Removal of a Giant Parapharyngeal Space Oncocytoma Without Osteotomy

Oncocytoma arising from the parotid gland and extending into the parapharyngeal space (PPS) has not been previously reported. A 64-year-old woman presented with a large slowly growing mass extending from the parotid to the submandibular area, expanding medially to displace the pharynx across the midline. Core-needle biopsy revealed an oncocytoma in the PPS measuring 120 × 88 × 60 mm in size. Although the tumor was of an unprecedentedly large size and extended into multiple spaces, it could be removed via a cervical-parotid approach without osteotomy. The resected tumor was again diagnosed as oncocytoma. A postoperative complication was weakness of the ipsilateral facial nerve, which almost completely resolved in 6 months. No recurrence has been noted on 1 y follow-up. We were able to resect an extremely large oncocytoma arising from the parotid gland without osteotomy.

Inflammatory Rhabdomyoblastic Tumor of the Posterior Pharyngeal Wall

This case report describes a healthy man in his 40s who presented with a 1-year history of snoring, sleep apnea, dysphonia, and dysphagia owing to a large mass of the posterior pharynx and was diagnosed with an inflammatory rhabdomyoblastic tumor.

[The upper airway in obstructive sleep apnea patients is pathological even when awake]

Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the pharyngeal airway. Anatomical factors can be distinguished from non-anatomical factors. Age and obesity are the main risk factors for OSA; however, approximately 50% of patients are not obese. In older patients (>60 years), the importance of obesity decreases. There is an increased prevalence of OSA among patients with normal weight. The effects of chronic intermittent hypoxemia, low-grade inflammation, increased sympathetic tone and mechanical stress contribute to a transformation of muscle fibers in the upper airway, resulting in reduced muscle mass and strength. Less frequently encountered non-anatomical factors include decreased muscle tone, increased arousal threshold, and altered sensitivity of CO2 chemoreceptors.

A Plasmacytoma of the Lateral Pharyngeal Wall: A Diagnostic Enigma

Plasmacytoma is a rare plasma cell dyscrasia that grows in bones or soft tissues such as the pharynx. Soft tissue plasmacytomas are rare, and a higher burden has been reported in the upper aero-digestive tract, often manifesting as hoarseness, dysphagia, or odynophagia. Due to their rarity, extramedullary plasmacytomas (EMPs) have unknown prognostic factors, and guidelines for optimal management are still lacking. However, radiation therapy and surgery have been used with positive outcomes. Herein, we describe a unique case of plasmacytoma of the pharyngeal tissue in a male patient with a history of HIV disease. The patient completed 28 sessions of radiation therapy, resulting in an improvement in his throat pain and hoarseness. Given the patient's age and lack of traditional risk factors for head and neck cancers, his hoarseness and odynophagia proved to be a diagnostic conundrum. Although infrequent, soft tissue plasmacytomas should be considered in the differential diagnosis of head and neck tumors.

Rare Case of a Schwannoma of the Posterior Pharyngeal Wall in a Child

We present a rare case of a schwannoma which is localized on the posterior pharyngeal wall. It caused severe difficulty in swallowing and breathing in a 3-year-old child. Schwannomas of the posterior pharyngeal wall have been rarely reported in children. To our knowledge, only 7 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, but none of them is associated with a child. The tumor was removed with plasma radiofrequency excision via a transoral route. Computed tomography or magnetic resonance imaging examination showed no recurrence of the tumor up to 2 years. To our knowledge, for the first time, a case of posterior pharyngeal wall schwannoma has been reported in a 3-year-old child, and the schwannoma was removed via plasma radiofrequency transoral excision. This case study illustrates that schwannoma may occur in children, and it is safe to treat this disease through plasma radiofrequency transoral excision route.

Detecting salivary host and microbiome RNA signature for aiding diagnosis of oral and throat cancer

OBJECTIVE

Oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) can go undetected resulting in late detection and poor outcomes. We describe the development and validation of CancerDetect for Oral & Throat cancer™ (CDOT), to detect markers of OSCC and/or OPSCC within a high-risk population.

MATERIAL AND METHODS

We collected saliva samples from 1,175 individuals who were 50 years or older, or adults with a tobacco use history. 945 of those were used to train a classifier using machine learning methods, resulting in a salivary microbial and human metatranscriptomic signature. The classifier was then independently validated on the 230 remaining samples prospectively collected and unseen by the classifier, consisting of 20 OSCC (all stages), 76 OPSCC (all stages), and 134 negatives (including 14 pre-malignant).

RESULTS

On the validation cohort, the specificity of the CDOT test was 94 %, sensitivity was 90 % for participants with OSCC, and 84.2 % for participants with OPSCC. Similar classification results were observed among people in early stage (stages I & II) vs late stage (stages III & IV).

CONCLUSIONS

CDOT is a non-invasive test that can be easily administered in dentist offices, primary care centres and specialised cancer clinics for early detection of OPSCC and OSCC. This test, having received FDA's breakthrough designation for accelerated review, has the potential to enable early diagnosis, saving lives and significantly reducing healthcare expenditure.

Imaging of pharyngeal pathology

The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who present with pharynx-related symptoms such as sore throat, globus, dysphagia or dysphonia will usually undergo visual and nasal endoscopic examination in the first instance. Imaging is frequently required to supplement clinical assessment and this typically involves MRI and CT. However, fluoroscopy, ultrasound and radionuclide imaging are valuable in certain clinical situations. The aforementioned complexity of the pharynx and the myriad of pathologies which may arise within it often make radiological evaluation challenging. In this pictorial review, we aim to provide a brief overview of cross-sectional pharyngeal anatomy and present the radiological features of a variety of pharyngeal pathologies, both benign and malignant.

Influence of tumor topography on clinical-morphological profile of laryngeal malignancies

AIM

Laryngeal cancers are redoubtable because they are still diagnosed in advanced stages which results in poor survival and the decline of life quality. The authors intend to identify if the tumor topography influences clinical behavior, the morphological profile and therapeutic strategy.

PATIENTS, MATERIALS AND METHODS

The study group included 188 patients with laryngeal malignancies diagnosed and treated in an Ear, Nose and Throat (ENT) Department. The patients have been divided into four groups according to the tumor topography and extension. Three categories of parameters were defined (epidemiological, clinical, and morphological) and analyzed comparatively between the four groups using filter scales and the χ² (chi-squared) correlation test.

