Hello, my name is
Doctor John E Pandolfino,
I'm an associate professor
at Northwestern University,
and Director of the Esophageal Center
at Northwestern Memorial Hospital.
It is my privilege and honor to provide
you with a talk on oro-pharyngeal and
esophageal motility and dysmotility for
the Henry Stewart Talks series.
Oro-pharyngeal and esophageal
motility encompass a very delicate
interplay between anatomy and
The primary functional responsibilities
of the oropharynx are to transfer food,
prevent aspiration, and
aid in breathing and speech.
In addition, the primary functional
responsibilities of the esophagus are to
transport food, prevent aspiration and
to prevent reflux.
Although all of these functional
responsibilities are extremely important,
today I will focus primarily on the
transfer of food through the oropharynx
and the transport of food
through the esophagus.
Focusing on these two functional
responsibilities will give us a very nice
overview of oropharyngeal and
esophageal motility and dysmotility.
As mentioned previously, the function of
swallowing through the oropharynx and
the esophagus is a very complicated
interplay between the neuromuscular
function and anatomy of these
particular anatomic components.
When looking at the stages of a swallow,
it is typically broken up into three
specific components, the oral phase, the
pharyngeal phase and the esophageal phase.
When reviewing the various stages of
a swallow, it is important to realize that
there are many differences between
the oropharyngeal phase of swallowing and
the pharyngeal phase of swallowing,
as well as the esophageal
phase of swallowing.
In terms of the muscle type,
in the oral phase and
the pharyngeal phase it is
predominantly striated muscle.
In contrast, in the esophageal phase,
it is a combination of the striated and
In addition, there are many differences
in terms of the nervous system control
of the stages of swallow.
As we can see here, in the oral phase
it is predominated by the cortex and
the medulla, while in the pharyngeal and
the esophageal there's more of a complex
of medulla, and in the esophageal phase of
swallowing specifically, the enteric
nervous system is extremely important.
In terms of volitional control,
in oral it is complete,
in pharyngeal there is some, and
in the esophageal phase it is poor.
In terms of sensation, it is very precise
in the oral phase, it is somewhat
good in the pharyngeal phase, but
extremely poor in the esophageal phase.