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International Orthodontics Mar 2021This systematic review assessed the effects of tooth-borne (TB), tooth-bone-borne (TBB) and bone-borne (BB) micro-implant assisted rapid maxillary expansion (RPE) on... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review assessed the effects of tooth-borne (TB), tooth-bone-borne (TBB) and bone-borne (BB) micro-implant assisted rapid maxillary expansion (RPE) on airway dimensions and function in young children and adolescents (10- to 17-years-old).
MATERIALS AND METHODS
Unrestricted search in 5 electronic databases until June 6th, 2020 was undertaken. This was supplemented with search in 6 additional resources for published, unpublished and ongoing trials up. Randomized (RCT) and non-randomized (Non-RCT) prospective studies that assessed the influence of the mini-screw-assisted rapid palatal expansion (MARPE) approach on airway and breathing in young children and adolescents were included. Two reviewers performed the study selection and data extraction blindly and in duplicate by two authors while disagreements. A random-effects model with a 95% confidence interval (CI), I2 and Chi tests were done. ROBINS-I, Cochrane Risk of Bias and GRADE tools were used. Reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Overall, 518 articles were retrieved; only 3 studies (2 RCT and one non-RCT) met the inclusion criteria. Both TB RPE and BB RPE improved on a short-term basis the dimensions of the airway, though the difference was not significant (P>0.05). TBB RPE significantly improved nasal airflow [(Mean difference (MD) 52.7 cm/s, 95% confidence interval (95% CI) 9.0-96.4), P=0.020)], reduced nasal resistance (MD -0.20Pa/cm, 95% (-0.38)-(-0.02), P=0.028), and changed respiratory muscle strength variables (P>0.05). No correlation was found between the anatomical dimensions of the airway and the functional airway parameters (P>0.05).
CONCLUSIONS
The short-term airway volumetric changes secondary to MARPE were not significant. The influence of MARPE appliances on breathing is still not clear. Registration PROSPERO database (CRD42020183340).
Topics: Adolescent; Bone Screws; Child; Databases, Factual; Humans; Maxilla; Middle Aged; Palatal Expansion Technique; Palate; Respiration
PubMed: 33516650
DOI: 10.1016/j.ortho.2021.01.004 -
Indian Journal of Otolaryngology and... Dec 2022Diphtheria is an acute infectious disease caused by the exotoxin produced by Corynebacterium diphtheriae, a gram positive bacteria. It has propensity to affect mainly...
Diphtheria is an acute infectious disease caused by the exotoxin produced by Corynebacterium diphtheriae, a gram positive bacteria. It has propensity to affect mainly cardiac muscle and nervous system. To study the percentage, spectrum of patients with various neurological complications and the pattern of recovery in followed up confirmed cases of diphtheria. Single centre prospective analysis of neurological complications in diphtheria patients from June 2019 to September 2020 at SMS Medical College and hospital,Jaipur. In this study, 60 cases were included. Immunised cases were 60% (36 out of 60 cases) whereas unimmunised constituted the rest 40% (24 out of 60 cases). Neurological complications were observed in 15% of the cases (9 out of 60). Isolated palatal palsy was the most common complication (4 out of 9 cases, 44.44%), succeeded by lower limb LMN palsies (2 out of 9 cases, 22.22%) with unilateral facial nerve palsy, bilateral abductor palsy and paralytic ileus constituting the rest (1 out of 9 cases each, 11.11% each). Onset of complications ranged from 10 to 36 days whereas recovery was complete and without any residual sequelae between 60 to 240 days. Our study concluded that neurological complications form a sizeable portion of post diptheritic complications and carries good prognosis, hence timely diagnosis and differentiation from other neuropathies is a pre requisite for rational management and contact tracing.
PubMed: 36742785
DOI: 10.1007/s12070-021-02706-6 -
Journal of Dental Research Mar 2017Although palatal muscle reconstruction in patients with cleft palate takes place during early childhood, normal speech development is often not achieved. We hypothesized...
