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Dysphagia 1996We examined the potential influence of cold stimulation of the anterior tonsillar pillars, before and after topical anesthesia, on the temporal linkage between the oral... (Comparative Study)
Comparative Study
We examined the potential influence of cold stimulation of the anterior tonsillar pillars, before and after topical anesthesia, on the temporal linkage between the oral and pharyngeal components of the swallow. We hypothesized that if elicitation of the pharyngeal swallow were dependent upon stimulation of faucial mucosal receptors this response would be facilitated by cold tactile stimulation and inhibited by topical anesthesia. In 14 healthy volunteers undergoing simultaneous videoradiography and manometry we measured and compared regional transit and clearance times, and the timing of hyoid motion, upper esophageal sphincter relaxation, and opening within the swallow sequence. There was a significant, volume-dependent forward shift in timings of hyoid motion, upper esophageal sphincter (UES) relaxation profile, and opening which were influenced neither by cold stimulation nor topical anesthesia. Regional transit and clearance times and UES coordination were not influenced by cold stimulation. Pharyngeal clearance time was prolonged by tonsillar pillar anesthesia due to earlier arrival of the bolus head at this region (p = 0.002). We conclude that the normal pharyngeal swallow response is neither facilitated nor inhibited by prior cold tactile stimulation or topical anesthesia to the tonsillar pillars, respectively. These observations do not support the hypothesis that elicitation of the pharyngeal swallow response is dependent upon stimulation of mucosal receptors in the tonsillar arches.
Topics: Adenoids; Adult; Aged; Analysis of Variance; Anesthesia, Local; Cineradiography; Cold Temperature; Deglutition; Esophagus; Humans; Manometry; Middle Aged; Mouth; Mucous Membrane; Muscle Contraction; Neck Muscles; Pharynx; Physical Stimulation; Sensory Receptor Cells; Time Factors; Touch; Videotape Recording
PubMed: 8556873
DOI: 10.1007/BF00385791 -
Nutricion Hospitalaria Sep 2015the objective was to demonstrate if treatment modality, nutritional status and oropharyngeal flora contribute to the development of mucositis in radiotherapy- treated...
PURPOSE
the objective was to demonstrate if treatment modality, nutritional status and oropharyngeal flora contribute to the development of mucositis in radiotherapy- treated head and neck cancer.
METHODS
single-cohort study of patients with head and neck cancer (H&N) in which radiotherapy was indicated. Nutritional status was evaluated using SGA, BMI, and FFMI. A buccal smear was performed before radiotherapy for cultivation of bacteria and yeasts. Mucositis was evaluated using the WHO grades. Relative risk (RR) and its 95% CI were calculated.
RESULTS
the study included 35 patients, 74.3% males, 63.8 (9.9) years of age, and 34.3% malnourished. The diagnoses included larynx (40.0%), oral (25.7%), and pharynx cancer (11.4%). Treatment comprised 66.0 Gy of radiation, chemotherapy (60.0%), and surgery (57.1%). Bacteria were found in 28.6%, including Staphylococcus aureus (8.6%) and Escherichia coli (8.6%). Yeasts (Candida spp.) were found in 35.3%. Mucositis was more frequent in patients with definitive radiotherapy [100% vs. 65%, p = 0.01; RR = 1.54 (CI95% 1.12 to 2.12)]. Neither SGA nor BMI or FFMI were related to the development or severity of mucositis. Positive cultures for bacteria before radiotherapy were related to severe mucositis [44.4% vs. 12%, p = 0.039; RR = 4.17 (CI95% 1.22 to 14.24)], but there was no relationship with the presence of yeasts. Previous surgery was not associated with the appearance of the studied strains of bacteria.
CONCLUSION
bacterial colonization of the oropharynx prior to radiotherapy may be a factor for severe mucositis in H&N patients.
Topics: Aged; Anthropometry; Cohort Studies; Combined Modality Therapy; Female; Head and Neck Neoplasms; Humans; Male; Microbiota; Middle Aged; Mucositis; Neoplasm Staging; Nutritional Status; Oropharynx
PubMed: 26319840
DOI: 10.3305/nh.2015.32.3.9299 -
Boletin Medico Del Hospital Infantil de... 2019Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL)....
BACKGROUND
Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients.
METHODS
A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish.
