-
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 -
PloS One 2020Parkinson disease (PD) is associated with speech and swallowing difficulties likely due to pathology in widespread brain and nervous system regions. In post-mortem...
Parkinson disease (PD) is associated with speech and swallowing difficulties likely due to pathology in widespread brain and nervous system regions. In post-mortem studies of PD, pathology has been reported in pharyngeal and laryngeal nerves and muscles. However, it is unknown whether PD is associated with neuromuscular changes in the tongue. Prior work in a rat model of PD (Pink1-/-) showed oromotor and swallowing deficits in the premanifest stage which suggested sensorimotor impairments of these functions. The present study tested the hypothesis that Pink1-/- rats show altered tongue function coinciding with neuromuscular differences within tongue muscles compared to wildtype (WT). Male Pink1-/- and WT rats underwent behavioral tongue function assays at 4 and 6 months of age (n = 7-8 rats per group), which are time points early in the disease. At 6 months, genioglossus (GG) and styloglossus (SG) muscles were analyzed for myosin heavy chain isoforms (MyHC), α-synuclein levels, myofiber size, centrally nucleated myofibers, and neuromuscular junction (NMJ) innervation. Pink1-/- showed greater tongue press force variability, and greater tongue press forces and rates as compared to WT. Additionally, Pink1-/- showed relative increases of MyHC 2a in SG, but typical MyHC profiles in GG. Western blots revealed Pink1-/- had more α-synuclein protein than WT in GG, but not in SG. There were no differences between Pink1-/- and WT in myofiber size, centrally-nucleated myofibers, or NMJ innervation. α-synuclein protein was observed in nerves, NMJ, and vessels in both genotypes. Findings at these early disease stages suggest small changes or no changes in several peripheral biological measures, and intact motor innervation of tongue muscles. Future work should evaluate these measures at later disease stages to determine when robust pathological peripheral change contributes to functional change, and what CNS deficits cause behavioral changes. Understanding how PD affects central and peripheral mechanisms will help determine therapy targets for speech and swallowing disorders.
Topics: Animals; Disease Models, Animal; Gene Knockout Techniques; Male; Myosin Heavy Chains; Palatal Muscles; Parkinson Disease; Protein Kinases; Rats; Tongue
PubMed: 33064741
DOI: 10.1371/journal.pone.0240366 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2020Herbivorous dinosaurs exhibited diverse cranial feeding mechanisms. Although osteological, microwear, and biomechanical research has revealed some of this diversity, the...
Herbivorous dinosaurs exhibited diverse cranial feeding mechanisms. Although osteological, microwear, and biomechanical research has revealed some of this diversity, the evolutionary reorientation of cranial musculature throughout nonavian herbivorous Dinosauria and its influence on feeding mechanisms requires more study. Here, cranial muscle reconstructions in herbivorous dinosaurs are reviewed and informative anatomical characters are compared across 142 dinosaur genera (84 ornithischians, 36 sauropodomorphs, and 22 herbivorous nonavian theropods), both through examination of specimens and literature. Traits include those relating to the temporal region, adductor chamber, palate, and mandibular attachments, such as the coronoid elevation and retroarticular process. Findings reveal many combinations of anatomical traits influencing a diversity of feeding mechanisms. Some primarily more orthal feeders, including herbivorous theropods, nonsauropod sauropodomorphs, basal ornithischians, and derived stegosaurs (which also show varying degrees of coinciding slight palinal motion and long-axis hemimandibular rotation), possess traits indicative of more prominent temporal musculature and moderately sized palatal musculature. However, orthal feeding sauropods and pachycephalosaurs possess traits indicative of greatly reduced, low-angled temporal musculature, and enhanced palatal musculature producing a primarily vertical, orthal feeding vector. Among ankylosaurs, hadrosaurids, and neoceratopsians, a rostrolabial temporal muscle expansion is present (with a tall coronoid elevation in hadrosaurids and ceratopsids) for greater temporal muscle support and mechanical advantage for complex palinal feeding motions. This also aids in long-axis hemimandibular rotation against the predentary in hadrosaurs and ankylosaurs. This diversity in cranial muscle architecture provides an informative spectrum of numerous adaptations acquired given the evolution of various anatomical constraints in the skull. Anat Rec, 303:1104-1145, 2020. © 2019 American Association for Anatomy.
Topics: Animals; Biological Evolution; Dinosaurs; Feeding Behavior; Fossils; Herbivory; Muscle, Skeletal; Skull
PubMed: 31675182
DOI: 10.1002/ar.24283 -
BMJ Case Reports Sep 2021A 16-year-old patient presented with sudden-onset difficulty in swallowing food especially for liquids with nasal regurgitation and rhinolalia with no history of fever...
