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Sitzman TJ, Baylis AL, Perry JL, Weidler EM, Temkit M, Ishman SL, Tse RW. Protocol for a Prospective Observational Study of Revision Palatoplasty Versus Pharyngoplasty for Treatment of Velopharyngeal Insufficiency Following Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:870-881. [PMID: 36562144 PMCID: PMC10287832 DOI: 10.1177/10556656221147159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI). DESIGN Prospective observational multicenter study. SETTING Twelve hospitals across the United States and Canada. PARTICIPANTS Individuals who are 3-23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants. INTERVENTIONS Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team. MAIN OUTCOME MEASURE(S) The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. RESULTS Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. CONCLUSIONS Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Adriane L. Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Speech Language Hearing Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders East Carolina University, Greenville, North Carolina, USA
| | - Erica M. Weidler
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - M’hamed Temkit
- Department of Clinical Research, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Raymond W. Tse
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
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Chwa ES, Stoehr JR, Gosain AK. Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data. Cleft Palate Craniofac J 2024; 61:844-853. [PMID: 36594527 DOI: 10.1177/10556656221148901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. DESIGN Multi-institution, retrospective review of Smile Train Express database. SETTING 1110 Smile Train partner hospitals. PATIENTS/PARTICIPANTS 2560 patients. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery. RESULTS The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. CONCLUSIONS Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.
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Affiliation(s)
- Emily S Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jenna R Stoehr
- Division of Plastic and Reconstructive Surgery, University of South Florida, Tampa, IL, USA
| | - Arun K Gosain
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Tewfik K, Rampinelli V, Burlini D, Buffoli B, Rezzani R, Deganello A, Felisati G, Piazza C. Video-Assisted Cleft Palate Surgery: Preclinical Comparison Between Endoscope- and Exoscope-Based Approaches. Cleft Palate Craniofac J 2024; 61:639-645. [PMID: 36417321 DOI: 10.1177/10556656221139340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Using both endoscope and exoscope in cleft soft palate surgery is not widespread, despite the potential advantages related to view magnification, ergonomic posture of the surgeon, and involvement of the surgical team. The aim of the current study is to compare endoscopic (Olympus Visera©) and exoscopic (Karl-Storz Vitom©) assistance in cleft soft palate surgery in a preclinical cadaver setting. A formalin fixed specimen was dissected to mimic the anatomical conditions of a cleft soft palate. Ten young surgeons with limited experience in transoral surgery were involved in the exercitation on the specimen. The exercitation consisted of 4 tasks: (1) device setting; (2) identification of muscle plane; (3) muscle suturing; (4) oral mucosa suturing. Participants were timed while performing each task both with exoscope and endoscope and asked to fill in 2 questionnaires related to the visual systems used (NASA Task Load System TLS and VAS 1-10). All surgeons completed the 4 tasks with both the endoscope and exoscope. The execution times were similar except for faster setting of the exoscope. Participants felt that completing surgical exercises using the exoscope required less physical, intellectual, and temporal efforts compared to the endoscope. The exoscope was also more appreciated for its handling, 3D visualization, and limited encumbrance. Exoscope scored better both at NASA TLS and VAS 1-10 and required a faster setting than endoscope. Further clinical in-vivo studies are required to explore the advantages of these devices in cleft palate repair.
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Affiliation(s)
- Karim Tewfik
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Dante Burlini
- Pediatric Maxillofacial Surgery Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Otorhinolaryngology Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Giovanni Felisati
- Otorhinolaryngology Unit, Head and Neck Department Santi Paolo e Carlo Hospital of Milan, University of Milan DISS, Milano, Italy
| | - Cesare Piazza
- Otorhinolaryngology Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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4
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Apandi A, Sai Guan L, Mohamad A, Muhamad Tamyez F, Ishak MN. An Atypical Squamous Papilloma of the Uvula. Cureus 2024; 16:e58008. [PMID: 38738073 PMCID: PMC11087670 DOI: 10.7759/cureus.58008] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
Squamous papilloma of the oral cavity is frequently seen in adult patients and is typically presented as painless exophytic granular or cauliflower-like lesions over the tongue, floor of the mouth, palate, uvula, lips, and faucial pillars. Most of the lesions are solitary and grow rapidly to about 0.5 cm. Oral squamous papilloma has no known malignant potential, with conservative surgical excision being the treatment of choice. Recurrence is rare. It occasionally causes symptoms, unless the presentation is atypical, as in our case. An elongated uvula can cause discomfort and reduce a patient's quality of life. This study aims to report an atypical presentation of a squamous papilloma over the soft palate.
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Affiliation(s)
- Afena Apandi
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Medicine, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, MYS
| | - Lum Sai Guan
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, MYS
- Department of Medicine, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, MYS
| | - Amran Mohamad
- Department of Otorhinolaryngology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, MYS
| | | | - Muhammad Nu'aim Ishak
- Department of Otorhinolaryngology - Head and Neck Surgery, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS
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Borg TM, Solomon S, Alfarrouh R, Barazi W, Abu Sittah G, Sommerlad B, Ghanem A. Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries. Cleft Palate Craniofac J 2024; 61:706-711. [PMID: 36330704 DOI: 10.1177/10556656221136650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. METHODOLOGY Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. RESULTS Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved (P < .001). CONCLUSION The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.
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Affiliation(s)
- Tiffanie-Marie Borg
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Sara Solomon
- Department of Surgery, Queen's Hospital, Romford, London, UK
| | - Rik Alfarrouh
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Wael Barazi
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Ghassan Abu Sittah
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
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6
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Matsumoto H, Ota T, Kato M, Makino T, Makihara S, Ando M, Kimata Y. Various arrangements of pharyngeal flap in soft palate reconstruction after cancer treatment. Head Neck 2024. [PMID: 38426332 DOI: 10.1002/hed.27712] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The pharyngeal flap (PF) is useful for reconstruction of soft palate defects, but effective arrangements of PF for various types of soft palate defects are controversial. Here, we classify three types of soft palate defects and discuss the arrangements of PF and their functional prognosis. METHODS Reconstruction was performed based on the classification of the defects. Clinical details were collected, and postoperative function was analyzed. RESULTS Eight patients were included in the study. The defect sizes ranged from 25 (width) × 40 (depth) to 40 × 60 mm. Six patients underwent pharyngeal flap reconstruction with free-flap reconstruction, and two underwent pharyngeal flap reconstruction. The pharyngeal flap was harvested at the maximum width of the posterior pharyngeal wall, ranging from 25 to 40 mm in length. Eating and speaking functions were maintained in all patients. CONCLUSIONS Good postoperative function can be maintained by narrowing the velopharyngeal space with a pharyngeal flap.
