STUDIES OF THE PHARYNX

THE INCREASING relative and absolute incidence of bulbar poliomyelitis1-34 has provided a valuable opportunity for the study of neurologic impairment of the pharynx. The varied distribution of impairment within the musculature of the area of the pharynx is appropriate to the typical pathologic finding in this disease of discrete and focal necrosis irregularly distributed in nuclear areas.21 This variety of impairments has been utilized to evaluate the contribution of specific elements of the musculature in this area to its general motor performance. Over the period of the past 7 years, a succession of patients having poliomyelitic disability in the area of the pharynx has been observed clinically, with supplementary cinema studies of the visible pharynx and the external neck27 and fluoroscopic and rapid-sequential roentgenographic studies, in which visualization of the pharynx was facilitated by radiopaque media. A useful classification of poliomyelitic impairments of the pharynx has been derived, with recognition of the compensatory and alternative maneuvers which they invoke. This report is particularly concerned with related impairments of swallow and of speech which results from deficient motor control of the oropharyngeal and the palatopharyngeal orifices. The observations are related to general anatomic, physiologic, and neurologic studies of the pharynx.35 Normal motor function of the lower pharynx and function impaired by poliomyelitis are considered in a succeeding report.36 PATIENT MATERIAL The normal subjects include 9 children, 7 to 13 years of age, and 11 young male adults, in each of which subject an examination of the area of mouth, pharynx, and neck was performed to obviate anatomic and neurologic abnormality.