Intraoral optical impression versus conventional impression for fully edentulous maxilla: an in vivo comparative study

AIM

The aim of the present in vivo study was to compare the clinical trueness of primary mucostatic impressions obtained either by a classical alginate or an optical intraoral scanner technique in patients with a fully edentulous maxilla.

MATERIALS AND METHODS

A total of 30 patients with a fully edentulous maxilla were included in the study and underwent both conventional impressions and intraoral optical impressions (Trios 3). The conventional impressions were casted and the resulting plaster casts were digitized using a desktop scanner (Imetric D104i). These digitized impressions were superimposed over the optical impressions to compare the differences between the two data sets. Statistical analyses were performed to identify relevant deviations.

RESULTS

For the 30 intraoral impressions, 80.88% of the surface areas were below the tolerance threshold of 25 µm and were thus considered similar to the areas scanned with the desktop scanner from the reference plaster cast. Interestingly, the differences (19.12% of the surface areas) were localized in depressible areas such as the vestibule, soft palate, incisive papilla, and flabby ridges. These locations were consistent with the mean of positive differences of +22.8 µm, indicating deformation or less compression with the use of the intraoral scanner.

CONCLUSIONS

The digital primary impression of the fully edentulous maxilla can be considered similar to the conventional alginate impression except in the depressible areas. Considering the mucostatic objective of such a primary impression, one may consider the optical impression to be more accurate than the conventional one.

Surgical treatment of velopharyngeal dysfunction: Incidence and associated factors in the Swedish cleft palate population

INTRODUCTION

Speech in children with cleft palate can be affected by velopharyngeal dysfunction, which persists after primary palate repair. The incidence of surgery to correct velopharyngeal dysfunction in this patient group has previously been reported as 2.6-37%. We aimed to investigate the incidence of velopharyngeal dysfunction surgery in Swedish children with cleft palate and to examine potential associations of independent variables with this incidence.

METHODS

In this cohort study, we analysed data from the Swedish cleft lip and palate quality registry for 1093 children with cleft palate with or without cleft lip. Kaplan-Meier analysis was used to estimate the risk of having velopharyngeal dysfunction surgery. Multivariable Cox proportional hazards models were used to estimate the associated effect of cleft subtype, additional diagnoses, gender, and age at and number of stages for primary palate repair on the primary outcome.

RESULTS

The risk of having velopharyngeal dysfunction surgery was 25.6%. Complete primary palate repair after the age of 18 months or in more than one stage was associated with a higher risk, but it could not be determined which of these was the more significant factor. Cleft soft palate was associated with a significantly lower risk than other cleft subtypes.

CONCLUSIONS

Primary palate repair at a higher age or in more than one stage may increase the risk of having velopharyngeal dysfunction surgery. Further analysis of potential unknown confounding factors and the association between the incidence of velopharyngeal dysfunction and surgery to correct this condition is needed.

A numerical study of palatal snoring

OBJECTIVES

The main purpose of this paper is to investigate the upper airway (oral and/or nasal) with different inhalation speeds and obstruction depths to generate remarkable notes on palatal snoring and obstructive sleep apnea (OSA). Another important aspect is to study different soft palate biomechanical properties and their relationships with different physical parameters on palatal snoring and OSA.

METHODS

The human upper-airway is modelled in 2D, and a cantilever plate model principle is adopted for the soft palate during fluid-structure interaction (FSI) simulations. Various scenarios are investigated under different inhalation speeds to characterize palatal snoring and OSA in terms of relevant physical parameters.

RESULTS

The parameters most prone for palatal snoring and OSA are obtained for soft material, the highest obstruction depth, and oral inhalation. Also, it is shown that the biomechanical properties of the human upper airway are the most sensitive parameters affecting the dynamics of the soft palate.

CONCLUSIONS

The numerical modeling approach presented allows a better understanding of palatal snoring and may be useful for confirming clinical results as well as for further design of new treatments and therapies.

Effect of Veau Class on Levator Veli Palatini Muscle Composition

OBJECTIVE

To examine levator veli palatini muscle composition in patients with nonsyndromic cleft palate and investigate the impact of Veau class.

DESIGN

Prospective cohort study.

SETTING

Tertiary care academic hospital.

PATIENTS/PARTICIPANTS

Thirteen patients with nonsyndromic cleft palate were recruited.

INTERVENTIONS

During primary palatoplasty, a sample of levator veli palatini muscle was excised and prepared for histological analysis.

MAIN OUTCOME MEASURES

Fat and collagen content were determined utilizing Oil Red and Sirius red stains, respectively, while muscle fiber cross-sectional areas were calculated from H&E-stained samples, with analysis using histomorphometric methods. Immunofluorescent staining of myosin heavy chain isoforms was performed.

RESULTS

Patients underwent repair at 10.8 months of age (interquartile range [IQR] 10.2-12.9). Fat content of the levator veli palatini muscle was low in both groups, ranging from 0% to 5.2%. Collagen content ranged from 8.5% to 39.8%; neither fat nor collagen content showed an association with Veau classes. Mean muscle fiber cross-sectional area decreased with increasing Veau class, from 808 µm2 (range 692-995 µm2) in Veau II to 651 µm2 (range 232-750 µm2) in Veau III (P = .02). There was also a nonsignificant decrease in proportion of type I muscle fibers with increasing Veau class (44.3% [range 31.4%-84.4%] in Veau II vs 35.3% [range 17.4%-61.3%] in Veau III).

CONCLUSIONS

Muscle fiber area in levator veli palatini muscles decreases in Veau III clefts in comparison to Veau II. The impact of these differences in velopharyngeal dysfunction requires further analysis of a larger cohort.

Essential Palatal Myoclonus and Clicking Tinnitus in a Nine-Year-Old Boy-A Case Report

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.

Thrombosis secondary to penetration of internal carotid artery due to soft palate impalement injury: A case report of hemiplegic syndrome and literature review

Intraoral injuries are frequently encountered in emergency departments due to children's desire and curiosity to put objects in their mouths. However, forward falls with objects in children's mouths can cause impalement injuries to soft palate, retropharyngeal-peritonsillar, and retromolar tissues, leading to serious morbidity and even mortality. These transoral (soft palate, pharynx-tonsil, retromolar region) penetration injuries can especially result in damage to major vascular structures like the Internal Carotid Artery (ICA) due to their close proximity. Dissection, thrombosis, and subsequent stroke can occur in the delicate ICA as a result. In the presented case, a 3-year-old male child experienced internal carotid artery dissection following penetrating injury with a pen, as demonstrated by imaging studies. A literature review is provided along with the case of this child, who developed a reduction in middle cerebral artery (MCA) flow due to thrombosis in the ICA. The study encompasses all penetrating oropharyngeal traumas reported in individuals aged 0-18 years from 1936 to 2023. A search in PubMed and Google Scholar using keywords such as 'internal carotid artery injury,' 'penetrating trauma,' and 'children' yielded 78 case reports from a pool of 36,000 studies. The analysis excludes injuries in areas like tongue, cheek, gums, lips, and floor of the mouth, post-tonsillectomy injuries, and those from sudden braking vehicles. This review encompasses the evaluation, diagnosis, and treatment of penetrating injuries to the soft palate, pharyngeal wall, tonsil, and retromolar regions.

