-
Oral Surgery, Oral Medicine, Oral... Jul 2023Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of inflammatory myofibroblastic tumors located mostly in the intra-abdominal region. Herein, we...
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of inflammatory myofibroblastic tumors located mostly in the intra-abdominal region. Herein, we present a case of a 32-year-old male with a lobulated growth in the right maxilla. Radiology revealed a solitary osteolytic lesion with an irregular margin, causing buccal and palatal cortex erosion. Histopathology revealed a tumor composed of spindle-shaped fascicles that blend into sheets of round to ovoid-shaped epithelioid cells, areas of myxoid changes, and necrosis. Tumor cells showed a moderate amount of eosinophilic cytoplasm, large vesicular nuclei with coarse chromatin, nuclear pleomorphism, and increased mitoses. Tumor cells were immunopositive for ALK-1, focal positivity for smooth muscle actin, panCK, epithelial membrane antigen, and immunonegativity for CD 30, desmin, CD34, and STAT6. P53 showed a wild-type staining pattern, and INI-1 expression was retained. The Ki-67 proliferative index was 22%. To the best of our knowledge, this is the first case of EIMS occurring in the maxilla.
Topics: Male; Humans; Adult; Maxilla; Biomarkers, Tumor; Immunohistochemistry; Sarcoma; Myofibroblasts
PubMed: 37246059
DOI: 10.1016/j.oooo.2023.03.001 -
European Journal of Paediatric Dentistry Jun 2023This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size.
AIM
This study aimed to characterise the palatal vault evolution during the first years of life, both in terms of shape and size.
MATERIALS
The study sample was composed of 168 healthy children aged less than 4 years. Twenty-one measurements of distances and 6 angles were taken from 7 fixed landmarks set on the palatal vaults 3D surfaces reconstructed from CT-scans. To analyse only the shape evolution, the "sizefree" log-shape ratio of those measurements were computed and the global shape of the palatal vault and their transversal curve were plotted. Statistical analyses were performed to highlight the shape and size differences separately.
CONCLUSION
The shape and size evolution of the palatal vault during the first years of life was not only correlated with deciduous dentition development. We assumed that the progressive orofacial muscles activation and tongue movements in the oral cavity may also explain these results as they induced strains on the palatal vault, warping it in various ways.
Topics: Humans; Child; Palate; Tomography, X-Ray Computed
PubMed: 37184237
DOI: 10.23804/ejpd.2023.1663 -
The Cleft Palate-craniofacial Journal :... May 2023To evaluate a method of measuring the change in palatal length and shape following maxillary advancement using synchronous lateral videofluoroscopy and voice recording...
OBJECTIVE
To evaluate a method of measuring the change in palatal length and shape following maxillary advancement using synchronous lateral videofluoroscopy and voice recording in order to understand how movement of the maxilla may affect VPI risk in patients with cleft lip and/or palate (CL/P).
DESIGN
Retrospective cohort study of children with cleft lip and/or palate.
SETTING
Single center, tertiary children's hospital.
PARTICIPANTS
Patients with cleft lip and/or palate who underwent maxillary advancement between 2016-21 inclusive.
INTERVENTIONS
Maxillary advancement surgery, including those who underwent concurrent mandibular procedures.
MAIN OUTCOME MEASURES
The length of the soft palate and the genu angle were measured throughout palatal dynamic range. Pre- and post-operative measurements were compared using a one sided T-test, with subgroup analysis for patients with clinical VPI.
RESULTS
Ten patients were examined. The mean distance of maxillary advancement was 10.5 mm. The average increase in pre-genu soft palate length was 2.8 mm in the resting position and 2.9 mm in the closed position. The genu angle decreased in the closed position by 16.3 degrees.
CONCLUSIONS
The soft palate showed limited ability to lengthen following maxillary advancement and this may explain the risk of VPI. There was partial compensation by the muscle sling of the palate as demonstrated by a more acute post-operative genu angle and this suggests one reason for the variability of VPI reported. Future research is required to investigate how length and shape changes measured using this method can predict VPI risk.
