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The Medical Clinics of North America Nov 2018Objective and subjective tinnitus can often be differentiated based on comprehensive history, physical examination, and audiogram. Examples of objective tinnitus include... (Review)
Review
Objective and subjective tinnitus can often be differentiated based on comprehensive history, physical examination, and audiogram. Examples of objective tinnitus include vascular abnormalities, palatal myoclonus, patulous eustachian tube, and stapedial/tensor tympani muscle spasm. Subjective tinnitus is usually associated with hearing loss. Rarely, tinnitus is the result of an underlying condition. In these cases, imaging and additional testing may be indicated. Classification of the type, quality, and intensity of tinnitus is helpful in the work-up and treatment of tinnitus. Treatment modalities include cognitive behavioral therapy, tinnitus retraining therapy, sound therapy, hearing aids, cochlear implants, pharmacotherapy, and brain stimulation.
Topics: Audiometry, Pure-Tone; Humans; Physical Examination; Primary Health Care; Speech Perception; Tinnitus
PubMed: 30342610
DOI: 10.1016/j.mcna.2018.06.014 -
Laryngoscope Investigative... Feb 2019The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the... (Review)
Review
UNLABELLED
The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the phenotypic variations that generate the shape and collapsibility of the retropalatal airway. Anatomically, the soft palate has both a proximal and distal segments separated by the palatal genu. The proximal palatal segment has a variable angle from the hard palate (ie, alpha angle) determined by the position and length of the levator veli palatini muscle. The palatopharyngeus muscle (PP) is a major defining element of the palate and lateral pharyngeal wall and forms the medial wall of the lateral palatal space. It is composed of two divisions: the longitudinal palatopharyngeus fasciculi which acts to elevate the pharynx and depress the soft palate and the transverse palatopharyngeus fascicle (Passavant's ridge) which function is a nasopharyngeal sphincter. The lateral palatal space incorporates the supra-tonsilar fat, and is bounded by muscles that determine the structure of the palate and associated lateral pharyngeal walls. Understanding of palatal muscles and pharyngeal airway phenotypes provides insight into the steps and mechanisms of pharyngoplasty procedures.
LEVEL OF EVIDENCE
N/A.
PubMed: 30828637
DOI: 10.1002/lio2.238 -
Ugeskrift For Laeger Sep 2023Palatal tremor (PT) is a rare cause of objective tinnitus. Symptomatic PT is caused by injuries of the Guillain-Mollaret triangle with contraction of levator veli...
Palatal tremor (PT) is a rare cause of objective tinnitus. Symptomatic PT is caused by injuries of the Guillain-Mollaret triangle with contraction of levator veli palatini. Essential PT causes are unknown and is produced by contraction of tensor veli palatini, with pathognomonic audible ear click. This is a case report of a 36-year-old female, who developed bilateral objective tinnitus, as well as vertigo, blepharospasm, and neck tension after a free fall trauma 30 metres in the net. She was diagnosed with essential PT and treated with botulinum neurotoxin injections in the soft palate.
Topics: Female; Humans; Adult; Tinnitus; Tremor; Palatal Muscles; Palate, Soft; Myoclonus
PubMed: 37767868
DOI: No ID Found -
Clinical Neurophysiology : Official... Apr 2022The various forms of tremor are now classified in two axes: clinical characteristics (axis 1) and etiology (axis 2). Electrophysiology is an extension of the clinical... (Review)
Review
The various forms of tremor are now classified in two axes: clinical characteristics (axis 1) and etiology (axis 2). Electrophysiology is an extension of the clinical exam. Electrophysiologic tests are diagnostic of physiologic tremor, primary orthostatic tremor, and functional tremor, but they are valuable in the clinical characterization of all forms of tremor. Electrophysiology will likely play an increasing role in axis 1 tremor classification because many features of tremor are not reliably assessed by clinical examination alone. In particular, electrophysiology may be needed to distinguish tremor from tremor mimics, assess tremor frequency, assess tremor rhythmicity or regularity, distinguish mechanical-reflex oscillation from central neurogenic oscillation, determine if tremors in different body parts, muscles, or brain regions are strongly correlated, document tremor suppression or entrainment by voluntary movements of contralateral body parts, and document the effects of voluntary movement on rest tremor. In addition, electrophysiologic brain mapping has been crucial in our understanding of tremor pathophysiology. The electrophysiologic methods of tremor analysis are reviewed in the context of physiologic tremor and pathologic tremors, with a focus on clinical characterization and pathophysiology. Electrophysiology is instrumental in elucidating tremor mechanisms, and the pathophysiology of the different forms of tremor is summarized in this review.
