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European Journal of Translational... Oct 2023Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can...
Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances). The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%) and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.
PubMed: 37905785
DOI: 10.4081/ejtm.2023.11471 -
Journal of Movement Disorders May 2016Cerebellar circuitry is important to controlling and modifying motor activity. It conducts the coordination and correction of errors in muscle contractions during active... (Review)
Review
Cerebellar circuitry is important to controlling and modifying motor activity. It conducts the coordination and correction of errors in muscle contractions during active movements. Therefore, cerebrovascular lesions of the cerebellum or its pathways can cause diverse movement disorders, such as action tremor, Holmes' tremor, palatal tremor, asterixis, and dystonia. The pathophysiology of abnormal movements after stroke remains poorly understood. However, due to the current advances in functional neuroimaging, it has recently been described as changes in functional brain networks. This review describes the clinical features and pathophysiological mechanisms in different types of movement disorders following cerebrovascular lesions in the cerebellar circuits.
PubMed: 27240809
DOI: 10.14802/jmd.16004 -
Journal of Otology Apr 2022Objective tinnitus is defined as a type of tinnitus perceived by both the patient and external observer. This paper presents two cases of objective tinnitus related to... (Review)
Review
Objective tinnitus is defined as a type of tinnitus perceived by both the patient and external observer. This paper presents two cases of objective tinnitus related to palatal tremor, along with a literature review. Palatal tremor is a condition characterized by soft palate involuntary contractions. Two types of palatal tremor have been described: symptomatic palatal tremor and essential palatal tremor, with different clinical manifestations. Diagnostic workup is based on medical history and physical examination, including direct oropharynx exploration and cavum visualization through nasopharyngoscopy. Brain MRI is mandatory in all cases. If a secondary origin is suspected, additional lab tests should be performed based on clinical suspicion. First-line treatment is botulinum toxin injection into the and muscles, with velopharyngeal insufficiency being its main adverse effect. Other medications have not been shown to be effective.
PubMed: 35949555
DOI: 10.1016/j.joto.2021.11.003 -
The Cleft Palate-craniofacial Journal :... May 2016Objective This study aimed to assess the safety and feasibility of transoral robotic surgery for the reconstruction of soft palatal clefts. Design The...
UNLABELLED
Objective This study aimed to assess the safety and feasibility of transoral robotic surgery for the reconstruction of soft palatal clefts. Design The application of transoral robotic surgery for soft palate muscle reconstruction was investigated. The da Vinci Surgical Robot was first used on a cadaver to assess the optimal positioning of the patient and the robot. The robot was then used for the dissection and reconstruction of palatal muscles in 10 consecutive patients with palatal clefts. The procedures were documented using video and still photography. A group of 30 control patients were subjected to surgery with manual instruments. Surgical and clinical outcomes were evaluated with at least 6 months of follow-up (8 ± 1 months). Results The use of the surgical robot on a cadaver provided great dexterity and excellent 3D depth perception. The transoral access was efficient and safe for the precise dissection, reorientation, and suturing of palatal muscles. In our series, the surgical duration was longer for the robotic approach than for the manual approach (87 ± 6 minutes versus 122 ± 8 minutes, P < .0001). No intraoperative or postoperative complications occurred in either group.
CONCLUSIONS
A robotic surgical approach can be used safely for palatal surgery. We believe that the precise dissection of the palatal muscles provided by the robotic system might reduce damage to the vascularization and innervation of these muscles, as well as damage to the mucosal surfaces that could cause fistula formation. In addition, this technique might improve palatal function and Eustachian tube function in cleft palate patients.
Topics: Cadaver; Cleft Palate; Humans; Palate, Soft; Plastic Surgery Procedures; Robotic Surgical Procedures
PubMed: 26120882
DOI: 10.1597/14-077 -
The Angle Orthodontist Sep 2019To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with...
OBJECTIVES
To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE).
MATERIALS AND METHODS
Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion.
RESULTS
There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly.
CONCLUSIONS
Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.