Although palatal muscle reconstruction in patients with cleft palate takes place during early childhood, normal speech development is often not achieved. We hypothesized that the intrinsic properties of head satellite cells (SCs) and the young age of these patients contribute to the poor muscle regeneration after surgery. First, we studied the fiber type distribution and the expression of SC markers in ex vivo muscle tissue from head (branchiomeric) and limb (somite-derived) muscles from neonatal (2-wk-old) and young (9-wk-old) rats. Next, we cultured SCs isolated from these muscles for 5, 7, and 9 d, and investigated the in vitro expression of SC markers, as well as changes in proliferation, early differentiation, and fusion index (myotube formation) in these cells. In our ex vivo samples, we found that virtually all myofibers in both the masseter (Mass) and the levator veli palatini (LVP) muscles contained fast myosin heavy chain (MyHC), and a small percentage of digastric (Dig) and extensor digitorum longus myofibers also contained slow MyHC. This was independent of age. More SCs were found in muscles from neonatal rats as compared with young rats [17.6 (3.8%) v. 2.3 (1.6%); P < 0.0001]. In vitro, young branchiomeric head muscle (BrHM) SCs proliferated longer and differentiated later than limb muscle SCs. No differences were found between SC cultures from the different BrHMs. SC cultures from neonatal muscles showed a much higher proliferation index than those from young animals at 5 d (0.8 v. 0.2; P < 0.001). In contrast, the fusion index in neonate SCs was about twice as low as that in SCs from young muscles at 9 d [27.6 (1.4) v. 62.8 (10.2), P < 0.0001]. In conclusion, SCs from BrHM differ from limb muscles especially in their delayed differentiation. SCs from neonatal muscles form myotubes less efficiently than those from young muscles. These age-dependent differences in stem cell properties urge careful consideration for future clinical applications in patients with cleft palate.
Topics: Age Factors; Animals; Animals, Newborn; Cell Culture Techniques; Cell Differentiation; Cell Proliferation; Immunohistochemistry; In Vitro Techniques; Muscle Fibers, Skeletal; Muscle, Skeletal; Myosin Heavy Chains; Rats; Satellite Cells, Skeletal Muscle
PubMed: 27856964
DOI: 10.1177/0022034516679136 -
Journal of Speech, Language, and... Jun 2020Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal...
Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women ( = 22.8 years, = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of "ansa." Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors ( < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin distance, velar thickness, pharyngeal depth, and velopharyngeal ratio. Significant predictors ( < .05) of maximum contraction velocity during velopharyngeal closure included mean extravelar length, intravelar length, LVP origin-to-origin distance, and velar thickness. Conclusions This study identified six velopharyngeal variables that predict LVP muscle function during real-time speech. These predictors should be considered among children and individuals with repaired cleft palate in future studies.
Topics: Adult; Child; Cleft Palate; Female; Humans; Magnetic Resonance Imaging; Male; Muscle Contraction; Palatal Muscles; Palate, Soft; Pharynx; Speech
PubMed: 32539646
DOI: 10.1044/2020_JSLHR-20-00013 -
Journal of Speech, Language, and... Nov 2022There is currently little evidence reporting the typical morphology of the palatoglossus (PG) muscle. The primary purpose of this exploratory study is to determine...
PURPOSE
There is currently little evidence reporting the typical morphology of the palatoglossus (PG) muscle. The primary purpose of this exploratory study is to determine whether magnetic resonance imaging (MRI) methods used to quantify the morphology of the levator veli palatini (LVP) muscle can be applied to the PG. The secondary purpose is to provide preliminary data regarding the relationship between the LVP and PG muscles in children.
METHOD
Ten children between ages of 4 and 7 years participated in this study. Each participant was scanned using a nonsedated, child-friendly protocol with a T2-weighted, three-dimensional anatomical scan to obtain images of the oropharyngeal anatomy. Custom, oblique-coronal image planes were created to visualize and measure the LVP and PG muscles in their entirety from origin to insertion. Thermo Scientific Amira Software was used to obtain 2D measurements of PG muscle length, width, velar insertion distance, lingual insertion distance, and several angle measurements.
RESULTS
The PG ranged from 17.95 to 26.96 mm in length across participants. Velar insertion distance ranged from 17.22 to 30.95 mm. Lingual insertion distance ranged from 26.91 to 36.02 mm. Width ranged from 2.32 to 3.08 mm. The angle formed by the PG and LVP muscle planes ranged from 7.3° to 52.7°. The LVP insertion angle ranged from 42.5° to 75.9°. The PG insertion angle ranged from 16.9° to 52.3°.
CONCLUSIONS
MRI was successful in visualizing the PG muscle. The PG was consistent in size and shape within an individual participant but varied across the participant cohort.
Topics: Humans; Child, Preschool; Child; Palatal Muscles; Magnetic Resonance Imaging; Tongue; Software; Palate, Soft
PubMed: 36283682
DOI: 10.1044/2022_JSLHR-22-00303 -
Otolaryngology--head and Neck Surgery :... Oct 2016To investigate the efficacy of anterolateral advancement pharyngoplasty to enlarge pharyngeal airspace and to decrease palatal and lateral pharyngeal wall collapse in...
OBJECTIVE
To investigate the efficacy of anterolateral advancement pharyngoplasty to enlarge pharyngeal airspace and to decrease palatal and lateral pharyngeal wall collapse in the treatment of obstructive sleep apnea (OSA).
