Hyperpharyngeal reflex

Introduction Pharyngeal reflex refers to the use of a tongue depressor to gently touch the posterior pharyngeal wall, which normally causes nausea reflex (pharyngeal muscle contraction). The reflex center is in the medulla, and those with nerve damage are slow or disappear. Pharyngeal reflex is a physiological reaction that prevents the swallowing of foreign bodies. When the toothbrush is placed in the mouth and brushing the teeth, it will also appear involuntarily "retching", which is caused by pharyngeal reflex. Pharyngeal reflex is a clinical manifestation of pseudobulbar paralysis. Ball paralysis is medullary paralysis. Because the medulla is also called the medullary ball, the medullary palsy is called ball paralysis, also known as true ball paralysis. There are two translations of medullary English: medulla oblongata and bulb, and the bulb has the meaning of a ball and a ball. Therefore, the medulla is called a "ball" and the medulla oblongata becomes a "ball paralysis." A group of symptoms occurs when the motor nuclei in the medulla, or the cranial nerves (including the pharyngeal, vagus, and hypoglossal nerves) from the medulla, cause paralysis due to illness. Mainly manifested in drinking water, eating cough, difficulty swallowing, hoarseness or loss of sound. Therefore, any lesion that directly damages the medulla oblongata or related cranial nerves is called true ball paralysis. The lesion is in the cerebral pons or the cerebral cerebral palsy, causing the inner nucleus of the cerebral ventricle to lose its upper innervation, and the medullary paralysis, which is called pseudobulbar paralysis. Pseudobulbar paralysis is caused by bilateral motor neuron lesions (mainly the motor cortex and its cortical brain stem bundle), which causes the medullary motor cranial nucleus---suspicion nucleus and pons trigeminal motor nucleus to lose upper motion. The innervation of neurons is caused by central sputum. The clinical manifestations are central sputum of tongue, soft palate, throat, face and masticatory muscles. The symptoms are very similar to bulbar palsy, but they are not caused by the lesion of the medulla itself. Pseudobulbar paralysis.

Cause

Causes of hyperpharyngeal hyperreflexia

It is a group of chronic progressive degenerative diseases with selective etiology of spinal cord anterior horn cells, brainstem group motor neurons, cortical pyramidal cells and pyramidal bundles. The clinical features are the combined symptoms and signs of upper and lower motor neurons, which are characterized by different combinations of muscle weakness, muscle atrophy and pyramidal tract. The sensory and sphincter functions are generally unaffected.

an examination

Related inspection

Nasopharyngeal MRI examination, oral endoscopy, neurological examination

Examination of pharyngeal reflex

Diagnosis is based on the clinical symptoms of the disease.

The clinical features are the combined symptoms and signs of upper and lower motor neurons, which are characterized by different combinations of muscle weakness, muscle atrophy and pyramidal tract. The sensory and sphincter functions are generally unaffected.

The specific manifestation is atrophy of the tongue muscle, eating cough, drinking water from the nostrils, speech speech is unclear, hoarseness, often accompanied by head lateral weakness; pharyngeal reflex disappears, soft palate does not move, lingual muscle bundle vibrates.

1. Neurological examination.

2. If necessary, MRI can be performed to further clarify the cause of the disease, to make a differential diagnosis, and to assist in the diagnosis and treatment.

Differential diagnosis

Symptoms of confusing hyperreflexia

1, pharyngeal reflex disappeared: use the tongue depressor to gently touch the posterior wall of the pharynx, causing nausea reflex (normal pharyngeal muscle contraction). The reflection center is in the medulla. Those with nerve damage are slow or disappear.

2, glossopharyngeal nerve injury: the glossopharyngeal nerve is a mixed nerve, containing movement and sensory fibers. After the cranial fossa is passed through the cranial vein, the pharyngeal wall is reached between the internal and external carotid arteries. The sensory fiber is the sensory afferent nerve of the pharynx, and its motor branch is responsible for the soft palate function, and the parasympathetic fiber tube is secreted by the parotid gland. The glossopharyngeal nerve belongs to the posterior group of cranial nerves. The chance of traumatic injury is relatively small, mostly due to the fracture line and the jugular foramen. However, the lesion of the jugular vein in the posterior cranial fossa is easy to cause glossopharyngeal nerve damage. The damage and injury of the glossopharyngeal nerve are often involved in the simultaneous involvement of the posterior group of cranial nerves. The clinical diagnosis of glossopharyngeal nerve alone is extremely rare. It is characterized by the loss or disappearance of the 1/3 of the posterior tongue of the affected side, and the general feeling of the upper part of the pharynx is reduced or lost, and the soft palate is drooping. More conservative treatment is used.

The glossopharyngeal nerve is a mixed nerve that contains motor and sensory fibers. After the cranial fossa is passed through the cranial vein, the pharyngeal wall is reached between the internal and external carotid arteries. The sensory fiber is the sensory afferent nerve of the pharynx, and its motor branch is responsible for the soft palate function, and the parasympathetic fiber tube is secreted by the parotid gland. The glossopharyngeal nerve belongs to the posterior group of cranial nerves. The chance of traumatic injury is relatively small, mostly due to the fracture line and the jugular foramen. However, the lesion of the jugular vein in the posterior cranial fossa is easy to cause glossopharyngeal nerve damage. The damage and injury of the glossopharyngeal nerve are often involved in the simultaneous involvement of the posterior group of cranial nerves. The clinical diagnosis of glossopharyngeal nerve alone is extremely rare. It is characterized by the loss or disappearance of the 1/3 of the posterior tongue of the affected side, and the general feeling of the upper part of the pharynx is reduced or lost, and the soft palate is drooping. More conservative treatment is used.

3, swallowing hairpin: normal humans swallowing reflex arc when a certain link is damaged, it will cause difficulty swallowing. Some patients with difficulty swallowing may cause swallowing due to mistakenly swallowed food into the trachea.

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