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Rosero Salazar DH, van Rheden REM, van Hulzen M, Carvajal Monroy PL, Wagener FADTG, Von den Hoff JW. Fibrin with Laminin-Nidogen Reduces Fibrosis and Improves Soft Palate Regeneration Following Palatal Injury. Biomolecules 2021; 11:1547. [PMID: 34680180 PMCID: PMC8533998 DOI: 10.3390/biom11101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to analyze the effects of fibrin constructs enhanced with laminin-nidogen, implanted in the wounded rat soft palate. Fibrin constructs with and without laminin-nidogen were implanted in 1 mm excisional wounds in the soft palate of 9-week-old rats and compared with the wounded soft palate without implantation. Collagen deposition and myofiber formation were analyzed at days 3, 7, 28 and 56 after wounding by histochemistry. In addition, immune staining was performed for a-smooth muscle actin (a-SMA), myosin heavy chain (MyHC) and paired homeobox protein 7 (Pax7). At day 56, collagen areas were smaller in both implant groups (31.25 ± 7.73% fibrin only and 21.11 ± 6.06% fibrin with laminin-nidogen)) compared to the empty wounds (38.25 ± 8.89%, p < 0.05). Moreover, the collagen area in the fibrin with laminin-nidogen group was smaller than in the fibrin only group (p ˂ 0.05). The areas of myofiber formation in the fibrin only group (31.77 ± 10.81%) and fibrin with laminin-nidogen group (43.13 ± 10.39%) were larger than in the empty wounds (28.10 ± 11.68%, p ˂ 0.05). Fibrin-based constructs with laminin-nidogen reduce fibrosis and improve muscle regeneration in the wounded soft palate. This is a promising strategy to enhance cleft soft palate repair and other severe muscle injuries.
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Affiliation(s)
- Doris H. Rosero Salazar
- Department of Dentistry, Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, 6525EX Nijmegen, The Netherlands; (D.H.R.S.); (R.E.M.v.R.); (F.A.D.T.G.W.)
- Department of Medical Basic Sciences, Faculty of Health, Universidad Icesi, Cali 760008, Colombia
| | - René E. M. van Rheden
- Department of Dentistry, Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, 6525EX Nijmegen, The Netherlands; (D.H.R.S.); (R.E.M.v.R.); (F.A.D.T.G.W.)
| | - Manon van Hulzen
- Central Facility for Research with Laboratory Animals (CDL), Radboud University Medical Centre, 6525EZ Nijmegen, The Netherlands;
| | - Paola L. Carvajal Monroy
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands;
| | - Frank A. D. T. G. Wagener
- Department of Dentistry, Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, 6525EX Nijmegen, The Netherlands; (D.H.R.S.); (R.E.M.v.R.); (F.A.D.T.G.W.)
| | - Johannes W. Von den Hoff
- Department of Dentistry, Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, 6525EX Nijmegen, The Netherlands; (D.H.R.S.); (R.E.M.v.R.); (F.A.D.T.G.W.)
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Daudfar S, Gorman C, Pham JT. Hemiplegic Syndrome After Chopstick Penetration Injury in the Lateral Soft Palate of a Young Child. J Osteopath Med 2018; 118:555-559. [PMID: 30073339 DOI: 10.7556/jaoa.2018.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Soft palate penetrating injuries have been reported among children, particularly in children falling with objects in their mouth. The authors present a case of a healthy 14-month-old child who fell onto a blunt-ended chopstick, the subsequent cerebrovascular accident, and the role of the osteopathic tenets thereafter. The child had an acute infarction to the region of his right middle cerebral artery secondary to right internal carotid artery occlusion. Physicians should consider the neurologic sequelae of lateral soft palate injuries and damage to the surrounding anatomical structures. A thorough, whole-patient approach to physical examination is critical.