A 16-year-old patient presented with sudden-onset difficulty in swallowing food especially for liquids with nasal regurgitation and rhinolalia with no history of fever and limb weakness. Examination revealed bilateral palatal palsy with absence of gag reflex. Other neurological examinations were normal. Investigations were done to rule out any known pathology leading to such a presentation. The symptoms were attributed to an idiopathic acute-onset-acquired bilateral palatal palsy, in the absence of any identifiable cause. This is a rare presentation in adolescent age with no case reported in the literature so far in this age group. Medical management was started and patient showed complete improvement within 2 weeks of his symptoms. Early diagnosis and aggressive management of this condition lead to a favourable prognosis.
Topics: Adolescent; Humans; Muscle Weakness; Palate; Paralysis; Speech Disorders
PubMed: 34479886
DOI: 10.1136/bcr-2021-243467 -
Journal of Clinical and Experimental... Apr 2021The term "symmetrical palatal fibromatosis" was recently suggested to designate bilateral palatal lesions presenting as typically broad, "mirror" images on the posterior...
BACKGROUND
The term "symmetrical palatal fibromatosis" was recently suggested to designate bilateral palatal lesions presenting as typically broad, "mirror" images on the posterior lateral region of the hard palate.
PURPOSE
We report an additional case of this as-yet poorly understood oral lesion in a 67-year-old male patient, with emphasis on differential diagnoses and immunohistochemical characterization.
CASE REPORT
The histopathological examination demonstrated a hypocellular, fibrous connective tissue with prominent thick collagen bundles and few blood vessels. Scattered large, stellate, and sometimes binucleated fibroblasts were found. Immunohistochemistry was positive for vimentin and negative for smooth muscle actin, S-100, desmin, HHF-35, AE1-AE3, Factor XIIIa, CD68, and FOSL1. This is the second study to show the immunohistochemical profile, with emphasis in FOSL1, of an additional case of symmetrical palatal fibromatosis.
CONCLUSIONS
We encourage further reports about this entity, especially in relation to immunohistochemical and molecular features, so far poorly described, but very important for better recognition of this entity. Palate, symmetrical palatal fibromatosis, desmoplastic fibroblastoma, immunohistochemistry.
PubMed: 33841744
DOI: 10.4317/jced.57732 -
Sensors (Basel, Switzerland) Apr 2020Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face....
Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face. The purpose of this study was to evaluate the efficiency of surface electromyography in describing the effects of the rapid palatal expansion (RPE) on Masseter (M) and Temporalis Anterior (T) muscles' activity in 53 children with different types of malocclusion: bilateral posterior crossbite (BPcb), underdeveloped maxillary complex without crossbite (NOcb) and unilateral posterior crossbite on the right (UPCBr) and on the left (UPCBl). The muscular activities during chewing tasks were assessed bilaterally before and after RPE application and three months after removal. Both the envelope's peak (µV) and its occurrence (% of chewing task) were extracted from the surface electromyography signal. Our results showed the presence of statistically significant differences (p < 0.05) on temporomandibular joint muscles, across different assessments, in all the tested populations of subjects. Surface electromyography demonstrated a relationship between the correction of a maxillary transverse discrepancy and the restoration of a muscle's activation patterns comparable to healthy subjects for both T and M.
Topics: Child; Electromyography; Female; Humans; Male; Malocclusion; Masseter Muscle; Palatal Expansion Technique; Temporal Muscle
PubMed: 32272810
DOI: 10.3390/s20072086 -
Biomimetics (Basel, Switzerland) Jun 2022The presence of posterior crossbite can trigger aesthetic and functional changes as mandibular asymmetry in individuals, contributing to asymmetrical muscle function....
BACKGROUND
The presence of posterior crossbite can trigger aesthetic and functional changes as mandibular asymmetry in individuals, contributing to asymmetrical muscle function. Mandibular asymmetry and respective condyle adaptation may be an etiological factor in temporomandibular disorder. This study aims to evaluate the effects of maxillary expansion on the position and angulation of the condyles as well as the intercondylar distance in children with cleft lip and palate.
METHODS
Twenty-five individuals with cleft lip and palate who underwent maxillary expansion were selected. Condylar changes were evaluated by cone beam computed tomography using the Pullinger and Hollender formula. To determine the statistically significant differences between the variables, the Student t-test and the Benjamini-Hochberg correction method for multiple comparisons were used.
RESULTS
No statistically significant differences between angulation and condylar position before and after maxillary expansion were found. The intercondylar distance tended to increase in growing individuals with cleft lip and palate after maxillary expansion.
CONCLUSIONS
Intercondylar distance shows a tendency to increase after expansion regardless of the cleft phenotype. No differences were found in angulation and condylar position with the changes in occlusion resulting from maxillary expansion.