RESULTS

Epidemiological parameters (sex, age, socio-economic status) showed no significant differences between the four groups. Clinical parameters (symptoms, lymphadenopathies, surgical procedures, and hospitalization) instead registered significant differences between the four groups. Morphological parameters (longitudinal diameter, transverse diameter, shape, gross aspect, histopathological aspect, grade, local invasion - pT, lymph node invasion - pN, metastases - pM and tumor stage), excepting shape, registered too significant differences between the four groups. The analysis of the whole set of parameters in each group revealed different, distinct profiles for each of the topographic groups, especially for glottic and large tumors. Our results concerning the entire series of tumors ranged in the limits of variation of each of the parameters observed in the literature.

CONCLUSIONS

Our study revealed that tumors placed in different regions of the larynx have distinct profiles from epidemiological, clinical, and morphological points of view. However, the profile of our entire group of tumors proved to be comparable with the literature data.

Secretory carcinoma of the sinonasal cavity and pharynx: A retrospective analysis of four cases and literature review

Secretory carcinoma (SC) is a recently recognized type of salivary gland tumor characterized by t(12;15) (p13;q25) translocation resulting in an ETV6-NTRK3 gene fusion. Most SCs are located in a main salivary gland, and primary sinonasal secretary carcinoma is rare. We describe three cases of primary SC in the sinonasal cavity with high-grade transformation (HGT) in one case, and the first case in the pharynx. All tumors comprised slightly atypical cells with solid, tubular, microcystic growth patterns. The case with HGT included two components with distinct sharp boundaries and comedo necrosis, high mitotic figures and obvious cellular atypia. Tumor cells were positive for vimentin, S100, and Gata-3 and negative for p63 and DOG-1. Three cases showed nuclear staining of pan-TRK and one showed cytoplasmic staining. All cases harbored ETV6 gene rearrangement, and ETV6-NTRK3 gene fusion was detected in three cases. Most patients were treated with radical resection and adjuvant therapy. After excision, all remained tumor-free for 65-164 months (medium 98.5 months). SC in the sinonasal cavity and pharynx is a low-grade malignant tumor with histologic features overlapping those of other salivary gland tumors. Immunohistochemical analysis and fluorescence in situ hybridization are useful techniques for its differential diagnosis.

Laryngeal and pharyngeal actinomycosis: a systematic review and report of 3 cases

INTRODUCTION

Actinomycosis is a granulomatous infection that rarely involves the larynx or pharynx. Three cases of actinomycosis of the larynx or pharynx from our institution were reviewed and a systematic literature review was performed to better define surgical management, antibiotic therapy, risk factors, and incidence of recurrence or complications.

MATERIALS AND METHODS

PubMed/Medline, Cochrane, Embase, and Google Scholar were searched on November 30, 2021 using the terms "laryngeal actinomycosis", "pharyngeal actinomycosis", "actinomycosis AND larynx", and "actinomycosis AND pharynx." Articles which did not describe appropriate sites or were non-English were excluded. Results were collected for demographic information, site(s) of infection, comorbidities, lesion characteristics and treatments.

RESULTS

Along with three cases reported from our institution, 40 unique cases were reviewed from 37 studies for a total of 43 patients (Table 1). 34 (81.0 %) of the patients were male with the highest incidence of infection in the seventh decade (54.8 %). The most common site for the infection was the larynx (69.0 %) followed by the pharynx (16.7 %). Risk factors included a history of radiation therapy, immunosuppression, inhalational irritant, and diabetes (Table 3). The duration of antibiotic therapy varied greatly, from one month to one year and total follow up ranged from 1 month to 2.5 years (Table 1).

CONCLUSIONS

A comprehensive review of the literature on pharyngolaryngeal actinomycosis shows that this infection has increased prevalence within the head and neck cancer patient population. Similar to cervicofacial actinomycosis, these atypical sites have shown favorable responses to extended antibiotic therapy and generally do not require aggressive surgical management.

[A large maxillary fibroepithelial polyp: a lump in the throat]

A 55-year-old woman was seen at an oral and maxillofacial surgery department because of a large oral swelling and complaints about difficulty eating, nasal speech and fatigue. She had full dentures in her upper jaw. Intraorally, a pain-free, pedunculated, combined solid-elastic and bone-hard tumour was found in the left maxillary tubercle region. A large, fibroepithelial polyp was diagnosed based on clinical and histopathological findings. Six weeks post-operatively, the complaints had disappeared. Chronic irritation of the oral mucosa can result in an oral fibroepithelial polyp that can be distinguished from peripheral ossifying fibroma or giant cell fibroma after histopathological examination. Such a polyp can grow to a large size if the source of irritation is not removed.

[Child with a vascularized throat mass]

We report the case of an 11-year-old girl with difficultly speaking and a history of singular, self-limiting oral bleeding. Clinical and radiological examination in the emergency room showed a vascularized tumor of the base of the tongue, which almost completely occluded the oropharynx. After complex anesthesiologic preparation and endoluminal embolization, the tumor was safely removed by transoral laser microsurgery. Histology revealed a rare benign schwannoma of the oropharynx. Further clinical examinations and genetic screening were recommended.

[A Case of Synchronous-Metachronous Cancer of the Rectum, Stomach, Pharynx, Esophagus and Small Intestine]

A 71-year-old man presented with the chief complaint of fecal occult blood. Based on imaging studies, the patient was diagnosed advanced rectal cancer. He received laparoscopic low anterior resection. Three months after the rectal cancer operation, upper gastrointestinal endoscopy revealed gastric cancer. The patient had a diagnosis of synchronous cancer of the rectum and stomach, and received laparoscopic distal gastrectomy. Two years after the rectal cancer operation, liver metastasis(S4)was detected and resected. Three years after the rectal cancer operation, esophageal cancer and laryngeal cancer were detected synchronously and chemoradiotherapy was performed. Five years after the rectal cancer operation, small intestinal cancer with infiltration of descending colon and esophagus cancer were detected synchronously. Small intestinal resection and Hartmann procedure were performed for small intestinal cancer. ESD was performed for esophageal cancer. Six years after the rectal cancer operation, FDG-PET showed the peritracheal lymph node metastasis, lumbar spine metastasis and local recurrence in the pelvis. Currently, systemic chemotherapy is undergoing. We report a rare case of synchronous- metachronous cancer of the rectum, stomach, pharynx, esophagus and small intestine.

