{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T19:29:13Z","timestamp":1648841353361},"reference-count":33,"publisher":"FapUNIFESP (SciELO)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"published-print":{"date-parts":[[2003,6]]},"abstract":"<jats:p>RACIONAL: O m\u00fasculo cricofar\u00edngeo \u00e9 de tipo estriado esquel\u00e9tico, por conseguinte, incapaz de manter contra\u00e7\u00e3o continuada por longos per\u00edodos. Apesar disto, tem sido considerado como o respons\u00e1vel pela zona de alta press\u00e3o registrada manometricamente na transi\u00e7\u00e3o faringoesof\u00e1gica. Em raz\u00e3o desta cren\u00e7a, tem sido alvo de terap\u00eauticas cruentas que visam, por ruptura de sua integridade, franquear a comunica\u00e7\u00e3o entre a faringe e o es\u00f4fago. OBJETIVO: Dar as bases anat\u00f4micas que definam os limites de participa\u00e7\u00e3o do m\u00fasculo cricofar\u00edngeo na fun\u00e7\u00e3o da transi\u00e7\u00e3o faringoesof\u00e1gica; considerar alternativa morfofuncional para explicar a zona de alta press\u00e3o desta transi\u00e7\u00e3o e as implica\u00e7\u00f5es das miotomias sobre ela, uso de toxina botul\u00ednica e das dilata\u00e7\u00f5es pneum\u00e1ticas. MATERIAL E M\u00c9TODOS: O total de 24 pe\u00e7as obtidas de cad\u00e1veres de adultos de ambos os sexos fixados em formalde\u00eddo a 10%, teve a laringofaringe estudada quanto as suas caracter\u00edsticas morfol\u00f3gicas e rela\u00e7\u00f5es. RESULTADOS: O m\u00fasculo cricofar\u00edngeo apresenta suas inser\u00e7\u00f5es \u00e2ntero-laterais nas bordas p\u00f3stero-laterais da cartilagem cric\u00f3ide, configurando morfologia em meia calha ou de uma letra C que n\u00e3o permite, quando de sua contra\u00e7\u00e3o, a gera\u00e7\u00e3o de press\u00e3o com predom\u00ednio anterior e posterior, como a encontrada na transi\u00e7\u00e3o faringoesof\u00e1gica. Este tipo de distribui\u00e7\u00e3o press\u00f3rica tem sustenta\u00e7\u00e3o na rela\u00e7\u00e3o de pin\u00e7a exercida, por um lado, pela rigidez oferecida pelos corpos vertebrais, por outro, pelo contorno posterior da cartilagem cric\u00f3ide. CONCLUS\u00d5ES: A organiza\u00e7\u00e3o muscular da laringofaringe permite afian\u00e7ar que a miotomia alargada da transi\u00e7\u00e3o faringoesof\u00e1gica, aquela que se estende al\u00e9m do fasc\u00edculo transverso do cricofar\u00edngeo, lesa musculatura ejetora e em \u00e1rea cuja a j\u00e1 maior dimens\u00e3o luminar dispensaria a sec\u00e7\u00e3o parietal. Miotomia que tome somente o fasc\u00edculo transverso do cricofar\u00edngeo poder\u00e1 contribuir positivamente para a melhoria do fluxo faringoesof\u00e1gico por diminui\u00e7\u00e3o da resist\u00eancia local. A efici\u00eancia deste procedimento ser\u00e1 dependente da exist\u00eancia de alguma for\u00e7a de eje\u00e7\u00e3o e eleva\u00e7\u00e3o hiolar\u00edngea. O fasc\u00edculo transverso do m\u00fasculo cricofar\u00edngeo \u00e9 fitado, de pequena espessura, para ser infiltrado por via transcut\u00e2nea com a toxina botul\u00ednica. Talvez por via endosc\u00f3pica, \u00e0 semelhan\u00e7a das miotomias, o indicado seria desnervar somente o fasc\u00edculo transverso do m\u00fasculo cricofar\u00edngeo. Neste contexto dose, dilui\u00e7\u00e3o e pontos de infiltra\u00e7\u00e3o assumem importante papel no uso terap\u00eautico desta neurotoxina em n\u00edvel do cricofar\u00edngeo. A dilata\u00e7\u00e3o por bal\u00e3o pneum\u00e1tico da transi\u00e7\u00e3o faringoesof\u00e1gica n\u00e3o parece ser procedimento adequado para regi\u00e3o que n\u00e3o apresente estenose fibr\u00f3tica a ser rompida. Em raz\u00e3o das caracter\u00edsticas anat\u00f4micas da transi\u00e7\u00e3o faringoesof\u00e1gica, a press\u00e3o m\u00e9dia de repouso, como registrada pelo m\u00e9todo manom\u00e9trico, n\u00e3o avalia adequadamente a inefici\u00eancia ou efetividade da miotomia, da desnerva\u00e7\u00e3o ou do resultado da dilata\u00e7\u00e3o por bal\u00e3o pneum\u00e1tico.<\/jats:p>","DOI":"10.1590\/s0004-28032003000200002","type":"journal-article","created":{"date-parts":[[2005,4,15]],"date-time":"2005-04-15T10:20:45Z","timestamp":1113560445000},"page":"63-72","source":"Crossref","is-referenced-by-count":2,"title":["An\u00e1lise estrutural da laringofaringe e suas implica\u00e7\u00f5es na miotomia do cricofar\u00edngeo, na inje\u00e7\u00e3o de toxina botul\u00ednica e na dilata\u00e7\u00e3o por bal\u00e3o"],"prefix":"10.1590","volume":"40","author":[{"given":"Milton Melciades 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