STUDY DESIGN
Prospective study.
SETTING
University medical hospital.
SUBJECTS AND METHOD
Forty-one patients underwent an anterolateral advancement pharyngoplasty procedure according to the following criteria: body mass index <30 kg/m(2), Friedman stage II or III, type I Fujita, nocturnal polysomnography diagnostic of OSA, retropalatal and lateral pharyngeal collapse, and diagnosis with flexible nasoendoscopy during a Müller's maneuver based on a 5-point scale. Patients with retroglossal airway collapse were excluded from the study. The principle of this technique is to advance and fix the palatopharyngeus muscle with the superior pharyngeus constrictor muscle without transecting any of their fascicules anterolateral to the pterygomandibular raphe and anterosuperior to the levator veli palatine muscle.
RESULTS
Pre- and postoperative polysomnography findings (mean ± SD) showed significant statistical differences: apnea hypopnea index (AHI) decreased from 42.1 ± 16.34 to 16.3 ± 10.3 (P ≤ .001); percentage of time with oxyhemoglobin saturation <90% decreased from 18.5% ± 4.2% to 10.1% ± 1.3% (P ≤ .001); and lowest oxygen saturation level increased from 79.9% ± 14.8% to 89.3% ± 11.1% (P ≤ .05). The mean time for patients to return to a normal diet was 12.2 days. There was no postoperative bleeding, velopharyngeal insufficiency, speech alternations, or taste loss. Based on a threshold of a 50% reduction in AHI and AHI <20, surgical success was 86.8%.
CONCLUSION
Anterolateral advancement pharyngoplasty appears to be an effective technique with a high surgical success rate in the treatment of OSA patients with lateral pharyngeal wall collapse.
Topics: Adult; Female; Humans; Male; Middle Aged; Pharynx; Prospective Studies; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 27221568
DOI: 10.1177/0194599816648127 -
Primary Palatoplasty With Intravelar Veloplasty Using Acellular Dermal Matrix Interpositional Graft.The Journal of Craniofacial SurgeryThe aim of this study was to analyze the effect of acellular dermal matrix (ADM) on fistula formation after primary palatoplasty using intravelar veloplasty for levator...
The aim of this study was to analyze the effect of acellular dermal matrix (ADM) on fistula formation after primary palatoplasty using intravelar veloplasty for levator veli palatini muscle repair.This single-center retrospective study included patients who underwent primary palatoplasty with intravelar veloplasty for reorientation of the levator veli palatini muscles between April 2014 and March 2018. In the control group (group A) conventional intravelar veloplasty was performed, while in the ADM group (group B) intravelar veloplasty using ADM was performed. The study sample was composed of 162 patients, 81 in each of the 2 groups (A and B). In group B, securely dissected muscles were overlapped, and a pentagon-shaped ADM (AlloDerm, LifeCell Corp., Branchburg, NJ) of 1.6 mm mean thickness, 11.3 mm mean width, and 14.4 mm mean length was designed, and placed under the repaired levator muscle sling. The outcome variable was the occurrence of oronasal fistula within the first 6 months after surgery.Postoperative fistula formation was reported in 6 patients in group A (7.4%) and in 5 patients in group B (6.2%). There was no statistically significant difference between the 2 groups (P = 0.755). There were 7 cases of ADM exposure and 2 cases of wound dehiscence in group B.The results of this study demonstrated that ADM use did not have any disadvantage with respect to oronasal fistula complications after intravelar veloplasty for levator veli palatini muscle repair.
Topics: Acellular Dermis; Cleft Palate; Female; Humans; Infant; Male; Muscle, Skeletal; Oral Fistula; Palatal Muscles; Palate, Soft; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies
PubMed: 32868731
DOI: 10.1097/SCS.0000000000006950 -
Auris, Nasus, Larynx Jun 2020Obstructive sleep apnea (OSA) is a prevalent disease, which influences social relations and quality of life with major health impact. The etiology of OSA is... (Review)
Review
Obstructive sleep apnea (OSA) is a prevalent disease, which influences social relations and quality of life with major health impact. The etiology of OSA is multi-factorial involving both anatomical obstruction and physiological collapse of the upper airway during sleep with different proportion in individual patients. Continuous positive airway pressure (CPAP) is the gold standard and first-line treatment for OSA patients. The mechanism of CPAP is acting as air splint to avoid principal pharyngeal collapse during sleep. Consequently, extrapharyngeal collapse and significant pharyngeal obstructions can lower its compliance and lead to its failure. Adequate mask and pressure with thorough survey to eliminate side effects of CPAP from nasal, mask and flow-related problems are the prerequisite to improve CPAP compliance. For CPAP failure patients, multi-dimensional surgery is an alternative and salvage treatment that involves soft tissue surgery, skeletal surgery, and bariatric surgery. OSA patients with craniofacial anomaly are suggested to skeletal surgery. By contrast, OSA patients with pathological obesity are referred to bariatric surgery. Soft tissue surgery targets at the nose, soft palate, lateral pharyngeal wall, tongue and epiglottis that can be implemented by multi-level surgery with hybrid technique (mucosa-preservation, fat-ablation, muscle-suspension, tonsil-excision, cartilage-reconstruction) to maximize surgical outcomes and minimize complications. Some evolution in surgical concept and technique are noteworthy that include mini-invasive septoturbinoplasty, palatal suspension instead of excision, whole tongue treatment, and two-dimensional supraglottoplasty. Postoperative integrated treatment including myofunctional, positional therapy and body weight control reduces relapse of OSA and improves long-term treatment outcomes.