RESULTS
One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = -0.720 and r = -0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01).
CONCLUSIONS
OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.
Topics: Adolescent; Child; Cross-Sectional Studies; Humans; Male; Mucositis; Neoplasms; Oropharynx; Pharyngeal Diseases; Psychometrics; Quality of Life; Reproducibility of Results
PubMed: 30657465
DOI: 10.24875/BMHIM.18000146 -
The Laryngoscope Apr 1996After total laryngectomy with or without partial pharyngectomy, the remaining pharyngeal defect can be repaired either by primary closure or with additional tissue,...
After total laryngectomy with or without partial pharyngectomy, the remaining pharyngeal defect can be repaired either by primary closure or with additional tissue, depending on the amount of pharyngeal tissue remnant available. The aim of this study was to determine the minimum width of the pharyngeal remnant that could be safely closed primarily without causing difficulty in swallowing. A total of 52 consecutive patients who underwent total laryngectomy were entered into the study. The relaxed and stretched widths of the pharyngeal remnant were measured after removal of the specimen. The widths of the pharyngeal mucosa ranged from 1.5 to 5.0 cm relaxed (mean, 3.24 cm) and from 2.5 to 8.0 cm stretched (mean, 4.83 cm). All neopharynx was reconstructed by closing the pharynx primarily. Seven of the 52 patients developed recurrent tumor with concomitant dysphagia. Two of the 45 patients without recurrence presented with acute dysphagia from food bolus obstruction, and 1 patient developed benign inflammatory stricture following an episode of fish-bone impaction. The narrowest widths of the pharyngeal remnant in this group of 45 were 1.5 cm relaxed and 2.5 cm stretched. As these patients do not have swallowing difficulty, we conclude that in the absence of tumor recurrence, this amount of residual pharyngeal tissue is sufficient both for primary closure of the pharynx and in restoring swallowing function.
Topics: Adult; Aged; Aged, 80 and over; Deglutition; Deglutition Disorders; Female; Follow-Up Studies; Humans; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Mucous Membrane; Neoplasm Recurrence, Local; Pharyngectomy; Pharynx; Postoperative Complications
PubMed: 8614227
DOI: 10.1097/00005537-199604000-00018 -
Ear, Nose, & Throat Journal Dec 2020The aim of this study is to research the correlation between pharyngeal mucosal suture techniques and pharyngocutaneous fistula (PCF) development after total...
Is It Important Which Suturing Technique Used for Pharyngeal Mucosal Closure in Total Laryngectomy? Modified Continuous Connell Suture May Decrease Pharyngocutaneous Fistula.
OBJECTIVE
The aim of this study is to research the correlation between pharyngeal mucosal suture techniques and pharyngocutaneous fistula (PCF) development after total laryngectomy. We also aimed to investigate other risk factor for fistula development.
METHODS
Medical charts of 85 patients who had total laryngectomy during August 2016 and February 2020 were reviewed. Sixteen patients were excluded due to exclusion criteria. Patients were grouped according to pharyngeal mucosal suture technique. Group 1 had modified continuous Connell suture and group 2 had interrupted submucosal suture for mucosal closure of pharynx. Demographic, medical, and surgical records reviewed for comparison.
RESULTS
Overall PCF rate was 28%;PCF rates were 16% (5/31) in group 1 and 39% (15/38) in group 2. This difference was significant (Pearson χ = .033). There was no difference between groups due to age, gender, smoking history, tumor stage preoperative albumin levels, preoperative hemoglobin levels, radiotherapy status, chronic obstructive pulmonary disorder and diabetes mellitus history of patients, previous tracheostomy, neck dissection. But correlation analysis revealed that PCF formation significantly related with suture technique ( = .032), preoperative albumin level <3.5 g/dL ( = .028), preoperative hemoglobin level <12.5 g/dL ( = .041), and previous radiotherapy status ( = .012) of the patients. We also showed that suture technique is an independent predictive factor for PCF formation when other factors were controlled by univariate analysis.
CONCLUSION
The suture technique used for pharyngeal mucosal closure, preoperative albumin level <3.5 g/dL, preoperative hemoglobin levels<12.5 g/dL, and previous radiotherapy to the head and neck are risk factors for PCF development. Modified continuous Connell suture is a good option for pharyngeal closure.