Development and validation of the international pediatric sleep endoscopy scale (IPSES)

OBJECTIVES

To develop and validate a consensus international pediatric sleep endoscopy scale (IPSES) for pediatric drug-induced sleep endoscopy (DISE).

METHODS

Existing published DISE ratings scales were reviewed in order to develop a consensus rating scale synthesizing the most common features and adding new elements to address areas of controversy. Samples of 30 de-identified DISE video recordings were reviewed to develop and refine the scale. After the consensus scale was defined, a separate sample of 25 de-identified DISE videos were scored with the new consensus scale by the development group and a panel of independent raters. A weighted kappa statistic was used to quantify the inter-rater and intra-rater reliability of the consensus scale at each anatomic level.

RESULTS

Among all raters, intra-rater reliability was most variable for the nasal airway (kappa range 0.33-0.94) and best for the lateral oropharynx (kappa range 0.68-0.95). Inter-rater reliability ranged from 0.43 for the nasal airway to 0.57 at the soft palate.

CONCLUSION

The IPSES is a reliable consensus scale that reflects the most common features of existing scales and can be adopted as a universal scoring scale for pediatric DISE.

Tissue adjuncts in primary cleft palate reconstruction: A systematic review

BACKGROUND

Tissue adjunct is non-palatal tissue used to manage tension at the defect site by providing additional coverage. This review aimed to compare outcomes of various adjuncts employed in primary palatoplasty.

METHODS

A literature search was conducted of MEDLINE, EMBASE, and Cochrane Library with keywords cleft palate, palatoplasty, surgical flaps, and allografts. Data extracted included demographics, cleft severity, primary/adjunctive techniques, outcomes, and follow-up periods. Logistic regression analyses and chi-squared tests were performed to investigate associations among variables.

RESULTS

A total of 1332 patients (aged 3 months-5 years) with follow-up of 1 month to 21 years were included. Cleft severity included submucous cleft (1.7%), Veau I/II (33.3%), Veau III (46.3%), and Veau IV (15.1%). Most reported techniques were Furlow (52%) and intravelar veloplasty (14.3%) for soft palate, Bardach (27.2%), and V-Y Pushback (11.1%) for hard palate. Buccal myomucosal flap (BMMF) was performed in 45.4% of cases, followed by buccal fat pad flap/graft (BFP) in 40.8% and acellular dermal matrix (ADM) in 14%. Severe clefts (Veau III/IV) were repaired more frequently with BMMF compared with ADM (p = 0.003) and BFP (p = 0.01). Oronasal fistula occurred in 3.1% of patients, and velopharyngeal insufficiency (VPI) in 4%, both associated with Veau IV (fistula: p = 0.002, VPI: p = 0.0002). No significant differences were found in fistula (p = 0.79) or VPI (p = 0.14) rates between adjuncts. In severe clefts (Veau III/IV), ADM was associated with fistula formation (p = 0.03).

CONCLUSIONS

Adjuncts in primary palatoplasty may mitigate unfavorable outcomes associated with severe clefts. BMMF is superior, given its inherent tissue properties, whereas BFP is effective in reducing fistula formation.

Pleomorphic Adenoma of the Palate: A Rare Case in an Adolescent With Cleft lip and Palate

Benign salivary gland tumors are rarely found in children and adolescents compared with adults. Pleomorphic adenomas (PAs), the most common benign salivary gland tumor, account for only 1% of all head and neck lesions and fewer than 5% of all salivary gland tumors in individuals under the age of 16 years. The data on palatal PA in the first 2 decades of life is confined to published case reports and case series. To date, there has never been a report of palatal PA in a patient with cleft lip and palate. Here we describe an adolescent female with bilateral cleft lip and palate with PA of the hard and soft palate who underwent wide local excision and reconstruction with a buccal fat pad and buccal myo-mucosal flap.

[A case of atezolizumab- and bevacizumab-induced myositis showing high intensity in the pterygoid muscles, soft palate, and tongue on STIR-MRI]

A 61-year-old woman was treated with atezolizumab plus bevacizumab for hepatocellular carcinoma with peritoneal dissemination. Blood tests revealed elevated creatine kinase (CK) that peaked at 2,657 U/l. After two cycles of atezolizumab plus bevacizumab combination therapy, she complained of progressive dysarthria and dysphagia. Needle electromyography showed myopathic changes. Initial MRI showed high signal intensity in the orbicularis oris muscle, soft palate, tongue, pterygoid muscles, and paravertebral muscles on STIR images. Myositis-specific autoantibodies were not detected. Based on these findings, the patient was diagnosed with immune checkpoint inhibitor-associated myositis. The clinical symptoms improved after administration of oral prednisone, and follow-up MRI showed reduced extent of areas of high signal intensity and almost complete resolution of signal abnormality in the paravertebral muscles. The CK level normalized after 1 months of oral steroid administration. MRI of the head and neck, including the tongue and soft palate, may be useful in diagnosis and for evaluating therapeutic efficiency in cases of bulbar symptoms that occur following the introduction of immune checkpoint inhibitors.

Do Disinfectant Solutions during Gargling Reach the Pharynx?

INTRODUCTION

In times of COVID-19, gargling disinfectant is commonly used. Disinfectant solutions seem to decrease the infection's symptoms. For disinfection, several techniques are reported. So far, there are no data about the regions in the upper airways achieved by gargled fluid.

METHODS

Ten healthy volunteers without any dysphagia were investigated with a high-sensitivity flexible endoscopic evaluation of swallowing (hsFEES®) during and after gargling colored water. One volunteer repeated the gargling process in fast and real-time MRI.

RESULTS

In all cases, no color accumulation was detected on the posterior pharyngeal wall, epi- or hypopharynx during gargling. The MRI scans confirmed the results.

CONCLUSIONS

hsFEES® and fast MRI provide an insight into the gargling pattern. Data show that during gargling, the fluid covers the soft tissue in the oral cavity and the anterior part of the soft palate, but not the posterior pharyngeal wall nor the epi- and hypopharynx.

