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The Medical Clinics of North America Nov 2014Patients often present to their physician with complaints of dental and/or oral pain. It is important for physicians to understand the complexities of oral anatomy and... (Review)
Review
Patients often present to their physician with complaints of dental and/or oral pain. It is important for physicians to understand the complexities of oral anatomy and how to perform a basic clinical examination of this area to evaluate and potentially manage patients with these complaints. This article discusses anatomic structures of the oral cavity and systematic clinical examination of this area.
Topics: Dentition; Diagnosis, Oral; Humans; Mouth; Mouth Mucosa; Pharynx; Primary Health Care; Salivary Glands
PubMed: 25443674
DOI: 10.1016/j.mcna.2014.08.001 -
European Journal of Cancer (Oxford,... Sep 2021To update the 2015 clinical practice guideline for the prevention of oral mucositis in pediatric cancer or hematopoietic stem cell transplant (HSCT) patients. (Review)
Review
PURPOSE
To update the 2015 clinical practice guideline for the prevention of oral mucositis in pediatric cancer or hematopoietic stem cell transplant (HSCT) patients.
METHODS
We performed seven systematic reviews of mucositis prevention. Three reviews included randomized controlled trials (RCTs) conducted in pediatric and adult patients evaluating cryotherapy, keratinocyte growth factor (KGF) or photobiomodulation therapy with a focus on efficacy. Three reviews included studies of any design conducted in pediatric patients evaluating these same interventions with a focus on adverse events and feasibility. One review included all RCTs of any intervention for mucositis prevention in pediatric patients. Primary outcome was severe oral mucositis.
RESULTS
We included 107 unique studies of cryotherapy (22 RCTs and 4 pediatric studies); KGF (15 RCTs and 12 pediatric studies); photobiomodulation therapy (29 RCTs and 8 pediatric studies) and any intervention (31 pediatric RCTs). Effects on severe mucositis reduction from RCTs were cryotherapy risk ratio (RR) 0.49 and 95% confidence interval (CI) 0.31-0.76; palifermin RR 0.81 and 95% CI 0.69-0.95 and photobiomodulation therapy RR 0.40 and 95% CI 0.27-0.60. Cryotherapy was not feasible in young children while photobiomodulation therapy was feasible across age groups. Palifermin was associated with adverse effects.
CONCLUSIONS
Cryotherapy should be used for older cooperative pediatric patients who will receive short infusions of melphalan or 5-fluorouracil. Intraoral photobiomodulation therapy (620-750 nm spectrum) should be used in pediatric patients undergoing autologous or allogeneic HSCT and for pediatric head and neck carcinoma patients undergoing radiotherapy. Palifermin should not be used routinely in pediatric cancer or HSCT patients.
Topics: Adult; Child; Cryotherapy; Hematopoietic Stem Cell Transplantation; Humans; Low-Level Light Therapy; Neoplasms; Oropharynx; Practice Guidelines as Topic; Radiotherapy; Stomatitis
PubMed: 34252760
DOI: 10.1016/j.ejca.2021.05.013 -
MMW Fortschritte Der Medizin Feb 2023
Topics: Humans; Pharynx; Globus Sensation; Neck; Gastric Mucosa
PubMed: 36759453
DOI: 10.1007/s15006-023-2372-7 -
Postgraduate Medical Journal Jul 2018Pathogenic bacteria associated with the adenoids and tonsils cause much morbidity in the paediatric population. Hyperplasia of the adenoids is associated with otitis... (Review)
Review
Pathogenic bacteria associated with the adenoids and tonsils cause much morbidity in the paediatric population. Hyperplasia of the adenoids is associated with otitis media with effusion and hyperplasia of the palatine tonsils is associated with both recurrent tonsillitis and obstructive sleep apnoea. Most current knowledge of the microbiology of the upper airways has been derived from culture-based studies, which usually reflect only a small fraction of the bacteria present on the mucosal surface. Culture-independent molecular surveys based on 16S ribosomal RNA sequencing are now being employed to determine the microbiota on the surface and within the tissue of adenoids and palatine tonsils. This review describes the new techniques applied in determining the microbiome and summarises the results of studies employing these techniques.
