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Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2022The aim of this study is to explore the anatomy and surgical approach of retropharyngeal lymphadenectomy via endoscopic transoral approach. The retropharyngeal spaces...
The aim of this study is to explore the anatomy and surgical approach of retropharyngeal lymphadenectomy via endoscopic transoral approach. The retropharyngeal spaces were studied with three fresh frozen cadaver head (6 sides) in the anatomical laboratory of Eye, Ear, Nose and Throat Hospital of Fudan University through endoscopic transoral approach. The superior pharyngeal constrictor muscle, medial pterygoid muscle, tendon of tensor veli palatini muscle, fat of prestyloid space, ascending palatine artery and its branches, styloglossus, stylopharyngeus, stylohyoideus, external carotid artery, levator veli palatini, carotid sheath, ascending pharyngeal artery and longus capitis muscle were revealed in order. The above-mentioned structures were photographed with a 0° Karl Storz nasal endoscope and adjacent relationships were recorded. A case of metastatic retropharyngeal lymphadenopathy was reviewed and the surgical methods and techniques of retropharyngeal lymphadenectomy via endoscopic transoral approach were introduced in detail. The retropharyngeal space and related anatomical structures were exposed through endoscopic transoral approach in all specimens. The styloglossus, stylopharyngius and levator veli palatini are the markers of locating the internal carotid artery. The superior pharyngeal constrictor muscle, medial pterygoid muscle, styloid muscle group, longus capitis muscle and carotid sheath are the markers that can be used to locate the retropharyngeal lymph nodes. Ascending palatine artery, ascending pharyngeal artery and internal carotid artery are the main arteries involved in retropharyngeal lymphadenectomy via endoscopic transoral approach. Endoscopic transoral approach is a new surgical technique to perform retropharyngeal lymphadenectomy safely and completely.
Topics: Carotid Artery, Internal; Endoscopy; Humans; Lymph Node Excision; Pharyngeal Muscles; Pharynx
PubMed: 35172541
DOI: 10.13201/j.issn.2096-7993.2022.02.001 -
PloS One 2023Sustained pharyngeal inflation (SPI) with pharyngeal oxygen flow and nasal closure (PhO2-NC) technique create positive inflation pressure in the airway. This study...
Sustained pharyngeal inflation (SPI) with pharyngeal oxygen flow and nasal closure (PhO2-NC) technique create positive inflation pressure in the airway. This study measured the peak inflation pressure (PIP) levels and image changes with SPI-assisted flexible bronchoscopy (SPI-FB) and compared the effects in the pharyngeal space and mid-tracheal lumen. This prospective study enrolled 20 participants aged 6 months to 3 years. Each participant underwent sequential SPI-FB of four different durations (0, 1s, 3s, and 5s) for three cycles. We used a 3.8 mm OD flexible bronchoscope to measure and analyze PIP levels, images, and lumen dimension scores. A total of 480 data were collected. The mean (SD) age and body weight were 12.0 (11.5) months and 7.8 (7.5) kg, respectively. The mean (IQR) PIPs were 4.2 (2.0), 18.5 (6.1), 30.6 (13.5), and 46.1 (25.0) cmH2O in the pharynx and 5.0 (1.6), 17.5 (6.5), 28.0 (12.3), 46.0 (28.5) cmH2O in the mid-trachea at SPI durations of 0, 1s, 3s, and 5s, respectively. The PIP levels had a positive correlation (p <0.001) with different SPI durations in both pharynx and trachea, and were nearly identical (p = 0.695, 0.787, and 0.725 at 1s, 3s, and 5s, respectively) at the same duration except the 0 s (p = 0.015). Lumen dimension scores also significantly increased with increasing SPI durations (p <0.05) in both locations. The identified lesions significantly increased as PIP levels increased (p <0.001). Conclusion: SPI-FB using PhO2-NC with durations up to 3s is safe and informative technique that provides controllable PIP, dilates airway lumens, and benefits lesion detection in the pharyngeal space and mid-tracheal lumen.