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Affiliation(s)
- Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Tomoyuki Ota
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Motoi Kato
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Takuma Makino
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Seiichiro Makihara
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Mizuo Ando
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
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Houkes RP, Smit JA, Lachkar N, Tse R, Breugem CC. Unraveling a Major Burden of Orofacial Clefts Analyses: Classification of Cleft Palate Fistulas by Cleft Surgeons. Cleft Palate Craniofac J 2024; 61:508-512. [PMID: 36594232 PMCID: PMC10893769 DOI: 10.1177/10556656221149521] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations. DESIGN Cross-sectional survey study. PARTICIPANTS Participants in an international webinar that focused on palatal fistula treatment were included. INTERVENTION Participants were presented with a survey pre- and post-webinar. MAIN OUTCOMES Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system. RESULTS A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system. CONCLUSIONS This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas.
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Affiliation(s)
- Ruben P. Houkes
- Dept. of Plastic Surgery, Amsterdam UMC, location University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Johannes A. Smit
- Dept. of Plastic Surgery, Amsterdam UMC, location University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - N. Lachkar
- Dept. of Plastic Surgery, Amsterdam UMC, location University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Raymond Tse
- Dept. of Plastic Surgery, Seattle Children's Hospital, Seattle, USA
| | - Corstiaan C. Breugem
- Dept. of Plastic Surgery, Amsterdam UMC, location University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
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Chiang SN, Meyer GA, Skolnick GB, Hunter DA, Wood MD, Li X, Snyder-Warwick AK, Patel KB. Effect of Veau Class on Levator Veli Palatini Muscle Composition. Cleft Palate Craniofac J 2024; 61:319-325. [PMID: 36330615 DOI: 10.1177/10556656221127840] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To examine levator veli palatini muscle composition in patients with nonsyndromic cleft palate and investigate the impact of Veau class. DESIGN Prospective cohort study. SETTING Tertiary care academic hospital. PATIENTS/PARTICIPANTS Thirteen patients with nonsyndromic cleft palate were recruited. INTERVENTIONS During primary palatoplasty, a sample of levator veli palatini muscle was excised and prepared for histological analysis. MAIN OUTCOME MEASURES Fat and collagen content were determined utilizing Oil Red and Sirius red stains, respectively, while muscle fiber cross-sectional areas were calculated from H&E-stained samples, with analysis using histomorphometric methods. Immunofluorescent staining of myosin heavy chain isoforms was performed. RESULTS Patients underwent repair at 10.8 months of age (interquartile range [IQR] 10.2-12.9). Fat content of the levator veli palatini muscle was low in both groups, ranging from 0% to 5.2%. Collagen content ranged from 8.5% to 39.8%; neither fat nor collagen content showed an association with Veau classes. Mean muscle fiber cross-sectional area decreased with increasing Veau class, from 808 µm2 (range 692-995 µm2) in Veau II to 651 µm2 (range 232-750 µm2) in Veau III (P = .02). There was also a nonsignificant decrease in proportion of type I muscle fibers with increasing Veau class (44.3% [range 31.4%-84.4%] in Veau II vs 35.3% [range 17.4%-61.3%] in Veau III). CONCLUSIONS Muscle fiber area in levator veli palatini muscles decreases in Veau III clefts in comparison to Veau II. The impact of these differences in velopharyngeal dysfunction requires further analysis of a larger cohort.
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Affiliation(s)
- Sarah N Chiang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Gretchen A Meyer
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA
- Departments of Neurology, Orthopaedic Surgery, and Biomedical Engineering, Washington University School of Medicine, St Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Daniel A Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Matthew D Wood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Xiaowei Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
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Denadai R, Seo HJ, Go Pascasio DC, Sato N, Murali S, Lo CC, Chou PY, Lo LJ. Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible? Cleft Palate Craniofac J 2024; 61:247-257. [PMID: 36066016 DOI: 10.1177/10556656221123917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. DESIGN Retrospective single-surgeon study. PATIENTS Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. INTERVENTIONS Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). MEAN OUTCOME MEASURES Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. RESULTS Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). CONCLUSION This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dax Carlo Go Pascasio
- Section of Plastic and Reconstructive Surgery, Southern Philippines Medical Center, Davao, Philippines
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Srinisha Murali
- Oral and Maxillofacial Surgery, Kumaran Clinic and Nursing Home Trichy, Tamil Nadu, India
| | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Morrison KA, Park J, Rochlin D, Lico M, Flores RL. Anatomical Study of Domain Rescue of Palatal Length in Patients With a Wide Cleft Palate: Buccal Flap Reconstruction in Primary Palatoplasty. Cleft Palate Craniofac J 2024; 61:103-109. [PMID: 35918811 DOI: 10.1177/10556656221117930] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study characterizes the potential loss of velar length in patients with a wide cleft and rescue of this loss of domain by local flap reconstruction, providing anatomic evidence in support of primary lengthening of the soft palate during palatoplasty. METHODS A retrospective review was conducted of all patients with a cleft palate at least 10mm in width, who underwent primary palatoplasty with a buccal flap prior to 18 months of age over a 2-year period. All patients underwent primary palatoplasty with horizontal transection of the nasal mucosa, which was performed after nasal mucosa repair, but prior to muscular reconstruction. The resulting palatal lengthening was measured and the mucosal defect was reconstructed with a buccal flap. RESULTS Of the 22 patients included, 3 (13.6%) had a history of Pierre Robin sequence, and 5 (22.7%) had an associated syndrome. No patients had a Veau I cleft, 7 (31.8%) had a Veau II, 12 (54.5%) had a Veau III, and 3 had (13.6%) a Veau IV cleft. All patients had a right buccal flap during primary palatoplasty. The mean cleft width at the posterior nasal spine was 10.6 ± 2.82mm, and mean lengthening of the velum after horizontal transection of the nasal mucosa closure was 10.5 ± 2.23mm. There were 2 (9.1%) fistulas, 1 (4.5%) wound dehiscence, 1 (4.5%) 30-day readmission, and no bleeding complications. CONCLUSIONS Patients with a wide cleft palate have a potential loss of 1cm velar length. The buccal flap can rescue the loss of domain in palatal length, and potentially improve palatal excursion.
