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Medicina (Kaunas, Lithuania) Aug 2023Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with... (Meta-Analysis)
Meta-Analysis
Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with retropalatal narrowing by reducing soft palate volume and tightening the muscles. Although some previous publications have demonstrated the effectiveness of limited PMR, the overall efficacy and therapeutic role of limited PMR for the treatment of OSA remain uncertain. This study utilized meta-analysis and a systematic literature review to estimate the overall effectiveness of limited PMR in treating OSA. Multiple databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched using specific keywords related to OSA and limited PMR. Original articles assessing respiratory disturbances before and after limited PMR in patients with OSA were included. Data from selected articles were collected using standardized forms, including clinicodemographic characteristics, apnea-hypopnea index (AHI), and lowest pulse oximetry values (minimum SpO). Random effect models were used for analyzing significant heterogeneity. Egger's test and funnel plot were used to identify publication bias. Four studies were included in this meta-analysis for AHI, and three studies were included for minimum SpO during sleep. A significant reduction in the AHI and an increase in the minimum SpO were shown following limited PMR as the standardized mean difference (95% confidence interval) was 2.591 (1.092-4.090) and 1.217 (0.248-2.186), respectively. No publication bias was found in either analysis. The results of the meta-analysis and systemic review add to the literature that limited PMR can result in a reduction in the AHI and an increase in min SaO. In OSA patients with suspected retropalatal obstruction, limited PMR may be efficiently performed.
Topics: Humans; Databases, Factual; Palatal Muscles; Sleep; Sleep Apnea, Obstructive
PubMed: 37629722
DOI: 10.3390/medicina59081432 -
BMJ Case Reports Jan 2022
Topics: Essential Tremor; Humans; Palatal Muscles; Palate; Tremor
PubMed: 35039383
DOI: 10.1136/bcr-2021-248139 -
Tremor and Other Hyperkinetic Movements... Oct 2020Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and... (Review)
Review
BACKGROUND
Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and palatal tremor associated with progressive ataxia.
METHODS
A thorough Pubmed search was conducted to look for the original articles, reviews, letters to editor, case reports, and teaching neuroimages, with the keywords "essential", "symptomatic palatal tremor", "myoclonus", "ataxia", "hypertrophic", "olivary" and "degeneration".
RESULTS
Essential palatal tremor is due to contraction of the tensor veli palatini muscle, supplied by the 5 cranial nerve. Symptomatic palatal tremor occurs due to the contraction of the levator veli palatini muscle, supplied by the 9% and 10% cranial nerves. Essential palatal tremor is idiopathic, while symptomatic palatal tremor occurs due to infarction, bleed or tumor within the Guillain-Mollaret triangle. Progressive ataxia and palatal tremor can be familial or idiopathic. Symptomatic palatal tremor and sporadic progressive ataxia with palatal tremor show signal changes in inferior olive of medulla in magnetic resonance imaging. The treatment options available for essential palatal tremor are clonazepam, lamotrigine, sodium valproate, flunarizine and botulinum toxin. The treatment of symptomatic palatal tremor involves the treatment of the underlying cause.
DISCUSSION
Further studies are required to understand the cause and pathophysiology of Essential palatal tremor and progressive ataxia and palatal tremor. Similarly, the link between tauopathy and palatal tremor associated progressive ataxia needs to be explored further. Oscillopsia and progressive ataxia are more debilitating than palatal tremor and needs new treatment approaches.
Topics: Anticonvulsants; Cerebellar Nuclei; Essential Tremor; Humans; Inflammation; Magnetic Resonance Imaging; Neuromuscular Agents; Neurosurgical Procedures; Olivary Nucleus; Palatal Muscles; Red Nucleus; Somatoform Disorders; Tremor
PubMed: 33101766
DOI: 10.5334/tohm.188 -
American Journal of Respiratory and... Sep 1995Eight subjects (5 men, 3 women, ages 27 to 55) with obstructive sleep apnea syndrome (OSAS) were studied to quantify and compare electromyographic (EMG) activity of...
Eight subjects (5 men, 3 women, ages 27 to 55) with obstructive sleep apnea syndrome (OSAS) were studied to quantify and compare electromyographic (EMG) activity of levator veli palatini (LVP) and palatoglossus (PG), two velopharyngeal muscles, and genioglossus (GG) during obstructive apnea cycles in non-rapid eye movement (NREM) sleep. EMG activity of three successive preapneic breaths, first and last apneic efforts, and three successive postapneic breaths was quantified for each muscle as peak phasic inspiratory EMG normalized as percent activity of the last preapneic breath. In all subjects, apnea onset coincided with simultaneous inspiratory EMG nadir of all three muscles (LVP = 63 +/- 40%, PG = 74 +/- 53%. GG = 83 +/- 48%. mean +/- SD activity of last preapneic breath). Apnea resolution did not occur until inspiratory EMG of all three muscles simultaneously reached maximal activity, at levels significantly greater than preapneic activity as well as activity of the last preapneic effort (LVP = 215 +/- 205%, PG = 227 +/- 240+, GG = 235 +/- 202%, mean +/- SD activity of last preapneic breath, p < 0.05, Fisher's partial least-squares difference [PLSD] test for each muscle). The presence or absence of electroencephalographic arousal at apnea resolution did not influence these patterns of EMG activity. Inspiratory recruitment of velopharyngeal as well as oropharyngeal muscles appears to be associated with upper airway patency during sleep in patients with OSAS.