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Pierrot S, Bernardeschi D, Morrisseau-Durand MP, Manach Y, Couloigner V. Dissection of the Internal Carotid Artery following Trauma of the Soft Palate in Children. Ann Otol Rhinol Laryngol 2016; 115:323-9. [PMID: 16739661 DOI: 10.1177/000348940611500501] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We undertook this report to underline the risks of lesions of the internal carotid artery after lateral oropharyngeal trauma in children and to discuss the diagnosis and treatment of this complication. Methods: We present 2 pediatric cases of carotid dissection following lateral soft palate trauma. Results: In 1 case, transient symptomatic cerebral ischemia occurred 24 hours after the initial traumatic injury. In both patients, the carotid dissection was assessed by magnetic resonance imaging with vascular and diffusion sequences. Treatment with low–molecular weight heparin calcium was maintained for several months. At the end of follow-up, both children were asymptomatic. Conclusions: We suggest noninvasive imaging of the carotid artery by enhanced computed tomographic scanning after trauma to the lateral part of the soft palate in children. Magnetic resonance imaging with vascular and diffusion sequences is useful in assessing the extension of the dissection toward the cerebral circulation and in early detection of cerebral ischemia. Anticoagulation with heparin probably reduces the risks of cerebral infarction. Patients must regularly undergo physical examination and noninvasive imaging of the carotid artery for at least 1 year after the traumatic injury.
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Affiliation(s)
- Sebastien Pierrot
- Department of Pediatric Otorhinolaryngology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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Abstract
Children present to emergency departments with soft palate impalement injuries on an infrequent though periodic basis. Although these usually heal without treatment, internal carotid artery thrombosis occurs on rare occasions due to vessel compression causing intimal disruption. Thirty-two cases have been reported in the English literature. Hospital observation for up to 72 hours had been recommended previously for all of these injuries because of a, “lucid interval,” usually present before onset of neurologic symptoms. Subsequent studies have shown a very low occurrence of carotid injury and support outpatient observation similar to that after minor head injury. This is further justified by the lack of evidence that any diagnostic study or therapeutic measure alters the ultimate prognosis and outcome. Laceration repair is suggested for retained foreign bodies, through and through injury, or if a large hanging flap is present. Antibiotic indications are not well defined but should be considered for lacerations over 1 to 2 cm in length.
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Affiliation(s)
- David A Randall
- Springfield ENT and Facial Plastic Surgery, 3555 South Culpepper Circle, Springfield, MO 65804, USA.
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Cintra HL, Basile FV, Tournieux TT, Pitanguy I, Basile AR. Midline palate perforation secondary to cocaine abuse. J Plast Reconstr Aesthet Surg 2008; 61:588-90. [PMID: 18321801 DOI: 10.1016/j.bjps.2007.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 04/17/2007] [Accepted: 08/28/2007] [Indexed: 11/15/2022]
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Raska GM, Cordova SW, Lema R, Goldwasser MS. Management of Penetrating Trauma to the Soft Palate: A Case Report. J Oral Maxillofac Surg 2007; 65:1279-85. [PMID: 17577489 DOI: 10.1016/j.joms.2006.10.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 07/26/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Gary M Raska
- Oral and Maxillofacial Surgery, Carle Foundation Hospital, Urbana, IL 61801, USA.
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Tunçbilek G, Konaş E, Ozgür F. A salvage procedure in cleft palate repair: suturing nasal mucosa directly to palatine process. Cleft Palate Craniofac J 2007; 44:233-4. [PMID: 17477758 DOI: 10.1597/06-062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Palatal fistulas are among the complications of cleft palate repair requiring additional surgery. Suturing the nasal mucosa and mucoperiosteal flaps together in a tension-free manner to create a double-layered closure in the hard palate is one of the most important points in prevention of dehiscence and fistula formation. In this report, we describe a salvage procedure to repair nasal mucosa that might be lacerated while being freed from the upper surface of the palatal process. METHOD To restore the nasal lining, an ipsilateral vomer mucoperiosteal flap or the opposite nasal mucosa flap is advanced to the palatine bone and sutured directly to the palatal process in order to guarantee an intact cleft palate repair. RESULTS This method is an easy, simple, and time-saving procedure. It should be a useful addition to the armamentarium of every plastic surgeon, especially those working as consultants in training units.