[Effect of mouth breathing on upper airway structure in patients with obstructive sleep apnea]

Objective:To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and healthy individuals during oral or nasal breathing, and explore the relevant influencing factors. Methods:Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed. ①The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed; ②The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing. Results:The control group consisted of 15 males and 5 females, with an apnea-hypopnea index （AHI）<5 events/h, while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation （LSaO2） was 79.5% ±10.0%. In the both groups, the vertical distance between the mandible and the posterior pharyngeal wall decreased （P<0.05）; The long axis of tongue body decreased （P<0.05）, and the contact area between tongue and palate decreased. There was no significant change in the total volume of the retropalatine（RP） and retroglossal（RG） airway in the control group （P>0.05）. However, the minimum cross-sectional area and volume of the RP airway in OSAHS decreased （P<0.001）. The lateral diameters of uvula plane in OSAHS decreased during mouth breathing, which was contrary to the trend in the control group （P=0.017）. The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing （P=0.001）; The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway （P<0.001）. Conclusion:Mouth breathing leads to the shortening of the long axis of the tongue, the reduction of the contact area between the soft palate and the tongue, vertical distance between the mandible and the posterior pharyngeal wall, and the cross-sectional area of the epiglottis plane. These changes vary between OSAHS patients and controls. During mouth breathing, the diameters, areas and volumes of the RP area decreased, and were more significant in severe cases.

Canonical Wnt signaling regulates soft palate development by mediating ciliary homeostasis

Craniofacial morphogenesis requires complex interactions involving different tissues, signaling pathways, secreted factors and organelles. The details of these interactions remain elusive. In this study, we have analyzed the molecular mechanisms and homeostatic cellular activities governing soft palate development to improve regenerative strategies for individuals with cleft palate. We have identified canonical Wnt signaling as a key signaling pathway primarily active in cranial neural crest (CNC)-derived mesenchymal cells surrounding soft palatal myogenic cells. Using Osr2-Cre;β-cateninfl/fl mice, we show that Wnt signaling is indispensable for mesenchymal cell proliferation and subsequently for myogenesis through mediating ciliogenesis. Specifically, we have identified that Wnt signaling directly regulates expression of the ciliary gene Ttll3. Impaired ciliary disassembly leads to differentiation defects in mesenchymal cells and indirectly disrupts myogenesis through decreased expression of Dlk1, a mesenchymal cell-derived pro-myogenesis factor. Moreover, we show that siRNA-mediated reduction of Ttll3 expression partly rescues mesenchymal cell proliferation and myogenesis in the palatal explant cultures from Osr2-Cre;β-cateninfl/fl embryos. This study highlights the role of Wnt signaling in palatogenesis through the control of ciliary homeostasis, which establishes a new mechanism for Wnt-regulated craniofacial morphogenesis.

Evaluation of pharyngeal airway dimensions and cephalometric changes after premolar extraction and nonextraction orthodontic treatment in adolescent and adult patients

PURPOSE

The purpose of this study was to investigate the effects of premolar extraction and non-extraction for orthodontic treatment on the skeletal, dentoalveolar and pharyngeal airway.

MATERIAL AND METHOD

The study was carried out with the radiographs of a total of 130 patients at the ages of 14 to 25, including 59 male and 71 female patients. The cases were divided into two groups as the "extraction" group(2 upper premolar teeth) (n = 66) and the "non extraction" group (n = 64).

RESULTS

Extraction Group:In both age groups, there was a statistically significant increase in the mean interincisal angle (U1xL1) and lower anterior facial height (ANS-Me) values(p < 0.05). In the 14-18 age group, there was a significant increase in the mean upper airway thickness, inferior airway space, hyoid position, soft palate length(PNSP) and upper pharynx values(p < 0.05). In both sexes, while the mean U1xL1 and ANS-Me values significantly increased, the mean upper incisors inclination values decreased significantly(p < 0.05). Non Extraction Group:In both age groups, the mean ANS-Me values increased significantly from T0 to T1(p < 0.05). In the 14-18 age group, the increase in the mean upper adenoid thickness, tongue length,PNSP, softpalate thickness and vertical airway length values was significant(p < 0.05). In the male patients, the mean U1xL1 value decreased significantly(p < 0.05).

CONCLUSION

The premolar teeth extraction performed in the patients receiving orthodontic treatment did not affect airway dimensions to a high extent.It was determined that the position of the hyoid bone and tongue length was not affected in the patients with premolar extraction and non extraction.

Long-term average spectrum measures of consecutive snore sounds from different sources determined by drug-induced sleep endoscopy

STUDY OBJECTIVES

The goal of this study was to investigate the value of the long-term average spectrum in the acoustic analysis of snore sounds arising from different sources in the upper airway.

METHODS

Long-term average spectrum was used to analyze sequences of 10 consecutive snore sounds that had been divided into 2 groups, soft-palate type and lateral-wall type, according to the vibration site generating the snore sounds and the patterns of soft tissue collapse in the upper airway as identified by drug-induced sleep endoscopy. We calculated the first spectral peak, mean spectral energy, high-frequency energy, 0-1 kHz spectral energy, 1-5 kHz spectral energy, and 0-1 kHz/1-5 kHz difference from each group and compared the differences between them.

RESULTS

All parameters except mean spectral energy showed significant differences between the 2 groups. The first spectral peak of less than 265.53 Hz, and the 0-1k/1-5 kHz difference of less than -11.6 dB strongly suggests soft-palate-type snore sounds.

CONCLUSIONS

Long-term average spectrum has potential application for snore sound source identification. We recommend using first spectral peak and a 0-1 kHz/1-5 Hz difference to identify soft-palate-type snore sounds.

CITATION

Peng H, Xu H, Xu Z, Jia R, Yu H. Long-term average spectrum measures of consecutive snore sounds from different sources determined by drug-induced sleep endoscopy. J Clin Sleep Med. 2023;19(1):145-150.

A Midsagittal-View Magnetic Resonance Imaging Study of the Growth and Involution of the Adenoid Mass and Related Changes in Selected Velopharyngeal Structures

PURPOSE

The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the posterior pharyngeal wall of the nasopharynx. During childhood, the adenoid pad serves as a contact site for the soft palate to assist with velopharyngeal closure during oral speech. During adenoidal involution, most children are able to maintain appropriate velopharyngeal closure necessary for normal speech resonance. The purpose of this study is to determine age-related trends of normal adenoid growth and involution from infancy through adulthood.

METHOD/DESCRIPTION

Lateral view magnetic resonance imaging was used to analyze velopharyngeal variables among 270 participants, between 3 months and 34 years of age. The velopharyngeal measures of interest included velar length, effective velar length, pharyngeal depth, adenoid height, adenoid thickness, adenoid depth, and adenoid area. Participants were divided into four age groups for statistical comparison.

