-
Iranian Journal of Otorhinolaryngology Jan 2020Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore,...
INTRODUCTION
Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore, it is important to treat snoring to reduce the disruption of the bed partner's sleep and the patients' own problems. This study aimed to present a minimally invasive procedure which is easy to perform with less tissue damage.
MATERIALS AND METHODS
This study included 13 patients suffering from primary snoring with soft palate length of 2.5cm or more. All of the patients were examined and their partners were asked to fill-out the relevant questionnaires at baselines, 90 days, 6 months and 1 year after the surgery in order to assess snoring. A crescent strip of oral mucosa along with the underlying muscle were removed under general anesthesia followed by the insertion of a piece of oval-shaped titanium mesh. Moreover, two subjective methods were employed to assess the snoring of all patients.
RESULTS
11 patients were male, and the mean age and the mean body mass index of the patients were 48.69 years and 28.34 kg/m, respectively. The scores obtained from the Visual Analog Scale for snoring loudness before surgery reduced from 7.63 to 3.54, which was statistically significant (P<0.05). None of the patients experienced major complications after surgery; however, there was a partial extrusion of the implant in one case which was managed conservatively with spontaneous healing.
CONCLUSIONS
Titanium snoreplasty was successful in the reduction of snoring in this study. This method is a single-stage treatment for simple snoring with the multiple effects of palatal shortening, space increasing, and palatal stiffening.
PubMed: 32083028
DOI: 10.22038/ijorl.2019.31930.2051 -
The Cleft Palate-craniofacial Journal :... Jul 2020Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness.
METHODS
PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale.
RESULTS
Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI]: 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI: 12%-33%). The incidence of OSA was 28% (95% CI: 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes ( = .6572).
CONCLUSIONS
Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.
Topics: Cleft Palate; Humans; Palatal Muscles; Speech; Treatment Outcome; Velopharyngeal Insufficiency
PubMed: 32070129
DOI: 10.1177/1055665620902883 -
PloS One 2020The strains of inbred laboratory mice are isogenic and homogeneous for over 98.6% of their genomes. However, geometric morphometric studies have demonstrated clear...
The strains of inbred laboratory mice are isogenic and homogeneous for over 98.6% of their genomes. However, geometric morphometric studies have demonstrated clear differences among the skull shapes of various mice strains. The question now arises: why are skull shapes different among the mice strains? Epigenetic processes, such as morphological interaction between the muscles and bones, may cause differences in the skull shapes among various mice strains. To test these predictions, the objective of this study is to examine the morphological association between a specific part of the skull and its adjacent muscle. We examined C57BL6J, BALB/cA, and ICR mice on embryonic days (E) 12.5 and 16.5 as well as on postnatal days (P) 0, 10, and 90. As a result, we found morphological differences between C57BL6J and BALB/cA mice with respect to the inferior spine of the hypophyseal cartilage or basisphenoid (SP) and the tensor veli palatini muscle (TVP) during the prenatal and postnatal periods. There was a morphological correlation between the SP and the TVP in the C57BL6J, BALB/cA, and ICR mice during E15 and P0. However, there were not correlation between the TVP and the SP during P10. After discectomy, bone deformation was associated with a change in the shape of the adjacent muscle. Therefore, epigenetic modifications linked to the interaction between the muscles and bones might occur easily during the prenatal period, and inflammation seems to allow epigenetic modifications between the two to occur.
Topics: Anatomy, Comparative; Animals; Animals, Newborn; Female; Humans; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Mice, Inbred ICR; Palatal Muscles; Pregnancy; Sphenoid Bone
PubMed: 31923241
DOI: 10.1371/journal.pone.0227301 -
International Archives of... Jan 2020Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of...
Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively ( = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; = 0.007). Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.
PubMed: 31892966
DOI: 10.1055/s-0039-1695026 -
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 -
PloS One 2019Exercise induced intermittent dorsal displacement of the soft palate (DDSP) is a common cause of airway obstruction and poor performance in racehorses. The definite...
