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====== Anatomic facts of pharynx and esophagus: ======
====== Anatomic facts of pharynx and esophagus: ======
* [[Pharynx]] is divided in to into three sections: the [[nasopharynx]], the [[oropharynx]] and the laryngopharynx. [[Odynophagia]] is due to painful stimuli of orophyranx and laryngopharynx.<ref name="pmid9104871">{{cite journal| author=Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T| title=Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. | journal=J Appl Physiol (1985) | year= 1997 | volume= 82 | issue= 4 | pages= 1319-26 | pmid=9104871 | doi=10.1152/jappl.1997.82.4.1319 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9104871  }}</ref>  
* [[Pharynx]] is partitioned  as  the [[nasopharynx]], the [[oropharynx]] and the laryngopharynx. [[Odynophagia]] is outcome of pain sensed in orophyranx and laryngopharynx.<ref name="pmid9104871">{{cite journal| author=Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T| title=Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. | journal=J Appl Physiol (1985) | year= 1997 | volume= 82 | issue= 4 | pages= 1319-26 | pmid=9104871 | doi=10.1152/jappl.1997.82.4.1319 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9104871  }}</ref>  
* The oropharynx lies behind the oral cavity, extending from the uvula to the level of the hyoid bone. It opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the palatoglossal arch and the palatopharyngeal arch, is the palatine tonsil. 
* The oropharynx starts from the uvula ends at hyoid bone. Anteriorly, through isthmus faucium,opens into the mouth, latterly it has  the palatine tonsil. 
* The oropharynx is lined by non-keratinised squamous stratified epithelium.<ref name="pmid29331210">{{cite journal| author=Schubert FR, Singh AJ, Afoyalan O, Kioussi C, Dietrich S| title=To roll the eyes and snap a bite - function, development and evolution of craniofacial muscles. | journal=Semin Cell Dev Biol | year= 2018 | volume=  | issue=  | pages=  | pmid=29331210 | doi=10.1016/j.semcdb.2017.12.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29331210  }} </ref>
* It is lined with non-keratinised squamous stratified epithelium.<ref name="pmid29331210">{{cite journal| author=Schubert FR, Singh AJ, Afoyalan O, Kioussi C, Dietrich S| title=To roll the eyes and snap a bite - function, development and evolution of craniofacial muscles. | journal=Semin Cell Dev Biol | year= 2018 | volume=  | issue=  | pages=  | pmid=29331210 | doi=10.1016/j.semcdb.2017.12.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29331210  }} </ref>
* The laryngopharynx, (Latin: ''pars laryngea pharyngis''), also known as '''hypopharynx''', is the caudal part of pharynx; it is the part of the throat that connects to the esophagus.
* The laryngopharynx aka '''hypopharynx''', is on rare end.
* The mucosa of the larynx is supplied on each side chiefly by the internal laryngeal branch of the superior laryngeal nerve, which supplies the larynx as far down as the vocal folds. The inferior part of the larynx receives sensory fibers from the recurrent laryngeal nerve.
* Internal laryngeal branch of the superior laryngeal nerve, innervate larynx up to vocal folds. The recurrent laryngeal nerve innervate larynx inferoirly..<ref name="pmid29310398">{{cite journal| author=Li X, Wang Y, Wang F, Li B, Sun S, Yang H| title=An unusual case of oropharyngeal chordoma: A case report and literature review. | journal=Medicine (Baltimore) | year= 2017 | volume= 96 | issue= 48 | pages= e8963 | pmid=29310398 | doi=10.1097/MD.0000000000008963 | pmc=5728799 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29310398  }} </ref>
* The motor and most of the sensory supply to the pharynx is by way of the pharyngeal plexus, which, situated chiefly on the middle constrictor, is formed by the pharyngeal branches of the vagus and glossopharyngeal nerves and also by sympathetic nerve fibers.<ref name="pmid29310398">{{cite journal| author=Li X, Wang Y, Wang F, Li B, Sun S, Yang H| title=An unusual case of oropharyngeal chordoma: A case report and literature review. | journal=Medicine (Baltimore) | year= 2017 | volume= 96 | issue= 48 | pages= e8963 | pmid=29310398 | doi=10.1097/MD.0000000000008963 | pmc=5728799 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29310398  }} </ref>
