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

Daniel Cates, Emily K. Plowman, Omid Mehdizadeh, Kaicheng Yen, Amanda Domer, Michael Gilden, Peter C Belafsky

Research output: Contribution to journalArticle

6 Citations (Scopus)

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

Original languageEnglish (US)
Pages (from-to)721-726
Number of pages6
JournalLaryngoscope
Volume123
Issue number3
DOIs
StatePublished - Mar 2013

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Upper Esophageal Sphincter
Sheep
Esophagus
Deglutition Disorders
Kidney
Dilatation
Laryngoscopes
Silicones
Platinum

Keywords

  • cross-section
  • dilator
  • dysphagia
  • oropharyngeal dysphagia
  • shape
  • Upper esophageal sphincter

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round. / Cates, Daniel; Plowman, Emily K.; Mehdizadeh, Omid; Yen, Kaicheng; Domer, Amanda; Gilden, Michael; Belafsky, Peter C.

In: Laryngoscope, Vol. 123, No. 3, 03.2013, p. 721-726.

Research output: Contribution to journalArticle

Cates, Daniel ; Plowman, Emily K. ; Mehdizadeh, Omid ; Yen, Kaicheng ; Domer, Amanda ; Gilden, Michael ; Belafsky, Peter C. / Geometric morphometric shape analysis in an ovine model confirms that the upper esophageal sphincter is not round. In: Laryngoscope. 2013 ; Vol. 123, No. 3. pp. 721-726.
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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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AU - Domer, Amanda

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N2 - 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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