Topics: Adult; Electromyography; Female; Humans; Male; Middle Aged; Palatal Muscles; Palate, Soft; Polysomnography; Respiration; Sleep Apnea Syndromes
PubMed: 7663778
DOI: 10.1164/ajrccm.152.3.7663778 -
Neurology May 1992
Topics: Ceruletide; Female; Humans; Middle Aged; Myoclonus; Palatal Muscles
PubMed: 1579245
DOI: 10.1212/wnl.42.5.1125-b -
Auris, Nasus, Larynx Dec 2014The ideal palatal surgery for obstructive sleep apnea (OSA) and snoring must maintain the airway patency and correct anatomic abnormalities without complications. The...
OBJECTIVE
The ideal palatal surgery for obstructive sleep apnea (OSA) and snoring must maintain the airway patency and correct anatomic abnormalities without complications. The purpose of this study was to investigate the efficacy of limited palatal muscle resection (LPMR) to improve OSA severity.
SUBJECTS AND METHODS
Twenty-three patients with OSA underwent LPMR. The LPMR was initiated with a bilateral tonsillectomy in patients with tonsil size 2 and 3. The LPMR consisted of partial resection of palatal muscles (levator veli palatini, palatoglossus, and musculus uvulae) with preservation of the uvula and a simple double layer suturing. The retropalatal space and the length of soft palate were evaluated by magnetic resonance imaging. Subjective outcomes using visual analog scales, Epworth Sleepiness Scale, and overnight polysomnography (PSG) data were assessed.
RESULTS
Six months after the operation, there was significant symptomatic improvement in snoring, morning headaches, tiredness, and daytime sleepiness. Postoperative magnetic resonance images showed upward and forward movement of uvula and soft palate after LPMR. The length of the soft palate was significantly shortened and the retropalatal space was significantly increased. Postoperative PSG revealed significant improvement in apnea-hypopnea index (AHI) and the total sleep time spent with oxygen saturation below 90%, and reduction in AHI following PMR was found in all patients. Furthermore, no patient experienced velopharyngeal insufficiency, voice changes, and pharyngeal dryness at 6 months follow-up.
CONCLUSIONS
The LPMR obtained significant improvement in subjective and objective outcomes in OSA, with preserved pharyngeal function. PMR is an effective and safe technique to treat oropharyngeal obstruction in OSA surgery.
Topics: Adult; Cohort Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Palatal Muscles; Palate, Soft; Pharynx; Polysomnography; Sleep Apnea, Obstructive; Tonsillectomy; Treatment Outcome; Young Adult
PubMed: 24862295
DOI: 10.1016/j.anl.2014.03.001 -
Plastic and Reconstructive Surgery May 2007This study was designed to compare two-layer palatoplasty (Wardill-Kilner V-Y pushback technique) without intravelar veloplasty versus three-layer palatoplasty (Kriens... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
This study was designed to compare two-layer palatoplasty (Wardill-Kilner V-Y pushback technique) without intravelar veloplasty versus three-layer palatoplasty (Kriens technique) with intravelar veloplasty with regard to postoperative functional outcome of eustachian tube and velopharyngeal competence.
METHODS
A prospective cohort study was conducted enrolling 70 patients with nonsyndromic cleft palate (except submucous type of cleft) over a period of 2 years. They were divided into two main groups according to the type of cleft palate: group A (Veau class II) included 32 patients and group B (Veau class I) included 38 patients. In each group, Wardill-Kilner palatoplasty (two-layer repair without intravelar veloplasty) versus Kriens palatoplasty (three-layer repair with intravelar veloplasty) was randomly selected for patients.
RESULTS
For the three-layer palatoplasty in both groups, there was a greater tendency for resolution of secretory otitis media in the early postoperative period, less time required for extrusion of the grommet tube, and a lower incidence of recurrent secretory otitis media. The incidence of postoperative velopharyngeal incompetence was greater with two-layer palatoplasty group. The incidence of palatal fistula was greater with three-layer palatoplasty.
CONCLUSIONS
Palatal muscle reconstruction in cleft palate patients confers better functional results regarding velopharyngeal competence and eustachian tube function. Although the overall incidence of postoperative palatal fistula is within the accepted range, the incidence of fistula is higher in the palatal muscle reconstruction subgroup. Future studies are required that include a larger number of patients.