The prognosis of HPV-associated metastatic pharyngeal patients by primary and distant site

OBJECTIVES

Human papillomavirus (HPV) positivity is a favorable prognostic factor in the general population of head and neck squamous cell carcinoma (HNSCC) patients. However, its impact on the survival of metastatic HNSCC of pharynx (mHNSC-P) patients is unclear. This study aims to investigate the associations between HPV status and survival in mHNSC-P patients.

METHODS

735 mHNSC-P patients diagnosed at first presentation from 2010 to 2016 were retrieved from the Surveillance, Epidemiology and End Result database (SEER). Chi-Squared test, univariate and multivariate cox proportional hazards model, Kaplan-Meier analysis, and log-rank test were applied to compare HPV-positive and -negative mHNSC-P patients.

RESULT

Using univariate cox proportional hazards analysis, HPV status, primary site, T stage, treatment and distant metastatic site correlate with the overall survival (OS) and disease-specific survival (DSS) in mHNSC-P patients. Multivariate cox regression analysis shows that HPV-positive mHNSC-P patients experienced significantly better OS (HR: 0.62 CI: 0.51-0.76, p < 0.001) and DSS (HR: 0.73 CI: 0.58-0.91, p < 0.01) as compared to HPV-negative mHNSC-P patients. Subgroup analysis indicates that HPV-associated OS and DSS benefits exist in patients with metastatic HNSCC of oropharynx (mHNSC-OP) but not in patients with metastatic HNSCC of non-oropharynx (mHNSC-non-OP). Among mHNSC-OP patients, HPV positivity confers disease-specific survival benefit in patients with oligometastatic rather than polymetastatic patients. Furthermore, HPV associated OS and DSS advantages in mHNSC-OP with lung metastasis was observed.

CONCLUSION

HPV-positive mHNSC-OP patients with lung metastasis show better survival than HPV-negative mHNSC-OP patients, providing key information to guide patient treatment approaches.

Transcriptomic Analyses Reveal 2 and 4 Family Members of Cytochromes P450 (CYP) Involved in LPS Inflammatory Response in Pharynx of Ciona robusta

Cytochromes P450 (CYP) are enzymes responsible for the biotransformation of most endogenous and exogenous agents. The expression of each CYP is influenced by a unique combination of mechanisms and factors including genetic polymorphisms, induction by xenobiotics, and regulation by cytokines and hormones. In recent years, Ciona robusta, one of the closest living relatives of vertebrates, has become a model in various fields of biology, in particular for studying inflammatory response. Using an in vivo LPS exposure strategy, next-generation sequencing (NGS) and qRT-PCR combined with bioinformatics and in silico analyses, compared whole pharynx transcripts from naïve and LPS-exposed C. robusta, and we provide the first view of cytochrome genes expression and miRNA regulation in the inflammatory response induced by LPS in a hematopoietic organ. In C. robusta, cytochromes belonging to 2B,2C, 2J, 2U, 4B and 4F subfamilies were deregulated and miRNA network interactions suggest that different conserved and species-specific miRNAs are involved in post-transcriptional regulation of cytochrome genes and that there could be an interplay between specific miRNAs regulating both inflammation and cytochrome molecules in the inflammatory response in C. robusta.

Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options

BACKGROUND

Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES.

METHODS

The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps.

RESULTS

The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy.

CONCLUSIONS

The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.

High or low temperature extraction, which is more conducive to Triphala against chronic pharyngitis?

OBJECTIVE

Explore the effects of high-temperature reflux extraction and low-temperature decompressing inner ebullition on Triphala's chemical composition and anti-chronic pharyngitis activity.

METHODS

The network pharmacology was used to analyze the material basis, targets and pathways of Triphala for chronic pharyngitis. HPLC were used to compare the fingerprint profile and content of components between the two extracts. The antioxidant and anti-chronic pharyngitis activities of the two extracts were compared by DPPH assay and ammonia induced chronic pharyngitis model in rats.

RESULTS

The network pharmacology results showed that the active ingredients of Triphala for chronic pharyngitis are epigallocatechin-3-gallate, (+)-catechin, epicatechin, epicatechin gallate, (+)-gallocatechin, quercetin, luteolin, leucodelphinidin and other flavonoids; phenolic acids such as gallic acid and ellagic acid; alkaloids such as ellipticine, cheilanthifoline; hydrolyzed tannins such as corilagin and chebulic acid. The high-temperature reflux extract and the low-temperature decompressing inner ebullition extract have extremely significant differences in the fingerprint profile. Among them, the content of gallic acid, ellagic acid, chebulic acid, catechin, epicatechin, corilagin, quercetin, and epicatechin gallate in the reflux extract is 1.1-5.3 times as much as decompressing inner ebullition extract. The free radical scavenging ability of reflux extract is significantly stronger than that of decompression extract (p < 0.01), and it has a repairing effect on pharyngeal mucosal damage (reducing keratinization or hyperplasia of mucosal epithelium, reducing inflammatory cell infiltration and bleeding), and reducing IL-1β (P＜0.05), IL-6 (p＜0.05), TNF-α overexpression ability is stronger than the decompressing inner ebullition extract.

CONCLUSIONS

gallic acid, ellagic acid, chebulic acid, catechin, epicatechin, corilagin and epicatechin gallate are the basic aglycones or oligomers of tannin. High temperature reflux extraction can significantly promote the occurrence of the hydrolysis of tannins and significantly increases the content of these components.Therefore, its anti-chronic pharyngitis activity is enhanced. It is suggested that high temperature reflux extraction should be used in the treatment of chronic pharyngitis.