RESULTS

There was a statistically significant difference (p < .05) in all linear and area measurements between the four age groups. Adenoid depth reached peak growth at age 4 years, whereas adenoid height and adenoid thickness peaked at 8 years of age. Qualitatively, adenoid growth progresses in an anterior and inferior direction whereas involution occurs in a posterior and superior direction.

CONCLUSIONS

This study contributes to the knowledge of time specific changes across an age span for adenoid growth and involution and presents a visualization of the shape and growth trends of adenoids. A new sequence of involution is reported beginning first with adenoid depth, followed by adenoid height at a slightly faster rate than adenoid thickness.

Prognosis of otitis media with effusion in pediatric patients with cleft palate during language-acquisition period treated by simultaneous tympanostomy tube placement with palatoplasty

OBJECTIVE

Cleft palate (CP) in children is frequently complicated by otitis media with effusion (OME) due to Eustachian tube dysfunction. Although tympanostomy tube (TT) placement can be beneficial in the treatment of OME to prevent short-term hearing loss, there is no consensus regarding the indications for and timing of TT insertion. The present study was performed to define the safety and effectiveness of simultaneous TT placement with palatoplasty during the language-acquisition period.

METHODS

We retrospectively reviewed the medical charts of pediatric patients who underwent palatoplasty for CP in a tertiary medical center, Kyoto University Hospital, from June 2010 to October 2018. The TT retention time was estimated using the Kaplan-Meier method. The incidence of OME recurrence was compared among four Veau classification groups based on the patients' sex, type of CP, median TT retention time, and type of fluid.

RESULTS

Seventy-six subjects (150 ears) were enrolled in the study. The median follow-up duration was 48.7 months (range, 18.2-108.0 months) after the first TT placement. A first TT retention time of <20.1 months was a significant risk factor for OME recurrence. Subjects with maxillofacial anomaly complex and subjects with cleft lip and palate and an alveolar cleft showed a significantly higher OME recurrence rate than subjects with clefts only in the hard and/or soft palate. There was no significant difference in the occurrence of sequelae between subjects with only a single TT placement and subjects with more than one TT placement.

CONCLUSIONS

Based on the findings of the present study, it is reasonable to perform TT insertion at the same time as palatoplasty on patients who meet the indications. This technique may reduce the number of times the patient requires general anesthesia and maintain good middle ear condition during the period of language acquisition between 1 and 3 years of age.

Age-Related Changes in Upper Airway Anatomy Via Ultrasonography in Pediatric Patients

PURPOSE

Ultrasonography is a portable, noninvasive tool that may be used to evaluate the upper airway. The purpose of our study was to present a systematic approach to identify salient features of the pediatric airway and determine whether ultrasonography can identify anatomical changes that occur with growth and development.

METHODS

We present a prospective, observational trial where patients included were between 1 day and 10 years of age presenting for elective surgery who had no known history of unfavorable airway pathology. We sequentially obtained 5 ultrasound views under anesthesia: (1) sagittal sternal notch view of the trachea, (2) sagittal longitudinal view of trachea (LT), (3) axial view at the level of the vocal cords (AVC), (4) axial view at the level of the cricoid membrane (AC), and (5) sagittal longitudinal submental space view (SM). A broadband linear array transducer was used to identify airway structures and perform measurements.

RESULTS

Eighty-four percent of enrolled patients underwent airway imaging and were analyzed using multiple regression and Spearman correlation (ρ). In view 1, tracheal diameter via sagittal sternal notch view was immeasurable because of air disturbance. In the LT view, the distance from the skin to the cricothyroid membrane (LT1) did not statistically increase with age in days (P = 0.06); however, the distance from the cricoid to thyroid cartilage (LT2) did correlate to age (P < 0.001; 99% confidence interval [CI], 1.8 × 10-5, 7.7 × 10-5; ρ = 0.77, P = 0.001). We found a statistically significant relationship between age and the distance between the anterior and posterior commissures (AVC2; P < 0.001; 99% CI, 1.0 × 10-4, 1.7 × 10-4; ρ = 0.80, P < 0.001), the distance from the skin to the posterior commissure (AVC3; P < 0.001; 99% CI, 9.6 × 10-5, 2.0 × 10-4; ρ = 0.73, P < 0.001), the distance to the cricoid cartilage (AC; P < 0.001; 99% CI, 2.0 × 10-5, 7.7 × 10-5; ρ = 0.66, P < 0.001), and the distance from the tongue base to the soft palate (SM2; P < 0.001; 9% CI, 1.8 × 10-4, 3.9 × 10-4; ρ = 0.85, P < 0.001). There were no significant relationships between age and AVC1 (P = 0.16) and SM1 (P = 0.44).

CONCLUSIONS

Airway ultrasound is a feasible tool to evaluate the pediatric airway in children younger than 10 years; however, the detection of age-related changes of certain structures is limited to select measurements.

The Biomechanical Mechanism of Upper Airway Collapse in OSAHS Patients Using Clinical Monitoring Data during Natural Sleep

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep disorder characterized by repeated pharyngeal collapse with partial or complete obstruction of the upper airway. This study investigates the biomechanics of upper airway collapse of OSASH patients during natural sleep. Computerized tomography (CT) scans and data obtained from a device installed on OSASH patients, which is comprised of micro pressure sensors and temperature sensors, are used to develop a pseudo three-dimensional (3D) finite element (FE) model of the upper airway. With consideration of the gravity effect on the soft palate while patients are in a supine position, a fluid–solid coupling analysis is performed using the FE model for the two respiratory modes, eupnea and apnea. The results of this study show that the FE simulations can provide a satisfactory representation of a patient’s actual respiratory physiological processes during natural sleep. The one-way valve effect of the soft palate is one of the important mechanical factors causing upper airway collapse. The monitoring data and FE simulation results obtained in this study provide a comprehensive understanding of the occurrence of OSAHS and a theoretical basis for the individualized treatment of patients. The study demonstrates that biomechanical simulation is a powerful supplementation to clinical monitoring and evaluation.

Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers

Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VP_area), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VP_area) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VP_area, HN, and Model_Kataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of Model_Kataoka, A ₃-P ₀, and B _F1 for the objective measurement of VPI or HN.

