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The Journal of International Advanced... Dec 2020This study aimed to compare the Eustachian tube (ET) and the paratubal structures between the two sides in subjects with unilateral acquired cholesteatoma and a healthy...
OBJECTIVES
This study aimed to compare the Eustachian tube (ET) and the paratubal structures between the two sides in subjects with unilateral acquired cholesteatoma and a healthy contralateral ear to determine if there are anatomical differences.
MATERIALS AND METHODS
Of the 217 patients with cholesteatoma evaluated, 36 patients with unilateral cholesteatoma were included in the study. All of the patients had a healthy contralateral ear with no history of surgery. Nine different paratubal parameters were measured through contrast-enhanced magnetic resonance imaging (MRI). The measurements of the ear with cholesteatoma were compared with those of the healthy ear.
RESULTS
The bimucosal thickness of the ET lumen, the mucosal thickness of the pharyngeal orifice, the lengths and diameters of the tensor veli palatini muscle and the levator veli palatini muscle, the diameter of the pharyngeal orifice of the ET, the diameter of the lateral pharyngeal recess mucosal thickness, and the diameter between the posterior border of the inferior nasal concha and the pharyngeal orifice of the ET were measured in MRI scans. No statistically significant difference was observed between the healthy ear and the ear with cholesteatoma for any of the parameters measured (p>0.05).
CONCLUSION
We did not observe any anatomical differences in the measurements of the ET and the paratubal structures on MRI scans. Although ET dysfunction is considered to be the leading etiologic factor in acquired cholesteatoma, the ET and the paratubal structures may not exhibit an anatomic difference between the ear with cholesteatoma and the healthy contralateral ear.
Topics: Cholesteatoma; Eustachian Tube; Humans; Magnetic Resonance Imaging; Otitis Media with Effusion; Palatal Muscles
PubMed: 33136019
DOI: 10.5152/iao.2020.7508 -
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 -
PloS One 2020Parkinson disease (PD) is associated with speech and swallowing difficulties likely due to pathology in widespread brain and nervous system regions. In post-mortem...
Parkinson disease (PD) is associated with speech and swallowing difficulties likely due to pathology in widespread brain and nervous system regions. In post-mortem studies of PD, pathology has been reported in pharyngeal and laryngeal nerves and muscles. However, it is unknown whether PD is associated with neuromuscular changes in the tongue. Prior work in a rat model of PD (Pink1-/-) showed oromotor and swallowing deficits in the premanifest stage which suggested sensorimotor impairments of these functions. The present study tested the hypothesis that Pink1-/- rats show altered tongue function coinciding with neuromuscular differences within tongue muscles compared to wildtype (WT). Male Pink1-/- and WT rats underwent behavioral tongue function assays at 4 and 6 months of age (n = 7-8 rats per group), which are time points early in the disease. At 6 months, genioglossus (GG) and styloglossus (SG) muscles were analyzed for myosin heavy chain isoforms (MyHC), α-synuclein levels, myofiber size, centrally nucleated myofibers, and neuromuscular junction (NMJ) innervation. Pink1-/- showed greater tongue press force variability, and greater tongue press forces and rates as compared to WT. Additionally, Pink1-/- showed relative increases of MyHC 2a in SG, but typical MyHC profiles in GG. Western blots revealed Pink1-/- had more α-synuclein protein than WT in GG, but not in SG. There were no differences between Pink1-/- and WT in myofiber size, centrally-nucleated myofibers, or NMJ innervation. α-synuclein protein was observed in nerves, NMJ, and vessels in both genotypes. Findings at these early disease stages suggest small changes or no changes in several peripheral biological measures, and intact motor innervation of tongue muscles. Future work should evaluate these measures at later disease stages to determine when robust pathological peripheral change contributes to functional change, and what CNS deficits cause behavioral changes. Understanding how PD affects central and peripheral mechanisms will help determine therapy targets for speech and swallowing disorders.
