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Clinical disorders
Clinical disorders of oral, pharyngeal and esophageal motility
W.G. Paterson, M.D. and?Raj K. Goyal, M.D.The main clinical presentation of patients with oral, pharyngeal, or esophageal motility disorders is dysphagia. Dysphagia caused by oral and pharyngeal disorders can be differentiated from dysphagia due to esophageal disorders, based on the patients localization of the site of the difficulty to the mouth and throat, or chest, respectively. Although dysphagia due to esophageal lesions may sometimes be localized to the throat, dysphagia due to oral or pharyngeal causes does not localize to the chest. The most distinguishing feature of dysphagia due to pharyngeal causes is the misdirection of food into the nose or the lungs, resulting in the complaint of nasal regurgitation of food and choking and coughing during swallowing. The oral cavity, pharynx and upper esophagus are often involved together due to the underlying neuromuscular disorders. Painful swallowing or odynophagia occurs in certain inflammatory conditions of the oral, pharyngeal, or esophageal mucosa.
Regurgitation of gastric contents into the esophagus suggests incompetence of the normal gastroesophageal antireflux barrier. Heartburn is a typical symptom of esophageal mucosal inflammation due to gastric acid-peptic reflux.
Motor Disorders of the Oral Cavity, Pharynx, and Cervical Esophagus
Muscles of the oral cavity, pharynx, and cervical esophagus are of the striated variety. These disorders may manifest as oral stasis of food, inability to initiate a swallow, premature spillage of food into the pharynx, pharyngeal stasis, nasal regurgitation, or laryngeal aspiration. A large number of neuromuscular diseases are associated with dysfunction of the oropharyngeal phase of deglutition. These can be classified by whether the disease affects the central nervous system, such as stroke, cerebral palsy, head injury, amyotrophic lateral sclerosis, multiple sclerosis, and Parkinsons disease; the peripheral nerv
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