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Ear, Nose, & Throat Journal Sep 2021Pharyngeal ectopic thymus is a rare cause of pharyngeal masses and is rarely considered in the differential diagnosis of neck and head masses in children. In this paper,...
Pharyngeal ectopic thymus is a rare cause of pharyngeal masses and is rarely considered in the differential diagnosis of neck and head masses in children. In this paper, the case of an infant with a pharyngeal ectopic thymus is presented and our intraoral surgical approach in the patient's treatment is described.
Topics: Choristoma; Diagnosis, Differential; Female; Humans; Infant, Newborn; Medical Illustration; Pharyngeal Diseases; Pharynx; Thymus Gland
PubMed: 32320300
DOI: 10.1177/0145561320918434 -
The Journal of Craniofacial Surgery Sep 2023To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the...
OBJECTIVE
To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with complete velopharyngeal closure (VPC) and velopharyngeal insufficiency (VPI) patients.
PARTICIPANTS AND INTERVENTION
Subjective evaluation indicators included speech intelligibility, nasality and consonant missing rate, for objective acoustic analysis, we used speech sample normalization and objective acoustic parameters included normalized vowel formants, voice onset time and the analysis of 3-dimensional spectrogram and spectrum, were carried out on speech samples produced by 3 groups of speakers: (a) speakers with velopharyngeal competence after palatorrhaphy (n=38); (b) speakers with velopharyngeal incompetence after palatorrhaphy (n=70), (c) adult patients with cleft palate (n=65) and (d) typical speakers (n=30).
RESULTS
There was a highly negative correlation between VPC grade and speech intelligibility (ρ=-0.933), and a highly positive correlation between VPC and nasality (ρ=0.813). In subjective evaluation, the speech level of VPI patients was significantly lower than that of VPC patients and normal adults. Although the nasality and consonant loss rate of VPC patients were significantly higher than that of normal adults, the speech intelligibility of VPC patients was not significantly different from that of normal adults. In acoustic analysis, patients with VPI still performed poorly compared with patients with VPC.
CONCLUSIONS
The speech function of adult cleft palate patients is affected by abnormal palatal structure and bad pronunciation habits. In subjective evaluation, there was no significant difference in speech level between VPC patients and normal adults, whereas there was significant difference between VPI patients and normal adults. The acoustic parameters were different between the 2 groups after cleft palate repair. The condition of palatopharyngeal closure after cleft palate can affect the patient's speech.
Topics: Adult; Humans; Cleft Palate; Speech; Pharynx; Velopharyngeal Insufficiency; Pharyngeal Muscles
PubMed: 36949035
DOI: 10.1097/SCS.0000000000009301 -
Plastic and Reconstructive Surgery Nov 2022Surgeons have traditionally believed that swallowing is mainly dependent on gravity after total glossolaryngectomy. However, swallowing function after total...
SUMMARY
Surgeons have traditionally believed that swallowing is mainly dependent on gravity after total glossolaryngectomy. However, swallowing function after total glossolaryngectomy varies widely among patients, and a thorough analysis is lacking. The authors aimed to clarify the swallowing function after total glossolaryngectomy and determine whether it is primarily dependent on gravity. The authors retrospectively analyzed videofluorographic examinations of patients who underwent total glossolaryngectomy and free or pedicle flap reconstruction. The authors enrolled 20 patients (12 male; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient's ability to swallow was dependent on gravity alone. Videofluorography showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3 percent of the patients with poor clearance showed adequate constriction, which was significantly different ( p = 0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance ( p = 0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to previous understanding, constriction of the remnant posterior pharyngeal wall played an important role in swallowing after total glossolaryngectomy, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after total glossolaryngectomy.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Adult; Aged; Aged, 80 and over; Humans; Male; Middle Aged; Barium; Deglutition; Pharynx; Retrospective Studies; Surgical Flaps; Digestive System Surgical Procedures; Female
PubMed: 36067466
DOI: 10.1097/PRS.0000000000009639 -
IEEE Transactions on Bio-medical... Jul 2024Swallowing is a primary and complex behaviour that transports food and drink from the oral cavity, through the pharynx and oesophagus, into the stomach at an appropriate... (Review)
Review
Swallowing is a primary and complex behaviour that transports food and drink from the oral cavity, through the pharynx and oesophagus, into the stomach at an appropriate rate and speed. To understand this sophisticated behaviour, a tremendous amount of research has been carried out by utilising the in vivo approach, which is often challenging to perform, poses a risk to the subjects if interventions are undertaken and are seldom able to control for confounding factors. In contrast, in silico (computational) and in vitro (instrumental) methods offer an alternate insight into the process of the human swallowing system. However, the appropriateness of the design and application of these methods have not been formally evaluated. The purpose of this review is to investigate and evaluate the state of the art of in vitro and in silico swallowing simulators, focusing on the evaluation of their mechanical or computational designs in comparison to the corresponding swallowing mechanisms during various phases of swallowing (oral phase, pharyngeal phase and esophageal phase). Additionally, the potential of the simulators is also discussed in various areas of applications, including the study of swallowing impairments, swallowing medications, food process design and dysphagia management. We also address current limitations and recommendations for the future development of existing simulators.