Topics: Aged; Aged, 80 and over; Cutaneous Fistula; Female; Hemoglobins; Humans; Laryngectomy; Male; Middle Aged; Pharyngeal Diseases; Pharynx; Postoperative Complications; Preoperative Period; Respiratory Mucosa; Retrospective Studies; Risk Factors; Serum Albumin; Suture Techniques; Treatment Outcome
PubMed: 32703029
DOI: 10.1177/0145561320938918 -
The Cleft Palate Journal Jan 1979Three methods of pharyngeal flap surgery were analyzed with multiview videofluoroscopy and nasopharyngoscopy at least six months post-operatively. It was found that, by...
Three methods of pharyngeal flap surgery were analyzed with multiview videofluoroscopy and nasopharyngoscopy at least six months post-operatively. It was found that, by varying the type of insertion of the flap into the palate, post-operative flap width could be "tailored" to the size of the gap in the velopharyngeal sphincter. The value of varying flap width according to gap size was assessed by analyzing speech results in 60 patients specifically assigned for narrow, moderate, or wide flaps. Results show a marked improvement in the effectiveness of pharyngeal flap surgery when operations are prescribed according to the degree of lateral pharyngeal wall motion seen pre-operatively.
Topics: Cineradiography; Endoscopy; Humans; Methods; Mouth Mucosa; Palate, Soft; Pharyngeal Muscles; Pharynx; Speech Disorders; Velopharyngeal Insufficiency
PubMed: 282029
DOI: No ID Found -
Medical Microbiology and Immunology 1985By culturing pharyngeal swabs from 199 students a carrier rate for Gemella haemolysans of 29.7% was detected. Demonstration of hemolysis depended on blood species and on...
By culturing pharyngeal swabs from 199 students a carrier rate for Gemella haemolysans of 29.7% was detected. Demonstration of hemolysis depended on blood species and on agar base. Optimum growth was obtained under aerobic conditions in a 10% CO2-enriched atmosphere. The cells divided in two planes which were not regularly at right angles to each other. They appeared to be surrounded by a small capsule. Contrary to earlier descriptions, acid was produced from galactose, acetoin was produced by practically all strains and nitrite was reduced by all strains. Acid production from trehalose and N-acetyl-glucosamine, alkaline and acid phosphatase, C4 and C8 esterase, pyrrolidone arylamidase and phosphoamidase activities were detected. In tube precipitation, antigenic relations between type strain and the new isolates were demonstrated.
Topics: Adult; Bacterial Infections; Carrier State; Female; Hemolysis; Humans; Male; Mucous Membrane; Nasopharynx; Streptococcaceae
PubMed: 4088129
DOI: 10.1007/BF02124811 -
Anesthesiology Dec 1999Pharyngeal airway devices can exert substantial pressures against the pharyngeal mucosa. The authors assess the relation between pharyngeal mucosal perfusion and... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Pharyngeal airway devices can exert substantial pressures against the pharyngeal mucosa. The authors assess the relation between pharyngeal mucosal perfusion and directly measured mucosal pressure (MP) in the posterior pharynx using a fiberoptic technique with a modified cuffed oropharyngeal airway (COPA). The authors also measure in vivo intracuff pressure (CP), airway sealing pressure and MP at four locations using an unmodified COPA.
METHODS
Twenty adult patients, American Society of Anesthesiologists status I or II, undergoing general anesthesia were allocated randomly to receive either (1) a COPA with a millimeter microchip sensor fixed on the external cuff surface to record distal posterior pharyngeal MP or (2) a COPA with a fiberoptic scope inserted inside the cuff to record digitized images of the distal posterior pharyngeal mucosa. MP and digitized images were obtained at the same location over an in vivo CP range of 10-160 cm H2O in 10- to 20-cm H2O increments. The digitized images were scored according to blood vessel caliber and mucosal color by two investigators blinded to MP and CP. In an additional 20 matched patients, in vivo CP, airway sealing pressure, and MP was measured at four different cuff locations (corresponding to the anterior, lateral, and posterior pharynx and the distal oropharynx) with increasing cuff volume.
