-
Indian Journal of Plastic Surgery :... Apr 2023Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by...
Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by various techniques of intravelar veloplasty (IVVP) leads to higher incidence of VPI due to scar contracture. Furlow's Z plasty has long, narrow, thin mucosal flaps and mucomuscular flaps with malaligned muscle closure. We present a technique of "hybrid palatoplasty" which borrows from and adds to the existing methods, is robust, is easy to replicate, and results in normal speech consistently. (1) To design a technique of "hybrid palatoplasty"-combining double opposing Z (DOZ) plasty and IVVP, which is applicable to all types of cleft palate. (2) To evaluate the results of cleft palate children operated using the technique of "hybrid palatoplasty" from 2014 to 2015 in terms of surgical complications (fistulae and dehiscence) and incidence of VPI. Our procedure combines aspects of both DOZ and IVVP. It is simplified with design of smaller Z plasties. On one side, from the oral Z plasty muscle is dissected off and sutured to the nasal mucomuscular flap of the opposite side to complete the palatal sling. Oral Z plasty is purely mucosal and reverse of the nasal side. A total of 123 cases, operated below 5 years of age were followed up. Speech was assessed by direct evaluation and tele-evaluation. A total of 123 cases, below 5 years of age, were operated between 2014 and 2016 with at least 5 years of follow-up. Note that 120 had normal speech, and 3 had VPI of which 2 were subsequently corrected and went on to develop normal speech. This novel "hybrid palatoplasty" is a simple technique with good speech outcome as it combines the principles of Z plasty and direct muscle repair with palatal sling formation.
PubMed: 37153330
DOI: 10.1055/s-0043-1762905 -
Bioengineering (Basel, Switzerland) Aug 2022The study aims to investigate the modifications in the temporalis and the masseter activity in adult patients before and after SARPE (Surgically Assisted Rapid Palatal...
The study aims to investigate the modifications in the temporalis and the masseter activity in adult patients before and after SARPE (Surgically Assisted Rapid Palatal Expansion) by measuring electromyographic and electrokinesographic activity. 24 adult patients with unilateral posterior crossbite on the right side were selected from the Orthodontic Department of the University of Milan. Three electromyographic and electrokinesographic surface readings were taken respectively before surgery (T0) and 8 months after surgery (T1). The electromyographic data of both right and left masseter and anterior temporalis muscles were recorded during multiple tests: standardized maximum voluntary contraction (MVC)s, after transcutaneous electrical nerve stimulation (TENS) and at rest. T0 and T1 values were compared with paired Student’s t-test (p < 0.05). Results: Significant differences were found in the activity of right masseter (p = 0.03) and right temporalis (p = 0.02) during clench, in the evaluation of right masseter at rest (p = 0.03), also the muscular activity of masseters at rest after TENS from T0 to T1 (pr = 0.04, pl = 0.04). No significant differences were found in the activity of left masseter (p = 0.41) and left temporalis (p = 0.39) during clench and MVC, in the evaluation of left masseter at rest (p = 0.57) and in the activity during MVC of right masseter (p = 0.41), left masseter (p = 0.34), right temporalis (p = 0.51) and left temporalis (p = 0.77). Results showed that the activity of the masseter and temporalis muscles increased significantly after SARPE during rest and clenching on the side where the cross-bite was treated.
PubMed: 36004886
DOI: 10.3390/bioengineering9080361 -
Indian Journal of Otolaryngology and... Dec 2022OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in...
OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in OSMF patients by audiometry and tympanometry. Two Hundred patients of < 40 years of age with OSMF were examined and followed by PTA and impedance audiometry. Impaired mobility was seen in 20(10%) ears, and retraction of tympanic membrane was found in 36(18%) ears. Clinical staging was done in four stages. Majority of the patients were males (58%) in the age group of 21-30 years belonging to stage III (38%) and IV (26%) respectively. PTA showed varying degrees of hearing loss in 73 (36.5%) ears. In Grade I, mild hearing loss was seen in 10 (35.71%) ears and moderately severe hearing loss was in 5 (11.36%) ears whereas in Grade II mild hearing loss in 11(25%) ears. Grade III and IV showed mild hearing loss in 11(14.47%) and 12 (23.07%) respectively. Tympanometry revealed type A curve in 126 (63%) ears followed by C curve in 50 (25%) and B curve in 24 (12%) ears. In patients of OSMF, there is involvement of palatal/paratubal muscles in the fibrosis process, which causes eustachian tube malfunction leading to disturbed middle ear functions and negative middle ear pressure. Most patients of oral submucous fibrosis showed direct association with grade of hearing impairment and eustachian tube dysfunction. Higher clinical grades, both clinically and histologically showed similar findings thereby we concluded that if the disease is treated early, preventing patients from having higher grades of disease, involvement of ear can be avoided, and patients can be saved from hearing impairment.
PubMed: 36742817
DOI: 10.1007/s12070-022-03077-2 -
Medicina (Kaunas, Lithuania) Jul 2023The current paper presents a case of a 33-year-old female with an uncommon localization of a leiomyoma in the oral cavity-the anterior palatal fibromucosa and the...