Topics: Humans; Deglutition; Computer Simulation; Models, Biological; Equipment Design; Pharynx; Deglutition Disorders
PubMed: 38294923
DOI: 10.1109/TBME.2024.3360893 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jul 2023To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and healthy individuals during oral or nasal...
To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and healthy individuals during oral or nasal breathing, and explore the relevant influencing factors. Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed. ①The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed; ②The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing. The control group consisted of 15 males and 5 females, with an apnea-hypopnea index (AHI)<5 events/h, while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation (LSaO2) was 79.5% ±10.0%. In the both groups, the vertical distance between the mandible and the posterior pharyngeal wall decreased (<0.05); The long axis of tongue body decreased (<0.05), and the contact area between tongue and palate decreased. There was no significant change in the total volume of the retropalatine(RP) and retroglossal(RG) airway in the control group (>0.05). However, the minimum cross-sectional area and volume of the RP airway in OSAHS decreased (<0.001). The lateral diameters of uvula plane in OSAHS decreased during mouth breathing, which was contrary to the trend in the control group (=0.017). The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing (=0.001); The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway (<0.001). Mouth breathing leads to the shortening of the long axis of the tongue, the reduction of the contact area between the soft palate and the tongue, vertical distance between the mandible and the posterior pharyngeal wall, and the cross-sectional area of the epiglottis plane. These changes vary between OSAHS patients and controls. During mouth breathing, the diameters, areas and volumes of the RP area decreased, and were more significant in severe cases.
Topics: Male; Adult; Female; Humans; Mouth Breathing; Sleep Apnea, Obstructive; Pharynx; Palate, Soft; Uvula; Syndrome
PubMed: 37549944
DOI: 10.13201/j.issn.2096-7993.2023.07.005 -
Zhongguo Dang Dai Er Ke Za Zhi =... May 2023To investigate the distribution characteristics and correlation of intestinal and pharyngeal microbiota in early neonates.
OBJECTIVES
To investigate the distribution characteristics and correlation of intestinal and pharyngeal microbiota in early neonates.
METHODS
Full-term healthy neonates who were born in Shanghai Pudong New Area Maternal and Child Health Hospital from September 2021 to January 2022 and were given mixed feeding were enrolled. The 16S rRNA sequencing technique was used to analyze the stool and pharyngeal swab samples collected on the day of birth and days 5-7 after birth, and the composition and function of intestinal and pharyngeal microbiota were analyzed and compared.