Topics: Humans; Infant; Pharynx; Bronchoscopy; Prospective Studies; Trachea; Oxygen
PubMed: 37992011
DOI: 10.1371/journal.pone.0294029 -
Journal of Speech, Language, and... May 2020Purpose The field lacks consensus about preferred metrics for capturing pharyngeal residue on videofluoroscopy. We explored four different methods, namely, the...
Purpose The field lacks consensus about preferred metrics for capturing pharyngeal residue on videofluoroscopy. We explored four different methods, namely, the visuoperceptual Eisenhuber scale and three pixel-based methods: (a) residue area divided by vallecular or pyriform sinus spatial housing ("%-Full"), (b) the Normalized Residue Ratio Scale, and (c) residue area divided by a cervical spine scalar (%(C2-4)). Method This study involved retrospective analysis of an existing data set of videofluoroscopies performed in 305 adults referred on the basis of suspected dysphagia, who swallowed 15 boluses each (six thin and three each of mildly, moderately, and extremely thick 20% w/v barium). The rest frame at the end of the initial swallow of each bolus was identified. Duplicate measures of pharyngeal residue were made independently by trained raters; interrater reliability was calculated prior to discrepancy resolution. Frequency distributions and descriptive statistics were calculated for all measures. Kendall's τ tests explored associations between Eisenhuber scale scores and pixel-based measures, that is, %-Full and %(C2-4). Cross-tabulations compared Eisenhuber scale scores to 25% increments of the %-Full measure. Spearman rank correlations evaluated relationships between the %-Full and %(C2-4) measures. Results Complete data were available for 3,545 boluses: 37% displayed pharyngeal residue (thin, 36%; mildly thick, 41%; moderately thick, 35%; extremely thick, 34%). Eisenhuber scale scores showed modest positive associations with pixel-based measures but inaccurately estimated residue severity when compared to %-Full measures with errors in 20.6% of vallecular ratings and 14.2% of pyriform sinus ratings. Strong correlations ( < .001) were seen between the %-Full and %(C2-4) measures, but the %-Full measures showed inflation when spatial housing area was small. Conclusions Generally good correspondence was seen across different methods of measuring pharyngeal residue. Pixel-based measurement using an anatomical reference scalar, for example, (C2-4) is recommended for valid, reliable, and precise measurement.
Topics: Adult; Cineradiography; Deglutition; Deglutition Disorders; Fluoroscopy; Humans; Pharynx; Reproducibility of Results; Retrospective Studies
PubMed: 32379520
DOI: 10.1044/2020_JSLHR-19-00314 -
Paediatric Respiratory Reviews Nov 2019Pediatric Obstructive Sleep Apnea (OSA) is a condition that may lead to a variety of comorbidities in adolescence and adulthood. The gold standard of diagnosing OSA is... (Review)
Review
Pediatric Obstructive Sleep Apnea (OSA) is a condition that may lead to a variety of comorbidities in adolescence and adulthood. The gold standard of diagnosing OSA is polysomnography (PSG). Over the past fifteen years numerous publications have explored how to better visualize the upper airway to further assess OSA in the pediatric population, and eventually institute personalized treatment. Lateral neck radiograph, cephalometry, computed axial tomography, and magnetic resonance imaging are all unique imaging techniques that are used in the diagnosis of OSA. Drug Induced Sleep Endoscopy is a direct visualization technique that is gathering momentum in pediatrics. Each approach has respective benefits and weaknesses. However, none of them at this time can replace PSG. They are a helpful supplement in those patients with complicated upper airway anatomy and in those with residual OSA.
Topics: Cephalometry; Child; Humans; Laryngoscopy; Larynx; Magnetic Resonance Imaging; Pharynx; Polysomnography; Radiography; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Trachea
PubMed: 31076378
DOI: 10.1016/j.prrv.2019.03.007 -
BMJ Case Reports Feb 2021
Topics: Humans; Neck; Nose; Otolaryngology; Pharynx
PubMed: 33563681
DOI: 10.1136/bcr-2020-241172 -
The Journal of Comparative Neurology Nov 2020Detailed anatomical maps of individual organs and entire animals have served as invaluable entry points for ensuing dissection of their evolution, development, and...