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Affiliation(s)
- Gökhan Tunçbilek
- Department of Plastic and Reconstructive Surgery, Hacettepe University, Faculty of Medicine, Ankara, 06100, Turkey.
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Chin KJ, Arango MF, Paez AF, Turkstra TP. Palatal injury associated with the GlideScope. Anaesth Intensive Care 2007; 35:449-50. [PMID: 17591148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Honda K, Urade M, Kandori Y. Application of a specially designed palatal lift prosthesis to a patient with velopharyngeal incompetence due to severe brain injury. Quintessence Int 2007; 38:e316-20. [PMID: 17625619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article reports the evaluation of the therapeutic effect of a palatal lift prosthesis with a specially designed connection between the anterior denture base and the palatal lifting plate in a patient with velopharyngeal incompetence due to severe brain injury.
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14
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D'souza D. Unusual foreign body in the soft palate. Br J Hosp Med (Lond) 2005; 66:125. [PMID: 15739715 DOI: 10.12968/hmed.2005.66.2.17564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
I would like to report a patient with an unusual airway foreign body that I recently encountered. A 38-year-old male, intoxicated with alcohol, presented to the accident and emergency department with a 30cm-long barbecue skewer sticking out of his mouth. The sharp pointed end of the skewer was sticking out of his mouth and the curved end was inside the mouth.There were pieces of meat still attached to the skewer.
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Dearlove O, Perkins RJ, Briggs G. Anaesthesia after cleft palate repair. Anaesthesia 2004; 59:1032. [PMID: 15488072 DOI: 10.1111/j.1365-2044.2004.03951.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Beckley ML, Ghafourpour KL, Indresano AT. The use of argon beam coagulation to control hemorrhage: a case report and review of the technology. J Oral Maxillofac Surg 2004; 62:615-8. [PMID: 15122571 DOI: 10.1016/j.joms.2003.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael L Beckley
- Department of Oral and Maxillofacial Surgery, University of the Pacific School of Dentistry, San Francisco, CA 94115, USA.
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Taniura S, Tatebayashi K, Akatsuka K, Takenobu A, Kamitani H, Yokota M, Watanabe T. Transoral penetration of a half-split chopstick between the basion and the dens. AJNR Am J Neuroradiol 2004; 25:871-2. [PMID: 15140738 PMCID: PMC7974482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 6-year-old girl was admitted for transoral penetrating injury by a half-split chopstick. Subsequent CT imaging examinations showed that the chopstick had passed between the basion and the dens and reached the subarachnoid space just at the medulla oblongata. A sagittal reconstructed CT scan was useful for the evaluation of the injury. Imaging findings and their clinical relevance are discussed.
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Affiliation(s)
- Seijiro Taniura
- Department of Neurosurgery, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
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19
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Shanel-Hogan KA. What is this red mark? J Calif Dent Assoc 2004; 32:304-5. [PMID: 15186059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
A 55-year-old man was admitted for routine examination of ears with insertion of grommets under general anaesthesia. At 2 years of age he had undergone successful repair of cleft lip and palate. A reinforced laryngeal mask airway was employed to maintain the airway. Postoperatively, it was evident he had suffered complete disruption of the soft palate repair, leading to velopharyngeal insufficiency with nasal regurgitation of fluids. We discuss the possible aetiology, having found no such reported injury pattern documented in the literature.
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Affiliation(s)
- N S Somerville
- Department of Anaesthesia, The Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK.