Radiological and histological findings in ancient salt mummies from the salt mine of Douzlākh, Iran

Computed tomography studies and histological analyses were performed on the mummified remains found in the Chehrābād salt mine in northwestern Iran. The ancient salt mummies are dated to the Achaemenid (550–330 BC) and Sassanid (3rd–7th century AD) time period and died in mining incidents. The aim of the study was to describe the radiological and histological findings of several ancient Iranian salt mummies with special interest in pathological and postmortem changes. The mummified remains show multiple traumatic alterations, such as fractures and signs of massive compression. Histological analyses can clearly differentiate soft tissue, however the preservation status is variable. These Iranian salt mummies are a rare example of the ancient Iranian population. The soft tissue and organs are well preserved, however in different degrees due to the varying conditions.

Prophylactic intranasal administration of a TLR2/6 agonist reduces upper respiratory tract viral shedding in a SARS-CoV-2 challenge ferret model

BACKGROUND

The novel human coronavirus SARS-CoV-2 is a major ongoing global threat with huge economic burden. Like all respiratory viruses, SARS-CoV-2 initiates infection in the upper respiratory tract (URT). Infected individuals are often asymptomatic, yet highly infectious and readily transmit virus. A therapy that restricts initial replication in the URT has the potential to prevent progression of severe lower respiratory tract disease as well as limiting person-to-person transmission.

METHODS

SARS-CoV-2 Victoria/01/2020 was passaged in Vero/hSLAM cells and virus titre determined by plaque assay. Challenge virus was delivered by intranasal instillation to female ferrets at 5.0 × 106 pfu/ml. Treatment groups received intranasal INNA-051, developed by Ena Respiratory. SARS-CoV-2 RNA was detected using the 2019-nCoV CDC RUO Kit and QuantStudio™ 7 Flex Real-Time PCR System. Histopathological analysis was performed using cut tissues stained with haematoxylin and eosin (H&E).

FINDINGS

We show that prophylactic intra-nasal administration of the TLR2/6 agonist INNA-051 in a SARS-CoV-2 ferret infection model effectively reduces levels of viral RNA in the nose and throat. After 5 days post-exposure to SARS-CoV-2, INNA-051 significantly reduced virus in throat swabs (p=<0.0001) by up to a 24 fold (96% reduction) and in nasal wash (p=0.0107) up to a 15 fold (93% reduction) in comparison to untreated animals.

INTERPRETATION

The results of our study support clinical development of a therapy based on prophylactic TLR2/6 innate immune activation in the URT, to reduce SARS-CoV-2 transmission and provide protection against COVID-19.

FUNDING

This work was funded by Ena Respiratory, Melbourne, Australia.

Association of mRNA Expression Levels of LRP1 and Actin-Binding Proteins with the Development of Laryngeal and Laryngopharyngeal Squamous Cell Carcinoma

We analyzed the association of the level of mRNA expression of the main endocytosis receptor LRP1 and actin-binding proteins (ezrin, profilin-1, cofilin-1, and adenylyl cyclase-associated protein 1) with the development and metastasis of laryngeal and laryngopharyngeal squamous cell carcinoma. The mRNA expression was evaluated in paired tissue samples using quantitative reverse transcription real-time PCR (RT-qPCR) and SYBR Green reagents. The study included 38 patients with stage T1-4N0-1M0 laryngeal and laryngopharyngeal squamous cell carcinoma and 10 patients with chronic hyperplastic laryngitis or grade II-III epithelial dysplasia. The expression of LRP1 in patients with laryngeal and laryngopharyngeal squamous cell carcinoma depended on the stage of the tumor process. Against the background of low expression of LRP1 mRNA, the relationship between cofilin 1 and profilin 1 expression became stronger (r=0.08; p=0.05) and a correlation between cofilin 1 and esrin expression (r=0.7; p=0.05) appeared. Studies on a larger patient cohort are required to make a definite conclusion on the role of LRP1 in the development of laryngeal and laryngopharyngeal squamous cell carcinoma.

Endoscopic laryngopharyngeal surgery for hypopharyngeal lesions

OBJECTIVES

Transoral approaches for laryngeal/pharyngeal malignancies have been widely accepted as minimally invasive treatment options; however, hypopharyngeal lesions treated by transoral surgery have rarely been reported due to the difficulties in visualizing the hypopharynx. Since 2010, we have treated superficial hypopharyngeal lesions with endoscopic laryngopharyngeal surgery (ELPS), and herein report the outcomes of this transoral procedure.

MATERIALS AND METHODS

One hundred and eighteen patients with superficial hypopharyngeal lesions were treated by ELPS from February 2010 to February 2017, and the clinical courses of the patients were reviewed.

RESULTS

Four females and 114 males (average: 65.6 y-o) were included in this study. Some patients had multiple lesions and a total of 154 superficial hypopharyngeal lesions (dysplasia: 29, Tis: 52, T1: 44, T2: 20, T3: 9) were treated with ELPS. Ten patients had only dysplasia and no carcinoma. Five patients presented with nodal metastases and 11 patients had simultaneous oropharyngeal lesions. In all cases, the hypopharynx was well visualized with sufficient working space, and no cases required a change in surgical approach. All post-operative complications were safely managed. In regard to the oncological outcomes, of the 108 patients with malignant lesions, the 3-year and 5-year overall survival (OS) rate was 93.6% and 85.5%, respectively.

CONCLUSIONS

During ELPS, the hypopharynx was well visualized providing sufficient working space for the resection. The procedure was safe and feasible for superficial hypopharyngeal lesions and exhibited very good oncological outcomes. ELPS is thought to be a very effective surgical alternative for superficial hypopharyngeal lesions.

Evaluation of sagittal airway dimensions after face mask therapy with rapid maxillary expansion in Class III growing patients

OBJECTIVE

The aim of this investigation was to analyze the effects of RME and FM on the airway dimensions in Class III patients compared with untreated controls.

METHODS

A sample of 47 Class III patients treated with RME and FM was analyzed. The treated group was compared with 18 untreated controls. Lateral cephalograms for each patient at T1, T2, and T3 were digitized.

RESULTS

At long-term evaluation a significant increase in airway size and a significant decrease in adenoid size were found in the treated group as well as an improvement in the pharynx dimension. During active treatment the treated group showed a significant improvement in lower airway size and in lower pharynx dimension. A significant decrease in adenoid size was also found.

CONCLUSION

The treatment with RME and FM produced favorable stable changes in the airway dimensions in Class III subjects when compared with untreated controls.