PubMed: 37170555
DOI: 10.1177/10556656231175860 -
The Laryngoscope Jan 2024The work describes a case of palatal myoclonus with distressing tinnitus in a 9-year-old boy and its successful treatment with injections of botulinum toxin. This case...
The work describes a case of palatal myoclonus with distressing tinnitus in a 9-year-old boy and its successful treatment with injections of botulinum toxin. This case report discusses common questions about myoclonic-induced clicking tinnitus and provides answers. Laryngoscope, 134:397-399, 2024.
Topics: Male; Humans; Child; Tinnitus; Myoclonus; Botulinum Toxins; Palate, Soft; Injections; Palatal Muscles
PubMed: 37161907
DOI: 10.1002/lary.30734 -
Indian Journal of Plastic Surgery :... Apr 2023Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by...
Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by various techniques of intravelar veloplasty (IVVP) leads to higher incidence of VPI due to scar contracture. Furlow's Z plasty has long, narrow, thin mucosal flaps and mucomuscular flaps with malaligned muscle closure. We present a technique of "hybrid palatoplasty" which borrows from and adds to the existing methods, is robust, is easy to replicate, and results in normal speech consistently. (1) To design a technique of "hybrid palatoplasty"-combining double opposing Z (DOZ) plasty and IVVP, which is applicable to all types of cleft palate. (2) To evaluate the results of cleft palate children operated using the technique of "hybrid palatoplasty" from 2014 to 2015 in terms of surgical complications (fistulae and dehiscence) and incidence of VPI. Our procedure combines aspects of both DOZ and IVVP. It is simplified with design of smaller Z plasties. On one side, from the oral Z plasty muscle is dissected off and sutured to the nasal mucomuscular flap of the opposite side to complete the palatal sling. Oral Z plasty is purely mucosal and reverse of the nasal side. A total of 123 cases, operated below 5 years of age were followed up. Speech was assessed by direct evaluation and tele-evaluation. A total of 123 cases, below 5 years of age, were operated between 2014 and 2016 with at least 5 years of follow-up. Note that 120 had normal speech, and 3 had VPI of which 2 were subsequently corrected and went on to develop normal speech. This novel "hybrid palatoplasty" is a simple technique with good speech outcome as it combines the principles of Z plasty and direct muscle repair with palatal sling formation.
PubMed: 37153330
DOI: 10.1055/s-0043-1762905 -
Journal of Plastic, Reconstructive &... Jun 2023Wide hard palate defects include congenital and acquired defects that are six square centimeters or larger in size. Obturator prostheses and autologous soft tissue...
Wide hard palate defects include congenital and acquired defects that are six square centimeters or larger in size. Obturator prostheses and autologous soft tissue transfers have been used to reconstruct palatal defects. This study aims to repair wide, hard palatal defects by using a pronator quadratus musculo-osseous free flap to achieve subtotal reconstruction. Seventeen formalin-fixed cadavers were dissected. Free musculo-osseous pronator quadratus flaps were prepared after a 12 cm curvilinear volar skin incision. Standard 30 × 23 mm (690 ± 52.12 mm) hard palate defects were made by chisels and saws. A subcutaneous tunnel was created between the mandibular edge cross point of the facial vessels and the retromolar trigone through the subcutaneous to the superficial musculoaponeurotic system by dissection. Area measurements of the pedicle and palate defects were performed by the ImageJ program (National Institutes of Health, Bethesda, MD, USA) on drawings over an acetate layer of materials. Mandibular distances of gonion-facial vessel cross point (a), gonion-gnathion (m), and facial vessels' cross point-retromolar entrance point (h) were measured. Ratios of h/m and a/m were calculated. The mean pronator quadratus area was 2349.39 ± 444.05 mm, and the arterial pedicle pronator quadratus diameter was 2.32 ± 0.34 mm. The mean pedicle length of the pronator quadratus was 117.13 ± 8.10 mm. Study results showed that musculo-osseous pronator quadratus flaps' bone and muscle parts perfectly fit on the defects in all cadavers. Pronator quadratus musculo-osseous flap is a feasible surgical option for wide, hard palatal defect reconstruction strategies.