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21
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Longás Valién J, Ortega Lucea S, Muñoz Rodríguez L, Guerrero Pardos LM, Viu Salmons MD, Martínez Ubieto J. [Lesion of the palatal mucosa: infrequent complication of nasotracheal intubation]. Rev Esp Anestesiol Reanim 2003; 50:486. [PMID: 14753144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Goldman JL, Ganzel TM, Ewing JE. Priorities in the management of penetrating maxillofacial trauma in the pediatric patient. J Craniomaxillofac Trauma 2002; 2:52-5. [PMID: 11951474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Penetrating facial trauma is uncommon in children; a large series published by Cooper et al revealed that only 1% to 2% of the total population of infants and children admitted for trauma during their study period had a diagnosis of penetrating trauma to the head or neck. Little has been published specifically addressing these injuries in the pediatric population. The records of 20 patients treated for penetrating facial injuries at Kosair-Children's Hospital in Louisville, Kentucky from January 1991 through December 1994 were reviewed. The location, mechanism and extent of injury, as well as the diagnostic and management practices used in patient treatment, were collected. Categorizing the injuries relative to the involvement of one or more facial zones helped guide diagnostic studies and therapeutic intervention and predict associated injuries. This article evaluates the authors' method of management and any differences in management between pediatric and similarly injured adult patients.
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MESH Headings
- Adolescent
- Adult
- Angiography
- Child
- Child, Preschool
- Female
- Fractures, Comminuted/surgery
- Humans
- Male
- Mandibular Condyle/injuries
- Mandibular Condyle/surgery
- Mandibular Fractures/surgery
- Maxillary Fractures/surgery
- Maxillofacial Injuries/classification
- Maxillofacial Injuries/diagnosis
- Maxillofacial Injuries/etiology
- Maxillofacial Injuries/surgery
- Palate, Soft/injuries
- Retrospective Studies
- Tomography, X-Ray Computed
- Wounds, Gunshot/classification
- Wounds, Gunshot/diagnosis
- Wounds, Gunshot/surgery
- Wounds, Penetrating/classification
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/etiology
- Wounds, Penetrating/surgery
- Wounds, Stab/classification
- Wounds, Stab/diagnosis
- Wounds, Stab/surgery
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Affiliation(s)
- J L Goldman
- Department of Surgery, Division of Otolaryngology, Myers Hall, University of Louisville, Louisville, Kentucky 40292, USA
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Abstract
A five-month-old intact/male Boxer dog was presented 5-days following bite wound trauma to the maxillary region resulting in an oronasal fistula extending from the maxillary canine teeth to the soft palate. Multiple surgical procedures using local, buccal mucosal flaps failed to repair the oronasal fistula. Free tissue transfer of the rectus abdominis myoperitoneal flap using microvascular surgical techniques was successful in providing soft tissue reconstruction of the hard palate area. Complications of these surgical techniques included muscle contraction and subsequent muzzle distortion. Small, refractory oronasal fistulae at the perimeter of the myoperitoneal flap were repaired by primary wound closure.
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Affiliation(s)
- O I Lanz
- Department of Small Animal Clinical Sciences, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA 24061, USA
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Terezhalmy GT, Riley CK, Moore WS. Oral lesions secondary to fellatio. Quintessence Int 2000; 31:361. [PMID: 11203948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- G T Terezhalmy
- University of Texas Health Science Center, San Antonio, Texas, USA
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Abstract
Brachytherapy in velo-tonsillar region is not applied in all the institutions because of difficulties to learn it. For the implantation of wires in the soft palate, the Reverdin needle is replaced by a curved guide of angiocatheter 14 Gauge. This technique is easy and reduces the risk of tear mucosa.
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Affiliation(s)
- M Lapeyre
- Radiotherapy Unit, Centre Alexis Vautrin, Avenue de Bourgogne, 54511, Vandoeuvre-les-Nancy, France
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Borges G, Bonilha L, Santos SF, Carelli EF, Fernandes YB, Ramina R, Zanardi V, Menezes JR, Nogueira RJ. Thrombosis of the internal carotid artery secondary to soft palate injury in children and childhood. Report of two cases. Pediatr Neurosurg 2000; 32:150-3. [PMID: 10867563 DOI: 10.1159/000028921] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Trauma to the soft palate is a uncommon event during childhood. Stroke following intraoral trauma is also rare, but has been well documented by the current literature as a potentially serious complication. In this article, we report 2 cases of posttraumatic internal carotid artery thrombosis depicted by imaging studies. We discuss pathogenesis, and the literature is reviewed.