Investigation into pathophysiology of naturally occurring palatal instability and intermittent dorsal displacement of the soft palate (DDSP) in racehorses: Thyro-hyoid muscles fatigue during exercise.
Exercise induced intermittent dorsal displacement of the soft palate (DDSP) is a common cause of airway obstruction and poor performance in racehorses. The definite etiology is still unclear, but through an experimental model, a role in the development of this condition was identified in the dysfunction of the thyro-hyoid muscles. The present study aimed to elucidate the nature of this dysfunction by investigating the spontaneous response to exercise of the thyro-hyoid muscles in racehorses with naturally occurring DDSP. Intramuscular electrodes were implanted in the thyro-hyoid muscles of nine racehorses, and connected to a telemetric unit for electromyographic monitoring implanted subcutaneously. The horses were recruited based on upper airway function evaluated through wireless endoscopy during exercise. Five horses, with normal function, were used as control; four horses were diagnosed as DDSP-affected horses based on repeated episodes of intermittent dorsal displacement of the soft palate. The electromyographic activity of the thyro-hyoid muscles recorded during incremental exercise tests on a high-speed treadmill was analyzed to measure the mean electrical activity and the median frequency of the power spectrum, thereafter subjected to wavelet decomposition. The affected horses had palatal instability with displacement on repeated exams prior to surgical implantation. Although palatal instability persisted after surgery, only two of these horses displaced the palate after instrumentation. The electromyographic traces from this group of four horses showed, at highest exercise intensity, a decrease in mean electrical activity and median power frequency, with progressive decrease in the contribution of the high frequency wavelets, consistent with development of thyro-hyoid muscle fatigue. The results of this study identified fatigue as the main factor leading to exercise induced palatal instability and DDSP in a group of racehorses. Further studies are required to evaluate the fiber type composition and metabolic characteristics of the thyro-hyoid muscles that could predispose to fatigue.
Topics: Animals; Electromyography; Female; Horse Diseases; Horses; Male; Muscle Fatigue; Palate, Soft; Physical Conditioning, Animal; Signal Processing, Computer-Assisted; Thyroid Gland
PubMed: 31652282
DOI: 10.1371/journal.pone.0224524 -
PloS One 2019The soft palate is a key component of the oropharyngeal complex that is critical for swallowing, breathing, hearing and speech. However, complete functional restoration...
The soft palate is a key component of the oropharyngeal complex that is critical for swallowing, breathing, hearing and speech. However, complete functional restoration in patients with cleft soft palate remains a challenging task. New insights into the molecular signaling network governing the development of soft palate will help to overcome these clinical challenges. In this study, we investigated whether key signaling pathways required for hard palate development are also involved in soft palate development in mice. We described the dynamic expression patterns of signaling molecules from well-known pathways, such as Wnt, Hh, and Fgf, during the development of the soft palate. We found that Wnt signaling is active throughout the development of soft palate myogenic sites, predominantly in cells of cranial neural crest (CNC) origin neighboring the myogenic cells, suggesting that Wnt signaling may play a significant role in CNC-myogenic cell-cell communication during myogenic differentiation in the soft palate. Hh signaling is abundantly active in early palatal epithelium, some myogenic cells, and the CNC-derived cells adjacent to the myogenic cells. Hh signaling gradually diminishes during the later stages of soft palate development, indicating its involvement mainly in early embryonic soft palate development. Fgf signaling is expressed most prominently in CNC-derived cells in the myogenic sites and persists until later stages of embryonic soft palate development. Collectively, our results highlight a network of Wnt, Hh, and Fgf signaling that may be involved in the development of the soft palate, particularly soft palate myogenesis. These findings provide a foundation for future studies on the functional significance of these signaling pathways individually and collectively in regulating soft palate development.
Topics: Animals; Cell Communication; Fibroblast Growth Factors; Gene Expression Regulation, Developmental; Hedgehog Proteins; Mice; Muscle Development; Neural Crest; Palate, Soft; Signal Transduction; Wnt Proteins
PubMed: 31613912
DOI: 10.1371/journal.pone.0223879 -
Journal of Clinical Sleep Medicine :... Sep 2019To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system.