* Vagus nerve supply all the muscles of the pharynx and soft palate except the two muscles.
* The motor fibers in the plexus are carried by the vagus (although they likely represent cranial accessory nerve components) and supply all the muscles of the pharynx and soft palate except the stylopharyngeus (supplied by cranial nerve IX) and tensor veli palatini (supplied by cranial nerve V).
* Stylopharyngeus receives innervation from cranial nerve IX
* The sensory fibers in the plexus are from the glossopharyngeal nerve, and they supply the greater portion of all three parts of the pharynx. <ref name="pmid29245445">{{cite journal| author=Negrete L, Brusa F| title=Increasing diversity of land planarians (Platyhelminthes: Geoplanidae) in the Interior Atlantic Forest with the description of two new species and new records from Argentina. | journal=Zootaxa | year= 2017 | volume= 4362 | issue= 1 | pages= 99-127 | pmid=29245445 | doi=10.11646/zootaxa.4362.1.5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29245445  }}</ref>
* Tensor veli palatini receives innervation from` cranial nerve V.
* The pharynx is supplied by branches of the external carotid (ascending pharyngeal) and subclavian (inferior thyroid) arteries.
* The glossopharyngeal nerve receive sensory input from greater portion of all three parts of the pharynx. <ref name="pmid29245445">{{cite journal| author=Negrete L, Brusa F| title=Increasing diversity of land planarians (Platyhelminthes: Geoplanidae) in the Interior Atlantic Forest with the description of two new species and new records from Argentina. | journal=Zootaxa | year= 2017 | volume= 4362 | issue= 1 | pages= 99-127 | pmid=29245445 | doi=10.11646/zootaxa.4362.1.5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29245445  }}</ref>
* The motor and most of the sensory supply to the pharynx is by way of the pharyngeal plexus.
* The Pharyngeal plexus is motor and sensory center of larynx.
* Pharyngeal plexus is formed by the pharyngeal branches of the vagus and glossopharyngeal nerves and also by sympathetic nerve fibers.
* Pharyngeal plexus consist of nerves from vagus and glossopharyngeal nerves and also by sympathetic nerve fibers.
* The motor fibers in the plexus are carried by the vagus (although they likely represent cranial accessory nerve components) and supply all the muscles of the pharynx and soft palate except the stylopharyngeus (supplied by cranial nerve IX) and tensor veli palatini (supplied by cranial nerve V).
* The esophagus has dual sensory innervation, from parasympathetic and sympathetic, which depends on location of level independently .<ref name="pmid29287649">{{cite journal| author=Irani SK, Oliver DR, Movahed R, Kim YI, Thiesen G, Kim KB| title=Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography. | journal=Am J Orthod Dentofacial Orthop | year= 2018 | volume= 153 | issue= 1 | pages= 46-53 | pmid=29287649 | doi=10.1016/j.ajodo.2017.05.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29287649  }}</ref>
* The sensory fibers in the plexus are from the glossopharyngeal nerve, and they supply the greater portion of all three parts of the pharynx. The pharynx is supplied by branches of the external carotid (ascending pharyngeal) and subclavian (inferior thyroid) arteries.<ref name="pmid29224765">{{cite journal| author=Lai D, Qin G, Pu J, Liu L, Yang Y| title=Pre- and post-operative application of acoustic rhinometry in children with otitis media with effusion and with or without adenoid hypertrophy-a retrospective analysis. | journal=Int J Pediatr Otorhinolaryngol | year= 2017 | volume= 103 | issue=  | pages= 51-54 | pmid=29224765 | doi=10.1016/j.ijporl.2017.10.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29224765  }}</ref>
* The esophagus, like the rest of the viscera, receives dual sensory innervation, traditionally referred to as parasympathetic and sympathetic, but more properly based on the actual nerves, vagal, and spinal.<ref name="pmid29287649">{{cite journal| author=Irani SK, Oliver DR, Movahed R, Kim YI, Thiesen G, Kim KB| title=Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography. | journal=Am J Orthod Dentofacial Orthop | year= 2018 | volume= 153 | issue= 1 | pages= 46-53 | pmid=29287649 | doi=10.1016/j.ajodo.2017.05.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29287649  }}</ref>