[Ultrasound measurement of upper airway related indicators and patients with obstructive sleep apnea hypopnea correlation study of disease severity]

Objective:To compare the difference of upper airway anatomy between non-obstructive sleep apnea（OSA） patients and OSA patients, and to analyse the correlation between upper airway anatomy and the disease severity based on the upper airway ultrasound examination. Methods:Eighty-five OSA patients （OSA group） and 36 non-OSA subjects （non-OSA group） who were admitted to the Second Hosipital of Shenzhen from January 2021 to May 2021 were recruited to perform upper airway ultrasound measurement. The airway anatomical parameters were compared and analyzed by t-test. The Spearman correlation analysis was performed on the ultrasound measurement values of OSA patients with the apnea-hypopnea index （AHI） and minimum blood oxygen saturation （ LSaO2）. Results:There were statistically significant differences in BMI, the distance between the soft and hard palate junction and the hyoid bone, the angle between the hard palate and the soft palate, and the angle between the hyoid bone and the hard palate between the OSA group and the non-OSA group（P<0.001，respectively）; For 85 cases of OSA， correlation analysis between the patient's upper airway B-ultrasound measurements and AHI and LSaO2 showed that the distance from the soft and hard palate junction to the mandible, the distance from the soft and hard palate junction to the hyoid bone, the thickness of the tongue（longitudinal section）, and the thickness of the soft palate（longitudinal section）are positively correlated with AHI（r=0.3758, 0.4619, 0.3227, 0.2738, P<0.05, respectively）; the distance from the soft and hard palate to the mandible, the distance from the soft and hard palate to the hyoid bone, the width of tongue（transverse section），and the tongue thickness（longitudinal section） are negatively correlated with LSaO2（r=-0.3566, -0.5470, -0.3168, -0.3098, P<0.05, respectively）; the angle between the hard palate and the soft palate is negatively correlated with AHI（r=-0.2262, P<0.05）; the angle between the hyoid bone and the hard palate is positively correlated with AHI and negatively correlated with LSaO2（r=0.2889, -0.3351, P<0.01）. Conclusion:The upper airway related anatomical parameters based on ultrasound measurement, such as the distance from the soft and hard palate junction to the mandible, the distance from the soft and hard palate junction to the hyoid bone, the angle between the hyoid bone and the hard palate, and the angle between the hard palate and the soft palate, etc.， are associated with the disease severity in OSA patients. The correlation may be used as a potential objective indicator to evaluate the severity of patients with OSA.

Dental, oral pH, orthodontic and salivary values in children with obstructive sleep apnea

OBJECTIVES

Mouth breathing is a key feature of obstructive sleep apnea (OSA). The current study evaluated dental, salivary and orthodontic characteristics of children with OSA, and compared them to those of children without OSA.

MATERIALS AND METHODS

Twenty-two children (mean age 5.3 years, 13 males) with OSA and 21 children without OSA who served as a control group (mean age 6.8 years, 11 males) underwent dental examinations. The OSA group was classified according to the apnea-hypopnea Index. Clinical examination included plaque index, gingival index, caries status, pH at 7 oral sites, salivary carries bacterial counts and inflammatory cytokine levels. Orthodontics measurements were calculated as the percentage of children with values in the normal range, in each group.

RESULTS

The mean values of the decayed, missing and filled teeth (DMFT)/dmft index, the gingival index and the plaque index were higher in the OSA than the control group. Salivary Mutans streptococci and lactobacilli counts were significantly higher in the OSA than the control group; as were pH values in the hard and soft palate, and in the posterior and middle tongue. Significantly lower values were observed in the OSA than the control group for most of the orthodontic variables examined. Similarly, stratification of AHI according to severity shows the lowest values among those with mild OSA, and the highest among those with severe AHI.

CONCLUSIONS

Compared to a control group, mouth breathing children with obstructive sleep apnea had differences in oral microbiota, greater acidity and poorer dental status.

CLINICAL RELEVANCE

Clinicians should be aware of the various oral disturbances that may accompany OSA, and implement preventive measures.

Presumed acquired dynamic pectus excavatum in a cat

An 11-year-old, spayed female American domestic shorthair cat was presented with open-mouth breathing and dyspnea due to respiratory tract disease. Radiographically, there was thickening of the retropharyngeal soft tissue and soft palate, focal pulmonary change, and severe pectus excavatum (PE), best seen on the left lateral view. Repeat thoracic radiographs 4 months later showed persistent PE, but only on the right lateral view; PE was absent on the left lateral view. The dynamic component of the observed PE was presumably acquired secondary to chronic upper respiratory disease and/or concurrent increased pliability of the thoracic wall from prolonged prednisolone treatment.

Quality of life in patients with soft palate resection: The relationship between reported functional prosthetic outcomes and the patient's psychological adjustment

STATEMENT OF PROBLEM

Tumors of the soft palate and the adjacent tissues often create considerable soft palate defects that are challenging for the maxillofacial prosthodontist. Soft palate obturator prostheses can usually address functional and esthetic concerns; however, the effectiveness of the prosthetic rehabilitation in improving the patient's well-being and overall quality of life (QOL) has not been extensively researched.

PURPOSE

The purpose of the present research was to evaluate the function of the prosthesis, to review the interrelation between sociodemographic, medical, and treatment (SMT) characteristics, QOL, and prosthesis functioning, and to analyze the role of the prosthesis in how the patient represents the illness and the psychological coping response.

MATERIAL AND METHODS

Thirty-three patients who underwent resection of the soft palate and had been using a technically successful soft palate obturator prosthesis for at least 1 year were interviewed by means of 5 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), Obturator Functioning Scale (OFS), Illness Perceptions Questionnaire (IPQ-R), and Mental Adjustment to Cancer Scale (MAC). Data analysis was performed at α=.01.

RESULTS

The QOL (r=-0.53, P=.001), personal control (r=-0.53, P=.001), negative adjustment to cancer (r=0.47, P=.005), treatment control (r=-0.55, P=.001), consequences (r=0.62, P<.001), and emotional representations (r=0.30, P=.009) were significantly related to prosthesis functioning. Better QOL was significantly related to prosthesis functioning (P=.006), age (P=.001), sex (P=.011), and type of soft palate defect (P=.009). The most important predictors of favorable soft palate obturator functioning were age (P<.001) and type of soft palate defect (P=.01).

CONCLUSIONS

A patient-perceived effective soft palate obturator prosthesis was a significant predictor for advanced QOL, better adjustment to illness and illness-related disabilities, as well as the overall coping response to cancer.

