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Medicina (Kaunas, Lithuania) Jul 2021Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological... (Review)
Review
Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.
Topics: Continuous Positive Airway Pressure; Endoscopy; Humans; Pharynx; Polysomnography; Sleep Apnea, Obstructive
PubMed: 34356971
DOI: 10.3390/medicina57070690 -
Ear, Nose, & Throat Journal Jul 2020
Topics: Cheek; Diagnosis, Differential; Female; Humans; Medical Illustration; Middle Aged; Mucositis; Palate, Soft; Pharyngeal Diseases; Pharynx; Plasma Cells; Singing
PubMed: 31072192
DOI: 10.1177/0145561319849001 -
Journal of Anatomy Dec 2019The pharyngeal arches are a prominent and significant feature of vertebrate embryos. These are visible as a series of bulges on the lateral surface of the embryonic... (Review)
Review
The pharyngeal arches are a prominent and significant feature of vertebrate embryos. These are visible as a series of bulges on the lateral surface of the embryonic head. In humans, and other amniotes, there are five pharyngeal arches numbered 1, 2, 3, 4 and 6; note the missing '5'. This is the standard scheme for the numbering of these structures, and it is a feature of modern anatomy textbooks. In this article, we discuss the rationale behind this odd numbering, and consider its origins. One reason given is that there is a transient 5th arch that is never fully realized, while another is that this numbering reflects considerations from comparative anatomy. We show here, however, that neither of these reasons has substance. There is no evidence from embryology for a '5th' arch, and the comparative argument does not hold as it does not apply across the vertebrates. We conclude that there is no justification for this strange numbering. We suggest that the pharyngeal arches should simply be numbered 1, 2, 3, 4 and 5 as this would be in keeping with the embryology and with the general numbering of the pharyngeal arches across the vertebrates.
Topics: Animals; Biological Evolution; Branchial Region; Head; Neural Crest; Pharynx; Vertebrates
PubMed: 31402457
DOI: 10.1111/joa.13067 -
Annual Review of Neuroscience Jul 2020All mammals must suckle and swallow at birth, and subsequently chew and swallow solid foods, for optimal growth and health. These initially innate behaviors depend... (Review)
Review
All mammals must suckle and swallow at birth, and subsequently chew and swallow solid foods, for optimal growth and health. These initially innate behaviors depend critically upon coordinated development of the mouth, tongue, pharynx, and larynx as well as the cranial nerves that control these structures. Disrupted suckling, feeding, and swallowing from birth onward-perinatal dysphagia-is often associated with several neurodevelopmental disorders that subsequently alter complex behaviors. Apparently, a broad range of neurodevelopmental pathologic mechanisms also target oropharyngeal and cranial nerve differentiation. These aberrant mechanisms, including altered patterning, progenitor specification, and neurite growth, prefigure dysphagia and may then compromise circuits for additional behavioral capacities. Thus, perinatal dysphagia may be an early indicator of disrupted genetic and developmental programs that compromise neural circuits and yield a broad range of behavioral deficits in neurodevelopmental disorders.
Topics: Animals; Animals, Suckling; Behavior; Deglutition; Deglutition Disorders; Humans; Nerve Net; Pharynx
PubMed: 32101484
DOI: 10.1146/annurev-neuro-100419-100636 -
Sleep & Breathing = Schlaf & Atmung Dec 2022Yawning is a stereotypical complex muscular movement and is commonly executed by most vertebrates. In seconds, the entire airway is fully dilated and surrounding muscles... (Review)
Review
BACKGROUND AND PURPOSE
Yawning is a stereotypical complex muscular movement and is commonly executed by most vertebrates. In seconds, the entire airway is fully dilated and surrounding muscles are powerfully stretched, most prominently around the pharynx. To date, yawning has been rarely studied, and as of yet there is no consensus on its main function.
MATERIAL AND METHODS
To investigate a mechanical airway function for yawning, a literature search was conducted to relate the frequency of yawning and obstructive airway conditions.
RESULTS
The results show that changes in obstructive airway conditions and alteration of the frequency of yawning are temporally related.
INTERPRETATION
These relationships, however, cannot be interpreted as causal, nor can they be extrapolated to explain the function of yawning. Yet airway management and yawning share many physiological characteristics. We therefore propose a novel hypotheses: yawning plays a significant role in airway physiology by muscle repositioning and widening the airway lumen, thereby securing long-term oxygenation.
Topics: Animals; Humans; Pharynx; Yawning; Respiratory Physiological Phenomena; Airway Obstruction
PubMed: 35122606
DOI: 10.1007/s11325-022-02565-7 -
Dysphagia Apr 2022Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental... (Review)
Review
Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental evaluation of swallowing were limited by technique and positioning. The advent of 320-row area detector CT solved previous challenges and allowed for the study of swallowing physiology and dysphagia in greater detail. In this summary, we describe the history and evolution of CT technology and describe research and clinical applications for the evaluation of swallowing physiology and pathophysiology.
