-
Journal of Speech, Language, and... Apr 2019Purpose This study predicts and simulates the function and relative contributions of the intravelar and extravelar portions of the levator veli palatini (LVP) and...
Purpose This study predicts and simulates the function and relative contributions of the intravelar and extravelar portions of the levator veli palatini (LVP) and palatoglossus (PG) muscles in velic constrictions. Method A finite element-based model of the 3-dimensional upper airway structures (palate, pharynx, tongue, jaw, maxilla) was implemented, with LVP and PG divided into intravelar and extravelar portions. Simulations were run to investigate the contributions of these muscles in velopharyngeal port (VPP) closure and constriction of the oropharyngeal isthmus (OPI). Results Simulations reveal that the extravelar portion of LVP, though crucial for lifting the palate, is not sufficient to effect VPP closure. Specifically, the characteristic "bulge" appearing in the posterior soft palate during VPP closure ( Pigott, 1969 ; Serrurier & Badin, 2008 ) is found to result from activation of the intravelar portion of LVP. Likewise, the intravelar portion of posterior PG is crucial in bending the "veil" or "traverse" ( Gick, Francis, Klenin, Mizrahi, & Tom, 2013 ) of the velum anteriorly to produce uvular constrictions of the OPI ( Gick et al., 2014 ). Conclusions Simulations support the view that intravelar LVP and PG play significant roles in VPP and OPI constrictions.
Topics: Computer Simulation; Constriction, Pathologic; Humans; Models, Anatomic; Palatal Muscles; Palate, Soft; Pharyngeal Muscles; Velopharyngeal Insufficiency
PubMed: 30964714
DOI: 10.1044/2018_JSLHR-S-17-0247 -
Journal of Medicine and Life 2016The present study aimed to perform a medico-surgical comparative analysis of the 2 most widely used techniques: gastrostomy with peritoneal collar versus percutaneous... (Comparative Study)
Comparative Study
The present study aimed to perform a medico-surgical comparative analysis of the 2 most widely used techniques: gastrostomy with peritoneal collar versus percutaneous endoscopic gastrostomy, based on the vast clinical experience in an Upper Digestive Surgery Clinic. A retrospective study was carried out between January 2010 and January 2015 on the patients admitted for a surgical solution for feeding. The indications, preoperative preparation, surgical techniques, and postoperative outcomes were analyzed. Out of the 94 cases admitted for a surgical solution for feeding, 67 underwent gastrostomy with peritoneal collar (GPC) and in 27 cases percutaneous endoscopic gastrostomy (PEG) was performed. The indications for GPC were benign or malign causes of dysphagia, the most frequent being malign tumors of tongue, pharynx and larynx (47.76%), advanced inoperable esophageal or eso-cardiac cancers (26,86%), post-caustic esophageal stenosis (10.44%). PEG was performed in patients with functional difficulties of swallowing: sequelae of cerebral vascular accidents (44.44%), low Glasgow Coma Scale Score (29.62%) of different etiologies, Parkinson disease (18.51%) advanced dementia (7.4%), early nasopharyngeal cancer (2 cases). The intraoperatory and postoperatory complications were few and of minor importance in both techniques, but PEG allowed an immediate retake of alimentation (vs. at least 48 hours wait in GPC), with less gastric stasis, biliary reflux and aspiration related respiratory problems. Both techniques are easy and safe to perform, but an appropriate selection is required according to the cause of the swallowing difficulty. In cases with permeable digestive tube, PEG may be an excellent minimally invasive solution, but the costs and availability of the PEG kit and prehydrolyzed nutritive solution, as well as the co-existence of an upper digestive endoscopy service were limitations that had to be taken into account.
Topics: Gastroscopy; Gastrostomy; Humans; Needles; Peritoneum; Postoperative Care; Retrospective Studies
PubMed: 27928446
DOI: No ID Found -
The Journal of International Advanced... Mar 2021Anatomical information regarding the eustachian tube (ET) is limited; therefore, more detailed analytical data on ET structure is needed when planning surgical...
Morphological Observations of the Bony Canal Structure of the Eustachian Tube in Elderly Human Cadavers With Cone-Beam Computed Tomography and Principal Component Analysis.
OBJECTIVE
Anatomical information regarding the eustachian tube (ET) is limited; therefore, more detailed analytical data on ET structure is needed when planning surgical treatments involving the temporal bone.
METHODS
We examined the bony structure of the middle ear and ET in 30 Japanese donor cadavers (71-97 years old at the time of death) both macroscopically and with cone-beam computed tomography. Each ET was reconstructed in 3 dimensions, and the structure and correlations of ET element measurements, identified via principal component analysis, were analyzed.
RESULTS
Delineation between bony and cartilaginous zones appeared unclear, and the space between ET cartilage and the carotid canal was narrow. We observed stenosis of the ET bony canal in 43.3% of the specimens (n = 30). In 50% of the specimens, the position of the ET bony canal was depressed at the pharyngeal orifice of the auditory side of the tube, and the middle region was a roundish structure. The lateral and central regions of the bony canal were related to the ET bony canal structure.