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Affiliation(s)
| | - Jenn Park
- NYU Langone Health, New York, NY, USA
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Mahajan R, Tambotra A, Ghildiyal H, Singh M, Thussu T, Bhamre A, Srinivasan K. Comparison of Furlow's Double Opposing Z-plasty and Straight-Line Intravelar Veloplasty as Methods of Cleft Palate Repair. Cureus 2024; 16:e52897. [PMID: 38406020 PMCID: PMC10891454 DOI: 10.7759/cureus.52897] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background One of the common craniofacial abnormalities is cleft lip and palate. Various surgical procedures have been employed to repair the cleft. However, immediate post-operative complications and formation of palatal fistula post surgery are common in surgical procedures. The study aims to compare the fistula rate, soft palate lengthening, and immediate complications of cleft palate repair of Furlow's Z-plasty and straight-line intravelar veloplasty techniques. Method Fifty Patients with isolated or unilateral cleft palate and lip with age between 9-18 months were randomly divided into two groups. One group underwent Furlow's Z-plasty while the other underwent straight-line intravelar veloplasty procedures. Post surgery, after discharge, the patients were followed up at 2 weeks, 1 month, and 3 months intervals. Immediate post-operative complications and fistula formation rate were compared along with other parameters like fistula width, duration of the procedure, intra-operative soft palate length, etc. Results Straight-line procedures took less time as compared to Furlow's Z-plasty. Bleeding (N=2, 8%) and dehiscence (N=1, 4%) of the wound were the immediate post-operative complications found in the straight-line group. Bleeding was also present in the Furlow's group (N=1, 4%). At 1-month follow-up, in the straight-line group (N=3, 12%) patients had fistula while (N=2, 8%) had minimal nasal regurgitation of liquids when compared to the Furlow's group. At 3-month follow-up, patients in the straight-line procedure group (three out of N=25, 12%) exhibited fistula, whereas in the Furlow's group, fistula occurrence was observed in one out of N=25 participants (4%). Intra-operative soft palate lengthening was 6.44 ± 0.768 mm and 1.64 ± 0.952 mm in the Furlow and straight-line groups, respectively. Conclusion Furlow's Z-plasty was observed to be the better surgical procedure for cleft repair as it had low immediate post-operative complications, and fistula development and had higher intra-operative soft palate lengthening.
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Affiliation(s)
- Ravikumar Mahajan
- Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, IND
| | - Ankush Tambotra
- Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, IND
| | - Harish Ghildiyal
- Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, IND
| | - Mahipal Singh
- Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, IND
| | | | - Abhishek Bhamre
- Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, IND
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12
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Washington GN, Cepeda A, Moffitt J, Groff CK, Greives MR, Nguyen PD. Is the Message Clear? Evaluation of Readability Levels for Cleft Lip, Cleft Palate, and Craniofacial Websites. Cleft Palate Craniofac J 2023; 60:1619-1624. [PMID: 35788157 DOI: 10.1177/10556656221112672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Web-based health information is the leading source of medical knowledge for patients and families. The American Medical Association (AMA) and US Department of Health and Human Services recommend reading material be at or below a sixth-grade reading level. This study aimed to evaluate and compare the readability of the most popularly searched cleft lip and/or palate (CL/P) and other craniofacial syndrome (CFS) websites. Google searches for "cleft lip," "cleft palate," and "craniofacial syndromes" were performed to identify the top 40 websites in an incognito window with the location set to the United States. Flesch Reading Ease Score (FRES) was used to determine ease of reading from 0 (most difficult) to 100 (greatest ease of reading) and Flesch-Kincaid Reading Grade (FKGL) for website content and compared between websites using an FRES of 80 to 90 and FKGL of 6.0 to 6.9 for a sixth-grade reading level. Readability was low for all sites with 6 CL/P websites and no CFS websites at or below a sixth-grade reading level. CL/P websites had FRES readability scores of 58.5 ± 12.3 and were at a 9.4 ± 2.3 grade level. CFS websites had readability scores on the FRES of 39.8 ± 13.1 and were at a 10.8 ± 1.8 grade level. Web-based information related to CL/P and CFS is on average several grade levels above the recommended sixth-grade reading level. Online information for CL/P and CFS may need to be revised to improve understanding for the public and families.
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Affiliation(s)
- George N Washington
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Alfredo Cepeda
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Joseph Moffitt
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Connor K Groff
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Matthew R Greives
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Phuong D Nguyen
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
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13
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Siddig KA, Nazhat OM, Saleem NM, Hamadi IS, AlHashimi FA. Uncommon Finding of a Soft Palate Schwannoma: A Case Report. Cureus 2023; 15:e50172. [PMID: 38186499 PMCID: PMC10771807 DOI: 10.7759/cureus.50172] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Schwannomas are relatively slow-growing benign tumors of the nerve sheath. Approximately 25-40% of schwannomas occur in the head and neck region. However, schwannomas that present in the oral cavity are relatively rare, constituting around 1% of all described cases in the head and neck region. We report a case of a 20-year-old female who was found to have an intraoral palatal schwannoma. The patient presented with a painless swelling located on the right side of the soft palate. Investigations and management were commenced, and a computed tomography (CT) scan with contrast was done, which revealed cystic changes in a large soft palate mass lesion with a heterogeneous enhancement. The mass was surgically excised and sent for histopathological examination. The diagnosis of schwannoma was made due to the presence of the characteristic Antoni A and Antoni B areas. The immunohistochemical study done was positive for protein S-100. The postoperative follow-up went uneventful.