Topics: Humans; Free Tissue Flaps; Plastic Surgery Procedures; Muscle, Skeletal; Cleft Palate
PubMed: 37105089
DOI: 10.1016/j.bjps.2023.01.021 -
Journal of Oral Biology and... 2023Dental malocclusions are deviations from normalities due to the inadequate growth and development of the dental arch which provides functional changes to the...
Dental malocclusions are deviations from normalities due to the inadequate growth and development of the dental arch which provides functional changes to the stomatognathic system. The aim of this longitudinal study was to evaluate the electromyographic activity (EMG) the masseter and temporalis muscles, strength of the orofacial tissues and occlusal force of children with anterior open bite (n = 15) and posterior crossbite (n = 20), 7 days after the removal of the orthodontic apparatus. A fixed horizontal palatal crib was used in the treatment of anterior open bite and the fixed appliances Hyrax or MacNamara was used in the treatment of posterior crossbite. EMG of the masticatory muscles was recorded using an electromyograph with wireless sensors during mandibular tasks. Habitual chewing was assessed using the integral of the linear envelope of the electromyographic signal in the masticatory cycles. The strength of the tongue and facial muscles was measured using the Iowa Oral Pressure Instrument. T-Scan was used to analyze the force of occlusal contact. Molar bite force was measured by digital dynamometer. Significant differences (p < 0.05) were found in the EMG data of the masseter and temporalis muscles in the static and dynamic mandibular tasks. There were no significant difference in strength of orofacial tissues, occlusal contact force and molar bite force 7 days after the removal of the orthodontic apparatus. The results of this study suggest that the orthodontic treatment of anterior open bite and posterior crossbite in children promoted functional alteration in the electromyographic activity of masseter and temporalis muscles.
PubMed: 37065972
DOI: 10.1016/j.jobcr.2022.12.005 -
Plastic and Reconstructive Surgery Jan 2024In cleft palate repair, palate length is associated with improved speech outcomes. Although direct closure offers poor palatal lengthening, use of two opposing...
BACKGROUND
In cleft palate repair, palate length is associated with improved speech outcomes. Although direct closure offers poor palatal lengthening, use of two opposing Z-plasties may reorient palatal musculature and lengthen the velum. The authors previously described a novel overlapping intravelar veloplasty to achieve longitudinal closure of the nasal mucosa with a single oral Z-plasty (1ZP), lengthening the palate in cadaver studies. This study aims to corroborate this finding in clinical cases.
METHODS
A retrospective comparative study of patients with a cleft palate was conducted. Patients underwent cleft palate closure with 1ZP or intravelar veloplasty with straight-line closure. Preoperative and postoperative measurements of the palate along four dimensions were recorded. Analysis was conducted on preoperative and postoperative measurements within and between groups using the Mann-Whitney-Wilcoxon or chi-square test.
RESULTS
Eighty-five patients were included (1ZP, n = 65; straight-line closure, n = 20). 1ZP increased soft palate length (SPL) by 33% ( P < 0.001) and total palate length (TPL) by 10% ( P < 0.001). Primary 1ZP increased SPL by 33% ( P < 0.001) and TPL by 10% ( P < 0.001). Secondary 1ZP increased SPL by 28% ( P < 0.001) and TPL by 8% ( P < 0.001). When comparing between primary and secondary 1ZP, 1ZP was equal with regard to percentage lengthening in SPL ( P > 0.9) and TPL ( P > 0.3). When compared with straight-line closure, 1ZP showed superior percentage lengthening in SPL ( P < 0.001) and TPL ( P = 0.038).