Topics: Cone-Beam Computed Tomography; Female; Humans; Male; Maxilla; Muscle Strength; Nasal Cavity; Palatal Expansion Technique; Palate; Respiratory Muscles
PubMed: 30896250
DOI: 10.2319/070518-504.1 -
European Archives of... Mar 2021The purpose of this study is to evaluate the effect of the different surgical techniques of expansion sphincter pharyngoplasty (ESP) on the dimensions of the...
PURPOSE
The purpose of this study is to evaluate the effect of the different surgical techniques of expansion sphincter pharyngoplasty (ESP) on the dimensions of the oropharyngeal airway.
METHODS
The techniques that were evaluated included the preservation and transection of the palatopharyngeus (PP) and superior pharyngeal constrictor (SPC) muscle attachment and transposition of the PP muscle to the hamulus of the medial pterygoid plate and the palatal musculature. Surgical techniques were applied in twenty half heads.
RESULTS
The preservation of the PP-SPC attachment inhibited the transposition of the PP muscle to the hamulus and resulted in comparable enlargement in the medial-lateral dimension in the oropharyngeal airway when the PP muscle was transposed to the palatal musculature. After transection of the PP-SPC attachment, significant enlargement was observed in anterior-posterior and medial-lateral directions in the oropharyngeal airway when the PP muscle was transposed both to the hamulus and the palatal musculature. The distances measured after both the transposition techniques were similar.
CONCLUSION
The present study is a basic study demonstrating how different techniques of ESP affect the position of the soft palate. The PP-SPC attachment can be transected in the patients with anterior-posterior palatal and lateral wall collapse to pull the soft palate anteriorly in addition to prevent the lateral wall collapse. The PP-SPC attachment can be preserved in the patients with only lateral wall collapse. Nevertheless, the clinical consequences of these static changes need to be evaluated in clinical studies.
Topics: Humans; Palate, Soft; Pharyngeal Muscles; Pharynx; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 32242262
DOI: 10.1007/s00405-020-05940-w -
Annals of Maxillofacial Surgery 2015The first true anatomical descriptions of the normal anatomy of the palate and pharynx were published by Von Luschka in 1868, and then in 1935 anatomist James Whillis... (Review)
Review
The first true anatomical descriptions of the normal anatomy of the palate and pharynx were published by Von Luschka in 1868, and then in 1935 anatomist James Whillis described pharyngeal sphincter. Later, in 1941 Michael Oldfield noted that the muscular elements of the soft palate have a sling-like function. Although there have been conflicting descriptions of the role of the palatopharyngeus, multiple function such as speech, swallowing, and respiration, it could role in all this function. Although, the palatopharyngeus muscle has many important functions, but it remains the missing muscle that we need to know more about it.
PubMed: 26981475
DOI: 10.4103/2231-0746.175768 -
Iranian Journal of Otorhinolaryngology Jan 2020Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore,...
INTRODUCTION
Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore, it is important to treat snoring to reduce the disruption of the bed partner's sleep and the patients' own problems. This study aimed to present a minimally invasive procedure which is easy to perform with less tissue damage.
MATERIALS AND METHODS
This study included 13 patients suffering from primary snoring with soft palate length of 2.5cm or more. All of the patients were examined and their partners were asked to fill-out the relevant questionnaires at baselines, 90 days, 6 months and 1 year after the surgery in order to assess snoring. A crescent strip of oral mucosa along with the underlying muscle were removed under general anesthesia followed by the insertion of a piece of oval-shaped titanium mesh. Moreover, two subjective methods were employed to assess the snoring of all patients.
RESULTS
11 patients were male, and the mean age and the mean body mass index of the patients were 48.69 years and 28.34 kg/m, respectively. The scores obtained from the Visual Analog Scale for snoring loudness before surgery reduced from 7.63 to 3.54, which was statistically significant (P<0.05). None of the patients experienced major complications after surgery; however, there was a partial extrusion of the implant in one case which was managed conservatively with spontaneous healing.