Topics: Adenoids; Child; Humans; Hypertrophy; Microbiota; Palatine Tonsil; Recurrence; Sequence Analysis, RNA; Tonsillitis
PubMed: 29884749
DOI: 10.1136/postgradmedj-2018-135602 -
The Surgical Clinics of North America Dec 2020Zenker diverticulum (ZD) is a rare but treatable surgical disease affecting the elderly. This article reviews current available evidence and management of ZD, which... (Review)
Review
Zenker diverticulum (ZD) is a rare but treatable surgical disease affecting the elderly. This article reviews current available evidence and management of ZD, which includes open surgical, rigid endoscopic, and flexible endoscopic diverticulotomy with common goal of complete division of cricopharyngeus muscle. Careful patient selection and operative intervention tailored to patient characteristics is important when evaluating patients for operative intervention for ZD. Described in detail is a novel flexible endoscopic approach using submucosal tunneling technique to perform cricopharyngeal myotomy, also called per oral endoscopic myotomy, which is demonstrated to be safe and effective in the management of ZD with low morbidity.
Topics: Esophageal Mucosa; Esophageal Sphincter, Upper; Humans; Myotomy; Natural Orifice Endoscopic Surgery; Zenker Diverticulum
PubMed: 33128890
DOI: 10.1016/j.suc.2020.08.005 -
Cell Sep 2021SARS-CoV-2 infection can cause severe respiratory COVID-19. However, many individuals present with isolated upper respiratory symptoms, suggesting potential to constrain...
SARS-CoV-2 infection can cause severe respiratory COVID-19. However, many individuals present with isolated upper respiratory symptoms, suggesting potential to constrain viral pathology to the nasopharynx. Which cells SARS-CoV-2 primarily targets and how infection influences the respiratory epithelium remains incompletely understood. We performed scRNA-seq on nasopharyngeal swabs from 58 healthy and COVID-19 participants. During COVID-19, we observe expansion of secretory, loss of ciliated, and epithelial cell repopulation via deuterosomal cell expansion. In mild and moderate COVID-19, epithelial cells express anti-viral/interferon-responsive genes, while cells in severe COVID-19 have muted anti-viral responses despite equivalent viral loads. SARS-CoV-2 RNA host-target cells are highly heterogenous, including developing ciliated, interferon-responsive ciliated, AZGP1 goblet, and KRT13 "hillock"-like cells, and we identify genes associated with susceptibility, resistance, or infection response. Our study defines protective and detrimental responses to SARS-CoV-2, the direct viral targets of infection, and suggests that failed nasal epithelial anti-viral immunity may underlie and precede severe COVID-19.
Topics: Adult; Aged; Bystander Effect; COVID-19; Cohort Studies; Female; Humans; Immunity; Male; Middle Aged; Nasopharynx; RNA, Viral; Respiratory Mucosa; SARS-CoV-2; Severity of Illness Index; Transcription, Genetic; Viral Load
PubMed: 34352228
DOI: 10.1016/j.cell.2021.07.023 -
Dysphagia Apr 2016Eructation is composed of three independent phases: gas escape, upper barrier elimination, and gas transport phases. The gas escape phase is the gastro-LES inhibitory... (Review)
Review
Eructation is composed of three independent phases: gas escape, upper barrier elimination, and gas transport phases. The gas escape phase is the gastro-LES inhibitory reflex that causes transient relaxation of the lower esophageal sphincter, which is activated by distension of stretch receptors of the proximal stomach. The upper barrier elimination phase is the transient relaxation of the upper esophageal sphincter along with airway protection. This phase is activated by stimulation of rapidly adapting mechanoreceptors of the esophageal mucosa. The gas transport phase is esophageal reverse peristalsis mediated by elementary reflexes, and it is theorized that this phase is activated by serosal rapidly adapting tension receptors. Alteration of the receptors which activate the upper barrier elimination phase of eructation by gastro-esophageal reflux of acid may in part contribute to the development of supra-esophageal reflux disease.