Electrical Characterization of the Tongue and the Soft Palate Using Lumped-Element Model for Intraoral Neuromodulation

Intraoral functions are results of complex and well-orchestrated sensorimotor loop operations, and therefore vulnerable to small functional or neural defects. To secure the vital intraoral functions, it is important to find a way to favorably intervene the intraoral sensorimotor loop operations. The tongue and the soft palate are heavily associated with intraoral sensorimotor loops, with their dense neural innervations and occupancy of intraoral space. Therefore, electrical stimulation onto the tongue and the soft palate has a great potential to solve the problems in the intraoral functions. However, the electrical interface for both of them have not been characterized yet as a lumped-element model, for designing electrical stimulation and analyzing its effect. In this study, we measured stimulation thresholds to evoke electrotactile feedback and characterized electrical impedance across electrodes using lumped-element models. We found that average perception/discomfort thresholds for the tongue tip, lateral-inferior side of the tongue, and anterolateral side of the soft palate as 0.18/1.31, 0.37/3.99, and 1.19/7.55 mA, respectively. An R-C-R-R-C model represented the electrical interface across the tongue and the soft palate with the highest accuracy. The average component values of the R-C-R-R-C model were found as 2.72kΩ, 45.25nF, 1.27kΩ, 22.09GΩ, and 53.00nF, on average.

Effective Velopharyngeal Ratio: A More Clinically Relevant Measure of Velopharyngeal Function

Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP function. An effective VP (EVP) ratio may be a more appropriate indicator of normal parameters for speech. The aims of this study are to examine if the VP ratio is preserved across the age span or if it varies with changes in the VP portal and to analyze if the EVP ratio is more stable across the age span. Method Magnetic resonance imaging was used to analyze VP variables of 270 participants. For statistical analysis, the participants were divided into the following groups based on age: infants, children, adolescents, and adults. Analyses of variance and a Games-Howell post hoc test were used to compare variables between groups. Results There was a statistically significant difference (p < .05) in all measurements between the age groups. Pairwise comparisons reported statistically significant adjacent group differences (p < .05) for velar length, VP ratio, effective velar length, adenoid depth, and pharyngeal depth. No statistically significant differences between adjacent age groups were reported for the EVP ratio. Conclusions Results from this study report the EVP ratio was not statistically significant between adjacent age groups, whereas the VP ratio was statistically significant between adjacent age groups. This study suggests that the EVP ratio is more correlated to VP function than the VP ratio and provides a more stable and consistent ratio of VP function across the age span.

Laryngeal and soft palate valving in the harbour seal (Phoca vitulina)

Effective 'valving' in the upper aerodigestive tract (UAT) is essential to temporarily separate the digestive and respiratory pathways. Marine mammals are largely dedicated to feeding underwater, and in many cases swallowing prey whole. In seals, little work has been done to explore the anatomy and function of the UAT in the context of valving mechanisms that function to separate food and air pathways. Here we use videofluoroscopy, gross dissection, histology and computed tomography (CT) renderings to explore the anatomy of the larynx and soft palate in the harbour seal (Phoca vitulina), and generate models for how valving mechanisms in the head and neck may function during breathing, phonating, diving and swallowing. Harbour seals have an elevated larynx and the epiglottis may rise above the level of the soft palate, particularly in pups when sucking. In addition, the corniculate and arytenoid cartilages with associated muscles form most of the lateral margins of the laryngeal inlet and vestibule, and move independently to facilitate airway closure. The corniculate cartilages flex over the laryngeal inlet beneath the epiglottis to completely close the laryngeal vestibule and inlet. The vocal folds are thick and muscular and the medial margin of the folds contains a small vocal ligament. The soft palate has well-defined levator veli palatini muscles that probably function to elevate the palate and close the pharyngeal isthmus during feeding. Our results support the conclusion that harbour seals have evolved UAT valving mechanisms as adaptations to a marine environment that are not seen in terrestrial carnivores.

Relationship between Vowel Sound Features and Pharyngeal Airway Cross-Sectional Area during Normal Breathing

Assessment of the pharyngeal airway is becoming important for delivering personalized treatment and better management of sleep apnea. However, evaluation of the pharyngeal airway area is difficult in the current state of the art. It is essential to use simple and accessible technology to measure the pharyngeal airway area. As vowel sounds are generated by vocal cords vibration and characterized by the pharyngeal airway, vowel sounds have the potential to evaluate the pharyngeal airway area. The objective of this study was to investigate the relationship between acoustic features of vowel sounds and the pharyngeal airway cross-sectional area (PAXSA) between soft palate and glottis. Twenty subjects were included in this study whose PAXSA was measured by acoustic pharyngometry. Vowel sounds were recorded with a microphone while lying supine. Vowel sound average power was calculated in different frequency ranges of 100-3000 Hz, 100-500 Hz, 500-1000 Hz, 1000-1500 Hz, 1500-2000 Hz, 2000-2500 Hz and 2500-3000 Hz. Statistical analysis showed that the decreases in the PAXSA were strongly correlated with the higher average power of vowel sounds in all frequency ranges. These results showed that individuals with low PAXSA might articulate the vowel in higher intensity. Clinical Relevance - This study demonstrates that the pharyngeal airway cross-sectional area during normal breathing has a significant effect on vowel articulation. Thus, vowel sound features can be used to estimate the resting pharyngeal airway cross-sectional area.

Interaction of the craniofacial complex and velopharyngeal musculature on speech resonance in children with 22q11.2 deletion syndrome: An MRI analysis

There are limited MRI studies of craniofacial and velopharyngeal features in children with 22q11.2 deletion syndrome (22q11.2DS) and to date, none have explored the potential relationship between these features and the speech phenotype. The purpose of this study was to examine the relationship between craniofacial and related velopharyngeal structures in children with 22q11.2DS and to assess their correlation to resonance features using an unsedated MRI protocol. Fifteen children with 22q11.2DS and 15 age- and sex-matched controls with normal velopharyngeal anatomy (ages 4-12 years) successfully completed the study. Analysis of covariance was used to compare differences between the experimental (22q11.2DS) and control (children with normal anatomy) groups. Correlation analyses and regression models were also utilized. The 22q11.2DS group demonstrated significantly shorter nasion-to-sella, sella-to-basion, and basion-to-opisthion distances. The anterior cranial base angle was significantly more obtuse. The levator veli palatini (levator) muscle was significantly thinner and shorter, with an obtuse angle of origin in the 22q11.2DS group. Levator length was significantly correlated with the sella-to-basion measure and hypernasality was correlated with levator origin-to-origin distance. Preliminary results from this study indicate a significant association between hypernasality and levator origin-to-origin distance. Findings from the present study, provide an insight into the pathophysiology of velopharyngeal dysfunction related to this clinically complex population.

[Palatal fistula rate after Huaxi Sommerlad-Furlow palatoplasty]

OBJECTIVE

This study aimed to determine the palatal fistula rate, explore the influencing factors of Huaxi Sommerlad-Furlow (SF) palatoplasty.

METHODS

A retrospective review of 385 consecutive cleft-palate cases was performed to determine the incidence of postoperative fistula and assess the possible contributing factors, such as sex, weight, age, cleft type, operator skills, preoperative white blood cell, preventive antibiotic use, and postoperative temperature.