Topics: Brain; Brain Mapping; Essential Tremor; Humans; Tremor
PubMed: 35149267
DOI: 10.1016/j.clinph.2022.01.004 -
Anatomical Record (Hoboken, N.J. : 2007) May 2021Our objective was to determine the branching and distribution of the motor nerves supplying the human soft palate muscles. Six adult specimens of the soft palate in...
Our objective was to determine the branching and distribution of the motor nerves supplying the human soft palate muscles. Six adult specimens of the soft palate in continuity with the pharynx, larynx, and tongue were processed with Sihler's stain, a technique that can render large specimens transparent while counterstaining their nerves. The cranial nerves were identified and dissection followed their branches as they divided into smaller divisions toward their terminations in individual muscles. The results showed that both the glossopharyngeal (IX) and vagus (X) nerves have three distinct branches, superior, middle, and inferior. Only the middle branches of each nerve contributed to the pharyngeal plexus to which the facial nerve also contributed. The pharyngeal plexus was divided into two parts, a superior innervating the palatal and neighboring muscles and an inferior innervating pharyngeal constrictors. The superior branches of the IX and X nerves contributed innervation to the palatoglossus, whereas their middle branches innervated the palatopharyngeus. The palatoglossus and palatopharyngeus muscles appeared to be composed of at least two neuromuscular compartments. The lesser palatine nerve not only supplied the palatal mucosa and palatine glandular tissue but also innervated the musculus uvulae, palatopharyngeus, and levator veli palatine. The latter muscle also received its innervation from the superior branch of X nerve. The findings would be useful for better understanding the neural control of the soft palate and for developing novel neuromodulation therapies to treat certain upper airway disorders such as obstructive sleep apnea.
Topics: Aged; Female; Glossopharyngeal Nerve; Humans; Male; Middle Aged; Palatal Muscles; Palate, Soft
PubMed: 33034133
DOI: 10.1002/ar.24531 -
Parkinsonism & Related Disorders Jun 2019Tremor is a key clinical feature of several common neurological disorders. Adequate management of tremor has been an unmet need in clinical practice. Most of the... (Review)
Review
Tremor is a key clinical feature of several common neurological disorders. Adequate management of tremor has been an unmet need in clinical practice. Most of the anti-tremor medications have limited efficacy and are associated with undesirable adverse effects, especially in elderly patients. Several studies have reported good outcomes with the use of botulinum neurotoxin (BoNT) for the treatment of tremor. This article aims to systematically review these studies and to highlight the role of BoNT in the management of tremor. A PubMed search was performed in August 2018 to identify articles pertinent to this review. Majority of the studies that have assessed the efficacy of BoNT in tremor, enrolled patients with essential tremor (ET), Parkinson's disease (PD), and dystonic tremor. Results of these studies suggest clinically meaningful improvement in hand tremor in both ET and PD and vocal tremor in ET after BoNT therapy. Additionally, BoNT has been reported to be efficacious in alleviating head and palatal tremor, tremor in multiple sclerosis, and proximal positional tremor. It is apparent that BoNT injections tailored to the needs of individual patients yield better efficacy and lower adverse effects compared to fixed-muscle-fixed-dose approach. BoNT individualized approach adds to the armamentarium for patients who have medically refractory tremors or those who are unable to tolerate the anti-tremor medications. The studies are limited and mostly open-label; thus, randomized placebo-controlled studies are needed to prove the efficacy of BoNT in various tremor conditions.
Topics: Botulinum Toxins; Humans; Neuromuscular Agents; Tremor
PubMed: 30709779
DOI: 10.1016/j.parkreldis.2019.01.023 -
Journal of Biomechanics May 2020Mobility is a fundamental characteristic of mammalian teeth, and has been widely used to determine individual tooth prognosis. However, the direction and extent of tooth...