Correlations between Aspiration and Pharyngeal Residue Scale Scores for Fiberoptic Endoscopic Evaluation and Videofluoroscopy

PURPOSE

To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients.

MATERIALS AND METHODS

We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed.

RESULTS

A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05).

CONCLUSION

Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.

Upper airway visualization in pediatric obstructive sleep apnea

Pediatric Obstructive Sleep Apnea (OSA) is a condition that may lead to a variety of comorbidities in adolescence and adulthood. The gold standard of diagnosing OSA is polysomnography (PSG). Over the past fifteen years numerous publications have explored how to better visualize the upper airway to further assess OSA in the pediatric population, and eventually institute personalized treatment. Lateral neck radiograph, cephalometry, computed axial tomography, and magnetic resonance imaging are all unique imaging techniques that are used in the diagnosis of OSA. Drug Induced Sleep Endoscopy is a direct visualization technique that is gathering momentum in pediatrics. Each approach has respective benefits and weaknesses. However, none of them at this time can replace PSG. They are a helpful supplement in those patients with complicated upper airway anatomy and in those with residual OSA.

A Case of Incomplete and Atypical Kawasaki Disease Presenting with Retropharyngeal Involvement

Background: Kawasaki disease (KD) is a childhood acute febrile vasculitis of unknown aetiology. The diagnosis is based on clinical criteria, including unilateral cervical lymphadenopathy, which is the only presenting symptom associated with fever in 12% of cases. A prompt differential diagnosis distinguishing KD from infective lymphadenitis is therefore necessary to avoid incorrect and delayed diagnosis and the risk of cardiovascular sequelae. Case presentation: We describe the case of a 4 years old boy presenting with febrile right cervical lymphadenopathy, in which the unresponsiveness to broad-spectrum antibiotics, the following onset of other characteristic clinical features and the evidence on the magnetic resonance imaging (MRI) of retropharyngeal inflammation led to the diagnosis of incomplete and atypical KD. On day 8 of hospitalisation (i.e., 13 days after the onset of symptoms), one dose of intravenous immunoglobulins (IVIG; 2 g/kg) was administered with rapid defervescence, and acetylsalicylic acid (4 mg/kg/day) was started and continued at home for a total of 8 weeks. Laboratory examinations revealed a reduction in the white blood cell count and the levels of inflammatory markers, thrombocytosis, and persistently negative echocardiography. Clinically, we observed a gradual reduction of the right-side neck swelling. Fifteen days after discharge, the MRI of the neck showed a regression of the laterocervical lymphadenopathy and a resolution of the infiltration of the parapharyngeal and retropharyngeal spaces. Conclusion: Head and neck manifestations can be early presentations of KD, which is frequently misdiagnosed as suppurative lymphadenitis or retropharyngeal infection. A growing awareness of the several possible presentations of KD is therefore necessary. Computed tomography (CT) or MRI can be utilised to facilitate the diagnosis.

[Pharyngeal acid load and different functional endoscopy findings]

The findings of functional endoscopy (upper esophageal sphincter insufficiency, cardia insufficiency, esophagitis, gastric heterotopia, axial sliding hernia, and visible aerosols) can be traced back to pharyngeal acid exposure by oropharyngeal pH measurement. Significantly increased pharyngeal acid loads are seen in gastric heterotopy and axial sliding hernia. For all measured statistics, the pharyngeal acid load is in the pathological or even very pathological range. The value of functional endoscopy in the context of laryngopharyngeal reflux diagnosis is clearly documented. The findings "heterotopic gastric mucosa" and "axial sliding hernia" may cause marked airway symptoms and a pathogenetic relationship with otorhinolaryngologic reflux-associated symptoms must be postulated for these entities.

The prognostic value of CT-based image-biomarkers for head and neck cancer patients treated with definitive (chemo-)radiation

OBJECTIVES

The aim of this study was to investigate whether quantitative CT image-biomarkers (IBMs) can improve the prediction models with only classical prognostic factors for local-control (LC), regional-control (RC), distant metastasis-free survival (DMFS) and disease-free survival (DFS) for head and neck cancer (HNC) patients.

MATERIALS AND METHODS

The cohort included 240 and 204 HNC patients in the training and validation analysis, respectively. Clinical variables were scored prospectively and IBMs of the primary tumor and lymph nodes were extracted from planning CT-images. Clinical, IBM and combined models were created from multivariable Cox proportional-hazard analyses based on clinical features, IBMs, and both for LC, RC, DMFS and DFS.

RESULTS

Clinical variables identified in the multivariable analysis included tumor-site, WHO performance-score, tumor-stage and age. Bounding-box-volume describing the tumor volume and irregular shape, IBM correlation representing radiological heterogeneity, and LN_major-axis-length showing the distance between lymph nodes were included in the IBM models. The performance of IBM LC, RC, DMFS and DFS models (c-index(validated):0.62, 0.80, 0.68 and 0.65) were comparable to that of the clinical models (0.62, 0.76, 0.70 and 0.66). The combined DFS model (0.70) including clinical features and IBMs performed significantly better than the clinical model. Patients stratified with the combined models revealed larger differences between risk groups in the validation cohort than with clinical models for LC, RC and DFS. For DMFS, the differences were similar to the clinical model.

CONCLUSION

For prediction of HNC treatment outcomes, image-biomarkers performed as good as or slightly better than clinical variables.

Prognostic value of retropharyngeal lymph node metastasis laterality in nasopharyngeal carcinoma and a proposed modification to the UICC/AJCC N staging system

BACKGROUND AND PURPOSE

Metastasis laterality is used for N classification of cervical lymph nodes, but not retropharyngeal lymph nodes (RLNs). This study explored the prognostic value of laterality of RLN metastasis to provide suggestions for a better N standard classification.

MATERIALS AND METHODS

This retrospective study evaluated 1225 patients with new biopsy-confirmed nasopharyngeal carcinoma (NPC). Univariable and multivariable Cox regression models were used to assess overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). A new N classification system was developed and compared to the 8th AJCC system. Kaplan-Meier methods with log-rank tests were used to compare OS, PFS, and DMFS between our proposed N stage and the AJCC N stages.