Topics: Child, Preschool; Cleft Palate; Cohort Studies; Eustachian Tube; Female; Follow-Up Studies; Humans; Infant; Male; Palatal Muscles; Postoperative Complications; Probability; Prospective Studies; Plastic Surgery Procedures; Risk Assessment; Treatment Outcome; Velopharyngeal Insufficiency
PubMed: 17440366
DOI: 10.1097/01.prs.0000259185.29517.79 -
Otolaryngologic Clinics of North America Oct 2016The eustachian tube consists of 2 compartments: the Rüdinger's safety canal and the auxiliary gap. It is surrounded by a cartilaginous wall on the craniomedial side and... (Review)
Review
The eustachian tube consists of 2 compartments: the Rüdinger's safety canal and the auxiliary gap. It is surrounded by a cartilaginous wall on the craniomedial side and a membranous wall on the inferolateral side. The eustachian tube cartilage is firmly attached to the skull base by the lateral and the medial suspensory ligaments, which are separated by the medial Ostmann fat pad. The function of the isometric tensor veli palatini muscle is modulated by hypomochlia, which have an influence on the muscular force vectors.
Topics: Cartilage; Eustachian Tube; Fascia; Humans; Isometric Contraction; Ligaments; Masticatory Muscles; Palatal Muscles; Pharyngeal Muscles
PubMed: 27468634
DOI: 10.1016/j.otc.2016.05.002 -
Annals of Plastic Surgery Mar 2022The use of a buccinator myomucosal flap in combination with Furlow's Z-plasty during primary and secondary palatal repairs has been proposed by many authors to overcome...
INTRODUCTION
The use of a buccinator myomucosal flap in combination with Furlow's Z-plasty during primary and secondary palatal repairs has been proposed by many authors to overcome some of the limitations of Furlow's technique. However, there have been no studies that quantitatively measured the effective palatal lengthening when the buccal flap is added.
PATIENTS AND METHODS
The buccal flap is routinely used during primary palate repair in order to fill the gap between the hard palate and reoriented palatal muscle sling. The soft palatal length was measured in the midline from the posterior edge of the hard palate to the base of the uvula. All patients were measured before starting the surgery and just after palatal closure in the standard position for cleft palate repair.
RESULTS
Seventy-three patients with cleft palate who were candidates for primary repair were included. The mean age at the time of operation was 11.4 ± 3.5 months. The mean preoperative palatal length was 21.36 ± 3.529 mm, whereas the mean postoperative palatal length was 29.64 ± 4.171) mm. The mean palatal length change was 8.29 ± 2.514 mm (P < 0.000).
CONCLUSIONS
The Combined use of a buccinator myomucosal flap with modified Furlow's Z-plasty in primary cleft palate repair has proven effective for palatal lengthening and achieved tensionless closure without the need for relaxing incision. It also provided a pliable soft tissue attachment of the palatal muscles to the hard palate allowing for better muscle function and mobility.
Topics: Cleft Palate; Facial Muscles; Humans; Infant; Mouth Mucosa; Oral Surgical Procedures; Palatal Muscles; Palate; Palate, Soft; Plastic Surgery Procedures; Surgical Flaps
PubMed: 34393194
DOI: 10.1097/SAP.0000000000002964 -
American Journal of Respiratory and... Sep 1997The sleep apnea/hypopnea syndrome (SAHS) affects 1-4% of the middle-aged population and is caused by repeated occlusion of the upper airway mainly at the retropalatal...
The sleep apnea/hypopnea syndrome (SAHS) affects 1-4% of the middle-aged population and is caused by repeated occlusion of the upper airway mainly at the retropalatal level. It is unclear why SAHS patients obstruct their upper airways during sleep while others do not. We hypothesized that upper airway dilator muscle function may be impaired in SAHS patients and that chronic CPAP therapy may enhance upper airway function. We, therefore, examined the effects of upper airway negative pressure on reflex palatal muscle activity in 16 normal nonsnoring awake male subjects and 16 awake SAHS patients using electromyography. The application of negative upper airway pressure (0 to -12.5 cm H2O) caused increases in levator palatini (LP, p < 0.001) and palatoglossus (PG, p < 0.001) activity, 100 msec after pressure stimulus in normal subjects. Application of upper airway negative pressure in SAHS patients caused an increase in LP activity (p < 0.05) but not in PG activity. Reflex electromyographic response to negative pressure was reduced in SAHS patients compared to normal subjects for both muscles (p < 0.001). When the seven thinnest SAHS patients were compared with seven normal subjects matched for BMI and age, the SAHS patients still demonstrated impaired responses to negative pressure for both muscles (p < 0.001). A further eight SAHS patients were studied either while concurrently taking nightly CPAP therapy and also off CPAP (at least 3 nights). Chronic nightly CPAP therapy improved the reflex response of both LP (p < 0.001) and PG (p = 0.003) to nasal negative pressure application. Thus, untreated SAHS patients have impaired electromyographic responses to negative upper airway pressure suggesting impaired defence of the upper airway, which is improved by nightly CPAP therapy.
Topics: Adult; Age Factors; Body Mass Index; Case-Control Studies; Electromyography; Humans; Male; Palatal Muscles; Positive-Pressure Respiration; Sleep Apnea Syndromes; Ventilators, Negative-Pressure
PubMed: 9310006
DOI: 10.1164/ajrccm.156.3.9608008