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Indian Journal of Otolaryngology and... Mar 2015Uvulopalatopharyngoplasty (UPPP) is still one of the most frequently performed procedures for snoring and obstructive sleep apnea syndrome (OSAS) in adults, with...
Uvulopalatopharyngoplasty (UPPP) is still one of the most frequently performed procedures for snoring and obstructive sleep apnea syndrome (OSAS) in adults, with unsatisfactory results. In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS, with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, we believe that we should re-evaluate the role of these procedures involving the resection of palatal/pharyngeal muscles and uvula.
PubMed: 25621277
DOI: 10.1007/s12070-014-0800-9 -
Journal (Canadian Dental Association) Sep 2005Based on this literature review, early orthodontic treatment of unilateral posterior crossbites with mandibular shifts is recommended. Treatment success is high if it is... (Review)
Review
Based on this literature review, early orthodontic treatment of unilateral posterior crossbites with mandibular shifts is recommended. Treatment success is high if it is started early. Evidence that crossbites are not self-correcting, have some association with temporomandibular disorders and cause skeletal, dental and muscle adaptation provides further rationale for early treatment. It can be difficult to treat unilateral crossbites in adults without a combination of orthodontics and surgery. The most appropriate timing of treatment occurs when the patient is in the late deciduous or early mixed dentition stage as expansion modalities are very successful in this age group and permanent incisors are given more space as a result of the expansion. Treatment of unilateral posterior crossbites generally involves symmetric expansion of the maxillary arch, removal of selective occlusal interferences and elimination of the mandibular functional shift. The general practitioner and pediatric dentist must be able to diagnose unilateral posterior crossbites successfully and provide treatment or referral to take advantage of the benefits of early treatment.
Topics: Adaptation, Physiological; Child; Dentition, Mixed; Diagnosis, Differential; Fingersucking; Humans; Malocclusion; Mandible; Orthodontic Appliance Design; Orthodontics, Corrective; Pacifiers; Palatal Expansion Technique
PubMed: 16202196
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Apr 2020Subepithelial connective tissue graft (SCTG) from the palate has been considered as the "gold standard" for the treatment of deep gingival recessions. A single-incision...
BACKGROUND AND OBJECTIVES
Subepithelial connective tissue graft (SCTG) from the palate has been considered as the "gold standard" for the treatment of deep gingival recessions. A single-incision technique was reported to allow primary wound healing. A palatal single incision was performed in a rat model. The present study assessed the histology and histomorphometry of palatal wound healing following surgical closure with primary intention.
MATERIALS AND METHODS
Twenty-six 6-month-old male Wistar rats weighing 427-650 g. An incision was made on the maxillary palate. A full thickness flap was raised palatally, and then repositioned and sutured. Two experimental groups: S-Study group, I-Intact control group. Half of the animals were sacrificed 7 days and the remaining 14 days postoperatively. Outcome parameters included-epithelial gap; inflammatory infiltration; vascular fraction, expression of myofibroblasts and stem cell markers within the oral epithelium and stromal cells and physical properties of stromal collagen fibers. Investigations were performed at two time-points (7 and 14 days) during the wound healing process.
RESULTS
The epithelial gap closed completely after 14 days. The inflammatory reaction and vascular fraction were relatively low. Surgical trauma downregulated the expression of cytokeratin (CK) 14 and CK 15, which returned to normal after 14 days. Epithelial differentiation was mediated through upregulation of connective tissue sex- determining-region-Y-box2 (SOX2). Epithelial SOX2, CD34, alpha smooth muscle actin (αSMA) and physical properties of stromal collagen fibers were not influenced by the surgical trauma.
CONCLUSIONS
Surgical trauma followed by palatal wound healing with primary intention in a rat model heals within 14 days. It induces minimal inflammatory infiltration and vascular proliferation. Epithelization is exerted through promotion of epithelial differentiation from stem cells by connective tissue SOX2.
Topics: Animals; Gingival Recession; Humans; Male; Palate; Random Allocation; Rats; Rats, Wistar; Surgical Flaps; Wound Healing
PubMed: 32344587
DOI: 10.3390/medicina56040200 -
Journal of Clinical Medicine Jul 2023Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical...
BACKGROUND
Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft.
MATERIAL AND METHODS
Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender.
RESULTS
44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls.
CONCLUSION
Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated.
PubMed: 37510713
DOI: 10.3390/jcm12144598 -
The Laryngoscope Apr 2017To examine feasibility of a simultaneous high-resolution pharyngeal manometry (HRM) and electromyography (EMG) experimental paradigm to detect swallowing-related...
OBJECTIVE
To examine feasibility of a simultaneous high-resolution pharyngeal manometry (HRM) and electromyography (EMG) experimental paradigm to detect swallowing-related patterns of palatal, laryngeal, and pharyngeal muscle activity during expiratory training.
STUDY DESIGN
Technical report.
METHODS
Simultaneous HRM, surface submental, and intramuscular EMG were acquired in two healthy participants during five tasks: 10-cc water swallow, maximum expiratory pressure (MEP) testing, and expiratory muscle strength training (EMST) at three pressure levels (sham, 50%, and 75% MEP).