Topics: Animals; Disease Models, Animal; Gene Knockout Techniques; Male; Myosin Heavy Chains; Palatal Muscles; Parkinson Disease; Protein Kinases; Rats; Tongue
PubMed: 33064741
DOI: 10.1371/journal.pone.0240366 -
Anatomical Record (Hoboken, N.J. : 2007) May 2021Our objective was to determine the branching and distribution of the motor nerves supplying the human soft palate muscles. Six adult specimens of the soft palate in...
Our objective was to determine the branching and distribution of the motor nerves supplying the human soft palate muscles. Six adult specimens of the soft palate in continuity with the pharynx, larynx, and tongue were processed with Sihler's stain, a technique that can render large specimens transparent while counterstaining their nerves. The cranial nerves were identified and dissection followed their branches as they divided into smaller divisions toward their terminations in individual muscles. The results showed that both the glossopharyngeal (IX) and vagus (X) nerves have three distinct branches, superior, middle, and inferior. Only the middle branches of each nerve contributed to the pharyngeal plexus to which the facial nerve also contributed. The pharyngeal plexus was divided into two parts, a superior innervating the palatal and neighboring muscles and an inferior innervating pharyngeal constrictors. The superior branches of the IX and X nerves contributed innervation to the palatoglossus, whereas their middle branches innervated the palatopharyngeus. The palatoglossus and palatopharyngeus muscles appeared to be composed of at least two neuromuscular compartments. The lesser palatine nerve not only supplied the palatal mucosa and palatine glandular tissue but also innervated the musculus uvulae, palatopharyngeus, and levator veli palatine. The latter muscle also received its innervation from the superior branch of X nerve. The findings would be useful for better understanding the neural control of the soft palate and for developing novel neuromodulation therapies to treat certain upper airway disorders such as obstructive sleep apnea.
Topics: Aged; Female; Glossopharyngeal Nerve; Humans; Male; Middle Aged; Palatal Muscles; Palate, Soft
PubMed: 33034133
DOI: 10.1002/ar.24531 -
The Cleft Palate-craniofacial Journal :... Jun 2021The goal of this study is to determine the typical range of asymmetry between the length and thickness of the levator veli palatini muscle and to explore the impact of...
PURPOSE
The goal of this study is to determine the typical range of asymmetry between the length and thickness of the levator veli palatini muscle and to explore the impact of the observed asymmetry on velopharyngeal closure. A second objective is to report normative length and thickness of the levator veli palatini muscle among adults with typical velopharyngeal anatomy.
METHOD
Magnetic resonance imaging (MRI) data and Amira 5.5 Visualization software were used to evaluate the levator veli palatini muscle among 89 participants with typical velopharyngeal anatomy. Flexible nasopharyngoscopy was used to determine the function of velopharyngeal closure among 39 of the 89 participants with typical velopharyngeal anatomy to examine the functional impact of observed asymmetry.
RESULTS
Matched paired tests demonstrated a nonsignificant difference between the length and thickness of the right and left levator muscle. The mean difference between the right and left length of the levator muscle was 2.28 mm but ranged from 0.09 mm to 10.37 mm. In all cases where individuals displayed asymmetry in the levator muscle through MRI, there was no observed impact on the symmetry of velopharyngeal closure.
DISCUSSION
This study suggest that differences in the right and left levator veli palatini muscle are not significant among individuals without cleft palate. However, among individual cases where asymmetry was sizeable, there was no direct impact on the closure pattern. This may suggest there are multiple factors that contribute to asymmetrical velopharyngeal closure that are beyond the level of the levator veli palatini muscle.
Topics: Adult; Cleft Palate; Humans; Magnetic Resonance Imaging; Palatal Muscles; Palate, Soft; Velopharyngeal Insufficiency
PubMed: 32990031
DOI: 10.1177/1055665620961269 -
Tremor and Other Hyperkinetic Movements... Aug 2020Cranial functional movement disorders (CFMDs) affect the face, eyes, jaw, tongue, and palate. (Review)
Review
BACKGROUND
Cranial functional movement disorders (CFMDs) affect the face, eyes, jaw, tongue, and palate.
