Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round

Authors

  • Daniel Cates MD,

    1. Department of Otolaryngology/Head and Neck Surgery, University of California Davis, Sacramento, California
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  • Emily K. Plowman PhD,

    1. Department of Communications Sciences and Disorders, University of South Florida, Tampa, Florida
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  • Omid Mehdizadeh MD,

    1. Department of Otolaryngology/Head and Neck Surgery, University of California Davis, Sacramento, California
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  • Kaicheng Yen MD,

    1. Department of Otolaryngology/Head and Neck Surgery, University of California Davis, Sacramento, California
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  • Amanda Domer MS,

    1. Department of Otolaryngology/Head and Neck Surgery, University of California Davis, Sacramento, California
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  • Michael Gilden,

    1. Columbia University, New York, New York
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    • Dr. Belafsky has submitted a provisional patent application for a kidney shaped esophageal dilator. Dr. Belafsky has had full access to all of the data in the investigation and takes full responsibility for the integrity of the data and accuracy of the data analysis.

  • Peter C. Belafsky MD, MPH, PhD

    Corresponding author
    1. Department of Otolaryngology/Head and Neck Surgery, University of California Davis, Sacramento, California
    2. University of California Davis School of Veterinary Medicine, Davis, California, U.S.A.
    • Center for Voice and Swallowing, Department of Otolaryngology Head and Neck Surgery, University of California, Davis School of Medicine, Department of Medicine and Epidemiology, University of California, Davis School of Veterinary Medicine, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817
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  • This work was funded by the University of California, Davis, Department of Otolaryngology/Head and Neck Surgery.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Dysfunction of the upper esophageal sphincter (UES) is a common cause of oral-pharyngeal dysphagia (OPD). Dilation is a primary treatment, although current techniques are subject to a high rate of failure and recurrence. Devices available for UES dilation are cylindrical and were designed to distend the round lumen of the esophagus. Our objective was to determine the cross-sectional dimension of the UES in an ovine model of OPD and compare it with that of the cervical esophagus.

Study Design:

Prospective cadaveric animal study.

Methods:

Three-dimensional casts of the upper aerodigestive tract of 10 fresh cadaveric ewes were constructed using a platinum-cured liquid silicone polymer. Cross-sections at the level of the UES and cervical esophagus were digitized and mathematically compared using geometric morphometric shape analysis.

Results:

Consensus shape among all 10 animals revealed that the narrowest region of the maximally distended UES has a cross-sectional shape that resembles a kidney, whereas the cervical esophagus approximates a circle. The shape of the UES and cervical esophagus were significantly different (P < .0001), and surface area calculations demonstrated that an inscribed circle significantly underestimated the area implied by the kidney-shaped UES model.

Conclusions:

Current dilators used to treat UES dysfunction are cylindrical and based on the assumption that the UES is round. This is the first report to empirically analyze the cross-sectional area of the UES utilizing an established ovine model. The data suggest that the cross-sectional area of the UES is shaped like a kidney, and currently available cylindrical dilators are suboptimal for UES distention. Laryngoscope, 2013

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