Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT

Minxing Gao; Yoko Inamoto; Eiichi Saitoh; Keiko Aihara; Seiko Shibata; Marlis Gonzalez-Fernandez; Yohei Otaka

doi:10.1111/joor.13686

Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT

J Oral Rehabil. 2024 Apr 3. doi: 10.1111/joor.13686. Online ahead of print.

Authors

Minxing Gao^{1

2}, Yoko Inamoto^{3

4}, Eiichi Saitoh⁴, Keiko Aihara³, Seiko Shibata⁴, Marlis Gonzalez-Fernandez⁵, Yohei Otaka⁴

Affiliations

¹ Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
² Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
³ Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
⁴ Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.
⁵ Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

PMID: 38570928
DOI: 10.1111/joor.13686

Abstract

Background: Upper oesophageal sphincter (UES) serves as an important anatomical and functional landmark during swallowing. However, the precise UES location before and during swallowing has not been well established.

Objective: This study aimed to determine upper oesophageal sphincter (UES) location and displacement during swallowing accounting for sex, age, and height in healthy adults using 320-row area detector computed tomography (320-ADCT).

Methods: Ninety-four healthy adults (43 males; 22-90 years) underwent 320-ADCT scanning while swallowing one trial of 10 mL honey thick barium. UES location at bolus hold and at maximum displacement and vertical displacement during swallowing were identified using the coordinates and the section classification of vertebrae (VERT scale). The differences and correlations of UES location and distance in terms of sex, age, and height were analysed using Mann-Whitney U test and Spearman's correlation coefficient.

Results: UES locations at bolus hold and at maximum displacement were significantly lower and UES vertical displacement was significantly larger in males than in females (p < .001). UES location at bolus hold became lower with increasing age (r = -.312, p = .002), but the negative correlation was low at maximum displacement (r = -.230, p = .026), resulting in larger vertical distance with ageing. UES locations showed high negative correlation at bolus hold with height (r = -.715, p < .001), and showed moderate negative correlation at maximum displacement with height (r = -.555, p < .001), although this effect was unclear when analysed by sex.

Conclusion: Males showed lower UES location and larger displacement than females. The impact of age was evident with lower location before swallowing and larger displacement during swallowing. Differences observed by sex were not completely explained by using the VERT scale to adjust for height.

Keywords: age; body height; deglutition; multidetector computed tomography; sex; upper oesophageal sphincter.