Mobility is a fundamental characteristic of mammalian teeth, and has been widely used to determine individual tooth prognosis. However, the direction and extent of tooth movement under functional loads are unknown. This study investigated maxillary molar mobility, alveolar bending, and periodontal space (PDL) fluid pressure during mastication and masseter muscle contraction in young pigs, along with PDL space measurements. Twelve three-month-old farm pigs were instrumented with some or all of the following: (1) ultrasonic crystals, one implanted into the pulp chamber of a deciduous maxillary molar and additional crystals glued onto its buccal and palatal alveolar plates; (2) rosette strain gauges affixed to the buccal and palatal of alveolar ridges; (3) a pressure transducer inserted into palatal alveolar bone facing the PDL. Tooth mobility, alveolar bending, and fluid pressure were simultaneously recorded during unrestrained feeding and subsequent masseter muscle stimulation. The PDL widths were measured using micro-CT. The results indicate that during the power stroke of mastication, (1) the molar displaced buccally and apically (192 ± 95 µm) regardless of the side of chewing; (2) compressive bone strain was greater on the buccal than on the palatal alveolar plate; and (3) PDL pressure increased during the power strok (3.63 ± 0.80 kPa). Masseter contraction produced similar results but with generally lower values. The PDL widths were larger than the range of tooth mobility, and showed no correlation with the mobility. Thus occlusal function causes buccal tipping and intrusion of maxillary molars with concomitant compression of the buccal alveolar plate and raised pressure within the PDL space.
Topics: Alveolar Process; Animals; Periodontal Ligament; Swine; Tooth; Tooth Mobility; Tooth Movement Techniques
PubMed: 32173029
DOI: 10.1016/j.jbiomech.2020.109716 -
Anatomical Record (Hoboken, N.J. : 2007) Nov 2023Herein, we compared the developmental maturity of the cranium, limbs, and feeding apparatus in a perinatal common vampire bat relative to its mother. In addition, we...
Herein, we compared the developmental maturity of the cranium, limbs, and feeding apparatus in a perinatal common vampire bat relative to its mother. In addition, we introduce a method for combining two computed tomographic imaging techniques to three-dimensionally reconstruct endocasts in poorly ossified crania. The Desmodus specimens were scanned using microcomputed tomography (microCT) and diffusible iodine-based contrast-enhanced CT to image bone and soft tissues. Muscles of the jaw and limbs, and the endocranial cavity were segmented using imaging software. Endocranial volume (ECV) of the perinatal Desmodus is 74% of adult ECV. The facial skeletal is less developed (e.g., palatal length 60% of adult length), but volumes for alveolar crypts/sockets of permanent teeth are nearly identical. The forelimb skeleton is uniformly less ossified than the distal hind limb, with no secondary centers ossified and an entirely cartilaginous carpus. All epiphyseal growth zones are active in the brachium and antebrachium, with the distal radius exhibiting the greatest number of proliferating chondrocytes arranged in columns. The hind limb skeleton is precociously ossified from the knee distally. The musculature of the fore limb, temporalis, and masseter muscles appear weakly developed (6-11% of the adult volume). In contrast, the leg and foot musculature is better developed (23-25% of adult volume), possibly enhancing the newborn's capability to grip the mother's fur. Desmodus is born relatively large, and our results suggest they are born neurally and dentally precocious, with generally underdeveloped limbs, especially the fore limb.
Topics: Animals; Infant, Newborn; Humans; X-Ray Microtomography; Skull; Osteogenesis; Muscles; Lower Extremity
PubMed: 36806921
DOI: 10.1002/ar.25179 -
Archives de Pediatrie : Organe Officiel... Jul 2017Bruxism is defined as repetitive activity of the masticatory muscles, characterized by clenching the teeth or teeth grinding and/or by tapping and swaying. This study... (Review)
Review
Bruxism is defined as repetitive activity of the masticatory muscles, characterized by clenching the teeth or teeth grinding and/or by tapping and swaying. This study investigated sleep bruxism. The etiology is multifactorial: mainly central (neuropathic disorder, anxiety) but also genetic and local (posture, mouth breathing). The diagnosis is based primarily on the anamnesis and examination of dental wear and progression over time (photos and dental castings). A diagnostic guide is proposed in this article. Frequently found in children, bruxism is not always considered pathological. The severity criteria relate intensity (number of dental attrition facets) as well as the context found in children: anxiety, ventilation disorders, and fragile dental structures. Management is multidisciplinary and depends on the etiologic diagnosis.
Topics: Adenoidectomy; Child; Cognitive Behavioral Therapy; Decision Trees; Dental Prosthesis; Dental Restoration, Temporary; Denture, Overlay; Denture, Partial, Removable; Humans; Palatal Expansion Technique; Patient Education as Topic; Risk Factors; Sleep Bruxism; Tonsillectomy; Tooth Abrasion
PubMed: 28587727
DOI: 10.1016/j.arcped.2017.04.005