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Upper Airway Reflex Control

The upper airways are complex, both in terms of the muscles and effector tissues that control their patency and in terms of the afferent nervous inputs that can influence these structures. The patterns of reflex control differ for the various parts of the upper respiratory tract. The larynx can dilate or constrict both during the normal pattern of breathing and in transient acts such as coughing and sneezing, where the changes in laryngeal caliber may be extreme. Similarly, for the oropharynx, there are both physiological rhythmical changes during breathing and more extreme effects induced by activities such as swallowing.' Spontaneous changes in oropharyngeal caliber seem to be primarily dilative during inspiration, when the constrictor muscles of the pharynx do not seem to be involved. For the nose, the sketetal muscles of the palate and the nares play a major role in determining nasal airflow resistance in breathing, and the former are important in determining the balance of nasal and oral airflows. Palatine muscle contraction is synchronized with that of the jaw muscles so that the mouth opens when nasal airflow is diverted in that direction. A further control system in the nose is the vascular bed,4 congestion of which leads to nasal blockage and diversion of flow through the mouth in all but obligatory nose breathers. All the skeletal muscle systems for the larynx, oropharynx and nose, and also the vascular bed of the nose, are under reflex control, with respiratory modulation of activity and powerful reflex inputs that affect upper airway caliber.