RESULTS

The incidence of RLN metastasis was 38.7% (unilateral) and 27.5% (bilateral). In the N1 subgroup, metastasis laterality was associated with significant differences in the 5-year rates of OS (89.4% vs. 82.6%, p = 0.016), DMFS (91.5% vs. 82.9%, p = 0.004), and PFS (80.3% vs. 71.2%, p = 0.016). However, no significant differences in these outcomes were observed when we compared N2 disease to N1 bilateral RLN metastasis. Multivariate analysis confirmed that bilateral RLN metastasis independently predicted OS, DMFS, and PFS. The proposed classification broadened the differences in OS, DMFS, PFS between N1 and N2 disease.

CONCLUSION

Patients with NPC and unilateral RLN metastasis had better survival than did patients with bilateral RLN metastasis. Upgrading cases with bilateral RLN metastasis from N1 to N2 may help improve prognostication using the 8th AJCC system.

"Epidemiology and aetiology of influenza-like illness among households in metropolitan Vientiane, Lao PDR": A prospective, community-based cohort study

Respiratory diseases are a major contributor to morbidity and mortality in many tropical countries, including Lao PDR. However, little has been published regarding viral or bacterial pathogens that can contribute to influenza-like illness (ILI) in a community setting. We report on the results of a community-based surveillance that prospectively monitored the incidence of ILI and its causative pathogens in Vientiane capital in Lao PDR. A cohort of 995 households, including 4885 study participants, were followed-up between May 2015 and May 2016. Nasopharyngeal swabs, throat swabs, and sputum specimens were collected from ILI cases identified through active case-finding. Real-Time PCR was used to test nasopharyngeal swabs for 21 respiratory pathogens, while throat and sputum samples were subjected to bacterial culture. Generalized linear mixed models were used to assess potential risk factors for associations with ILI. In total, 548 episodes of ILI were reported among 476 (9.7%) of the study participants and 330 (33.2%) of the study households. The adjusted estimated incidence of ILI within the study area was 10.7 (95%CI: 9.4-11.9) episodes per 100 person-years. ILI was significantly associated with age group (p<0.001), sex (p<0.001), and number of bedrooms (p = 0.04) in multivariate analysis. In 548 nasopharyngeal swabs, the most commonly detected potential pathogens were Streptococcus pneumoniae (17.0%), Staphylococcus aureus (11.3%), influenza A (11.1%; mostly subtype H3N2), rhinovirus (7.5%), and influenza B (8.0%). Streptococci were isolated from 42 (8.6%) of 536 throat swabs, most (27) of which were Lancefield Group G. Co-infections were observed in 132 (24.1%) of the 548 ILI episodes. Our study generated valuable data on respiratory disease burden and patterns of etiologies associated with community-acquired acute respiratory illness Laos. Establishment of a surveillance strategy in Laos to monitor trends in the epidemiology and burden of acute respiratory infections is required to minimize their impact on human health.

A case report of application of posterior pharyngeal flap in resection and reconstruction of posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage

RATIONALE

posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage is a rare occurrence. Surgical treatment is a dilemma owing to the retention of laryngeal function PATIENT CONCERNS:: A 56-year-old man underwent a "resection of left cervical tumor" at another hospital. Postoperative pathological report noted a left metastatic squamous cell carcinoma of the neck. Neck-enhanced computed tomography (CT) revealed thickening of the right posterior pharyngeal wall, and an image of soft tissue density was present on the posterior pharyngeal wall with a size of approximately 1.0 × 1.5 cm.

DIAGNOSIS

Hypopharyngeal carcinoma (T1N2M0).

INTERVENTIONS

We performed operation on a patient who suffered from posterior pharyngeal wall carcinomas at the level of the cricoid cartilage. The postoperative defects were repaired with posterior pharyngeal flaps.

OUTCOMES

The patient with posterior pharyngeal flap after operation survived without necrosis, the neck wounds of patient healed in 1 stage, and the phonation, swallowing and respiratory function was good.

LESSONS

The application of posterior pharyngeal flap to repair defects due to posterior pharyngeal wall carcinomas that were located at the level of the cricoid cartilage after resection is an effective reconstruction method that is easy to use and has excellent repair effects.

Diagnosis and treatment of the pharyngeal glial choristoma accompanied with incomplete cleft palate: A case report

INTRODUCTION

A choristoma formed by heterotopic tissue rarely occurs in the throat, especially one accompanied with cleft palate in a new-born baby.

PATIENT CONCERNS

An 18-month-old female patient was admitted to the hospital for apparent snoring symptoms accompanied by mouth breathing and sleep apnea. In addition, the patient presented with weak aspiration and nasal leakage during fluid intake.

DIAGNOSIS

The patient received routine physical examination and endoscopy showing that there was a wide fissure which split from the palate vertical anterior cleft to 1/3 of the hard palate. Meanwhile, we found an unclear-bordered uplift in the left palate and a soft mass. The radiographs revealed a mass with inhomogeneous density convex to the pharyngeal cavity.

INTERVENTIONS

The patient was subsequently referred for surgical resection and tissue diagnosis of choristoma was confirmed by pathological examination. H&E staining showed well demarcated mature brain tissue with scattered sand-like calcification.

OUTCOMES

According to the diagnosis, the patient suffered from pharyngeal glial choristoma and incomplete cleft palate. The surgical resection and repair were performed together. The postoperative recovery was very good.

LESSONS

Choristoma rarely occurs in the head and neck, especially if accompanied by cleft palate. Early diagnosis for choristoma relies heavily on clinical examination and radiological imaging. Complete resection of choristoma remains the gold standard for treatment of these patients.

Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis

Mucocutaneous leishmaniasis and paracoccidioidomycosis are infectious diseases with similar epidemiological and clinical aspects. Cases of both diseases may manifest similar lesions in the mucosa. Therefore, the determination of distinguishing characteristics for the purpose of differential diagnosis is critical for better management of the diseases. The present study evaluated factors that assist in the differentiation of mucosal lesions between these diseases. This cross-sectional study included data from medical records of 122 cases of mucocutaneous leishmaniasis and 83 cases of paracoccidioidomycosis attended at the university hospital Cassiano Antonio Moraes, located in Vitória, Espírito Santo State, Brazil. Comparison between the diseases included the following variables: sex, age, time of disease evolution, location of the lesion and symptoms. Adults and males were affected by both diseases at higher rates. Lesions in the nasal region (95.1%; p-value = 0.000) and the pharynx (20.5%; p-value = 0.009) and nasal obstruction (34.4%; p-value = 0.000) were associated with leishmaniasis. Paracoccidioidomycosis was associated with lesions in the oral region (90.4%; p-value = 0.000), oral pain (16.9%; p-value = 0.000), and hoarseness (14.5%; p-value = 0.008). In leishmaniasis, lesions in oral regions were not associated with oral pain and were frequently located close to the nasal area. The manifestations cited above could improve the differential diagnosis of leishmaniasis and paracoccidioidomycosis, and thereby potentially aid in the choice of appropriate confirmatory diagnostic testing.

A Study on the Evaluation of Pharyngeal Size in Different Skeletal Patterns: A Radiographic Study

AIM

The aim of this study was to evaluate the upper and lower pharyngeal airway dimensions were affected by different skeletal malocclusions.

MATERIALS AND METHODS

Lateral cephalograms of 120 subjects were used to measure the pharyngeal airway and were divided into three groups (each group included 40 subjects) according to ANB angle: Class I (ANB angle 2° ≤ ANB ≤ 4°), Class II (ANB angle(ANB ≥ 6°), and Class III (ANB angle ≤ 0°). Various linear cephalometric airway measurements (14 measurements) were used to evaluate pharyngeal airway at various levels. Statistical analyses were performed Using the ANOVA and student t-test.

RESULTS

PNS-ppwl (p < 0.001) and McNamara' lower pharynx dimension (p < 0.05) showed a statistically significant difference between the groups. Two out of 14 variables ie Ba-PNS and t-ppw showed a statistically significant difference between male and female. In both measurements, the difference is significant only in the Class II group with the level of significance being (p < 0.001) in Ba-PNS measurement, and (p < 0.05) in t-ppw measurement. In both measurements males have statistically significant higher mean values than the females.

CONCLUSION

The dimensions of pharyngeal structures were not affected by the changes of the ANB angle. The sagittal skeletal pattern does not seem to influence the variations in the upper airway dimension. There was no significant difference in the dimensions of pharyngeal structures among males and females.

CLINICAL SIGNIFICANCE

The upper and lower pharyngeal airway dimensions are affected by different skeletal malocclusions can significantly aid in Orthodontic treatment planning.

Three-dimensional evaluation of changes in upper airway volume in growing skeletal Class II patients following mandibular advancement treatment with functional orthopedic appliances

OBJECTIVES

The aim of this study was to assess three-dimensionally the upper airway changes following functional appliance treatment in growing Class II patients.

MATERIALS AND METHODS

Pre-and post-treatment Cone beam computed tomography scans of 20 patients (age range: 9 to 12; mean: 11.4 ± 1.0 years) were retrieved from the list of patients previously treated with functional appliances in the Postgraduate Clinic at the Section of Orthodontics, Aarhus University, Denmark. Total and partial volumes of the upper airway (ie, lower nasopharynx, velopharynx, and oropharynx) were calculated. To rule out the effect of growth, the changes in the functional appliance group were compared to an age-matched Class I group of 18 patients (age range: 8 to 14; mean: 11.8 ± 1.4 years).

RESULTS

In the functional appliance group, all the partial and total volumes were significantly larger at the end of treatment when compared to the start of treatment ( P < .003). On the other hand, when comparing the changes for the total and partial volumes of the upper airway in the functional appliance group with the Class I group, a statistical difference was seen only for the oropharynx ( P = .022) and total volume ( P = .025), with the functional appliance group showing a larger volume increment.

CONCLUSIONS

An increase in the upper airway volume was found after treatment with functional appliances. This difference was mainly related to the changes at the oropharynx level, which differed significantly from what was observed in the Class I group.

Sequence Analysis of Toxin Gene-Bearing Corynebacterium diphtheriae Strains, Australia

By conducting a molecular characterization of Corynebacterium diphtheriae strains in Australia, we identified novel sequences, nonfunctional toxin genes, and 5 recent cases of toxigenic cutaneous diphtheria. These findings highlight the importance of extrapharyngeal infections for toxin gene-bearing (functional or not) and non-toxin gene-bearing C. diphtheriae strains. Continued surveillance is recommended.

Three-dimensional evaluation of maxillary dentoalveolar changes and airway space after distalization in adults

OBJECTIVES

To evaluate the changes in position of the maxillary dentition and the airway space after distalization using a modified C-palatal plate (MCPP) in adult patients through CBCT images and to analyze the relationship between the amount of distalization and the changes in the airway space.

MATERIALS AND METHODS

CBCT images of 33 adult Class II patients (22.2 ± 4.0 years old; 27 women and 6 men) treated by total maxillary arch distalization using the MCPP were evaluated before and after distalization. The patients were divided into nonextraction and extraction groups. The changes in the airway space as well as the changes in the positions of the maxillary dentition were evaluated. The distalization effects were calculated and assessed using paired t-tests.

RESULTS

After distalization, the first molar showed significant distalization and intrusion ( P < .001) with no significant rotation of the crown and no significant buccal displacement of its root in the transverse dimension. There were no significant changes in the airway volume or the minimum cross-sectional area of the oropharynx.

CONCLUSIONS

The application of the MCPP resulted in significant total arch distalization without a significant effect on the transverse dimensions or changes in the oropharynx airway space. The MCPP can be considered a viable treatment option for patients with Class II malocclusion.

Craniofacial, Craniocervical, and Pharyngeal Morphology in Bilateral Cleft Lip and Palate and Obstructive Sleep Apnea Patients

Objective:

The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men.

Subjects and methods:

Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 ± 8.3 years), 27 untreated male OSA patients (mean age 38.6 ± 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 ± 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance.

Results:

Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group.

Conclusions:

Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.

The Relationship between the Characteristics of Speech and Velopharyngeal Gap Size

Objective

The purpose of this study was to examine the relationship between perceptual characteristics of hypernasality, nasal emission and nasal rustle, and size of the velopharyngeal gap.

Design

A retrospective medical chart review.

Setting

Cincinnati Children's Hospital Medical Center.