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Affiliation(s)
- G Borges
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, UNICAMP, Campinas, SP, Brazil.
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Borges G, Ramina R, Fernandes YB, Zambelli HJ, Marques EL, Menezes JR, Zanardi V, dos Santos SF. [Thrombosis of the internal artery secondary to soft palate injury: case report]. Arq Neuropsiquiatr 1999; 57:1027-31. [PMID: 10683698 DOI: 10.1590/s0004-282x1999000600022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stroke following intraoral trauma is a rare complication of a common childhood injury. In the literature these complications have been well documented, however this condition is still infrequent. In order to alert the physicians about this possible injury we report our experience with one case. Computer tomography and magnetic resonance imaging evidenced complete occlusion of the internal carotid artery. Pathogenesis of this oral trauma is discussed.
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Affiliation(s)
- G Borges
- Faculdade de Ciências Médicas da Universidade de Campinas (UNICAMP) Disciplina de Neurocirurgia, Brasil.
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Courey MS, Fomin D, Smith T, Huang S, Sanders D, Reinisch L. Histologic and physiologic effects of electrocautery, CO2 laser, and radiofrequency injury in the porcine soft palate. Laryngoscope 1999; 109:1316-9. [PMID: 10443841 DOI: 10.1097/00005537-199908000-00025] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was undertaken to compare the effects of electrosurgery, CO2 laser, and radiofrequency on the histological structure and physiological properties of the soft palate. These surgical techniques are used for stiffening and reducing the soft palate in the treatment of snoring and mild sleep apnea. STUDY DESIGN Fifteen pigs were divided into five groups. METHODS group 1 underwent electrosurgery incision of the lateral soft palate and excision of the uvula. Group 2 underwent the same procedure with the CO2 laser. Group 3 underwent CO2 laser ablation of the midline soft palate mucosa. Group 4 underwent radiofrequency volumetric reduction. Group 5 served as control. After 5 weeks the animals were sacrificed. Soft palate mucosa and muscle were subjected to tensiometric and histological analysis. Statistical analysis of tensiometric measurements was done with an ANOVA using a Bonferroni-Dunn correction. RESULTS Tensiometric measurements of the mucosa were increased over normal controls when the surgical technique resulted in mucosal disruption. When the surgical technique resulted in primarily muscle disruption (radiofrequency) tensiometric measurements of the muscle were increased over controls. Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased at the site of the primary injury. CONCLUSIONS The type of injury produced resulted in identifiable patterns of physiological and histological change. Understanding of the effects of available surgical techniques is important in guiding our choice of surgical approach and allows us to better counsel our patients on their surgical options.
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Affiliation(s)
- M S Courey
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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29
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Affiliation(s)
- A Mikulaschek
- Division of Trauma Surgery, UCSD Medical Center, University of California, San Diego 92103, USA
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31
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Ohnesorge B, Deegen E. [Transendoscopic laser surgery of exercise-induced dorsal displacement of the soft palate in horses]. Tierarztl Prax Ausg G Grosstiere Nutztiere 1998; 26:287-93. [PMID: 9810607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
From 1995 to 1997 11 racehorses, one Hanoverian and one Pony were presented to the clinic with a sudden appearing, very loudly gurgling expiratory respiratory noise. Considering the preliminary report and the clinical and endoscopical findings, as exercise induced dorsal displacement of the soft palate (DDSP) was found to be the cause of the respiratory noise. The 13 horses were treated in general anaesthesia by transendoscopic coagulation of the caudal margin of the soft palate with a Neodym-YAG-Laser. This surgical intervention had to be repeated on four horses with unchanged signs. Eight of 13 horses (62%) did not show any respiratory noises after the operation. These horses were again successfully raced and ridden. Only an improvement was observed in two horses (15%), while in three patients (23%) the respiratory noise was unchanged after surgery. The laser chirurgic approach to the exercise induced DDSP offers, compared to previous therapies important advantages, like shorter recoveries, combined with similar success rates.