Topics: Benchmarking; Deglutition; Deglutition Disorders; Humans; Pharynx; Tomography, X-Ray Computed
PubMed: 33818630
DOI: 10.1007/s00455-021-10288-2 -
Scientific Reports Apr 2021Group A Streptococcus (GAS) causes 700 million infections and accounts for half a million deaths per year. Biofilm formation has been implicated in both pharyngeal and...
Group A Streptococcus (GAS) causes 700 million infections and accounts for half a million deaths per year. Biofilm formation has been implicated in both pharyngeal and dermal GAS infections. In vitro, plate-based assays have shown that several GAS M-types form biofilms, and multiple GAS virulence factors have been linked to biofilm formation. Although the contributions of these plate-based studies have been valuable, most have failed to mimic the host environment, with many studies utilising abiotic surfaces. GAS is a human specific pathogen, and colonisation and subsequent biofilm formation is likely facilitated by distinct interactions with host tissue surfaces. As such, a host cell-GAS model has been optimised to support and grow GAS biofilms of a variety of GAS M-types. Improvements and adjustments to the crystal violet biofilm biomass assay have also been tailored to reproducibly detect delicate GAS biofilms. We propose 72 h as an optimal growth period for yielding detectable biofilm biomass. GAS biofilms formed are robust and durable, and can be reproducibly assessed via staining/washing intensive assays such as crystal violet with the aid of methanol fixation prior to staining. Lastly, SEM imaging of GAS biofilms formed by this model revealed GAS cocci chains arranged into three-dimensional aggregated structures with EPS matrix material. Taken together, we outline an efficacious GAS biofilm pharyngeal cell model that can support long-term GAS biofilm formation, with biofilms formed closely resembling those seen in vivo.
Topics: Biofilms; Calibration; Cell Culture Techniques; Cells, Cultured; Humans; Microbiological Techniques; Models, Biological; Pharynx; Streptococcal Infections; Streptococcus pyogenes; Virulence Factors
PubMed: 33859234
DOI: 10.1038/s41598-021-87377-7 -
Nature Communications Nov 2023Even slight imbalance between the growth rate of different organs can accumulate to a large deviation from their appropriate size during development. Here, we use live...
Even slight imbalance between the growth rate of different organs can accumulate to a large deviation from their appropriate size during development. Here, we use live imaging of the pharynx of C. elegans to ask if and how organ size scaling nevertheless remains uniform among individuals. Growth trajectories of hundreds of individuals reveal that pharynxes grow by a near constant volume per larval stage that is independent of their initial size, such that undersized pharynxes catch-up in size during development. Tissue-specific depletion of RAGA-1, an activator of mTOR and growth, shows that maintaining correct pharynx-to-body size proportions involves a bi-directional coupling between pharynx size and body growth. In simulations, this coupling cannot be explained by limitation of food uptake alone, and genetic experiments reveal an involvement of the mechanotransducing transcriptional co-regulator yap-1. Our data suggests that mechanotransduction coordinates pharynx growth with other tissues, ensuring body plan uniformity among individuals.
Topics: Humans; Animals; Caenorhabditis elegans; Pharynx; Mechanotransduction, Cellular; Caenorhabditis elegans Proteins; YAP-Signaling Proteins
PubMed: 37985670
DOI: 10.1038/s41467-023-43230-1 -
Clinical Rehabilitation May 2023To analyze intervention goals, protocols, and outcome measures used for oral and pharyngeal motor exercises in post-stroke recovery. (Review)
Review
OBJECTIVE
To analyze intervention goals, protocols, and outcome measures used for oral and pharyngeal motor exercises in post-stroke recovery.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane databases were searched in September 2022.
METHODS
Studies were included if they (1) recruited post-stroke adult patients, (2) administered exercises for the oral and/ or pharyngeal muscles, and (3) reported results at baseline and post-exercise. The extracted data included intervention goals, protocols, and outcomes. All outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF).
RESULTS
A total of 26 studies were identified. Their intervention goals aimed to rehabilitate a broad spectrum of muscle groups within the oral cavity and pharynx and to improve the functions of swallowing, speech, facial expressions, or sleep breathing. Protocol duration ranged from 1 to 13 weeks, with various exercise repetitions (times per day) and frequency (days per week). Half of the studies reported using feedback to support the training, and these studies varied in the feedback strategy and technology tool. A total of 37 unique outcome measures were identified. Most measures represented the body functions and body structure component of the ICF, and several of these measures showed large treatment effects.
CONCLUSIONS
This review demonstrated inconsistency across published studies in intervention goals and exercise protocols. It has also identified current limitations and provided recommendations for the selection of outcome measures while advancing a multidisciplinary view of oral and pharyngeal exercises in post-stroke recovery across relevant functions.
Topics: Adult; Humans; Pharynx; Exercise Therapy; Exercise; Stroke; Deglutition
PubMed: 36426582
DOI: 10.1177/02692155221141395 -
HNO May 2023Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus... (Review)
Review
Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with a variety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.
Topics: Humans; Laryngopharyngeal Reflux; Proton Pump Inhibitors; Larynx; Pharynx; Hoarseness
PubMed: 36795120
DOI: 10.1007/s00106-023-01280-3