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Affiliation(s)
- Khulood A Siddig
- Department of Otorhinolaryngology, Dubai Academic Health Corporation, Dubai, ARE
| | - Omar M Nazhat
- Department of Otorhinolaryngology, Dubai Hospital, Dubai, ARE
| | - Nadia M Saleem
- Department of Medicine, Dubai Academic Health Corporation, Dubai, ARE
| | - Iyad S Hamadi
- Department of Otorhinolaryngology, Dubai Hospital, Dubai, ARE
| | - Fatma A AlHashimi
- Department of Otorhinolaryngology, Dubai Academic Health Corporation, Dubai, ARE
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14
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Lentskevich MA, Yau A, Figueroa AE, Termanini KM, Gosain AK. Speech Outcomes of Buccal Myomucosal Flap Palatal Lengthening for Treatment of Velopharyngeal Insufficiency: Systematic Literature Review and Meta-Analysis. Cleft Palate Craniofac J 2023:10556656231216834. [PMID: 37993983 DOI: 10.1177/10556656231216834] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Buccal myomucosal flaps (BMF) anatomically lengthen the palate in the treatment of velopharyngeal insufficiency (VPI). We systematically reviewed the existing literature on speech outcome of BMF palatal lengthening. DESIGN Three databases were used to identify studies of interest published in English. Studies that did not use standardized speech assessments were excluded. PRISMA checklist was followed, and the risk of bias in the included studies was assessed. SETTING Long-term follow up of patients. PATIENTS With history of cleft palate presenting with VPI. INTERVENTION BMF palatal lengthening. MAIN OUTCOME MEASURE Random-effects model meta-analyses were performed for hypernasality, intelligibility, and nasal air emission score improvements, which were derived from reported preoperative and postoperative scores, and controlled for variability of scales and timing of postoperative assessment. RESULTS From the initial 7115 articles, 13 were included in this review. Two of these had a significant patient overlap and a study with a smaller patient population was excluded. All 12 included articles met the National Institutes of Health Quality Assessment Tool criteria. Six retrospective studies evaluated 230 patients and six prospective studies evaluated 181 patients. The most common indications for BMF were large size of the velopharyngeal gap and prior surgery for VPI. Meta-analyses demonstrated effect sizes below zero, confirming the improvement of standardized assessment scores in patients with VPI after BMF palatal lengthening. Egger regressions revealed low risk of publication bias. CONCLUSIONS BMF palatal lengthening provides adequate treatment for VPI in patients with large velopharyngeal gap size and a history of prior unsuccessful surgery.
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Affiliation(s)
- Marina A Lentskevich
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Alice Yau
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Ariel E Figueroa
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Kareem M Termanini
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
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15
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Li P, Laudato M, Mihaescu M. Time-Dependent Fluid-Structure Interaction Simulations of a Simplified Human Soft Palate. Bioengineering (Basel) 2023; 10:1313. [PMID: 38002437 PMCID: PMC10669192 DOI: 10.3390/bioengineering10111313] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep-related disorder. It is characterized by recurrent partial or total collapse of pharyngeal upper airway accompanied by induced vibrations of the soft tissues (e.g., soft palate). The knowledge of the tissue behavior subject to a particular airflow is relevant for realistic clinic applications. However, in-vivo measurements are usually impractical. The goal of the present study is to develop a 3D fluid-structure interaction model for the human uvulopalatal system relevant to OSA based on simplified geometries under physiological conditions. Numerical simulations are performed to assess the influence of the different breathing conditions on the vibrational dynamics of the flexible structure. Meanwhile, the fluid patterns are investigated for the coupled fluid-structure system as well. Increasing the respiratory flow rate is shown to induce larger structural deformation. Vortex shedding induced resonance is not observed due to the large discrepancy between the flow oscillatory frequency and the natural frequency of the structure. The large deformation for symmetric breathing case under intensive respiration is mainly because of the positive feedback from the pressure differences on the top and the bottom surfaces of the structure.
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Affiliation(s)
- Peng Li
- Department of Engineering Mechanics, FLOW, KTH Royal Institute of Technology, 10044 Stockholm, Sweden;
| | - Marco Laudato
- Department of Engineering Mechanics, FLOW, KTH Royal Institute of Technology, 10044 Stockholm, Sweden;
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16
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Nunes HDSS, Vaz de Castro J, Favier V, Carsuzaa F, Kim MHR, Mira FA, Meccariello G, Vicini C, De Vito A, Lechien JR, Chiesa Estomba C, Maniaci A, Iannella G, Cammaroto G. Predictors of Success of Pharyngeal Surgery in the Treatment of Obstructive Sleep Apnea: A Narrative Review. J Clin Med 2023; 12:6773. [PMID: 37959237 PMCID: PMC10649816 DOI: 10.3390/jcm12216773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: This narrative review aims to explore the predictors of success for pharyngeal surgery in the treatment of obstructive sleep apnea (OSA). An extensive literature search was conducted, identifying relevant studies published up to June 2023, utilizing various databases and key search terms related to OSA, surgical interventions, and predictors of success. The review encompasses both retrospective and prospective studies, case series, and cohort studies to provide a broad understanding of the topic; (2) Methods: Review of English scientific literature on phenotypes of OSA related to predictors of success of pharyngeal surgery; (3) Results: Of 75 articles, 21 were included, in these the following were determined to be factors for surgical success: body mass index (BMI) (8 articles), apnea/hypopnea index (AHI) (8 articles), cephalometry (8 articles), palatine tonsil size (7 articles), Modified Mallampati score (2 articles), genioglossus electromyography (2 articles), Friedman score or upper airway anatomy (3 articles), nasopharyngolaryngoscopy (2 articles), drug-induced sleep endoscopy (DISE) (1 article), oral cavity anatomy (1 article) and oxygen desaturation index (ODI) (1 article); (4) Conclusions: The lack of standardized protocols for the indication of pharyngeal surgery is a reality, however identifying known predictors of surgical success may facilitate homogenizing indications.