PubMed: 35735589
DOI: 10.3390/biomimetics7020073 -
Frontiers in Cell and Developmental... 2021The roles of bone morphogenetic protein (BMP) signaling in palatogenesis were well documented in the developing hard palate; however, little is known about how BMP...
The roles of bone morphogenetic protein (BMP) signaling in palatogenesis were well documented in the developing hard palate; however, little is known about how BMP signaling regulates the development of soft palate. In this study, we overexpressed transgene via allele to suppress BMP signaling in the developing soft palate. We found that BMP-Smad signaling was detected in the palatal muscles and surrounding mesenchyme. When BMP-Smad signaling was suppressed by the overexpressed , the soft palatal shelves were reduced in size with the hypoplastic muscles and the extroversive hypophosphatasia (HPP). The downregulated cell proliferation and survival in the soft palates were suggested to result from the repressed transcription and Gli1 activity, implicating that the BMP-Shh-Gli1 network played a similar role in soft palate development as in the hard palate. The downregulated Sox9, (), and expression in soft palate indicated the impaired differentiation of the aponeurosis and tendons, which was suggested to result in the hypoplasia of palatal muscles. Intriguingly, in the and the soft palates, the hypoplastic or abrogated muscles affected little the fusion of soft palate. Although the , , and transcription was significantly repressed in the tenogenic mesenchyme of the soft palate, the Sox9 expression, and the and transcription in aponeurosis mesenchyme were almost unaffected. It implicated that the fusion of soft palate was controlled by the mesenchymal clues at the tensor veli palatini (TVP) and levator veli palatini (LVP) levels, but by the myogenic components at the palatopharyngeus (PLP) level.
PubMed: 34557486
DOI: 10.3389/fcell.2021.711334 -
Craniomaxillofacial Trauma &... Mar 2023Description and validation of a surgical technique.
STUDY DESIGN
Description and validation of a surgical technique.
OBJECTIVE
En-bloc maxillectomy with removal of the nasal septum is a rare procedure; preservation of the nasal bones and integrity of the alveolar ridge is even rarer. These procedures traditionally required a combined transfacial-transoral approach based on lateral rhinotomy. We describe a combined endoscopic transnasal-transoral approach for treatment of nasal septal malignancies that involve the hard palate.
METHODS
Excision of malignant tumours arising from the nasal septum was achieved in 4 patients using a transnasal-transoral endoscopic approach. Using 4-mm optics angled at 0° and 30°, the septum was freed from the ethmoid and removed with the hard palate, by pulling the septum down through the hard palate.
RESULTS
Of the 4 patients, 2 underwent complete removal of septal chondrosarcomas, one removal of a sinonasal undifferentiated carcinoma and one removal of a mucoepidermoid carcinoma. In two cases, the palatal mucosa was spared and repositioned to restore separation between the nose and oral cavity. The remaining two cases underwent complete resection of the hard palate; one palate was reconstructed using a pedicled temporalis muscle flap and the other by employing an obturator. No infection was encountered. Partial ethmoidectomy was performed in all four cases. The mean hospital stay was 5 days. All patients are free of disease after a mean follow-up of 4 years (range: 2-7 years).
CONCLUSIONS
Our new approach allows for minimally invasive resection of nasal septal malignancies that extend to the palate. Our maxillary pull-through technique is a valuable new surgical procedure for malignant pathologies of the nasal septum; the only drawback is that endoscopic surgery has a steep learning curve.
PubMed: 36824185
DOI: 10.1177/19433875211067010 -
Tremor and Other Hyperkinetic Movements... 2019A 54-year-old Thai male who has suffered from multiple episodes of ischemic and hemorrhagic strokes developed facio-oculo-palatal myoclonus (FOPM) 1 month after the...
BACKGROUND
A 54-year-old Thai male who has suffered from multiple episodes of ischemic and hemorrhagic strokes developed facio-oculo-palatal myoclonus (FOPM) 1 month after the latest episode of the brainstem stroke.
PHENOMENOLOGY SHOWN
The patient presented with semirhythmic, involuntary, horizontal jerky, and rotatory ocular oscillation concomitant with asymmetrical palatal and perioral myoclonus consistent with FOPM.
EDUCATIONAL VALUE
FOPM is a useful clinical clue for diagnosing brainstem lesions, specifically in the Guillain-Mollaret triangle. The commonest etiology is cerebrovascular diseases.
Topics: Brain Stem Infarctions; Facial Muscles; Humans; Male; Middle Aged; Myoclonus; Ocular Motility Disorders; Palate; Video Recording
PubMed: 31498332
DOI: 10.7916/tohm.v0.658