RESULTS
Experimental conditions were feasible. Velopharyngeal closing pressure, palate EMG activity, and pharyngeal EMG activity increased as expiratory load increased. In contrast, thyroarytenoid EMG activity was low during the expiratory task, consistent with glottic opening during exhalation. Submental EMG patterns were more variable during expiratory tasks. Intraluminal air pressures recorded with HRM were correlated with measured expiratory pressures and target valve-opening pressures of the EMST device.
CONCLUSION
Results suggest that a simultaneous HRM/EMG/EMST paradigm may be used to detect previously unquantified swallowing-related muscle activity during EMST, particularly in the palate and pharynx. Our approach and initial findings will be helpful to guide future hypothesis-driven studies and may enable investigators to evaluate other muscle groups active during these tasks. Defining mechanisms of action is a critical next step toward refining therapeutic algorithms using EMST and other targeted treatments for populations with dysphagia and airway disorders.
LEVEL OF EVIDENCE
4. Laryngoscope, 127:797-804, 2017.
Topics: Deglutition; Electromyography; Exercise Therapy; Exhalation; Female; Healthy Volunteers; Humans; Manometry; Muscle Strength; Pharyngeal Muscles; Reference Values; Sampling Studies; Velopharyngeal Sphincter; Young Adult
PubMed: 28083946
DOI: 10.1002/lary.26397 -
BMJ Case Reports Apr 2017Sleep apnoea and respiratory difficulties are reported in adult-onset Alexander's disease (AOAD), an autosomal-dominant leukodystrophy that presents mainly with...
Sleep apnoea and respiratory difficulties are reported in adult-onset Alexander's disease (AOAD), an autosomal-dominant leukodystrophy that presents mainly with progressive ataxia. We demonstrate for the first time that the respiratory symptoms can result from association of palatal tremor with a similar tremor of laryngeal and respiratory muscles that interrupts normal inspiration and expiration.A 60-year-old woman presented with progressive ataxia, palatal tremor and breathlessness. MRI revealed medullary atrophy, bilateral T2 hyperintensities in the dentate nuclei and hypertrophic olivary degeneration (HOD). AOAD was confirmed genetically with a positive glial fibrillary acidic protein (GFAP) mutation. Electrophysiological study revealed 1.5 Hz rhythmic laryngeal and respiratory muscle activity. Her respiratory symptoms were significantly improved at night with variable positive pressure ventilation.This case illustrates that palatal tremor in AOAD, and potentially in other conditions, may be associated with treatable breathlessness due to a similar tremor of respiratory muscles.
Topics: Alexander Disease; Diagnosis, Differential; Dyspnea; Female; Humans; Laryngeal Muscles; Magnetic Resonance Imaging; Middle Aged; Palatal Muscles; Positive-Pressure Respiration; Respiratory Muscles
PubMed: 28438749
DOI: 10.1136/bcr-2016-218484 -
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 -
Journal of Speech, Language, and... May 2020Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning,...
Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle ( = .031) and effective velopharyngeal ratio ( = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length ( = .018), thickness at midline ( = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum ( = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.
Topics: Child; Child, Preschool; Cleft Palate; Humans; Magnetic Resonance Imaging; Palatal Muscles; Palate, Soft; Velopharyngeal Insufficiency
PubMed: 32402223
DOI: 10.1044/2020_JSLHR-19-00240 -
Journal of Speech, Language, and... Nov 2022There is currently little evidence reporting the typical morphology of the palatoglossus (PG) muscle. The primary purpose of this exploratory study is to determine...
PURPOSE
There is currently little evidence reporting the typical morphology of the palatoglossus (PG) muscle. The primary purpose of this exploratory study is to determine whether magnetic resonance imaging (MRI) methods used to quantify the morphology of the levator veli palatini (LVP) muscle can be applied to the PG. The secondary purpose is to provide preliminary data regarding the relationship between the LVP and PG muscles in children.
METHOD
Ten children between ages of 4 and 7 years participated in this study. Each participant was scanned using a nonsedated, child-friendly protocol with a T2-weighted, three-dimensional anatomical scan to obtain images of the oropharyngeal anatomy. Custom, oblique-coronal image planes were created to visualize and measure the LVP and PG muscles in their entirety from origin to insertion. Thermo Scientific Amira Software was used to obtain 2D measurements of PG muscle length, width, velar insertion distance, lingual insertion distance, and several angle measurements.
RESULTS
The PG ranged from 17.95 to 26.96 mm in length across participants. Velar insertion distance ranged from 17.22 to 30.95 mm. Lingual insertion distance ranged from 26.91 to 36.02 mm. Width ranged from 2.32 to 3.08 mm. The angle formed by the PG and LVP muscle planes ranged from 7.3° to 52.7°. The LVP insertion angle ranged from 42.5° to 75.9°. The PG insertion angle ranged from 16.9° to 52.3°.
CONCLUSIONS
MRI was successful in visualizing the PG muscle. The PG was consistent in size and shape within an individual participant but varied across the participant cohort.
Topics: Humans; Child, Preschool; Child; Palatal Muscles; Magnetic Resonance Imaging; Tongue; Software; Palate, Soft
PubMed: 36283682
DOI: 10.1044/2022_JSLHR-22-00303