutitive airway protective mechanisms include glottal closure, epiglottal descent, and antero-superior displacement of the larynx. Aspiration of swallowed material may occur during pre-, intra- or post-pharyngeal 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. Following myotomy, superior excursions of the hyoid, thyroid and cricoid cartilages and antero-posterior diameter of maximum UES opening were significantly diminished, but incidence of pharyngeal residue increased significantly (P< 0.05). No aspiration was observed in the pre-deglutitive period. After myotomy the incidence of aspiration increased significantly in both intra- and post-deglutitive periods. Epiglottectomy did not alter aspiration incidence, but unilateral cordectomy resulted in 100% incidence of intra- and post-deglutitive aspiration. In conclusion, glottal closure constitutes the primary mechanism for prevention of intra- and post-deglutitive 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.







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