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Affiliation(s)
- Heloisa dos Santos Sobreira Nunes
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo 04090-010, Brazil
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
| | - Joana Vaz de Castro
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, Armed Forces Hospital, 1649-026 Lisbon, Portugal
| | - Valentin Favier
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, University Hospital of Montpellier, 34080 Montpellier, France
| | - Florent Carsuzaa
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Marina He Ryi Kim
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo 04090-010, Brazil
| | - Felipe Ahumada Mira
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, Hospital of Linares, Linares 3582259, Chile
| | - Giuseppe Meccariello
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Jerome R. Lechien
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology and Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons, 7000 Mons, Belgium
| | - Carlos Chiesa Estomba
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of Otorhinolaryngology, Donostia University Hospital, Biodonostia Research Institute, Osakidetza, 20014 San Sebastian, Spain
| | - Antonino Maniaci
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Piazza Università 2, 95100 Catania, Italy
| | - Giannicola Iannella
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università 33, 00185 Rome, Italy
| | - Giovanni Cammaroto
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
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17
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Damalachervu MR, Yellinedi R, A D, Nuvvula R. 'Suspension Palatoplasty' - A new Method of Primary Palate Repair for Speaking Un-Repaired Clefts. Cleft Palate Craniofac J 2023:10556656231207554. [PMID: 37844610 DOI: 10.1177/10556656231207554] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To design a technique of palate repair with predictable Velo Pharyngeal (VP) closure and normal speech - 'Suspension Palatoplasty' in speaking unrepaired Cleft Palate (CP) patients. To evaluate the results of patients with CP operated using the technique of 'Suspension palatoplasty' from 2014 -2018 in terms of surgical complications and speech outcomes. DESIGN An ambi-spective longitudinal clinical study. SETTING Comprehensive cleft care clinic in a private trust hospital. PATIENTS/ PARTICIPANTS Patients above 6 years of age with isolated CP, cleft lip and palate (CLP), operated using 'Suspension Palatoplasty' technique between 2014 and 2018 were included with minimum follow up period of 5 years. Subjective speech evaluation was done by two speech therapists and analysed. INTERVENTION Author designed the technique of 'Suspension Palatoplasty' which aims to suspend the soft palate repaired by 'Hybrid Palatoplasty' technique, close to the nasopharynx using narrow pharyngeal flap with the pedicle based superiorly at adenoids, for an acceptable VP closure. MAIN OUTCOME MEASURES Speech outcome and surgical complications were assessed. RESULTS Out of 94 cases operated with age ranging from 6 to 45 years, 59 (62.8%) had normal speech, 12 (12.8%) had articulation errors but with no Velo-Pharyngeal Insufficiency (VPI) and 23 patients (24.4%) had hypernasality/ nasal emission (Suspected VPI). None of them had difficulty in breathing but one patient had snoring. CONCLUSION 'Suspension Palatoplasty' is a simple primary operation with excellent speech outcomes with no obstructive sequelae in patients with speaking unrepaired cleft palate.
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Affiliation(s)
- Mukunda Reddy Damalachervu
- Basavatarakam Smile Train Centre, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Rajesh Yellinedi
- Basavatarakam Smile Train Centre, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Dharanipriya A
- Basavatarakam Smile Train Centre, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Rambabu Nuvvula
- Basavatarakam Smile Train Centre, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
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18
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Robinson K, Mosley TJ, Rivera-González KS, Jabbarpour CR, Curtis SW, Adeyemo WL, Beaty TH, Butali A, Buxó CJ, Cutler DJ, Epstein MP, Gowans LJ, Hecht JT, Murray JC, Shaw GM, Uribe LM, Weinberg SM, Brand H, Marazita ML, Lipinski RJ, Leslie EJ. Trio-based GWAS identifies novel associations and subtype-specific risk factors for cleft palate. HGG Adv 2023; 4:100234. [PMID: 37719664 PMCID: PMC10502411 DOI: 10.1016/j.xhgg.2023.100234] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Cleft palate (CP) is one of the most common craniofacial birth defects; however, there are relatively few established genetic risk factors associated with its occurrence despite high heritability. Historically, CP has been studied as a single phenotype, although it manifests across a spectrum of defects involving the hard and/or soft palate. We performed a genome-wide association study using transmission disequilibrium tests of 435 case-parent trios to evaluate broad risks for any cleft palate (ACP) (n = 435), and subtype-specific risks for any cleft soft palate (CSP), (n = 259) and any cleft hard palate (CHP) (n = 125). We identified a single genome-wide significant locus at 9q33.3 (lead SNP rs7035976, p = 4.24 × 10-8) associated with CHP. One gene at this locus, angiopoietin-like 2 (ANGPTL2), plays a role in osteoblast differentiation. It is expressed both in craniofacial tissue of human embryos and developing mouse palatal shelves. We found 19 additional loci reaching suggestive significance (p < 5 × 10-6), of which only one overlapped between groups (chromosome 17q24.2, ACP and CSP). Odds ratios for the 20 loci were most similar across all 3 groups for SNPs associated with the ACP group, but more distinct when comparing SNPs associated with either subtype. We also found nominal evidence of replication (p < 0.05) for 22 SNPs previously associated with orofacial clefts. Our study to evaluate CP risks in the context of its subtypes and we provide newly reported associations affecting the broad risk for CP as well as evidence of subtype-specific risks.