====== Pathological conditions causing pain in swallowing: ======
====== Pathological conditions causing pain in swallowing: ======
Infections:


==== Infections: ====
Infection of esophagus or pharynx causes fluid leaking in interstitial media  of mucous epithelium and it produce pressure on sensory nerve terminals situated in mucousa.<ref name="pmid29364802">{{cite journal| author=Salgado C, Garcia AM, Rúbio C, Cunha F| title=[Infectious Mononucleosis and Cholestatic Hepatitis: A Rare Association]. | journal=Acta Med Port | year= 2017 | volume= 30 | issue= 12 | pages= 886-888 | pmid=29364802 | doi=10.20344/amp.8715 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29364802  }}</ref>
Infection of esophagus or pharynx causes fluid leaking in interstitial media  of mucous epithelium and it produce pressure on sensory nerve terminals situated in mucousa.<ref name="pmid29364802">{{cite journal| author=Salgado C, Garcia AM, Rúbio C, Cunha F| title=[Infectious Mononucleosis and Cholestatic Hepatitis: A Rare Association]. | journal=Acta Med Port | year= 2017 | volume= 30 | issue= 12 | pages= 886-888 | pmid=29364802 | doi=10.20344/amp.8715 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29364802  }}</ref>


Tumors:
==== Tumors: ====
 
It produce pain due to compression effect of mass on sensory nerve terminals situated in mucousa.<ref name="pmid29372954">{{cite journal| author=Sheridan GA, Nusrath MA, Toner M, Stassen LF| title=Treatment Options for Amelobastic Carcinoma of the Mandible: A Case Series and Review of the Literature. | journal=Ir Med J | year= 2017 | volume= 110 | issue= 9 | pages= 639 | pmid=29372954 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29372954  }}</ref>
It produce pain due to compression effect of mass on sensory nerve terminals situated in mucousa.<ref name="pmid29372954">{{cite journal| author=Sheridan GA, Nusrath MA, Toner M, Stassen LF| title=Treatment Options for Amelobastic Carcinoma of the Mandible: A Case Series and Review of the Literature. | journal=Ir Med J | year= 2017 | volume= 110 | issue= 9 | pages= 639 | pmid=29372954 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29372954  }}</ref>


Foreign body:
==== Foreign body: ====
 
It produce pain due to compression effect of foreign body on sensory nerve terminals situated in mucousa.<ref name="pmid29372139">{{cite journal| author=Sclafani JA, Ross DI, Weeks BH, Yang M, Kim CW| title=Validity and reliability of a novel patient reported outcome tool to evaluate post-operative dysphagia, odynophagia, and voice (DOV) disability after anterior cervical procedures. | journal=Int J Spine Surg | year= 2017 | volume= 11 | issue=  | pages= 35 | pmid=29372139 | doi=10.14444/4035 | pmc=5779272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29372139  }}</ref>
It produce pain due to compression effect of foreign body on sensory nerve terminals situated in mucousa.<ref name="pmid29372139">{{cite journal| author=Sclafani JA, Ross DI, Weeks BH, Yang M, Kim CW| title=Validity and reliability of a novel patient reported outcome tool to evaluate post-operative dysphagia, odynophagia, and voice (DOV) disability after anterior cervical procedures. | journal=Int J Spine Surg | year= 2017 | volume= 11 | issue=  | pages= 35 | pmid=29372139 | doi=10.14444/4035 | pmc=5779272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29372139  }}</ref>


Revision as of 08:18, 2 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Odynophagia pathophysiology is related to causes.Following are common mechanisms involved in inducing pain in esophagus and pharynx