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Affiliation(s)
- B Ohnesorge
- Klinik für Pferde, Tierärztlichen Hochschule Hannover
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Abstract
OBJECTIVE To determine the indications for admission, requisite imaging studies, and urgent medical or surgical intervention. DESIGN We retrospectively reviewed the charts of 26 children (age range, 5 months to 14 years) who were seen by the otolaryngology service in the emergency department at the Children's National Medical Center, Washington, DC, from 1985 to 1993 and who were diagnosed as having oropharyngeal trauma. We specifically looked for common findings in the history and physical examination on initial presentation to predict the necessary steps in evaluation and management. SETTING Tertiary care pediatric referral center. RESULTS Indications for admission were (1) concern about neurologic injury, (2) concern about vascular injury, (3) radiographic evidence of retropharyngeal free air or abscess, (4) pneumomediastinum, and (5) unreliable adult supervision at home. Six patients required surgery; 3 underwent retropharyngeal aspiration or incision and drainage procedures; 2 required neck explorations; and 1, who had an impaled foreign body in the parapharyngeal space, underwent surgical extraction. There were no vascular, neurologic, or other permanent injuries. CONCLUSIONS Oropharyngeal trauma may result in palatal and posterior pharyngeal wall injury requiring closure of lacerations and management of retropharyngeal free air. Rarely does an injury lead to retropharyngeal abscess or significant pneumomediastinum. Lateral oropharyngeal injuries require increased concern about potential neurovascular impairment. However, neither the mechanism of injury nor the degree of injury correlates with the potential for neurovascular sequelae. Since neurovascular involvement may not become clinically apparent until days or weeks after the incident, admission for observation alone should be based on the distance from the patient's home to the hospital and on the level of reliable adult supervision. Indications for medical and surgical treatment of internal carotid artery thrombosis remain controversial.
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Affiliation(s)
- S R Schoem
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
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Abstract
Penetrating injuries of the soft palate are not uncommon in the pediatric population. The majority are minor, requiring only conservative treatment. Despite the close proximity of the carotid artery to lateral soft palate and tonsillar fossa, the incidence of carotid injury is low. When carotid injury does occur, it is usually secondary to blunt trauma to the carotid with a resultant thrombosis. A concomitant neurologic deterioration often follows occurring from 3 h to 3 days after the initial injury (Hengerer et al. (1984). Laryngoscope 94, 1571-1575). The potential neurologic sequelae of such an injury make these seemingly innocuous wounds a diagnostic and management dilemma for the clinician. We present an unusual case of an internal carotid artery pseudoaneurysm in a neurologically intact child following soft palate impalement. We review the diagnostic evaluation including angiography and magnetic resonance angiography, the surgical approach, and postoperative issues including anticoagulation. The literature is reviewed and a discussion regarding the approach to penetrating injuries of the soft palate is presented.
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Affiliation(s)
- D L Suskind
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia 19104, USA
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34
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Affiliation(s)
- P G Harries
- Department of Otolaryngology, Wexham Park Hospital, Slough, Southampton, UK
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35
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Abstract
Angina bullosa hemorrhagica is characterized by acute blood blisters, mainly on the soft palate. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long term use of steroid inhalers has also been implicated in the disease. No underlying hematologic or immunopathogenic disorder has been found. Treatment is symptomatic. We present a 67-year-old patient with recurrent oral blood blisters which were diagnosed as angina bullosa hemorrhagica. Trauma by dental injections and use of steroid inhalers were identified as etiologic factors in this case. Erosions healed with a week. Although this is a benign condition, it may result in acute airway obstruction. Recognition is, therefore, of great importance for dermatologists.