RESULTS
The diversity analysis showed that the diversity of pharyngeal microbiota was higher than that of intestinal microbiota in early neonates, but the difference was not statistically significant (>0.05). On the day of birth, the relative abundance of in the intestine was significantly higher than that in the pharynx (<0.05). On days 5-7 after birth, the relative abundance of and in the intestine was significantly higher than that in the pharynx (<0.05), and the relative abundance of in the intestine was significantly lower than that in the pharynx (<0.05). At the genus level, there was no significant difference in the composition of dominant bacteria between the intestine and the pharynx on the day of birth (>0.05), while on days 5-7 after birth, there were significant differences in the symbiotic bacteria of , , , , and - between the intestine and the pharynx (<0.05). The analysis based on the database of Clusters of Orthologous Groups of proteins showed that pharyngeal microbiota was more concentrated on chromatin structure and dynamics and cytoskeleton, while intestinal microbiota was more abundant in RNA processing and modification, energy production and conversion, amino acid transport and metabolism, carbohydrate transport and metabolism, coenzyme transport and metabolism, and others (<0.05). The Kyoto Encyclopedia of Genes and Genomes analysis showed that compared with pharyngeal microbiota, intestinal microbiota was more predictive of cell motility, cellular processes and signal transduction, endocrine system, excretory system, immune system, metabolic diseases, nervous system, and transcription parameters (<0.05).
CONCLUSIONS
The composition and diversity of intestinal and pharyngeal microbiota of neonates are not significantly different at birth. The microbiota of these two ecological niches begin to differentiate and gradually exhibit distinct functions over time.
Topics: Humans; Infant, Newborn; Bacteria; China; High-Throughput Nucleotide Sequencing; Intestines; Microbiota; Pharynx; RNA, Ribosomal, 16S
PubMed: 37272178
DOI: 10.7499/j.issn.1008-8830.2301015 -
European Archives of... Mar 2023Pharyngoplasty represents one of the most widely performed surgical procedures for the treatment of obstructive sleep apnea (OSA) in the presence of palate-oropharyngeal...
Pharyngoplasty represents one of the most widely performed surgical procedures for the treatment of obstructive sleep apnea (OSA) in the presence of palate-oropharyngeal collapse. The learning curve for pharyngoplasties is steep and success is conditional on the correct use of the sutures and the careful application of the surgical steps in a narrow surgical field. The use of synthetic models may be conveniently and safely employed for hands-on surgical practice in pharyngoplasties, especially when fresh frozen cadaveric specimens are not available. We present the "Pharyngolab", a new simulator for pharyngoplasties.
Topics: Humans; Treatment Outcome; Pharynx; Oropharynx; Plastic Surgery Procedures; Palate
PubMed: 36169723
DOI: 10.1007/s00405-022-07667-2 -
Neurogastroenterology and Motility May 2021Chronic opioid use can induce esophageal dysfunction with symptoms resembling achalasia and a manometric pattern of esophagogastric junction-outflow obstruction... (Randomized Controlled Trial)
Randomized Controlled Trial
Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double-blind, placebo-controlled, cross-over trial.
BACKGROUND
Chronic opioid use can induce esophageal dysfunction with symptoms resembling achalasia and a manometric pattern of esophagogastric junction-outflow obstruction (EGJ-OO). However, the effect of opioids in acute setting on pharyngeal function and esophageal body contractility has not been investigated.
METHODS
After positioning the high-resolution impedance manometry (HRiM) catheter, codeine (60 mg) or placebo (glucose syrup) was infused intragastrically. Forty-five minutes post-infusion, participants received liquid, semi-solid, and solid boluses to assess esophageal and pharyngeal function. HRiM analysis was performed adhering to the Chicago classification v3.0. (CC v3.0). Pressure flow analysis (PFA) for the esophageal body and the pharynx was performed using the SwallowGateway™ online platform.
KEY RESULTS
Nineteen healthy volunteers (HV) [5 male; age 38.3] were included. After codeine administration, higher integrated relaxation pressure 4 s values resulted in significantly reduced deglutitive EGJ relaxation and distal latency was significantly shorter. Distal contractility was similar in both conditions. Bolus flow resistance at the EGJ and distention pressures increased significantly after codeine infusion. Based on CC v3.0, acute infusion of codeine induced EGJ-OO in six HV (p = 0.0003 vs. placebo). Codeine administration induced no significant alterations in any of the pharyngeal PFA metrics.
