ObjectiveHigh‐resolution manometry (HRM) is used to analyze upper esophageal sphincter (UES) physiology. Conventional HRM can yield imprecise measurements of UES resting pressure given its unidirectional sensors and averaging of circumferential pressure. In contrast, three‐dimensional (3D) measurements can yield precise UES resting pressure data over the entire length of the UES. This study conducted a detailed analysis of UES resting pressure as evaluated by 3D‐HRM.MethodsSeventeen young, healthy adult participants (7 females and 10 males) were recruited. The 3D‐HRM system used includes a pressure sensor catheter (outer diameter, 4 mm) and eight‐channel transducers arranged circumferentially to acquire pressure data at 45° intervals. The catheter was inserted transnasally into the esophagus and automatically retracted at a speed of 1 mm/s. Participants performed the following tasks: maintain resting breathing, perform breath holding, and perform the Valsalva maneuver. Data were obtained and compared per millimeter over the longitudinal UES length.ResultsClear 3D waveforms were identified, with greater mean UES pressures in anterior‐posterior directions than in lateral directions (P < .05). The anterior distribution was located superior to the posterior portion. Significant differences were observed in mean UES pressures and UES resting integrals between resting breathing and the Valsalva maneuver (P < 0.05). No differences in functional UES length were observed.ConclusionsThe normal UES resting pressure was not directionally uniform in the luminal structure. 3D‐HRM imaging of UES resting pressure can help deepen our understanding of UES physiology.Level of Evidence4
Postoperative maxillary cyst POMC causes cheek pain, and also results in various ocular symptoms and nasal obstruction, depending on the direction of expansion. We experienced a rare case of trismus due to a POMC that involved the lateral pterygoid muscle. The patient was a -year-old man who was admitted to our hospital with a chief complaint of trismus. A CT scan showed cystic lesions of about mm in the left maxilla. Emergency endoscopic sinus surgery was performed under local anesthesia on the same day. After as much fenestration of the cyst as possible, the site was covered with a mucosal flap harvested from the nasal floor to prevent stenosis and obstruction of the fenestration site. Three days after surgery, symptoms gradually began to improve and the patient recovered without problems. No recurrence was found in CT performed months postoperatively.
We report two cases of giant soft tissue tumor of the hypopharynx.Patient 1:A 61-year-old man presented with a smooth-surfaced pedunculated soft tissue tumor in the postcricoid of the hypopharynx but had no incarceration in the larynx and underwent surgical treatment on an elective basis. Postoperative pathological examination revealed a giant vascular fiber polyp.Patient 2:A 60-year-old woman was transported to our hospital due to nausea and vomiting. A tumor protruded out of the oral cavity. She had two smooth-surfaced pedunculated soft tissue tumors on the posterior wall of the hypopharynx and underwent emergency surgery due to the risk of airway stenosis.Postoperative pathological examination revealed well-differentiated liposarcoma, but the course was good without recurrence.Giant soft tissue sarcoma of the hypopharynx, a very rare disease, may require emergency surgery due to the potential for choking associated with incarceration in the larynx.
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