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Streitmann MJ, Frable MA. Soft palate perforation: a complication posterior nasal packing. Otolaryngol Head Neck Surg 1996; 114:806-7. [PMID: 8643307 DOI: 10.1016/s0194-59989670106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M J Streitmann
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Virginia, USA
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Takenoshita Y, Sasaki M, Horinouchi Y, Ikebe T, Kawano Y. Impalement injuries of the oral cavity in children. ASDC J Dent Child 1996; 63:181-4. [PMID: 8853821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Y Takenoshita
- Second Department of Oral and maxillofacial Surgery, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
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38
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Abstract
A case is described of a 3-year-old boy who presented with a seemingly trivial injury to his soft palate, who went on to develop a parotid sinus as a result of a retained foreign body. This is a rare clinical problem and it highlights the difficulty in the clinical assessment of a palatal injury--especially in children. The child had the foreign body removed successfully 5 months after the initial injury and made an uneventful recovery.
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Affiliation(s)
- J P Grieve
- Department of ENT, Lewisham Hospital, London, UK
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Gawlik JA, Ott NW, Mathieu GP. Modifications of the palatal crib habit-breaker appliance to prevent palatal soft tissue embedment. ASDC J Dent Child 1995; 62:409-11. [PMID: 8636476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors recommended the use of an acrylic palatal button and .040 to .045 inch palatal wires as modifications to the palatal crib appliance. By enhancing the strength of the wire, and providing anterior support, these modifications can reduce the likelihood of the crib becoming embedded in the palatal soft tissues.
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Affiliation(s)
- J A Gawlik
- Pediatric Dentistry, US. Army, Vicenza, Italy
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Affiliation(s)
- M Kraus
- Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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41
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Semchenko IP, Kovbyk LV. [The histogenetic characteristics of the epithelial tissues of the mucosa of the pharyngeal and oral surfaces of the soft palate in ontogeny and under experimental conditions]. Morfologiia 1995; 108:54-56. [PMID: 8688940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Processes of the development and growth of the soft palate mucosas in ontogenesis and also proliferation, growth and differentiation of epithelial structures were studied in the experiment. The epithelium of the soft palate nasal surface was established to be more labile and to be characterized with polymorphism forming single-layer and pseudostratified structures. Under these conditions the oral surface epithelium keeps stratified structures firmly. On the basis of discovered differences of the epithelium biological qualities a suggestion is made on the different genetic origin of epithelial tissues of mucosas of the soft palate oral and pharyngeal surfaces.
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42
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Ingram CS. Oral blood blisters: angina bullosa haemorrhagica (ABH). J N Z Soc Periodontol 1995:16-20. [PMID: 9227093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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43
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Holcombe SJ, Robertson JT, Richardson L. Surgical repair of iatrogenic soft palate defects in two horses. J Am Vet Med Assoc 1994; 205:1315-7. [PMID: 7698945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 4-year-old Thoroughbred filly was referred for evaluation of a soft palate defect that had been created several weeks earlier during surgical correction of epiglottic entrapment, performed transorally. Surgical correction of the defect was performed via mandibular symphysiotomy. At 85 days after repair, the horse raced successfully. A 2-year-old Thoroughbred filly was admitted for evaluation and treatment of epiglottic entrapment. The soft palate was lacerated during transnasal division of the entrapping membrane. A 2-cm full-thickness soft palate laceration was repaired transorally.
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Affiliation(s)
- S J Holcombe
- Department of Veterinary Clinical Sciences, Equine Surgery, College of Veterinary Medicine, Ohio State University, Columbus 43210-1089
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Affiliation(s)
- J S Savino
- Hospital of the University of Pennsylvania, Philadelphia 19104-4283
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45
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Abstract
Penetrating trauma of the oropharynx is not an uncommon problem in the pediatric population. Innocuous injuries with minor soft-tissue trauma have been associated with severe neurologic sequelae. A review of 77 oral trauma cases that occurred from 1981 to 1990 at Boston Children's Hospital was undertaken to see if constant factors could be identified so that a treatment protocol might be outlined for these patients. Twenty-three (30%) patients sustained injury to the soft palate and peritonsillar area. Fifty percent of these cases required surgical debridement and repair. None of the 23 patients developed neurological sequelae. Physical examination may not correlate with the development of symptoms nor the mechanism of injury. Care should be taken during the examination to identify any neurological problems that may not relate to the degree of injury. Conservative management can be entertained if no abnormal neurologic findings are noted.