CONCLUSION
The close proximity of the ET bony canal to the carotid canal is an important anatomical and morphological finding. Pre-surgical 3D modeling of the middle ear structure, or at a minimum, of the central region of the middle ear canal, may provide useful information for planning procedures that involve the ET.
Topics: Aged; Aged, 80 and over; Cadaver; Cone-Beam Computed Tomography; Eustachian Tube; Humans; Principal Component Analysis; Temporal Bone
PubMed: 33893783
DOI: 10.5152/JIAO.2021.0058 -
Journal of Veterinary Internal Medicine 2023Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically...
BACKGROUND
Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically do not undergo diagnostic testing that identifies comorbid alimentary disease. A videofluoroscopic swallow study (VFSS) identifies defects in swallowing, reflux, and aspiration.
OBJECTIVES/HYPOTHESIS
We hypothesized that dogs with respiratory and no alimentary disease (RESP) would have significantly more abnormal VFSS metrics versus controls (CON). We hypothesized RESP dogs with pulmonary parenchymal disease would have more reflux and higher penetration-aspiration score (PAS) than those with airway disease.
ANIMALS
Client-owned dogs: RESP (n = 45) and CON (n = 15) groups.
METHODS
Prospectively, all dogs underwent VFSS. The RESP dogs had advanced respiratory diagnostic testing. Eight subjective and 3 objective VFSS metrics (pharyngeal constriction ratio [PCR], PAS, and esophageal transit time [ETT]) were assessed. Fisher's exact test compared differences between groups (presence or absence of VFSS abnormalities). The Mann-Whitney rank sum test was used to compare PCR and PAS.
RESULTS
Subjective VFSS abnormalities were present in 34/45 (75%) RESP and 2/15 (13%) CON dogs, with RESP dogs significantly more likely to have VFSS abnormalities (P = .01). No difference in PCR was found between groups. Pathologic PAS was more common in RESP than CON dogs (P = .03). The RESP dogs with airway disease had higher PAS than CON dogs (P = .01) but not RESP dogs with parenchymal disease (P = .25).
CONCLUSIONS
Most (75%) RESP dogs had VFSS abnormalities, emphasizing that AeroD are common. The VFSS has value in diagnostic evaluation of respiratory disease.
Topics: Dogs; Animals; Fluoroscopy; Deglutition Disorders; Deglutition; Respiratory Tract Diseases; Gastroesophageal Reflux; Dog Diseases
PubMed: 36951400
DOI: 10.1111/jvim.16685 -
Frontiers in Oncology 2023To assess the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of subglottic hemangiomas that did not respond...
PURPOSE
To assess the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of subglottic hemangiomas that did not respond appreciably to propranolol.
MATERIALS AND METHODS
This study was a retrospective analysis. Of the 101 patients with subglottic hemangiomas admitted to our center, 10 (4 male and 6 female) patients were included in this study. All these patients underwent arterial embolization using Pingyangmycin and polyvinyl alcohol particles (300-500 μm). All patients were examined 1 month after the last treatment and monthly thereafter.
RESULTS
TASE treatment was technically successful in all patients. Ten lesions were located in the subglottic region. The blood supply included the superior thyroid artery, brachiocephalic trunk, facial artery, and ascending pharyngeal arteries. The median maximal diameter of the hemangiomas significantly decreased from 8.5 mm before treatment to 2 mm after TASE (P <.05). The degree of laryngeal obstruction improved in all patients. No serious complications were noted. One patient developed fever postoperatively, and three patients had a mild cough.
CONCLUSIONS
For even subglottic hemangiomas with suboptimal efficacy of propranolol, TASE significantly reduced the size of hemangiomas with minimal adverse effects. It had a positive effect on the improvement of airway stenosis caused by subglottic hemangioma with poor effect of oral propranolol.
PubMed: 36937450
DOI: 10.3389/fonc.2023.1062510 -
Radiation Oncology (London, England) Jun 2020Radiation-induced choanal stenosis (RICS) severely decreases life quality of patients with nasopharyngeal carcinoma (NPC) and originates from nasal mucositis, which...
BACKGROUND
Radiation-induced choanal stenosis (RICS) severely decreases life quality of patients with nasopharyngeal carcinoma (NPC) and originates from nasal mucositis, which depends on radiation dose. This self-controlled study aimed to find the correlations between dosimetric parameters and RICS.
METHODS
Totally 49 NPC patients treated with intensity-modulated radiotherapy from May 2010 to Aug. 2013 and diagnosed with RICS during follow-up were enrolled into this study. Minimum point dose, maximum point dose, mean dose (Dmean), dose covering ≥33% volume (D33), dose covering ≥66% volume (D66), and volume receiving ≥60 Gy (V60) were compared between the nasal cavities with and without RICS, through paired t-test. The parameters with difference would enter receiver operating characteristic analysis to determine their cutoff values. Then predicting abilities of the cutoff values were tested by Chi-square test.
