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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 -
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 of Oral Biology Jan 2024Chewing, swallowing, and respiration are synchronized oropharyngeal functions. This study aimed to analyze the dynamics and coordination during natural chewing and...
OBJECTIVE
Chewing, swallowing, and respiration are synchronized oropharyngeal functions. This study aimed to analyze the dynamics and coordination during natural chewing and swallowing in relation to respiratory phases.
DESIGN
Eight oropharyngeal muscles in minipigs were recorded using electromyography, X-ray fluoroscopy, and nasopharyngeal dynamics. Chewing cycles and swallowing episodes were analyzed for timing and activity amplitude along respiratory cycles. Digastric and middle pharyngeal constrictor were used as zero-points for timing analysis in chewing cycles and swallowing episodes, respectively. The beginning of these cycles and episodes were used as the zero-point for timing analysis in respiration during feeding.
RESULTS
The timing of jaw closing (57.8%) was longer than opening (42.2%) during chewing. Muscle activity occurred 20% later than digastric onsets and 15% earlier than jaw closing phase. Duration of muscle activity was shorter in ipsilateral than contralateral sides except for palatal muscles. Pharyngeal, palatal, and hyoid muscles showed longer durations than tongue muscles in jaw opening (p < 0.05). Palatal and hyoid muscles showed 2-phased activity in chewing while hyoid muscles showed higher amplitude in chewing and swallowing than other muscles. About 80% of the chewing cycles and swallowing episodes occurred in expiration. Nasopharyngeal airflow velocity increased from jaw opening to swallowing while airflow pressure decreased.
CONCLUSION
These findings indicate key activity of palatal and pharyngeal muscles mostly in chewing. The respiratory cycle changes in chewing and swallowing simultaneously with the activation of the tongue, palatal, and pharyngeal muscles. These findings will be useful for further understanding the mechanisms in swallowing and breathing disorders.
Topics: Animals; Swine; Mastication; Deglutition; Swine, Miniature; Tongue; Pharyngeal Muscles; Electromyography; Respiration
PubMed: 37948985
DOI: 10.1016/j.archoralbio.2023.105845 -
BMJ Case Reports Jan 2022
Topics: Essential Tremor; Humans; Palatal Muscles; Palate; Tremor
PubMed: 35039383
DOI: 10.1136/bcr-2021-248139 -
International Journal of Surgery Case... Jan 2021Pain in the soft palate and pharynx can originate from numerous related anatomical structures. Therefore, the diagnosis of patients who complain of pain in these areas...
INTRODUCTION
Pain in the soft palate and pharynx can originate from numerous related anatomical structures. Therefore, the diagnosis of patients who complain of pain in these areas is also difficult and challenging. One of the anatomic disorders that causes pain and discomfort in this region is pterygoid hamulus elongation syndrome.
PRESENTATION OF CASE
We report a rare case of pterygoid hamulus elongation with persistent sharp localized pain in the hamular region radiating to the temporal area for four years that was treated successfully by surgical resection of elongated hamulus.
DISCUSSION
Pterygoid Hamulus elongation syndrome is a unique disease presenting many symptoms in the palatal and pharyngeal areas. May caused by injury, infection, or a pre-existing condition. The diagnosis of hamular elongation should be based on detailed history, clinical examination, and correlation with radiographic imaging.
CONCLUSION
Due to the rarity, PHE syndrome should be diagnosed accurately. Management of hamular elongation is either surgical or conservative but resection of the pterygoid hamulus is usually preferred.
PubMed: 33316610
DOI: 10.1016/j.ijscr.2020.10.035 -
Tremor and Other Hyperkinetic Movements... Oct 2020Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and... (Review)
Review
BACKGROUND
Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and palatal tremor associated with progressive ataxia.
METHODS
A thorough Pubmed search was conducted to look for the original articles, reviews, letters to editor, case reports, and teaching neuroimages, with the keywords "essential", "symptomatic palatal tremor", "myoclonus", "ataxia", "hypertrophic", "olivary" and "degeneration".
RESULTS
Essential palatal tremor is due to contraction of the tensor veli palatini muscle, supplied by the 5 cranial nerve. Symptomatic palatal tremor occurs due to the contraction of the levator veli palatini muscle, supplied by the 9% and 10% cranial nerves. Essential palatal tremor is idiopathic, while symptomatic palatal tremor occurs due to infarction, bleed or tumor within the Guillain-Mollaret triangle. Progressive ataxia and palatal tremor can be familial or idiopathic. Symptomatic palatal tremor and sporadic progressive ataxia with palatal tremor show signal changes in inferior olive of medulla in magnetic resonance imaging. The treatment options available for essential palatal tremor are clonazepam, lamotrigine, sodium valproate, flunarizine and botulinum toxin. The treatment of symptomatic palatal tremor involves the treatment of the underlying cause.
DISCUSSION
Further studies are required to understand the cause and pathophysiology of Essential palatal tremor and progressive ataxia and palatal tremor. Similarly, the link between tauopathy and palatal tremor associated progressive ataxia needs to be explored further. Oscillopsia and progressive ataxia are more debilitating than palatal tremor and needs new treatment approaches.
Topics: Anticonvulsants; Cerebellar Nuclei; Essential Tremor; Humans; Inflammation; Magnetic Resonance Imaging; Neuromuscular Agents; Neurosurgical Procedures; Olivary Nucleus; Palatal Muscles; Red Nucleus; Somatoform Disorders; Tremor
PubMed: 33101766
DOI: 10.5334/tohm.188