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Affiliation(s)
- D Radkowski
- Department of Otolaryngology, Harvard Medical School, Children's Hospital, Boston, MA 02115
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46
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Abstract
Impalement injuries of the soft palate and oropharynx are common injuries especially in children. Devastating neurologic sequelae secondary to thrombus propagation in the internal carotid artery are rare but well-documented complications of these innocuous appearing injuries. Neurologic sequelae have been reported anywhere from 3 to 60 hours after the injury. Protocols that include hospitalization up to 72 hours have been advocated. In order to evaluate the effectiveness and practicality of such protocols, all hospital admissions for palate injuries in the past 17 years were reviewed. Of the 131 cases reviewed, no complications were discovered during hospitalization, nor were there any complications in these patients seen in follow up. Based on this review, the majority of soft plate and oropharyngeal impalement injuries can be managed on an outpatient basis. Parental counseling, similar to instructions given in instances of mild head trauma, as well as close follow up in the office are felt to be a more reasonable and as well as a safe treatment plan. A suggested instruction form is presented.
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Affiliation(s)
- J R Hellmann
- Department of Pediatric Otolaryngology, and Maxillofacial Surgery, Children's Hospital Medical Center, Cincinnati, OH 45229-2899
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Liu GT, Deskin RW, Bienfang DC. Horner's syndrome caused by intra-oral trauma. J Clin Neuroophthalmol 1992; 12:110-5. [PMID: 1629371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 7-year-old boy developed a Horner's syndrome after falling on a stick that penetrated his peritonsillar soft palate. He did not suffer from any major vascular injury, and pharmacologic testing indicated a preganglionic lesion. We review previously reported cases of oculosympathetic paresis caused by surgical and nonsurgical intra-oral trauma. Because of the proximity between sympathetic and vascular structures in the lateral and parapharyngeal space, Horner's syndrome in the setting of intra-oral trauma should prompt evaluation of the internal carotid artery. Magnetic resonance imaging may be a reasonable noninvasive method for this investigation.
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Affiliation(s)
- G T Liu
- Division of Neurology, Brigham and Women's Hospital, Boston MA 02115
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48
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Connolly AA. Laryngeal mask airway in ENT surgery. J Laryngol Otol 1992; 106:479. [PMID: 1613386 DOI: 10.1017/s0022215100119899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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49
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Abstract
Few reports have described in detail the injuries that occur to the oral cavity, pharynx, and larynx following caustic ingestion. The role of dynamic radiographic studies to delineate the extent of damage has been minimized. In-depth radiographic analysis of such cases has not, to our knowledge, been previously reported. In order to examine the injuries and functional abnormalities of these sites following caustic ingestion, the records of The Johns Hopkins Swallowing Center were reviewed. Five patients were identified as having significant upper aerodigestive tract caustic injuries. All patients had dysphagia, epiglottis injuries, and incomplete laryngeal protection with aspiration. Four of five had sustained some degree of esophageal stenosis. Also noted were pharyngeal muscle dysfunction, nasopharyngeal regurgitation, tongue fixation, and hypopharyngeal stenosis. Roentgenographic findings are described and illustrated. The multidisciplinary approach to the management and rehabilitation of these patients is discussed.
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Affiliation(s)
- J C Scott
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
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50
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Abstract
Ingestion of small bones often causes oropharyngeal trauma. I present an unusual case of a potentially life-threatening haematoma of the soft palate caused by a chicken bone. To my knowledge, this is the only case reported in the English literature.
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