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Affiliation(s)
- Kelsey Robinson
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | - Trenell J. Mosley
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | - Kenneth S. Rivera-González
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Christopher R. Jabbarpour
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Sarah W. Curtis
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos 101017, Nigeria
| | - Terri H. Beaty
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Azeez Butali
- Department of Oral Biology, Radiology, and Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Carmen J. Buxó
- School of Dental Medicine, University of Puerto Rico, San Juan, PR 00925, USA
| | - David J. Cutler
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | | | - Lord J.J. Gowans
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacqueline T. Hecht
- Department of Pediatrics, McGovern Medical School University of Texas Health at Houston, Houston, TX 77030, USA
| | - Jeffrey C. Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
| | - Lina Moreno Uribe
- Department of Orthodontics & The Iowa Institute for Oral Health Research, University of Iowa, Iowa City, IA 52242, USA
| | - Seth M. Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, and Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Harrison Brand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mary L. Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, and Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Robert J. Lipinski
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
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Kantar RS, Esenlik E, Al Abyad OS, Melhem A, Younan RA, Haddad M, Keith K, Kassam S, Annan B, Vijayakumar C, Picard A, Padwa BL, Sommerlad B, Raposo-Amaral CE, Forrest CR, Gillett DA, Steinbacher DM, Runyan CM, Tanikawa DYS, Chong DK, Fisher DM, Mark H, Canter HI, Losee JE, Patel KG, Hartzell LD, Johnson AB, Collares MVM, Alonso N, Chen PKT, Tse R, Mann RJ, Prada-Madrid JR, Kobayashi S, Hussain SA, Kummer A, Sell DA, Pereira VJ, Mabry K, Gonsoulin CK, Persson M, Davies G, Sethna NF, Munoz-Pareja JC, Kuijpers-Jagtman AM, Grayson BH, Grollemund B, Garib DG, Meazzini MC, Kharbanda OP, Santiago PE, Nalabothu P, Batra P, Stieber E, Prasad D, Brewster H, Ayala R, Erbay E, Akcam MO, Don Griot JPW, Vyas RM, Flores RL, Breugem CC, Hamdan US. The First Hybrid International Educational Comprehensive Cleft Care Workshop. Cleft Palate Craniofac J 2023; 60:1189-1198. [PMID: 35532040 DOI: 10.1177/10556656221097820] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. DESIGN Cross-sectional survey-based evaluation. SETTING International comprehensive cleft care workshop. PARTICIPANTS Total of 489 participants. INTERVENTIONS Three-day simulation-based hybrid comprehensive cleft care workshop. MAIN OUTCOME MEASURES Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. RESULTS The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). CONCLUSION Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.
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Affiliation(s)
- Rami S Kantar
- Global Smile Foundation, Norwood, USA
- The University of Maryland Medical System/Shock Trauma, Baltimore, USA
- Amsterdam University Medical Center, Department of Plastic and Reconstructive Surgery, Amsterdam, the Netherlands
| | - Elçin Esenlik
- Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | | | | | | | | | | | - Serena Kassam
- Global Smile Foundation, Norwood, USA
- British Columbia Children's Hospital, Vancouver, Canada
| | | | - Charanya Vijayakumar
- Global Smile Foundation, Norwood, USA
- Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
| | - Arnaud Picard
- Université de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Bonnie L Padwa
- Children's Hospital and Harvard Medical School, Boston, USA
| | - Brian Sommerlad
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Christopher R Forrest
- Division of Plastic and Reconstructive Surgery, The University of Toronto and Hospital for Sick Children, Toronto, Canada
| | - David A Gillett
- Division of Plastic and Reconstructive Surgery, Perth Children's Hospital, Perth, Australia
| | - Derek M Steinbacher
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, USA
| | | | - Daniela Y S Tanikawa
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês and Departamento de Fissura Lábio Palatina, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | - David M Fisher
- Division of Plastic and Reconstructive Surgery, The University of Toronto and Hospital for Sick Children, Toronto, Canada
| | - Hans Mark
- Sahlgrenska University Hospital and Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Joseph E Losee
- Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Krishna G Patel
- Global Smile Foundation, Norwood, USA
- University of South Carolina, Charleston, USA
| | - Larry D Hartzell
- The University of Arkansas for Medical Sciences, Little Rock, USA
| | - Adam B Johnson
- Global Smile Foundation, Norwood, USA
- The University of Arkansas for Medical Sciences, Little Rock, USA
| | - Marcus Vinícius Martins Collares
- Plastic and Craniomaxillofacial Surgery Division, School of Medicine, Rio Grande do Sul Federal University, Porto Alegre, Brazil
| | | | | | - Raymond Tse
- University of Washington and Seattle Children's Hospital, Seattle, USA
| | - Robert J Mann
- Division of Pediatric Plastic Surgery, Spectrum Health Medical Group, Michigan State College of Human Medicine, Grand Rapids, USA
| | | | | | - Syed Altaf Hussain
- Cleft and Craniofacial Center, Sri Ramachandra University, Chennai, India
| | - Ann Kummer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Debbie A Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), London, UK
| | - Valerie J Pereira
- Division of Speech Therapy, Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelly Mabry
- Division of Speech Pathology/Craniofacial, Connecticut Children's Medical Center, Hartford, USA
| | | | - Martin Persson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Gareth Davies
- European Cleft and Craniofacial Initiative for Equality in Care, European Cleft Organization, the Netherlands
| | - Navil F Sethna
- Global Smile Foundation, Norwood, USA
- Critical Care and Pain Medicine, Boston Children's Hospital, Boston, USA
| | - Jennifer C Munoz-Pareja
- Global Smile Foundation, Norwood, USA
- University of Miami Miller School of Medicine, Miami, USA
| | - Anne Marie Kuijpers-Jagtman
- University Medical Centre Groningen, Groningen, the Netherlands
- School of Dental Medicine, Medical Faculty, University of Bern, Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Barry H Grayson
- The Hansjörg Department of Plastic Surgery, New York University Langone Health, New York City, USA
| | - Bruno Grollemund
- Cleft Competence Center, Strasbourg University Hospital, Strasbourg, France
| | - Daniela G Garib
- Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), São Paulo, Brazil
| | | | - Om P Kharbanda
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Prasad Nalabothu
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Puneet Batra
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | | | | | - Ruben Ayala
- Operation Smile, Virginia Beach and The G4 Alliance, Chicago, USA
| | - Elif Erbay
- Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - M Okan Akcam
- Faculty of Dental Medicine, Ankara University, Ankara, Turkey
| | - J Peter W Don Griot
- Amsterdam University Medical Center, Department of Plastic and Reconstructive Surgery, Amsterdam, the Netherlands
| | - Raj M Vyas
- Global Smile Foundation, Norwood, USA
- University of California, Irvine, Department of Plastic and Reconstructive Surgery, California, USA
| | - Roberto L Flores
- The Hansjörg Department of Plastic Surgery, New York University Langone Health, New York City, USA
- Smile Train, New York City, USA
| | - Corstiaan C Breugem
- Amsterdam University Medical Center, Department of Plastic and Reconstructive Surgery, Amsterdam, the Netherlands
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Abstract
Benign salivary gland tumors are rarely found in children and adolescents compared with adults. Pleomorphic adenomas (PAs), the most common benign salivary gland tumor, account for only 1% of all head and neck lesions and fewer than 5% of all salivary gland tumors in individuals under the age of 16 years. The data on palatal PA in the first 2 decades of life is confined to published case reports and case series. To date, there has never been a report of palatal PA in a patient with cleft lip and palate. Here we describe an adolescent female with bilateral cleft lip and palate with PA of the hard and soft palate who underwent wide local excision and reconstruction with a buccal fat pad and buccal myo-mucosal flap.