The current paper presents a case of a 33-year-old female with an uncommon localization of a leiomyoma in the oral cavity-the anterior palatal fibromucosa and the incisive papilla. The patient referred to the Oro-Maxillo-Facial Surgery Clinic of Emergency City Hospital Timisoara, Romania, complaining of a slight discomfort in the act of mastication and the occurrence and persistence of a diastema between the upper central incisors, due to the presence of a nodule located in the anterior palatal mucosa, between the upper central incisors, without any changes of the subjacent bone structure in the anterior hard palate visible on a cone beam computed tomography image (CBCT). The lesion was removed using a surgical excisional biopsy and a histopathological examination was performed using morphological Hematoxylin-Eosin (HE) staining and additional immunohistochemical (IHC) reactions, in order to confirm the diagnosis. On microscopic examination, bundles of spindle cells were found with eosinophilic cytoplasm and vesicular nuclei, with finely granular chromatin. The immunohistochemical reactions were positive for smooth muscle actin (SMA) and desmin and negative for vimentin. The treatment of choice for leiomyoma of the oral cavity is surgical excision with clear margins, followed by periodical clinical monitoring.
Topics: Female; Humans; Adult; Leiomyoma; Palate, Hard; Biopsy; Incisor; Cone-Beam Computed Tomography
PubMed: 37512157
DOI: 10.3390/medicina59071346 -
Acta Otorhinolaryngologica Italica :... Dec 2022To describe a clear and intuitive way to analyse the anatomical meaning of images observed in Drug-induced Sleep Endoscopy (DISE) to fully understand the obstructive...
OBJECTIVE
To describe a clear and intuitive way to analyse the anatomical meaning of images observed in Drug-induced Sleep Endoscopy (DISE) to fully understand the obstructive dynamics and therefore opt for a tailor-made pharyngeal surgical technique.
METHODS
From January 2016 to December 2020, 298 patients who underwent DISE were selected according to inclusion criteria.
RESULTS
The case series consisted of 204 males and 94 females with a mean age of 56 years. Body mass index ranged from 19 kg/m to 34 kg/m with a median of 26.5 kg/m. Median Apnoea-Hypopnea Index (AHI) was 27 (range 5-62.3). The authors also observed four palate pharyngeal phenotypic patterns of collapse and clarify the morphology and role of the main muscles involved in upper airway collapse.
CONCLUSIONS
DISE is fundamental to determine the collapse site in patients affected by obstructive sleep apnoea syndrome. The velopharyngeal region is the most common site of obstruction and lateral pharyngeal wall collapse is the major determining factor. DISE can lead to a deeper understanding of the obstructive dynamic patterns and a more precise identification of the muscle bundles responsible for upper airway collapse.
Topics: Male; Female; Humans; Middle Aged; Airway Obstruction; Sleep Apnea, Obstructive; Pharynx; Endoscopy; Sleep
PubMed: 36654522
DOI: 10.14639/0392-100X-N2143 -
Journal of Anatomy May 2022The extinct freshwater choristoderan reptiles Champsosaurus and Simoedosaurus are characterised by large body size and an elongated snout. They have often been...
Feeding behaviour and functional morphology of the neck in the long-snouted aquatic fossil reptile Champsosaurus (Reptilia: Diapsida) in comparison with the modern crocodilian Gavialis gangeticus.
The extinct freshwater choristoderan reptiles Champsosaurus and Simoedosaurus are characterised by large body size and an elongated snout. They have often been considered as eco-analogues of crocodilians based on superficial similarities. The slender-snouted Champsosaurus has been described as a 'gavial-like reptile', which implies it feeds underwater with a lateral swipe of the head and neck, as in the living slender-snouted crocodilians such as Gavialis gangeticus. In contrast, the short-snouted Simoedosaurus is often compared with short-snouted living crocodilians and is considered to take single prey items. However, the neck mobility and flexibility needed for feeding movements are poorly understood even in extant crocodilians. This study explores the relationship between cervical morphology and neck flexion, focusing particularly on lateral and dorsal movements in G. gangeticus by comparison with shorter-snouted crocodilians. The paper also describes a method to estimate the maximum angle of neck dorsiflexion in choristoderes based on the cervical morphology of extant crocodilian species. Three indices were used in this study, of which Index 3 is newly proposed, to compare cervical morphology and intervertebral joint flexibility: (1) Enclosed zygapophyseal angles (EZA) as an index of dorsoventral/ bilateral flexibility, (2) moment arm (M) of dorsiflexor muscles as an Index of resistance against ventroflexion and (3) the orientations of zygapophysial facets for a maximum angle of dorsiflexion. These Indices were validated using µCT scanning of fresh specimens of G. gangeticus and Caiman latirostris in lateral and dorsal flexion. A unique mechanism of lateral flexion was identified in G. gangeticus that uses a combination of the following features: (1) lateral flexion mainly restricted to the anterior cervical vertebrae (v2/v3: high EZA, with more horizontal zygapophyses) and (2) high degree of dorsiflexion at the v3/v4 and v4/v5 joints with potential for dorsal flexibility through the middle-posterior neck, which is used in inertial feeding. In contrast, Champsosaurus and Simoedosaurus possess relatively short cervical vertebrae, as in short-snouted crocodilians. The middle-posterior cervical vertebrae of Champsosaurus are specialised for lateral flexion (high EZA), and there is only limited capacity for dorsiflexion throughout the neck. Like G. gangeticus, therefore, Champsosaurus may have used its slender snout to grab fish from shoals using lateral sweeping motions of the head and neck, but the movement is through the neck, not the craniocervical joint. However, inertial feeding is less likely to have occurred in this genus, and the aligned palatal dentition may have aided the lingual transport of prey into the mouth. Simoedosaurus, on the other hand, appears to have been less specialised, with a neck that combined lateral and dorsolateral flexion, a move that could have been effective in catching both terrestrial and aquatic prey. Where these two choristoderan genera occurred in the same place, they may have divided their niche by prey types.