RESULT
The nasal cavities with RICS appeared to have higher Dmean, D33, D66 and V60, compared with those without RICS (P values were 0.014, 0.003, 0.006 and 0.010). Dmean ≥54.22 Gy, D33 ≥ 61.96 Gy, D66 ≥ 46.50 Gy and V60 ≥ 48.13% were demonstrated to be related with a higher risk of RICS.
CONCLUSION
Dmean, D33, D66 and V60 of nasal cavity might be used as predictors of RICS. Their values needed to be controlled whenever possible, for ameliorating life quality of NPC patients.
Topics: Adult; Aged; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Radiation Injuries; Radiometry; Radiotherapy; Radiotherapy Dosage; Retrospective Studies; Young Adult
PubMed: 32503596
DOI: 10.1186/s13014-020-01512-8 -
Annals of Translational Medicine Feb 2020Eagle syndrome is a condition that causes pharyngeal pain, facial pain, swallowing difficulties, and symptoms of arterial impingement due to the elongated styloid...
BACKGROUND
Eagle syndrome is a condition that causes pharyngeal pain, facial pain, swallowing difficulties, and symptoms of arterial impingement due to the elongated styloid process. However, few reports were about eagle syndrome with venous compression up to now. This study aimed to identify the clinical profiles of the internal jugular vein stenosis (IJVS) related eagle syndrome comprehensively.
METHODS
A total of 27 patients, who were diagnosed as IJVS induced by styloid process compression were enrolled. The clinical manifestations and imaging features were analyzed.
RESULTS
Styloid process compression was presented in all of the 27 IJVS patients, in which, the top three symptoms included insomnia (81.5%), tinnitus (63.0%) and head noises (63.0%). The most vulnerable segment of internal jugular vein (IJV) was J3 segment (96.3%). The average styloid process length in our study was 3.7 cm. Hearing impairment was more common in bilateral IJVS (68.8% 18.2%, P=0.018). One patient reported significant relief of symptoms at 1 year follow-up after underwent styloidectomy combined with stenting.
CONCLUSIONS
Neurological symptoms of eagle syndrome induced IJVS were various, including either arterial or venous issues. Better understanding of this disease entity may be helpful for clinical diagnosis and treatment.
PubMed: 32175390
DOI: 10.21037/atm.2019.12.93 -
Medicine Aug 2020The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim... (Comparative Study)
Comparative Study Observational Study
The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (β = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.
Topics: Deglutition Disorders; Dilatation; Endoscopes; Esophageal Sphincter, Upper; Esophageal Stenosis; Female; Humans; Male; Middle Aged
PubMed: 32871899
DOI: 10.1097/MD.0000000000021793 -
Journal of Surgical Case Reports Jul 2022Crouzon's syndrome is associated with the respiratory impairment of the upper airway due to mid-facial hypoplasia. We managed an adult Crouzon patient who wanted us to...
Crouzon's syndrome is associated with the respiratory impairment of the upper airway due to mid-facial hypoplasia. We managed an adult Crouzon patient who wanted us to treat his choanal and nasopharyngeal stenosis for obstructive sleep apnea relief and tracheostomy tube extubation. We drilled out the abnormal maxillary bone and created a new nasal passage to the pharynx. Epithelialization of the new nasal cavity was completed within a month, and the patient was able to breathe through the nose and his sense of smell improved somewhat after the surgery. Although the apnea-hypopnea index had decreased, sleep apnea remained.
PubMed: 35919695
DOI: 10.1093/jscr/rjac358 -
Journal of Thoracic Disease Sep 2019Self-expandable metallic Y-shaped airway stents (SEMYS) are commonly used in the management of airway stenosis and fistulae caused by thoracic neoplasms.
BACKGROUND
Self-expandable metallic Y-shaped airway stents (SEMYS) are commonly used in the management of airway stenosis and fistulae caused by thoracic neoplasms.
METHODS
A new technique using a slightly modified regular endotracheal tube has been developed for the deployment of SEMYS with flexible bronchoscopy alone. The technique and devices are described.
RESULTS
To date, successful deployment of SEMYS with this method has been carried out successfully in 17 out of 20 patients without major complications while the other 3 required conversion to rigid bronchoscopy because of limited pharyngeal cavity space, massive hemorrhage and severe cicatrization of the airway, respectively.
CONCLUSIONS
This simplified deployment technique with the modified endotracheal tube enables safe, simple and fast insertion of SEMYS in a regular bronchoscopy suite, which may benefit the vast less privileged institutions where SEMYS are necessary but rigid bronchoscopy and fluoroscopy are not available. The skill of the bronchoscopist, cautious selection of patients and effective coordination of the operating team are crucial for the procedure.
PubMed: 31656657
DOI: 10.21037/jtd.2019.09.16