RESULTS
Blood vessel caliber and mucosal color was normal in all patients when the mean mucosal pressure was 17 cm H2O. Blood vessel caliber was first reduced when the mean mucosal pressure was 34 cm H2O. There was a progressive incremental reduction in blood vessel caliber and mucosal color when the mean mucosal pressure increased from 34 to 80 cm H2O (P < or = 0.05). Complete blood vessel collapse and mucosal paling first occurred with the mean mucosal pressure was 73 cm H2O and was present in 90% of patients when the mean mucosal pressure was 80 cm H2O. Mean MP was always higher in the posterior pharynx compared with the other locations when the cuff volume was 20 ml or greater (P < 0.001). In vivo CP is an excellent predictor of mucosal pressure. Mean (95% confidence interval [CI]) MP in the posterior pharynx was 35 (5-67) and 78 (50-109) cm H2O when the airway sealing pressure was 10 (6-16) and 17 (13-21) cm H2O respectively.
CONCLUSION
Pharyngeal mucosal perfusion is reduced progressively in the posterior pharynx when MP is increased from 34 to 80 cm H2O with the COPA. CP provides reliable information about MP and should be less than 120 cm H2O to prevent mucosal ischemia.
Topics: Adult; Aged; Anesthesia, Inhalation; Female; Fiber Optic Technology; Humans; Image Processing, Computer-Assisted; Intubation, Intratracheal; Male; Middle Aged; Mucous Membrane; Oropharynx; Pharynx; Pressure; Regional Blood Flow; Tongue
PubMed: 10598608
DOI: 10.1097/00000542-199912000-00018 -
Cell Stem Cell Sep 2012The integrity of the epidermis and mucosal epithelia is highly dependent on resident self-renewing stem cells, which makes them vulnerable to physical and chemical...
The integrity of the epidermis and mucosal epithelia is highly dependent on resident self-renewing stem cells, which makes them vulnerable to physical and chemical insults compromising the repopulating capacity of the epithelial stem cell compartment. This is frequently the case in cancer patients receiving radiation or chemotherapy, many of whom develop mucositis, a debilitating condition involving painful and deep mucosal ulcerations. Here, we show that inhibiting the mammalian target of rapamycin (mTOR) with rapamycin increases the clonogenic capacity of primary human oral keratinocytes and their resident self-renewing cells by preventing stem cell senescence. This protective effect of rapamycin is mediated by the increase in expression of mitochondrial superoxide dismutase (MnSOD), and the consequent inhibition of ROS formation and oxidative stress. mTOR inhibition also protects from the loss of proliferative basal epithelial stem cells upon ionizing radiation in vivo, thereby preserving the integrity of the oral mucosa and protecting from radiation-induced mucositis.
Topics: Animals; Carcinoma, Squamous Cell; Cell Compartmentation; Cell Death; Cell Proliferation; Cells, Cultured; Cellular Senescence; Clone Cells; Cytoprotection; Epithelial Cells; Head and Neck Neoplasms; Humans; Keratinocytes; Mice; Mouth Mucosa; Mucositis; Oxidative Stress; Radiation Injuries; Radiation, Ionizing; Sirolimus; Stem Cells; Superoxide Dismutase; TOR Serine-Threonine Kinases
PubMed: 22958932
DOI: 10.1016/j.stem.2012.06.007 -
British Journal of Anaesthesia Jan 1993Ten patients were studied for each of the sizes 2, 3 and 4 laryngeal mask airways (LMA) in order to calculate the pressure exerted by the cuff upon the pharyngeal...
Ten patients were studied for each of the sizes 2, 3 and 4 laryngeal mask airways (LMA) in order to calculate the pressure exerted by the cuff upon the pharyngeal mucosa. Using a non-invasive method of comparing intracuff pressures recorded both in vitro and in vivo, the transmitted pharyngeal mucosal pressures were calculated over the clinical range of injection volumes. Cuff inflation with the "normal" injection volumes recommended resulted in the residual volumes of the cuffs being exceeded. The intracuff pressures recorded with the mask in situ at these normal injection volumes were in the range 103-251 mm Hg. The calculated transmitted mucosal pressures were substantial for all three sizes of cuff and potentially exceeded the capillary perfusion pressure of the adjacent pharyngeal mucosa, despite apparent pharyngeal accommodation to the mask.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Laryngeal Masks; Male; Middle Aged; Mucous Membrane; Pharynx; Pressure
PubMed: 8431328
DOI: 10.1093/bja/70.1.25