RESULTS

Fistulas occurred in 15/385 patients (3.9%). Among them, 1 fistula was located at the junction of the hard and soft palates, 12 fistulas in hard palate, and 2 fistulas in alveolar near the hard palate. No evidence suggested that sex, weight, age, preoperative white blood cell, preventive antibiotic use, and postoperative temperature are associated with fistula formation. The incidences of cleft palate fistulas as encountered by senior professors (3.03%) and associate senior professors (2.23%) were significantly lower than those by attending doctors (14.29%, P<0.05). The incidences of cleft palate fistulas in bilateral completely cleft palate cases (20.6%) were significantly higher than those in hard and soft (3.6%) and unilateral cleft palate cases (2.6%, P<
0.05).

CONCLUSIONS

Huaxi SF palatoplasty can avoid the inhibited maxillary growth without requiring lateral relaxing incision, which poses an acceptable risk of fistula formation. The palatal fistula rate is not related to the sex, weight, age of operation, prophylactic use of antibiotics before operation, infection before operation, temperature after operation and other factors. The occurrence of the fistula is related mainly to cleft type and experience level of the surgeon.

[Modified palatoplasty for children of Pierre Robin sequence with cleft palate：clinical analysis of 12 consecutive cases]

PURPOSE

To explore a safe, effective and functional surgical treatment for children of Pierre Robin sequence (PRS) with cleft palate.

METHODS

Twelve children of PRS with cleft palate underwent mandibular distraction osteogenesis before cleft palate surgery in order to correct severe hypoxia. A modified palatoplasty was then performed, the palatal flaps on both sides were not elevated in the anterior portions to prevent soft palate backward moving, and the levator veli palatini was repositioned simultaneously.

RESULTS

All children achieved velopharyngeal closure without dyspnea after follow-up of 10-12 months.

CONCLUSIONS

Measures should be taken to avoid backward movement of the soft palate, which may result in dyspnea of children with PRS in palatoplasty.

[Multilayer repair of palatal fistula with an interpositional collagen matrix]

OBJECTIVE

Palatal fistula after the repair of cleft palate appears in 7.7-35% of patients. We present two cases of palatal fistula, detailing a multi-layer repair with an interpositional collagen graft.

MATERIAL AND METHODS

Patient 1: girl with a cleft palate operated using a Furlow technique. A reintervention was performed due to a Pittsburgh type III fistula. Patient 2: male with cleft palate operated using a Furlow technique. A reintervention was performed due to a type V fistula.

RESULTS

We used a multilayer repair with a local rotational flap and the interposition of a collagen matrix between the nasal and oral layers. The suture was reinforced with a fibrin hemostatic adhesive. No recurrence of the fistula after 2 years.

CONCLUSIONS

The three-layer closure is simple, safe, effective and avoids refistulizations. Interpositional grafts of a resorbable collagen membrane provide a "scaffold" for tissue growth, revascularization and epithelialization of the mucosa.

[Palato velar fistulae in cleft palate]

Palatal fistulas after primary closure of a cleft palate are extremely variable ranging from 15 to 35%. When they are symptomatic, these fistulas affect feeding (nasal regurgitation to liquids, discharge, bad smells) and phonation (hypernasality that can hinder the precise assessment of velar incompetence). First of all, it is important to analyze the cause of the fistula, it helps to avoid early recurrences. The correction must apply to respect the 2 mucosal planes (nasal mucosa and oral mucosa), the only guarantee of surgical success. Different techniques are usually described: lingual flap, lifting of all palatal mucosa, flap hinge, blaster, FAMM. In all cases, postoperative care plays a key role in the success of the surgical correction.

[The efficacy of using cephalometrics to predict difficult intubation of patients with obstructive sleep apnea hypopnea syndrome]

PURPOSE

To investigate the difference of radiological measurements between difficult-to-intubate obstructive sleep apnea hypopnea syndrome(OSAHS) patients and easily-to-intubate ones, and explore the feasibility of cephalometry in predicting difficult intubation.

METHODS

Thirty male OSAS patients who received general anesthesia underwent cephalometrics before operation. Mallampati grade was used to evaluate the intubating condition of all patients before endotracheal intubation. After awake intubation and general anaesthesia, Cormack and Lehane laryngoscope grade was used to confirm the difficult-to-intubate patients and easily-to-intubate ones. The difficult-to-intubate patients were set into group I (n=13), the easily-to-intubate patients were set into group II (n=17). X-ray cephalometric radiographs were scanned into computer, 22 cephalometric parameters were measured with CASSOS 2001 cephalometric software. The measured items included hard tissue of maxilla and mandible, soft tissue of tongue and soft palate, airway space, hyoid and other parameters. SPSS13.0 software package was used for independent sample t test.

RESULTS

The interface length of tongue and soft palate (CL), the tongue length (TGL) and the hyoid-mental distance (H-MP) were significantly different between the two groups (P<0.05). In difficult-to-intubate OSAS patients, the tongue area (TA) was larger, the soft palate length (PNS-U) was longer, the Atlanto-occipital gap (AOG) was shorter, but the difference was not significant.

CONCLUTIONS

X-ray cephalometric indicators closest associated with difficult intubation in OSAHS patients are CL, TGL and H-MP, which are instructive for predicting difficult intubation.

A Suspected Case of Abruzzo-Erickson Syndrome

The features of Abruzzo-Erickson syndrome are described. A case report of an adult female suspected to have this condition is described and illustrated. The possible link to Abruzzo-Erickson syndrome and differential diagnosis of CHARGE is discussed.

Acute localized exanthem due to Coxsackievirus A4

Enteroviruses are the leading cause of exanthems in children, especially during summer and autumn. Enterovirus infections may occur in epidemics or small outbreaks. A 30-year-old woman presented with a three-day history of an erythematous maculopapular skin rash with petechiae localized exclusively under the nipple of the right breast. The skin eruption was associated with an erythematous-petechial enanthem. The patient complained of low-grade fever, headache, asthenia, sore throat and arthromyalgias. IgM (1:128) and IgG (1:640) antibodies against Coxsackievirus A4 were detected by the virus neutralization test. Reverse transcriptase real time polymerase chain reaction (PCR) assay detected enterovirus RNA in the patient's plasma and faeces. Diagnosis of an acute localized exanthem due to Coxsachievirus A4 was performed. Skin lesions improved in seven days and completely cleared in two weeks without any systemic or topical treatment. Physicians should be aware of the possibility that enteroviruses may determine localized skin eruptions in addition to hand-foot-mouth disease and atypical exanthems. Viral infections should be considered in the differential diagnosis of localized dermatitis especially when the skin eruption is associated with enanthems and with systemic symptoms.