Detailed anatomical maps of individual organs and entire animals have served as invaluable entry points for ensuing dissection of their evolution, development, and function. The pharynx of the nematode Caenorhabditis elegans is a simple neuromuscular organ with a self-contained, autonomously acting nervous system, composed of 20 neurons that fall into 14 anatomically distinct types. Using serial electron micrograph (EM) reconstruction, we re-evaluate here the connectome of the pharyngeal nervous system, providing a novel and more detailed view of its structure and predicted function. Contrasting the previous classification of pharyngeal neurons into distinct inter- and motor neuron classes, we provide evidence that most pharyngeal neurons are also likely sensory neurons and most, if not all, pharyngeal neurons also classify as motor neurons. Together with the extensive cross-connectivity among pharyngeal neurons, which is more widespread than previously realized, the sensory-motor characteristics of most neurons define a shallow network architecture of the pharyngeal connectome. Network analysis reveals that the patterns of neuronal connections are organized into putative computational modules that reflect the known functional domains of the pharynx. Compared with the somatic nervous system, pharyngeal neurons both physically associate with a larger fraction of their neighbors and create synapses with a greater proportion of their neighbors. We speculate that the overall architecture of the pharyngeal nervous system may be reminiscent of the architecture of ancestral, primitive nervous systems.
Topics: Animals; Caenorhabditis elegans; Connectome; Feeding Behavior; Motor Neurons; Pharynx; Sensory Receptor Cells; Synapses
PubMed: 32352566
DOI: 10.1002/cne.24932 -
Journal of Speech, Language, and... Jan 2022Within-individual pharyngeal swallowing pressure variability differs among pharyngeal regions in healthy individuals and increases with age. It remains unknown if...
PURPOSE
Within-individual pharyngeal swallowing pressure variability differs among pharyngeal regions in healthy individuals and increases with age. It remains unknown if pharyngeal pressure variability is impacted by volitional swallowing tasks. We hypothesized that pressure variability would increase during volitional swallowing maneuvers and differ among pharyngeal regions depending on the type of swallowing task being performed.
METHOD
Pharyngeal high-resolution manometry was used to record swallowing pressure data from 156 healthy participants during liquid (5 cc) or saliva swallows, and during volitional swallowing tasks including effortful swallow, Mendelsohn maneuver, Masako maneuver, or during postural adjustments. The coefficient of variation was used to determine pressure variability of velopharynx, tongue base, hypopharynx, and upper esophageal sphincter regions. Repeated-measures analysis of variance was used on log-transformed data to examine effects of pharyngeal region and swallowing tasks on swallow-to-swallow variability.
RESULTS
There was a significant main effect of task with greater pressure variability for the effortful swallow ( = .002), Mendelsohn maneuver ( < .001), Masako maneuver ( = .002), and the head turn ( = .006) compared with normal effort swallowing. There was also a significant main effect of region ( < .01). In general, swallowing pressure variability was lower for the tongue base and upper esophageal sphincter regions than the hypopharynx. There was no significant interaction of task and region (effortful, = .182; Mendelsohn, = .365; Masako, = .885; chin tuck, = .840; head turn, = .059; and inverted, = .773).
CONCLUSIONS
Pharyngeal swallowing pressure variability increases in healthy individuals during volitional swallowing tasks. Less stable swallow patterns may result when tasks are less automatic and greater in complexity. These findings may have relevance to swallowing motor control integrity in healthy aging and individuals with neurogenic dysphagia.
Topics: Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Humans; Manometry; Pharynx; Pressure
PubMed: 34929106
DOI: 10.1044/2021_JSLHR-21-00359 -
BMJ Case Reports Jan 2023This case discusses a man in his 20s, referred to the ear, nose and throat department with a suspected ear lobe abscess. He presented with a 5-day history of worsening...