CONCLUSIONS
1ZP results in a statistically significant increase in palate length in both primary and secondary cleft palate repair. This technique provides an effective alternative in patients for whom 2ZP is not feasible.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Humans; Cleft Palate; Plastic Surgery Procedures; Retrospective Studies; Palate, Soft; Palatal Muscles; Treatment Outcome
PubMed: 37036320
DOI: 10.1097/PRS.0000000000010524 -
Comparative Biochemistry and... Jun 2023The palatal organ is a filter-feeding related organ and occupies a considerable proportion of the head of bighead carp (Hypophthalmichthys nobilis), a large cyprinid...
The palatal organ is a filter-feeding related organ and occupies a considerable proportion of the head of bighead carp (Hypophthalmichthys nobilis), a large cyprinid fish intensive aquaculture in Asia. In this study, we performed RNA-seq of the palatal organ during growth periods of two (M2), six (M6) and 15 (M15) months of age after hatching. The numbers of differentially expressed genes (DEGs) were 1384, 481 and 1837 for M2 VS M6, M6 VS M15 and M2 VS M15 respectively. The following signaling pathways of energy metabolism and cytoskeleton function were enriched, including ECM-receptor interaction, Cardiac muscle contraction, Steroid biosynthesis and PPAR signaling pathway. Several members of collagen family (col1a1, col2a1, col6a2, col6a3, col9a2), Laminin gamma 1 (lamc1), integrin alpha 1 (itga1), Fatty acid binding protein 2 (fads2) and lipoprotein lipase (lpl), and Protein tyrosine kinase 7 (Ptk7) are candidate genes for growth and development of basic tissues of the palatal organ. Furthermore, taste-related genes such as fgfrl1, fgf8a, fsta and notch1a were also identified, which may be involved in the development of taste buds of the palatal organ. The transcriptome data obtained in this study provide insights into the understanding functions and development mechanisms of palatal organ, and potential candidate genes that may be related to the genetic modulation of head size of bighead carp.
Topics: Animals; Cyprinidae; Gene Expression Profiling; Transcriptome; RNA-Seq; Carps
PubMed: 36990038
DOI: 10.1016/j.cbd.2023.101072 -
The Journal of Craniofacial Surgery Sep 2023To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the...
OBJECTIVE
To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with complete velopharyngeal closure (VPC) and velopharyngeal insufficiency (VPI) patients.
PARTICIPANTS AND INTERVENTION
Subjective evaluation indicators included speech intelligibility, nasality and consonant missing rate, for objective acoustic analysis, we used speech sample normalization and objective acoustic parameters included normalized vowel formants, voice onset time and the analysis of 3-dimensional spectrogram and spectrum, were carried out on speech samples produced by 3 groups of speakers: (a) speakers with velopharyngeal competence after palatorrhaphy (n=38); (b) speakers with velopharyngeal incompetence after palatorrhaphy (n=70), (c) adult patients with cleft palate (n=65) and (d) typical speakers (n=30).
RESULTS
There was a highly negative correlation between VPC grade and speech intelligibility (ρ=-0.933), and a highly positive correlation between VPC and nasality (ρ=0.813). In subjective evaluation, the speech level of VPI patients was significantly lower than that of VPC patients and normal adults. Although the nasality and consonant loss rate of VPC patients were significantly higher than that of normal adults, the speech intelligibility of VPC patients was not significantly different from that of normal adults. In acoustic analysis, patients with VPI still performed poorly compared with patients with VPC.
CONCLUSIONS
The speech function of adult cleft palate patients is affected by abnormal palatal structure and bad pronunciation habits. In subjective evaluation, there was no significant difference in speech level between VPC patients and normal adults, whereas there was significant difference between VPI patients and normal adults. The acoustic parameters were different between the 2 groups after cleft palate repair. The condition of palatopharyngeal closure after cleft palate can affect the patient's speech.
Topics: Adult; Humans; Cleft Palate; Speech; Pharynx; Velopharyngeal Insufficiency; Pharyngeal Muscles
PubMed: 36949035
DOI: 10.1097/SCS.0000000000009301