STUDY OBJECTIVES
To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system.
METHODS
A total of 32 patients with OSA and 18 healthy control patients were included in the study. All participants were selected based on medical history, physical examination, and nocturnal polysomnography (PSG) and divided into two groups. The palatal sensory status of participants was examined with a Neurometer current perception threshold (CPT) system. The system was used to deliver an electrical stimulus at three different frequencies (2,000 Hz, 250 Hz, and 5 Hz) by an investigator blinded to the PSG results.
RESULTS
There were no significant differences in the CPT values of the hard palate between the patients with OSA and control patients at any of the three stimulation frequencies. The differences in the CPT values of the soft palate between these groups failed to show any statistical significance at 250 Hz and 5 Hz. However, the patients with OSA showed significantly higher CPT values of the soft palate at 2,000 Hz than the age-matched healthy control patients (256.56 ± 129.34 versus 372.13 ± 152.06; P = .009).
CONCLUSIONS
Our study revealed an impairment of 2,000 Hz-related sensory nerve function of the soft palate among patients with OSA. The CPT test could be a useful tool for the quantitative and selective assessment of the sensory nerve function in patients with OSA. Additional research is required to evaluate the different types of sensory nerve dysfunctions among such patients.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Title: The Effects of Nasal Airflow on Upper Airway Dilator Muscles During Sleep; Identifier: NCT03506178; URL: https://clinicaltrials.gov/ct2/show/NCT03506178.
CITATION
An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative evaluation of the function of the sensory nerve fibers of the palate in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(9):1347-1353.
Topics: Adult; Electric Stimulation; Evaluation Studies as Topic; Female; Humans; Male; Nerve Fibers; Palate, Soft; Polysomnography; Sleep Apnea, Obstructive
PubMed: 31538606
DOI: 10.5664/jcsm.7756 -
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 -
The Cleft Palate-craniofacial Journal :... Mar 2020To investigate the dimensions of the tensor veli palatini (TVP) muscle using high image resolution 3-dimensional magnetic resonance imaging (MRI) of the soft palate...
PURPOSE
To investigate the dimensions of the tensor veli palatini (TVP) muscle using high image resolution 3-dimensional magnetic resonance imaging (MRI) of the soft palate among children with normal velopharyngeal and craniofacial anatomy and to compare values to individuals with a diagnosis of 22q11.2 deletion syndrome (22q11DS). We also sought to determine whether there is a relationship between hypoplasia of the TVP and severity of middle ear dysfunction and hearing loss.
METHODS
Three-dimensional MRI were used to collect and analyze data obtained across 53 children between 4 and 12 years of age, including 40 children with normal velopharyngeal and craniofacial anatomy and 13 children with a diagnosis of 22q11.2 DS. Tensor veli palatini muscle length, thickness, and volume as well as bihamular distance were compared among participant groups.
RESULTS
A Welch's -test revealed that the TVP in participants with 22q11DS is significantly shorter ( = .005, 17.3 vs 19.0 mm), thinner ( < .001, 1.1 vs 1.8 mm), and less voluminous ( < .001, 457.5 vs 667.3 mm) than participants without 22q11DS. Participants with 22q11DS also had a greater ( = .006, 27.7 vs 24.7 mm) bihamular distance than participants without 22q11DS. There was an inverse relationship between TVP abnormalities noted above and the severity of audiologic and otologic histories.
CONCLUSION
The TVP muscle is substantially reduced in volume, length, and thickness in children with 22q11DS. These findings serve as preliminary support for the association of patient hearing and otologic severity and TVP dysmorphology.
Topics: Child; Craniosynostoses; DiGeorge Syndrome; Eustachian Tube; Humans; Marfan Syndrome; Palatal Muscles
PubMed: 31446782
DOI: 10.1177/1055665619869142