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Otolaryngologic Clinics of North America Jun 2020Successful palatopharyngoplasty is critical for successful sleep apnea surgery. Traditional uvulopalatopharyngoplasty was primarily excisional, whereas newer techniques,... (Review)
Review
Successful palatopharyngoplasty is critical for successful sleep apnea surgery. Traditional uvulopalatopharyngoplasty was primarily excisional, whereas newer techniques, such as expansion sphincterpharyngoplasty, are more reconstructive. Studies of flow dynamics even demonstrate that the effectiveness of maxillofacial surgery is significantly mediated through stiffening and enlargement of the lateral retropalatal and pharyngeal airway. The current modified technique of uvulopalatopharyngoplasty/expansion sphincteroplasty aims to maximize relocation and tension on the palatopharyngeus muscle, opening the retropalatal airway and the palatal genu, and minimizing tension on the final mucosal closure.
Topics: Endoscopy; Humans; Palate; Pharynx; Phenotype; Plastic Surgery Procedures; Sleep Apnea, Obstructive; Uvula
PubMed: 32334865
DOI: 10.1016/j.otc.2020.02.005 -
Journal of Dental Research Aug 2019Orofacial clefting is the most common congenital craniofacial malformation, appearing in approximately 1 in 700 live births. Orofacial clefting includes several distinct... (Review)
Review
Orofacial clefting is the most common congenital craniofacial malformation, appearing in approximately 1 in 700 live births. Orofacial clefting includes several distinct anatomic malformations affecting the upper lip and hard and soft palate. The etiology of orofacial clefting is multifactorial, including genetic or environmental factors or their combination. A large body of work has focused on the molecular etiology of cleft lip and clefts of the hard palate, but study of the underlying etiology of soft palate clefts is an emerging field. Recent advances in the understanding of soft palate development suggest that it may be regulated by distinct pathways from those implicated in hard palate development. Soft palate clefting leads to muscle misorientation and oropharyngeal deficiency and adversely affects speech, swallowing, breathing, and hearing. Hence, there is an important need to investigate the regulatory mechanisms of soft palate development. Significantly, the anatomy, function, and development of soft palatal muscles are similar in humans and mice, rendering the mouse an excellent model for investigating molecular and cellular mechanisms of soft palate clefts. Cranial neural crest-derived cells provide important regulatory cues to guide myogenic progenitors to differentiate into muscles in the soft palate. Signals from the palatal epithelium also play key roles via tissue-tissue interactions mediated by Tgf-β, Wnt, Fgf, and Hh signaling molecules. Additionally, mutations in transcription factors, such as , and , have been associated with soft palate clefting in humans and mice, suggesting that they play important regulatory roles during soft palate development. Finally, we highlight the importance of distinguishing specific types of soft palate defects in patients and developing relevant animal models for each of these types to improve our understanding of the regulatory mechanism of soft palate development. This knowledge will provide a foundation for improving treatment for patients in the future.
Topics: Animals; Cleft Palate; Disease Models, Animal; Humans; Mice; Mutation; Palate, Soft; Signal Transduction; Transcription Factors
PubMed: 31150594
DOI: 10.1177/0022034519851786 -
Medicina (Kaunas, Lithuania) Aug 2023Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with... (Meta-Analysis)
Meta-Analysis
Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with retropalatal narrowing by reducing soft palate volume and tightening the muscles. Although some previous publications have demonstrated the effectiveness of limited PMR, the overall efficacy and therapeutic role of limited PMR for the treatment of OSA remain uncertain. This study utilized meta-analysis and a systematic literature review to estimate the overall effectiveness of limited PMR in treating OSA. Multiple databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched using specific keywords related to OSA and limited PMR. Original articles assessing respiratory disturbances before and after limited PMR in patients with OSA were included. Data from selected articles were collected using standardized forms, including clinicodemographic characteristics, apnea-hypopnea index (AHI), and lowest pulse oximetry values (minimum SpO). Random effect models were used for analyzing significant heterogeneity. Egger's test and funnel plot were used to identify publication bias. Four studies were included in this meta-analysis for AHI, and three studies were included for minimum SpO during sleep. A significant reduction in the AHI and an increase in the minimum SpO were shown following limited PMR as the standardized mean difference (95% confidence interval) was 2.591 (1.092-4.090) and 1.217 (0.248-2.186), respectively. No publication bias was found in either analysis. The results of the meta-analysis and systemic review add to the literature that limited PMR can result in a reduction in the AHI and an increase in min SaO. In OSA patients with suspected retropalatal obstruction, limited PMR may be efficiently performed.