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Affiliation(s)
| | - Alison Kaye
- Division of Plastic and Craniofacial Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michael Lypka
- Division of Plastic and Craniofacial Surgery, Children's Mercy Hospital, Kansas City, MO, USA
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21
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Mahdy MAA, Mohamed SA, Abdalla KEH. Morphology of the soft palate and palatine tonsil of the goat (Capra hyricus). Microsc Res Tech 2023; 86:1091-1098. [PMID: 37191111 DOI: 10.1002/jemt.24346] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/04/2023] [Accepted: 05/06/2023] [Indexed: 05/17/2023]
Abstract
The present study was carried out to study the morphology of the goat's soft palate and palatine tonsil by gross anatomy, morphometry, light and scanning electron microscopy (SEM). Twelve heads of normal adult (18-24 months) apparently healthy goats of both sexes were collected from local commercial slaughterhouses in Qena Governorate, Egypt. The oral cavity was dissected, and samples were collected for both light and SEM. The soft palate of the goat formed the caudal continuation of the hard palate. It was relatively short, it extended from the level of the caudal border of the last upper molar tooth to terminate caudally against the base of the epiglottis. The oral mucous membrane of the soft palate was covered by non-keratinized stratified squamous epithelium. The lamina propria and submucosa contained connective tissue fibers, diffuse and nodular lymphatic tissue, striated muscle fibers, and a large number of mucous and serous palatine glands. By SEM, the ventral surface had several rounded openings occupied by flower-like structures. These openings represented the entrances to the palatine glands. The palatine tonsil was large and protruded from a fossa in the lateral wall of the oropharynx. It had 2-3 elongated irregular openings that lead to the underlying crypts. These crypts were well-developed and lined by non-keratinized stratified squamous epithelium. The epithelium of the tonsillar crypts directly covered lymphoid tissue and was infiltrated by lymphocytes. Tonsillar glands of pure mucous type were demonstrated. In conclusion, the study provides the basic morphological features of soft palate, as well as the palatine tonsil of the goat by gross observation, light and SEM. The palatine tonsils of goat were well-developed with extensive crypt system, suggesting their essential role in the immunological response against antigens that enter through the oral cavity. The current findings may be useful to understand the role of the palatine tonsil in immunity and disease pathogenesis. RESEARCH HIGHLIGHTS: The study reported the basic morphological features of soft palate and palatine tonsil of goat. The ventral surface of the soft palate had several rounded openings occupied by flower-like structures. The palatine tonsils of goat were well-developed with extensive crypt system. The findings might help to understand the role of the palatine tonsil in immunity and disease pathogenesis.
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Affiliation(s)
- Mohamed A A Mahdy
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, King Salman International University, Ras Sudr, Egypt
| | - Salma A Mohamed
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Kamal E H Abdalla
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
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22
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Nnko KA, Rwakatema DS, Mariki JM, Baraka CJ, Pima RT, Damas S, Mremi A. Management of a giant pleomorphic adenoma of the soft palate: A case report. Clin Case Rep 2023; 11:e7786. [PMID: 37564605 PMCID: PMC10410117 DOI: 10.1002/ccr3.7786] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
Key Clinical Message Benign mixed salivary gland tumor is comprised of epithelial and myoepithelial cells and represents up to 80% of tumors of the parotid gland. It is relatively rare in the soft palate and in other minor salivary glands. Surgery is the standard care. Abstract Salivary gland tumors are relatively rare and morphologically diverse group of lesions. Pleomorphic adenoma (PA) is the most common salivary gland tumor, accounting for approximately 80% of all major and minor salivary gland tumors. PA usually affects the parotid gland. Huge PA occurring in soft palate is extremely rare. Patients with these tumors are usually between at the age of 40 and 60 years. The tumors exhibit pleomorphic nature microscopically that may pose diagnostic challenges to pathologists as may confuse PA histopathologically with other salivary gland tumors. Surgery is the standard treatment. The purpose of writing this case study is to describe unusual case of a giant PA of the soft palate found in a 44-year-old male successfully managed at our facility.