Topics: Eructation; Esophageal Mucosa; Esophageal Sphincter, Lower; Esophageal Sphincter, Upper; Gases; Gastroesophageal Reflux; Humans; Mechanoreceptors; Peristalsis; Stomach
PubMed: 26694063
DOI: 10.1007/s00455-015-9674-6 -
Dermatologie (Heidelberg, Germany) Sep 2022Mucosal lichen planus (MLP) is a chronic inflammatory disease of the mucosa. This condition can affect the mouth, esophagus, pharynx, genitalia, anus, and conjunctiva.... (Review)
Review
Mucosal lichen planus (MLP) is a chronic inflammatory disease of the mucosa. This condition can affect the mouth, esophagus, pharynx, genitalia, anus, and conjunctiva. This disease shows a tendency to chronicity with phases of relapses for a duration of 3-10 years. It presents with varying morphologies including lacy or fern-like, slightly raised striae, erosions, erythema, and atrophy. The pathophysiology is not yet fully understood and is dominated by the classic band-like lymphocytic infiltrate along the dermoepidermal junction. MLP is very challenging to treat, since the clinical course entails frequent relapses and shows resistance to therapy. The most commonly used local treatments are topical corticosteroids or calcineurin inhibitors. In addition to systemic glucocorticosteroids and traditional systemic drugs such as oral retinoids or methotrexate, emerging anti-inflammatory therapies such as Janus kinase inhibitors and biologics may be promising and are currently being evaluated in clinical trials.
Topics: Dermatologic Agents; Glucocorticoids; Humans; Lichen Planus; Mucous Membrane; Recurrence
PubMed: 35943534
DOI: 10.1007/s00105-022-05034-0 -
The Journal of Craniofacial Surgery Nov 2014Improvements in the efficacy of extended endonasal approaches to resect skull base pathologies have created the need for new reconstructive alternatives. Hereby, we...
OBJECTIVES
Improvements in the efficacy of extended endonasal approaches to resect skull base pathologies have created the need for new reconstructive alternatives. Hereby, we describe a novel pedicled myomucosal flap that allows the reconstruction of dural defects in the lower clivus and craniovertebral junction or to cover the paraclival and petrous segments of the internal carotid artery.
STUDY DESIGN
Anatomic description. Technical report. Feasibility.
METHODS
We describe a myomucosal flap with a cephalic pedicle based on the salpingopharyngeus muscle and its vessels. Subsequently, using a cadaveric model, we harvested the flap and explored its potential for the reconstruction of various dural defects or to cover the internal carotid artery.
RESULTS
Our study confirmed the feasibility of harvesting and transposing the myomucosal salpingopharyngeus (Dicle flap) flap for the reconstruction of inferior clival and craniovertebral junction defects or to cover the petrous and paraclival segments of the internal carotid artery.
CONCLUSIONS
The Dicle flap is a feasible, reconstructive alternative for the reconstruction of select small- to medium-sized defects of the posterior and inferior aspects of the ventral skull base.
Topics: Cadaver; Carotid Artery, Internal; Cranial Fossa, Posterior; Dissection; Dura Mater; Endoscopy; Feasibility Studies; Humans; Mouth Mucosa; Petrous Bone; Pharyngeal Muscles; Plastic Surgery Procedures; Skull Base; Surgical Flaps; Tissue and Organ Harvesting
PubMed: 25329841
DOI: 10.1097/SCS.0000000000000977 -
Developmental and Comparative Immunology Aug 2021Immunoglobulins (Igs) are complex glycoproteins that play critical functions in innate and adaptive immunity of all jawed vertebrates. Given the unique characteristics... (Review)
Review
Immunoglobulins (Igs) are complex glycoproteins that play critical functions in innate and adaptive immunity of all jawed vertebrates. Given the unique characteristics of mucosal barriers, secretory Igs (sIgs) have specialized to maintain homeostasis and keep pathogens at bay at mucosal tissues from fish to mammals. In teleost fish, the three main IgH isotypes, IgM, IgD and IgT/Z can be found in different proportions at the mucosal secretions of the skin, gills, gut, nasal, buccal, and pharyngeal mucosae. Similar to the role of mammalian IgA, IgT plays a predominant role in fish mucosal immunity. Recent studies in IgT have illuminated the primordial role of sIgs in both microbiota homeostasis and pathogen control at mucosal sites. Ten years ago, IgT was discovered to be an immunoglobulin class specialized in mucosal immunity. Aiming at this 10-year anniversary, the goal of this review is to summarize the current status of the field of fish Igs since that discovery, while identifying knowledge gaps and future avenues that will move the field forward in both basic and applied science areas.
Topics: Animals; Fish Diseases; Fish Proteins; Fishes; Immunity, Mucosal; Immunoglobulins; Lymphoid Tissue; Mucous Membrane; Vaccination
PubMed: 33785432
DOI: 10.1016/j.dci.2021.104079