CONCLUSIONS
Titanium snoreplasty was successful in the reduction of snoring in this study. This method is a single-stage treatment for simple snoring with the multiple effects of palatal shortening, space increasing, and palatal stiffening.
PubMed: 32083028
DOI: 10.22038/ijorl.2019.31930.2051 -
Orthodontics & Craniofacial Research Feb 2018To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were... (Review)
Review
To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were searched. Clinical trials in DS allocated to test (treatment with palatal plates) versus control group (without palatal plates/special physiotherapy for orofacial stimulation) with follow-up of any time duration and assessing mouth closure, tongue position, active and inactive muscle function as outcomes. Study designs, subject demographics, frequency and duration of palatal plate therapy, method for assessment, follow-up period and outcomes were reported according to the PRISMA guidelines. Eight clinical studies were included. The risk of bias was considered high in three studies and moderate in 5 studies. The number of children with DS ranged between 9 and 42. The mean age of children with DS at the start of the study ranged between 2 months and 12 years. The duration of palatal plate therapy ranged between 4 months and 48 months. The follow-up period in all studies ranged from 12 to 58 months. All studies reported OPPT to be effective in improving orofacial disorders in children with DS. Most of the included studies suggest that palatal plate therapy in combination with physiotherapy/orofacial regulation therapy according to Castillo Morales/speech and language intervention seems to be effective in improving orofacial disorders in children with DS. However, the risk of bias of the included studies was high to moderate. Longitudinal trials with standardized evaluation methods, age of children at treatment initiation, treatment duration and standard orofacial outcomes are recommended.
Topics: Child; Child, Preschool; Down Syndrome; Facial Muscles; Humans; Infant; Lip; Myofunctional Therapy; Orthodontic Appliances; Tongue
PubMed: 29232055
DOI: 10.1111/ocr.12211 -
Clinical Oral Investigations Dec 2023Skull morphology and growth patterns are essential for orthodontic treatment, impacting clinical decision making. We aimed to determine the association of different...
OBJECTIVES
Skull morphology and growth patterns are essential for orthodontic treatment, impacting clinical decision making. We aimed to determine the association of different cephalometric skeletal configurations on midface parameters as measured in 3D CT datasets.
MATERIALS AND METHODS
After sample size calculation, a total of 240 fully dentulous patients between 20 and 79 years of age (mean age: 42 ± 15), who had received a CT of the skull within the scope of trauma diagnosis or intracranial bleeding, were retrospectively selected. On the basis of cephalometric analysis, using MPR reconstructions, patients were subdivided into three different vertical skull configurations (brachyfacial, mesofacial, dolichofacial) and the respective skeletal Class I, II, and III relationships. Anatomic parameters were measured using a three-dimensional post-processing console: the thickness of the maxillary and palatine bones as well as the alveolar crest, maxillary body and sutural length, width and height of the hard palate, maxillary facial wall thickness, and masseter muscle thickness and length.
RESULTS
Individuals with brachyfacial configurations had a significantly increased palatal and alveolar ridge thicknesses compared to those with dolichofacial- or mesofacial configurations. Brachyfacial configurations presented a significantly increased length and thickness of the masseter muscle (4.599 cm; 1.526 cm) than mesofacial (4.431 cm; 1.466 cm) and dolichofacial configurations (4.405 cm; 1.397 cm) (p < 0.001). Individuals with a skeletal Class III had a significantly shorter palatal length (5.313 cm) than those with Class I (5.406 cm) and Class II (5.404 cm) (p < 0.01). Sutural length was also significantly shorter in Class III (p < 0.05).
CONCLUSIONS
Skeletal configurations have an impact on parameters of the bony skull. Also, measurable adaptations of the muscular phenotype could result.
CLINICAL RELEVANCE
The association between viscerocranial morphology and midface anatomy might be beneficial for tailoring orthodontic appliances to individual anatomy and planning cortically anchored orthodontic appliances.
Topics: Adult; Humans; Middle Aged; Retrospective Studies; Face; Cephalometry; Maxilla; Palate, Hard
PubMed: 38157063
DOI: 10.1007/s00784-023-05472-7