Topics: Combined Modality Therapy; Continuous Positive Airway Pressure; Humans; Otorhinolaryngologic Surgical Procedures; Pharynx; Plastic Surgery Procedures; Sleep Apnea, Obstructive; Treatment Failure
PubMed: 32386825
DOI: 10.1016/j.anl.2020.03.007 -
The Cleft Palate-craniofacial Journal :... Jun 2021The goal of this study is to determine the typical range of asymmetry between the length and thickness of the levator veli palatini muscle and to explore the impact of...
PURPOSE
The goal of this study is to determine the typical range of asymmetry between the length and thickness of the levator veli palatini muscle and to explore the impact of the observed asymmetry on velopharyngeal closure. A second objective is to report normative length and thickness of the levator veli palatini muscle among adults with typical velopharyngeal anatomy.
METHOD
Magnetic resonance imaging (MRI) data and Amira 5.5 Visualization software were used to evaluate the levator veli palatini muscle among 89 participants with typical velopharyngeal anatomy. Flexible nasopharyngoscopy was used to determine the function of velopharyngeal closure among 39 of the 89 participants with typical velopharyngeal anatomy to examine the functional impact of observed asymmetry.
RESULTS
Matched paired tests demonstrated a nonsignificant difference between the length and thickness of the right and left levator muscle. The mean difference between the right and left length of the levator muscle was 2.28 mm but ranged from 0.09 mm to 10.37 mm. In all cases where individuals displayed asymmetry in the levator muscle through MRI, there was no observed impact on the symmetry of velopharyngeal closure.
DISCUSSION
This study suggest that differences in the right and left levator veli palatini muscle are not significant among individuals without cleft palate. However, among individual cases where asymmetry was sizeable, there was no direct impact on the closure pattern. This may suggest there are multiple factors that contribute to asymmetrical velopharyngeal closure that are beyond the level of the levator veli palatini muscle.
Topics: Adult; Cleft Palate; Humans; Magnetic Resonance Imaging; Palatal Muscles; Palate, Soft; Velopharyngeal Insufficiency
PubMed: 32990031
DOI: 10.1177/1055665620961269 -
The Journal of Craniofacial Surgery May 2017The purpose of this study was to examine differences in levator veli palatini (levator) morphology between adults with repaired cleft palate and adults with noncleft...
The purpose of this study was to examine differences in levator veli palatini (levator) morphology between adults with repaired cleft palate and adults with noncleft anatomy. Fifteen adult participants (10 with noncleft anatomy, 5 with repaired cleft palate) underwent 3-dimensional (3D) static magnetic resonance imaging (MRI). Image analyses included measures of total muscle volume and the circumference and diameter at 6 points along the length of the muscle. Differences between groups were analyzed using independent sample Mann-Whitney U tests (α < 0.05). Significant differences between groups were noted for measures of muscle volume, circumference at the origin and midline, anterior-posterior diameter at the origin and midline, and superior-inferior diameter at the point of insertion into the velum and midline. Differences in measures at other points along the levator muscle belly were not statistically significant. Limited sample size and gender differences may have impacted statistical findings. Overall, the levator muscle in adults with repaired cleft palate is significantly different than that of adults with noncleft anatomy. This study demonstrates the successful implementation of a method for 3D analysis of velopharyngeal (VP) musculature with potential clinical utility given continued technological advancements in MRI. Continued evaluation of pre- and postsurgical anatomy and short- and long-term outcomes may contribute to a better understanding of the effects of various types of palatoplasties on levator structure, which is important to VP function for speech.
Topics: Adult; Cleft Palate; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Organ Size; Orthognathic Surgical Procedures; Palatal Muscles; Palate, Soft; Postoperative Complications; Reproducibility of Results; Velopharyngeal Insufficiency
PubMed: 28060090
DOI: 10.1097/SCS.0000000000003373