CONCLUSIONS & INFERENCES
In HV, acute administration of codeine increased bolus resistance at the EGJ secondary to induced incomplete EGJ relaxation leading to major motility disorders in a subset of subjects including EGJ-OO. However, an acute single dose of codeine did not affect motility or bolus flow in pharynx and UES. ClinicalTrials.gov number, NCT03784105.
Topics: Adult; Analgesics, Opioid; Codeine; Cross-Over Studies; Double-Blind Method; Electric Impedance; Esophageal Sphincter, Upper; Esophagogastric Junction; Female; Gastrointestinal Motility; Healthy Volunteers; Humans; Male; Manometry; Pharynx
PubMed: 33232555
DOI: 10.1111/nmo.14041 -
Clinical Neurophysiology : Official... Jun 2024To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD). (Observational Study)
Observational Study
OBJECTIVE
To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD).
METHODS
Observational study in 12 young healthy volunteers (HV), 9 older HV (OHV) and 12 older patients with OD with no previous diseases causing OD (OOD). Swallowing biomechanics were measured by videofluoroscopy, neurophysiology with pharyngeal sensory (pSEP) and motor evoked-potentials (pMEP) to intrapharyngeal electrical and transcranial magnetic stimulation (TMS), respectively, and salivary neuropeptides with enzyme-linked immunosorbent assay (ELISA).
RESULTS
83.3% of OOD patients had unsafe swallows (Penetration-Aspiration scale = 4.3 ± 2.1; p < 0.0001) with delayed time to laryngeal vestibule closure (362.5 ± 73.3 ms; p < 0.0001) compared to both HV groups. OOD patients had: (a) higher pharyngeal sensory threshold (p = 0.009) and delayed pSEP P1 and N2 latencies (p < 0.05 vs HV) to electrical stimulus; and (b) higher pharyngeal motor thresholds to TMS in both hemispheres (p < 0.05) and delayed pMEPs latencies (right, p < 0.0001 HV vs OHV/OOD; left, p < 0.0001 HV vs OHV/OOD).
CONCLUSIONS
OOD patients have unsafe swallow and delayed swallowing biomechanics, pharyngeal hypoesthesia with disrupted conduction of pharyngeal sensory inputs, and reduced excitability and delayed cortical motor response.
SIGNIFICANCE
These findings suggest new elements in the pathophysiology of aging-associated OD and herald new and more specific neurorehabilitation treatments for these patients.
Topics: Humans; Male; Female; Deglutition Disorders; Aged; Adult; Deglutition; Transcranial Magnetic Stimulation; Evoked Potentials, Motor; Middle Aged; Pharynx; Aged, 80 and over
PubMed: 38615499
DOI: 10.1016/j.clinph.2024.03.030 -
Oral Oncology Dec 2019The aim of the study is proposing a classification of different transoral lateral oropharyngectomy procedures in order to ensure better definitions of post-operative...
PURPOSE
The aim of the study is proposing a classification of different transoral lateral oropharyngectomy procedures in order to ensure better definitions of post-operative results.
METHODS
The classification resulted from the consensus of the different authors and was based on anatomical-surgical principles.
RESULTS
The classification comprises three types of lateral oropharyngectomy: type 1 is the resection of the palatine tonsil deep to the pharyngobasilar fascia; type 2 is performed by removing the entire palatine tonsil, the palatoglossus muscle, the palatopharyngeal muscle and the superior constrictor muscle; type 3 is performed by removing the entire palatine tonsil, the palatoglossus muscle, the palatopharyngeal muscle, the superior constrictor muscle, the buccopharyngeal fascia with extension to the pterygoid muscle and parapharyngeal space fat content. Based on the extension of the dissection we can use the suffix A (soft palate), B (posterior pharyngeal wall), C (base of tongue) and D (retromolar trigone).
CONCLUSION
The proposed classification introduces a simple and easy to use categorization of transoral lateral oropharyngectomies into three classes. Resection extensions are easily described using suffixes.
Topics: Female; Humans; Male; Oropharyngeal Neoplasms; Pharynx; Robotic Surgical Procedures
PubMed: 31707218
DOI: 10.1016/j.oraloncology.2019.104450