Evaluation of two methods for topical application of contrast medium to the pharyngeal and laryngeal region of horses

OBJECTIVE To determine the pharyngeal and laryngeal distribution of radiopaque contrast medium administered orally or via nasopharyngeal catheter to standing horses. ANIMALS 5 healthy adult horses. PROCEDURES A crossover study was conducted. Radiopaque contrast medium (12 mL) was administered orally and via nasopharyngeal catheter to each horse. Pharyngeal and laryngeal distribution of contrast medium was determined by examination of radiographs obtained immediately after administration of contrast medium, compared with those obtained before administration. Regional distribution of contrast medium was graded. Endoscopic examination of the nasopharynx, laryngopharynx, and larynx was performed to confirm radiographic results. RESULTS Examination of radiographs obtained after nasopharyngeal administration revealed contrast medium in the nasopharynx (n = 5), oropharynx (2), laryngopharynx (3), and larynx (5) of the 5 horses. Examination of radiographs obtained after oral administration revealed contrast medium in the oropharynx (n = 4) and larynx (1) of the 5 horses. Endoscopic examination confirmed radiographic findings and was found to be sensitive for detection of contrast medium in the laryngopharynx, whereby detection rates were higher for both administration methods. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that medication administered by use of a nasopharyngeal catheter will result in topical distribution within the nasopharynx, including the dorsal surface of the soft palate, and larynx, although distribution should be evaluated in horses with clinical airway disease to confirm these findings. Oral administration did not result in consistently detectable topical laryngeal distribution but could be used for selected conditions (eg, palatitis).

Advanced Soft Palate Cancer: The Clinical Importance of the Parapharyngeal Space

OBJECTIVE: To identify the incidence of parapharyngeal space (PPS) recurrences and how they impact survival in advanced-stage soft-palate carcinoma patients.

STUDY DESIGN AND SETTING: One hundred thirty-seven patients' charts were reviewed from 1971 to 1996. Inclusion criteria were patients who received a per-oral resection, discontinuous neck dissection, and postoperative adjuvant radiation therapy; 15 patients met criteria for inclusion. The incidence of PPS recurrences, regional failure, and survival were endpoints that were analyzed.

RESULTS: There were no local failures in our study. Regional failures excluding the PPS (levels I-V) were 27%, and 40% occurred within the PPS. Cervical adenopathy was associated with 83% of the PPS recurrences. Median survival for PPS recurrences was 26 months, compared with 67 months for levels I-V recurrences (n = ns).

CONCLUSIONS: The incidence of PPS recurrences is substantial in advanced-stage soft-palate cancer. PPS recurrences negatively impact survival; without effective salvage techniques for these recurrences or effective adjuvant therapy, poor patient outcomes can be expected.

[Airway Management Utilizing an air-Q blocker in a Patient with Motor Neuron Disease and Soft Palate Paralysis]

A 67-year-old woman suffering from hoarseness or dysphagia was diagnosed with motor neuron disease. She was scheduled for laparoscopic cholecystectomy under general anesthesia for suspected gallbladder cancer. She was concerned about the exacerbation of her hoarseness or dysphagia from tracheal intubation. We therefore decided to perform airway management by using supraglottic device air-Q blocker, through which a gastric tube could be inserted. We first passed the gastric tube through the outer blocker hole and inserted it into the esophagus using Magill forceps. The air-Q blocker was placed position under the guidance of a McGrath videolaryngoscope. Sealing pressure was over 20 cmH2O and mechanical ventilation was performed uneventfully during artificial pneumoperitoneum. We were able to deflate the stomach and perform tracheal suction via the inner hole of the air-Q. Following the operation, the patient developed neither hoarseness nor pharyngeal pain.

ACE-inhibitor induced angio-oedema treated with complement C1-inhibitor concentrate

ACE-inhibitor is an antihypertensive drug which is increasingly used to treat a wide range of medical conditions. A known adverse reaction is angio-oedema of the head and neck, which can become fatal when the upper airway is involved, causing asphyxia. We present a Caucasian man, who developed severe angio-oedema of the tongue and floor of the mouth. He was successfully treated with complement C1-concentrate causing the swelling to regress within 20 min. This treatment option can be an effective alternative to bradykinin antagonists, which might not be available in the emergency room, or more invasive measures like intubation or emergency airway puncture.

[Analysis of velopharyngeal morphology in operated cleft palate patients with levator veli palatini retropositioning according to Sommerlad]

OBJECTIVE

To study the relationship between velopharyngeal morphology and velopharyngeal function in operated cleft palate patients with velopharyngeal competence (VPC) with levator veli palatini retropositioning according to Sommerlad.

METHODS

Three groups were included in the study. The experimental group comprised 18 incomplete cleft patients (group T1) repaired with VPC repaired with levator veli palatini retropositioning according to Sommerlad and 14 incomplete cleft patients (group T2) with velopharyngeal incompetence (VPI) repaired with Langenbeck's technique. The control group was composed of 13 normal adults. The outcome of the velopharyngeal function by nasopharyngoscopy and lateral cephalogram was assessed. Skeletal landmarks and measurements were derived from the tracing of lateral cephalograms. The measurements included velar length, pharyngeal depth, and adequate ratio of velar length to pharyngeal depth. The cranial base, cervical vertebrae, posterior nasal spine, and the position of the posterior pharyngeal wall (PPW) in the pharyngeal triangle were also analyzed. All data were subjected to student's t-test of statistical significance.

RESULTS

All 18 subjects in group T1 obtained complete velopharyngeal closure. Velopharyngeal closure in seven, five, and two subjects in group T2 was 70%, 50% to 70%, and less than 50%, respectively, according to the results of nasopharyngoscopy. The lateral velar length (25.7 mm + 2.3 mm) in group T1 was similar to that of the control group (29.9 mm + 2.7 mm) (P > 0.05). The pharyngeal depth in group T1 was shorter than that in the other two groups, and the adequate ratio (1.43 + 0.26) was similar to that in the normal group (1.45 + 0.26). Group T2 had a significantly short velar length (22.9 mm + 2.3 mm) and normal pharyngeal depth, resulting in a small length/depth ratio (0.95 + 0.14) than that in group T1 and the control group. PPW in the pharyngeal triangle was positioned superiorly in group T2 compared with the control group.

CONCLUSION

The velopharyngeal morphology of operated cleft palate patients with VPC with levator veli palatini retropositioning according to Sommerlad was found to be similar to that of the normal control group. VPI cleft palate patients are characterized by a shorter palate, smaller adequate ratio (< 1.0), slightly counterclockwise-rotated pharyngeal triangle, and superiorly positioned PPW.