Topics: Alligators and Crocodiles; Animals; Feeding Behavior; Fossils; Head; Neck
PubMed: 34865223
DOI: 10.1111/joa.13600 -
Journal of Speech, Language, and... Jun 2020Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal...
Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women ( = 22.8 years, = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of "ansa." Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors ( < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin distance, velar thickness, pharyngeal depth, and velopharyngeal ratio. Significant predictors ( < .05) of maximum contraction velocity during velopharyngeal closure included mean extravelar length, intravelar length, LVP origin-to-origin distance, and velar thickness. Conclusions This study identified six velopharyngeal variables that predict LVP muscle function during real-time speech. These predictors should be considered among children and individuals with repaired cleft palate in future studies.
Topics: Adult; Child; Cleft Palate; Female; Humans; Magnetic Resonance Imaging; Male; Muscle Contraction; Palatal Muscles; Palate, Soft; Pharynx; Speech
PubMed: 32539646
DOI: 10.1044/2020_JSLHR-20-00013 -
Tremor and Other Hyperkinetic Movements... Dec 2020Ear click is a rare type of objective tinnitus, classically described with associated palatal tremor/myoclonus (PT).
BACKGROUND
Ear click is a rare type of objective tinnitus, classically described with associated palatal tremor/myoclonus (PT).
CASE REPORT
A 15-year-old boy reported a constant bilateral ear clicking for 4 years, that could be stopped at will for a few seconds. Clinically, the ear clicks were audible without visible eardrum or palatal movement, and could be entrained by the examiner. Brain MRI was normal.
DISCUSSION
We propose to classify this as isolated ear clicks with partial voluntary control, putting it into context with other subcategories of "essential" or "isolated" PT.
Topics: Adolescent; Humans; Male; Palatal Muscles; Tinnitus; Tremor
PubMed: 33362949
DOI: 10.5334/tohm.574 -
European Journal of Paediatric Dentistry Jun 2023This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size.
AIM
This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size.
MATERIALS
The study sample was composed of 168 healthy children aged less than 4 years. Twenty-one measurements of distances and 6 angles were taken from 7 fixed landmarks set on the palatal vaults 3D surfaces reconstructed from CT-scans. To analyse only the shape evolution, the "sizefree" log-shape ratio of those measurements were computed and the global shape of the palatal vault and their transversal curve were plotted. Statistical analyses were performed to highlight the shape and size differences separately.
CONCLUSION
The shape and size evolution of the palatal vault during the first years of life was not only correlated with deciduous dentition development. We assumed that the progressive orofacial muscles activation and tongue movements in the oral cavity may also explain these results as they induced strains on the palatal vault, warping it in various ways.
Topics: Humans; Child; Palate; Tomography, X-Ray Computed
PubMed: 37184237
DOI: 10.23804/ejpd.2023.1663 -
Journal of Oral Biology and... 2022The conventional surgical procedures for the closure of cleft-lip and palate are based on proven plastic-surgical procedures from tumour surgery or traumatology. These...
Cleft lip, alveolus and palate: Defect or dislocation malformation? Importance of adopting a physiological concept for surgical repair in achieving optimal outcomes in LMICs. Part 1: Physiological processes in facial development.
The conventional surgical procedures for the closure of cleft-lip and palate are based on proven plastic-surgical procedures from tumour surgery or traumatology. These flap surgeries take little account of the fact that the treatment of such malformations takes place during the time of a child's increased growth and is known to lead to pronounced scarring and skeletal growth disorders. It is therefore imperative to develop modified surgical procedures based on physiological growth processes. These physiological procedures must include the reconstruction of all facial structures such as orofacial, palatal and pharyngeal muscles, complete nose, upper jaw and palate. Transfer of this know how to low resource LMIC and training is essential if optimal outcomes are to be achieved.
PubMed: 34820255
DOI: 10.1016/j.jobcr.2021.11.001