Anatomic facts of pharynx and esophagus:
  • Pharynx is partitioned as the nasopharynx, the oropharynx and the laryngopharynx. Odynophagia is outcome of pain sensed in orophyranx and laryngopharynx.[1]
  • The oropharynx starts from the uvula ends at hyoid bone. Anteriorly, through isthmus faucium,opens into the mouth, latterly it has the palatine tonsil. 
  • It is lined with non-keratinised squamous stratified epithelium.[2]
  • The laryngopharynx aka hypopharynx, is on rare end.
  • Internal laryngeal branch of the superior laryngeal nerve, innervate larynx up to vocal folds. The recurrent laryngeal nerve innervate larynx inferoirly..[3]
  • Vagus nerve supply all the muscles of the pharynx and soft palate except the two muscles.
  • Stylopharyngeus receives innervation from cranial nerve IX
  • Tensor veli palatini receives innervation from` cranial nerve V.
  • The glossopharyngeal nerve receive sensory input from greater portion of all three parts of the pharynx. [4]
  • The Pharyngeal plexus is motor and sensory center of larynx.
  • Pharyngeal plexus consist of nerves from vagus and glossopharyngeal nerves and also by sympathetic nerve fibers.
  • The esophagus has dual sensory innervation, from parasympathetic and sympathetic, which depends on location of level independently .[5]
Pathological conditions causing pain in swallowing:

Infections:

Infection of esophagus or pharynx causes fluid leaking in interstitial media of mucous epithelium and it produce pressure on sensory nerve terminals situated in mucousa.[6]

Tumors:

It produce pain due to compression effect of mass on sensory nerve terminals situated in mucousa.[7]

Foreign body:

It produce pain due to compression effect of foreign body on sensory nerve terminals situated in mucousa.[8]

References

  1. ↑ Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T (1997). "Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects". J Appl Physiol (1985). 82 (4): 1319–26. doi:10.1152/jappl.1997.82.4.1319. PMID 9104871.
  2. ↑ Schubert FR, Singh AJ, Afoyalan O, Kioussi C, Dietrich S (2018). "To roll the eyes and snap a bite - function, development and evolution of craniofacial muscles". Semin Cell Dev Biol. doi:10.1016/j.semcdb.2017.12.013. PMID 29331210.
  3. ↑ Li X, Wang Y, Wang F, Li B, Sun S, Yang H (2017). "An unusual case of oropharyngeal chordoma: A case report and literature review". Medicine (Baltimore). 96 (48): e8963. doi:10.1097/MD.0000000000008963. PMC 5728799. PMID 29310398.
  4. ↑ Negrete L, Brusa F (2017). "Increasing diversity of land planarians (Platyhelminthes: Geoplanidae) in the Interior Atlantic Forest with the description of two new species and new records from Argentina". Zootaxa. 4362 (1): 99–127. doi:10.11646/zootaxa.4362.1.5. PMID 29245445.
  5. ↑ Irani SK, Oliver DR, Movahed R, Kim YI, Thiesen G, Kim KB (2018). "Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography". Am J Orthod Dentofacial Orthop. 153 (1): 46–53. doi:10.1016/j.ajodo.2017.05.031. PMID 29287649.
  6. ↑ Salgado C, Garcia AM, Rúbio C, Cunha F (2017). "[Infectious Mononucleosis and Cholestatic Hepatitis: A Rare Association]". Acta Med Port. 30 (12): 886–888. doi:10.20344/amp.8715. PMID 29364802.
  7. ↑ Sheridan GA, Nusrath MA, Toner M, Stassen LF (2017). "Treatment Options for Amelobastic Carcinoma of the Mandible: A Case Series and Review of the Literature". Ir Med J. 110 (9): 639. PMID 29372954.
  8. ↑ Sclafani JA, Ross DI, Weeks BH, Yang M, Kim CW (2017). "Validity and reliability of a novel patient reported outcome tool to evaluate post-operative dysphagia, odynophagia, and voice (DOV) disability after anterior cervical procedures". Int J Spine Surg. 11: 35. doi:10.14444/4035. PMC 5779272. PMID 29372139.

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