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.
Article first published online: 5 OCT 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 123, Issue 3, pages 721–726, March 2013
How to Cite
Cates, D., Plowman, E. K., Mehdizadeh, O., Yen, K., Domer, A., Gilden, M. and Belafsky, P. C. (2013), Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round. The Laryngoscope, 123: 721–726. doi: 10.1002/lary.23634
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.
- Issue published online: 26 FEB 2013
- Article first published online: 5 OCT 2012
- Manuscript Accepted: 9 JUL 2012
- Manuscript Revised: 28 JUN 2012
- Manuscript Received: 7 MAY 2012
- Upper esophageal sphincter;
- oropharyngeal dysphagia
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.
Prospective cadaveric animal study.
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.
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.
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