OBJECTIVES
We aimed to examine our large series of functional movement disorders (FMDs) patients where the cranial muscles were involved to determine their phenomenology and other clinical features.
METHODS
This is a chart review of 26 patients who presented with CFMDs.
RESULTS
There were 16 (61.53%) females and 10 (38.46%) male patients. The mean ± [standard deviation (SD)] age at the presentation was 33.96 ± 16.94 (Range: 11-83) years. The duration of symptoms ranged from one day to 6 years (Mean ±SD: 402.03 ±534.97 days). According to the Fahn-Williams criteria, CFMDs were documented in 24 patients and clinically established in two patients. The facial [38.46% (10/26)] involvement was the most common in our CFMDs patients. Oromandibular [19.23% (5/26)], ocular [15.38% (4/26)], lingual [15.38% (4/26)], speech [15.38% (4/26)] and palatal [(3.85; 1/26)] involvement was also seen. 10 (38.46%) patients also had associated FMD in the extracranial regions. Precipitating factors were present in 84.61% (22/26) of the patients and associated illnesses were present in 42.30% (11/26) of the patients. At 3 months follow-up, 9 (34.61%) patients had improved, 13 (50%) had partial improvement and 4 (15.38%) had no improvement.
CONCLUSIONS
There was a slight female preponderance in our patients. CFMDs are more likely to involve facial muscles. Associated medical conditions like neuropsychiatric disturbances and headaches are frequently present in CFMDs patients. Early clinical diagnosis will avoid unnecessary investigations and allow the patient to seek the right treatment.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Middle Aged; Movement Disorders; Somatoform Disorders; Stomatognathic Diseases; Young Adult
PubMed: 32963892
DOI: 10.5334/tohm.352 -
Matrix Biology : Journal of the... Dec 2020Although the matricellular protein periostin is prominently upregulated in skin and gingival healing, it plays contrasting roles in myofibroblast differentiation and...
Although the matricellular protein periostin is prominently upregulated in skin and gingival healing, it plays contrasting roles in myofibroblast differentiation and matrix synthesis respectively. Palatal healing is associated with scarring that can alter or restrict maxilla growth, but the expression pattern and contribution of periostin in palatal healing is unknown. Using periostin-knockout (Postn) and wild-type (WT) mice, the contribution of periostin to palatal healing was investigated through 1.5 mm full-thickness excisional wounds in the hard palate. In WT mice, periostin was upregulated 6 days post-wounding, with mRNA levels peaking at day 12. Genetic deletion of periostin significantly reduced wound closure rates compared to WT mice. Absence of periostin reduced mRNA levels of pivotal genes in wound repair, including α-SMA/acta2, fibronectin and βigh3. Recruitment of fibroblasts and inflammatory cells, as visualized by immunofluorescent staining for fibroblast specific factor-1, vimentin, and macrophages markers Arginase-1 and iNOS was also impaired in Postn, but not WT mice. Palatal fibroblasts isolated from the hard palate of mice were cultured on collagen gels and prefabricated silicon substrates with varying stiffness. Postn fibroblasts showed a significantly reduced ability to contract a collagen gel, which was rescued by the exogenous addition of recombinant periostin. As the stiffness increased, Postn fibroblasts increasingly differentiated into myofibroblasts, but not to the same degree as the WT. Pharmacological inhibition of Rac rescued the deficient myofibroblastic phenotype of Postn cells. Low stiffness substrates (0.2 kPa) resulted in upregulation of fibronectin in WT cells, an effect which was significantly reduced in Postn cells. Quantification of immunostaining for vinculin and integrinβ1 adhesions revealed that Periostin is required for the formation of focal and fibrillar adhesions in mPFBs. Our results suggest that periostin modulates myofibroblast differentiation and contraction via integrinβ1/RhoA pathway, and fibronectin synthesis in an ECM stiffness dependent manner in palatal healing.