Topics: Humans; Databases, Factual; Palatal Muscles; Sleep; Sleep Apnea, Obstructive
PubMed: 37629722
DOI: 10.3390/medicina59081432 -
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 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 -
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 -
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 -
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 -
The Journal of Histochemistry and... Mar 2022The soft palate is the only structure that reversibly separates the respiratory and gastrointestinal systems. Most species can eat and breathe at the same time. Humans...
The soft palate is the only structure that reversibly separates the respiratory and gastrointestinal systems. Most species can eat and breathe at the same time. Humans cannot do this and malfunction of the soft palate may allow food to enter the lungs and cause fatal aspiration pneumonia. Speech is the most defining characteristic of humans and the soft palate, along with the larynx and tongue, plays the key roles. In addition, palatal muscles are involved in snoring and obstructive sleep apnea. Considering the significance of the soft palate, its function is insufficiently understood. The objectives of this study were to document morphometric and immunohistochemical characteristics of adult human soft palate muscles, including fiber size, the fiber type, and myosin heavy chain (MyHC) composition for better understanding muscle functions. In this study, 15 soft palates were obtained from human autopsies. The palatal muscles were separated, cryosectioned, and stained using histological and immunohistochemical techniques. The results showed that there was a fast type II predominance in the musculus uvulae and palatopharyngeus and a slow type I predominance in the levator veli palatine. Approximately equal proportions of type I and type II fibers existed in both the palatoglossus and tensor veli palatine. Soft palate muscles also contained hybrid fibers and some specialized myofibers expressing slow-tonic and embryonic MyHC isoforms. These findings would help better understand muscle functions.
Topics: Adult; Aged; Female; Humans; Immunohistochemistry; Male; Middle Aged; Myosin Heavy Chains; Palatal Muscles; Palate, Soft
PubMed: 34957888
DOI: 10.1369/00221554211066985 -
The Annals of Otology, Rhinology, and... Feb 2021To compare the size of Ostmann's fat pad (OFP) between healthy ears and ears with chronic otitis media with cholestatoma (COMwC) using magnetic resonance imaging (MRI).
OBJECTIVE
To compare the size of Ostmann's fat pad (OFP) between healthy ears and ears with chronic otitis media with cholestatoma (COMwC) using magnetic resonance imaging (MRI).
METHODS
Twenty-six patients with unilateral COMwC underwent mastoidectomy. Pre-operative MRI records were reviewed retrospectively. The healthy ears served as the control group. OFP is represented by the maximum diameter of the high intensity area medial to the tensor veli palatini muscle (TVP); M1. A reference diameter was defined from the medial border of OFP reaching the medial border of the medial pterygoid muscle; M2. Values of M1, M2 and the ratio of M1:M2 was compared between the healthy and pathological ear in each patient.
RESULTS
All 26 patients (16 females,10 males) had unilateral cholestatoma. Mean age was 37.6 years (range 19-83). In the healthy () ears group, mean M1 was 2.04 ± 0.53 mm, mean M2 was 9.57 ± 2.57 mm.In the pathological () ears group; mean M1 was 2.03 ± 0.55 mm, mean M2 was 9.86 ± 2.37 mm. A comparison of M1 and M2 values between the healthy and pathological ear groups was not statistically significant ( = .853 and = .509, respectively).Mean M1:M2 ratio in the healthy ears group was 0.22 ± 0.05, mean M1:M2 ratio in the pathological ear group was 0.21 ± 0.06. A comparison between these ratios found no significant statistical correlation ( = .607).
CONCLUSION
The size of Ostmann's fat pad does not affect the development of chronic otitis media with cholestatoma in adults.
Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Case-Control Studies; Cholesteatoma, Middle Ear; Chronic Disease; Eustachian Tube; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Otitis Media; Palatal Muscles; Pterygoid Muscles; Retrospective Studies; Young Adult
PubMed: 32700549
DOI: 10.1177/0003489420943219