Subjects

Subjects were patients of the Craniofacial Anomaly Team. All were between ages 3 and 12 years and diagnosed with velopharyngeal dysfunction secondary to cleft palate ± cleft lip. A total of 173 charts were reviewed.

Outcome Measures

Speech characteristics were assessed perceptually by an experienced speech-language pathologist. Following that assessment, velopharyngeal closure was evaluated using videofluoroscopy, nasopharyngoscopy, or both.

Results

Based on the perceptual ratings alone, 21 subjects were diagnosed with nasal rustle only, 27 had hypernasality with nasal rustle, 89 had hypernasality with nasal emission without nasal rustle, and 36 had hypernasality with no audible nasal emission. An ordinal logit regression was conducted and showed that moderate and severe hypernasality contributed significantly to the prediction of a large gap size; nasal rustle contributed significantly to prediction of a small gap size. Perceptual characteristics of speech correctly predicted gap size for 121 of the 173 subjects (70%).

Conclusions

This investigation revealed that some information regarding velopharyngeal gap size may be predicted from the speech assessment alone. Confidence in the prediction is strongest if the patient has nasal rustle, suggesting a small gap, or if the patient has moderate to severe hypernasality, which is more commonly associated with a large opening.

Long-Term Effects of Palate Repair on Craniofacial Morphology in Patients with Unilateral Cleft Lip and Palate

Objective

To identify the long-term effects of palate repair on craniofacial growth in patients with unilateral cleft lip and palate (UCLP).

Design

Retrospective cross-sectional study.

Setting

Sri Lankan Cleft Lip and Palate Project.

Subjects

Forty-eight adults with nonsyndromic unilateral cleft lip and palate, 29 men and 19 women, had lip repair only (LRO group). Fifty-eight adults with nonsyndromic unilateral cleft lip and palate, 35 men and 23 women, had lip and palate repairs by the age of 9 (LPR group).

Main Outcome Measures

Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine craniofacial morphology.

Results

In the lip and palate repair group, the depth of the bony pharynx (Ba-PMP), the maxillary length at the alveolar level (PMP-A), the effective length of the maxilla (Ar-IZ, Ar-ANS, Ar-A), the maxillary protrusion (S-N-ANS, SNA), the anteroposterior jaw relation (ANS-N-Pog, ANB), and the overjet were smaller than in the lip repair only group. There were no significant differences in the maxillary length at the basal level (PMP-IZ, PMP-ANS) and the anterior and posterior maxillary heights (N-ANS and R-PMP, respectively) in the two groups.

Conclusion

Palate repair inhibits the forward displacement of the basal maxilla and anteroposterior development of the maxillary dentoalveolus in patients with unilateral cleft lip and palate. Palate repair has no detrimental effects on the downward displacement of the basal maxilla or on palatal remodeling in patients with unilateral cleft lip and palate.

Speech Outcome and Velopharyngeal Function in Cleft Palate: Comparison of Le Fort I Maxillary Osteotomy and Distraction Osteogenesis—Early Results

Objective:

To compare speech outcome and velopharyngeal (VP) status of subjects with repaired cleft palate who underwent either conventional Le Fort I osteotomy or maxillary distraction osteogenesis to correct maxillary hypoplasia.

Design:

Prospective randomized study with blind assessment of speech outcome and VP status.

Subjects:

Twenty-two subjects were randomized into conventional Le Fort I osteotomy and Le Fort I distraction groups. All were native Chinese (Cantonese) speakers.

Method:

Perceptual judgment of resonance and nasal emission, study of VP structures by nasoendoscopy, and instrumental measurement by nasometry. Assessments were performed preoperatively and at 3 months postoperatively.

Main Outcome Measures:

Assessment of VP closure, perceptual rating of hypernasality and nasal emission, nasalance, and amount of maxillary advancement.

Results:

There was no statistical difference in any of the outcome measures between the 10 subjects with conventional Le Fort I osteotomy and the 12 subjects with maxillary distraction: hypernasality (chi-square = 3.850, p = 0.221), nasal emission (chi-square = 0.687, p = 0.774), VP gap size (chi-square = 1.527, p = 0.635, and nasalance (t = −0.145, p = 0.886). There was no correlation between amount of maxillary advancement and any of the outcome measures (p = .05 for all). Changes in VP gap size and resonance are described.

Conclusion:

Results need to be interpreted with caution because of the small sample size and early follow-up. However, this study utilized an assessment protocol involving a variety of outcome measures and careful consideration of reliability factors, which can be a model for further and follow-up studies.

Velopharyngeal Morphology of Patients with Persistent Velopharyngeal Incompetence following Repushback Surgery for Cleft Palate

Objective

To characterize the velopharyngeal morphology of patients with persistent velopharyngeal incompetence (VPI) following repushback surgery for cleft palate.

Participants

Seven patients with moderate to severe VPI following repushback surgery for secondary correction of cleft palate, and 14 patients who had already obtained complete velopharyngeal closure function (VPF) were enrolled. Control data were obtained from the longitudinal files of 20 normal children in Kyushu University Dental Hospital.

Main Outcome Measures

Skeletal landmarks and measurements were derived from tracing of lateral roentgenographic cephalograms. The measurements included velar length, pharyngeal depth, and pharyngeal height and the ratio of velar length to pharyngeal depth. Additionally, the configuration of the upper pharynx (pharyngeal triangle) involving the cranial base, cervical vertebrae, and the posterior maxilla and also the position of posterior pharyngeal wall (PPW) in the pharyngeal triangle were analyzed.

Results

The VPI group had a significantly shorter velar length and greater pharyngeal depth, resulting in a smaller length/depth ratio than the controls. The points of PPW and cervical vertebrae of the VPI group were located more posteriorly and inferiorly than those in the group with complete VPF after the primary operation and the controls. The positions of cranial base and maxilla were not significantly different. Additionally, the position of PPW in the pharyngeal triangle was located significantly posteriorly and superiorly in the VPI group, compared with the controls.

Conclusions

The craniopharyngeal morphology of patients with persistent VPI was characterized by a short palate, wide-based and counterclockwise-rotated pharyngeal triangle, and posteriorly and superiorly positioned PPW. These might be contributory factors for the prediction of VPF before repushback surgery for cleft palate.