Topics: Actins; Animals; Cell Adhesion Molecules; Cell Differentiation; Disease Models, Animal; Fibroblasts; Fibronectins; Humans; Integrin beta1; Maxilla; Mice; Mice, Knockout; Myofibroblasts; Palate, Hard; Signal Transduction; Wound Healing; rhoA GTP-Binding Protein
PubMed: 32777343
DOI: 10.1016/j.matbio.2020.07.002 -
Tremor and Other Hyperkinetic Movements... Jun 2020There is little published work describing the electrophysiological characteristics of essential palatal tremor, a condition now believed by many to be a functional...
BACKGROUND
There is little published work describing the electrophysiological characteristics of essential palatal tremor, a condition now believed by many to be a functional (psychogenic) movement disorder.
CASE REPORT
Here we combine electroencephalography and electromyography with time-locked video recordings to document two cases of essential palatal tremor in which a definitive diagnosis is achieved using these electrophysiological tools.
DISCUSSION
We believe that sharing how these objective tools can be used to diagnose a functional movement disorder, as well as providing more published evidence to support the functional origin of essential palatal myoclonus, will help to diagnose this condition in the future.
Topics: Contingent Negative Variation; Electroencephalography; Electromyography; Essential Tremor; Humans; Male; Middle Aged; Palatal Muscles; Somatoform Disorders
PubMed: 32775024
DOI: 10.5334/tohm.70 -
Tremor and Other Hyperkinetic Movements... Jun 2020It is well known that myoclonus can be a paraneoplastic manifestation of underlying malignancy.
BACKGROUND
It is well known that myoclonus can be a paraneoplastic manifestation of underlying malignancy.
CASE REPORT
A 78-year-old male diagnosed with papillary variant non-small cell lung cancer (NSCLC) presented with tremulousness that rapidly evolved into severe, diffuse myoclonus with prominent palatal involvement requiring intubation. The generalized myoclonus resolved with on levetiracetam, chemotherapy and immune modulation. While low titer positive P/Q type calcium channel autoantibodies were detected, it's etiologic relevance is unclear.
DISCUSSION
This case highlights a rare neurologic paraneoplastic presentation of papillary NSCLC. It also illustrates the importance of monitoring airway safety when myoclonus is generalized.
HIGHLIGHTS
A new, rare paraneoplastic presentation of papillary variant non-small cell lung adenocarcinoma is described. The patient presented with severe diffuse myoclonus with prominent palatal involvement without encephalitis that responded to a combination of chemotherapy, immune modulation, and levetiracetam. No clear causal antibody was found.
Topics: Adenocarcinoma, Papillary; Aged; Anticonvulsants; Antineoplastic Combined Chemotherapy Protocols; Autoantibodies; Carboplatin; Carcinoma, Non-Small-Cell Lung; Dexamethasone; Humans; Intubation, Intratracheal; Levetiracetam; Lung Neoplasms; Male; Myoclonus; Palatal Muscles; Paraneoplastic Syndromes, Nervous System; Pemetrexed; Respiratory Aspiration
PubMed: 32775021
DOI: 10.5334/tohm.42 -
Journal of Movement Disorders Sep 2020Palatal myoclonus generally entails a visible elevation of the palate and uvula and may be accompanied by myoclonus of other oropharyngeal muscles. A 55-year-old man...
Palatal myoclonus generally entails a visible elevation of the palate and uvula and may be accompanied by myoclonus of other oropharyngeal muscles. A 55-year-old man presented with left ear clicking and hyperacusis. Examination showed arrhythmic left lateral soft palate contraction in the tensor veli palatini region without elevation of the uvula, which correlated with an audible click by auscultation with a stethoscope over the left ear. This is a rare case of focal, unilateral palatal myoclonus without visual uvula elevation with concurrent auscultation, demonstrating the importance of careful examination to detect focal myoclonic contractions.
PubMed: 32654474
DOI: 10.14802/jmd.20010