This case discusses a man in his 20s, referred to the ear, nose and throat department with a suspected ear lobe abscess. He presented with a 5-day history of worsening ear pain, fevers and localised papules. An in-depth history showed a relevant sexual health history and medical history. Initial investigations shone no light on the cause of the infection. A second presentation with further generalised symptoms, including further outbreaks of pustules, led to PCR testing, confirming the presence of mpox (monkeypox) virus. He was admitted to the infectious disease ward where he made a good recovery and was supported until discharge.
Topics: Male; Humans; Mpox (monkeypox); Pharynx; Nose; Neck; Disease Outbreaks
PubMed: 36657823
DOI: 10.1136/bcr-2022-252931 -
HNO Aug 2021In 1864, the worldwide oldest journal in an area of the later established specialty of otorhinolaryngology was founded as the German Archiv für Ohrenheilkunde ("Archive...
In 1864, the worldwide oldest journal in an area of the later established specialty of otorhinolaryngology was founded as the German Archiv für Ohrenheilkunde ("Archive of Otology") by its first editors Anton von Tröltsch (Würzburg), Adam Politzer (Vienna), and Hermann Schwartze (Halle/S.). Ear, nose, and throat (ENT) topics had previously been published in universal medical journals. In the next few decades, numerous journals in the field of ENT were founded, the eventful history of which is presented up to the present day. Particular attention is paid to the historical and personal context of the editors of newly founded magazines and their publishers. The journal landscape, which was changing through acquisitions and mergers of publishers, is described in detail. The merging of the specialties of otology and laryngo-rhinology in Germany, which lasted until the 1920s, had a profound influence on journal titles and contents. An attempt is made to present the most important titles in their historical development. All the important editors of the German ENT journals are mentioned, although it was not possible to include the names of the editors of the current journals, which are becoming more and more numerous. One chapter deals exclusively with the development of journal publishers. The inserted tables and figures will help to resolve some of the confusion caused by repeated similar names of journals by showing their historical development.
Topics: Language; Nose; Otolaryngology; Periodicals as Topic; Pharynx
PubMed: 34061220
DOI: 10.1007/s00106-021-01036-x -
Forensic Science, Medicine, and... Mar 2023The persistence and infectivity of SARS-CoV-2 in different postmortem COVID-19 specimens remain unclear despite numerous published studies. This information is essential... (Review)
Review
The persistence and infectivity of SARS-CoV-2 in different postmortem COVID-19 specimens remain unclear despite numerous published studies. This information is essential to improve corpses management related to clinical biosafety and viral transmission in medical staff and the public community. We aim to understand SARS-CoV-2 persistence and infectivity in COVID-19 corpses. We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocols. A systematic literature search was performed in PubMed, Science Direct Scopus, and Google Scholar databases using specific keywords. We critically reviewed the collected studies and selected the articles that met the criteria. We included 33 scientific papers that involved 491 COVID-19 corpses. The persistence rate and maximum postmortem interval (PMI) range of the SARS-CoV-2 findings were reported in the lungs (138/155, 89.0%; 4 months), followed by the vitreous humor (7/37, 18.9%; 3 months), nasopharynx/oropharynx (156/248, 62.9%; 41 days), abdominal organs (67/110, 60.9%; 17 days), skin (14/24, 58.3%; 17 days), brain (14/31, 45.2%; 17 days), bone marrow (2/2, 100%; 12 days), heart (31/69, 44.9%; 6 days), muscle tissues (9/83, 10.8%; 6 days), trachea (9/20, 45.0%; 5 days), and perioral tissues (21/24, 87.5%; 3.5 days). SARS-CoV-2 infectivity rates in viral culture studies were detected in the lungs (9/15, 60%), trachea (2/4, 50%), oropharynx (1/4, 25%), and perioral (1/4, 25%) at a maximum PMI range of 17 days. The SARS-CoV-2 persists in the human body months after death and should be infectious for weeks. This data should be helpful for postmortem COVID-19 management and viral transmission preventive strategy.
Topics: Humans; COVID-19; SARS-CoV-2; Oropharynx; Nasopharynx; Cadaver
PubMed: 36001241
DOI: 10.1007/s12024-022-00518-w