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Affiliation(s)
- Kanankira A. Nnko
- Department of DentistryKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Deogratius S. Rwakatema
- Department of DentistryKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Jackson M. Mariki
- Department of DentistryKilimanjaro Christian Medical CentreMoshiTanzania
| | - Calvin J. Baraka
- Department of DentistryKilimanjaro Christian Medical CentreMoshiTanzania
| | - Raphael T. Pima
- Department of DentistryKilimanjaro Christian Medical CentreMoshiTanzania
| | - Sosthenes Damas
- Department of DentistryKilimanjaro Christian Medical CentreMoshiTanzania
| | - Alex Mremi
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of PathologyKilimanjaro Christian Medical CentreMoshiTanzania
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23
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Pérez López P, Café Marçal V, Leece EA, Hattersley RD. Assessment of the number of mast cells in the soft palate of dogs affected by brachycephalic obstructive airway syndrome. Vet Rec 2023; 193:e2833. [PMID: 36951103 DOI: 10.1002/vetr.2833] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/29/2023] [Accepted: 02/28/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Oedema is described in the soft palate of dogs affected by brachycephalic obstructive airway syndrome (BOAS). Activated mast cells (MCs) release vasoactive mediators that temporarily increase vascular permeability. METHODS Data and caudal soft palate tissue were prospectively collected from a population of dogs undergoing surgical management of BOAS and a control group of greyhound cadavers with no previous history of respiratory signs. Histological assessment was performed to quantify the number of MCs within the lamina propria of each group. RESULTS The mean number of MCs in the BOAS group (53 MCs/10 400× high-power fields [HPF]; standard deviation [SD] = 23) was significantly greater than that in the greyhound group (24 MCs/10 400×HPF; SD = 10). LIMITATIONS The small size of the control group and the heterogeneous nature of the dogs in the BOAS group limit the generalisability of the findings. The use of different surgical techniques in the BOAS group may have also affected the degree of inflammation present within the samples. The cohort was not screened for concurrent disease processes that could potentially increase the number of circulating MCs. CONCLUSION This study demonstrated a statistically significant difference between the numbers of MCs in the soft palate of brachycephalic dogs with clinically significant BOAS and the greyhound control group.
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Affiliation(s)
| | - Valéria Café Marçal
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
- IDEXX Laboratories, Westbrook, Maine, USA
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24
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Weigelt MA, Franklin MJ, Mathur D, Billings SD, Ronen S. Pseudoxanthoma-elasticum-like changes on the soft palate. J Cutan Pathol 2023. [PMID: 37150825 DOI: 10.1111/cup.14445] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
Pseudoxanthoma elasticum (PXE) is an autosomal recessive genetic disorder characterized by aberrant fragmentation and calcification of elastic fibers, leading to characteristic cutaneous, ophthalmic, and cardiovascular manifestations. PXE demonstrates significant phenotypic variability; involvement of the oral mucosa may be the only clue to the diagnosis. Reports on mucous membrane involvement in PXE are scarce. Here, we present a case of PXE-like changes in the oral cavity. A 70-year-old male patient presented with a painless leukoplakic lesion on the soft palate. Biopsy revealed numerous degenerated fibers in the lamina propria. Verhoeff-van Gieson and von Kossa staining confirmed their identity as calcified elastic fibers. A histopathological diagnosis of PXE-like changes was made; the patient was referred to ophthalmology where angioid streaks were visualized fundoscopically. PXE-like changes in the absence of the characteristic genetic mutation have also been reported with or without systemic manifestations. Furthermore, PXE-like changes have been reported in up to 10% of oral biopsy specimens undertaken without clinical suspicion for PXE. Therefore, the significance of such changes in isolation is unclear. Clinicians and pathologists should be aware of the potential oral manifestations of PXE to facilitate prompt diagnosis and subspecialist referral.
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Affiliation(s)
| | - Matthew J Franklin
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Deepan Mathur
- Department of Pathology, Sharon Regional Medical Center, Sharon, Pennsylvania, USA
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shira Ronen
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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25
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Fuller C, Reed Gardner J, Speed O, Thomason A, Zaniletti I, Buckmiller L, Johnson A, Hartzell L. Outcomes After Pharyngeal Flap Surgery in Children: A Comparison of Lined Versus Unlined Flaps. Cleft Palate Craniofac J 2023:10556656231172642. [PMID: 37143290 DOI: 10.1177/10556656231172642] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution. DESIGN Retrospective cohort study. SETTING Tertiary children's hospital. PATIENTS Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017. OUTCOME MEASURES We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA). RESULTS 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p = 0.037) and more likely to have cleft palate (63/119 vs 14/41; p = 0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p = 0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p = 0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p = 0.032). PSA scores were found to be lower (less hypernasal) after PFU (p = 0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p = 0.001), while PFT (p = 0.525) did not demonstrate a statistical difference. CONCLUSION The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications.
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Affiliation(s)
- Colin Fuller
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - J Reed Gardner
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Olivia Speed
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ashlen Thomason
- Department of Audiology and Speech-Language Pathology, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Lisa Buckmiller
- Department of Ear, Nose and Throat, Cook Children's Hospital, Fort Worth, TX, USA
| | - Adam Johnson
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Larry Hartzell
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, AR, USA
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26
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Amin MA, Shawon TA, Shaon NK, Nahin S, Fardous J, Hawlader MDH. A case of Pierre Robin syndrome in a child with no soft palate and complications from pneumonia in Bangladesh. Clin Case Rep 2023; 11:e7350. [PMID: 37205152 PMCID: PMC10185733 DOI: 10.1002/ccr3.7350] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023] Open
Abstract
Key Clinical Message Children with Pierre Robin syndrome (PRS) often have trouble breathing and eating as soon as they are born. If conservative therapy fails to alleviate airway obstruction, surgical surgery may be considered. Patients with PRS require multidisciplinary approaches for treatment. Abstract Pierre Robin syndrome is a common craniofacial abnormality that causes glossoptosis and blockage of the upper airway. This renders it difficult to feed, which leads to severe malnutrition. This condition is also often marked by an absence of a soft palate. We mention a newborn with Pierre Robin syndrome with the absence of a soft palate and pneumonia complications, whose impending respiratory failure was treated successfully. To solve the complex problems that these babies and their families are facing, a multidisciplinary approach is needed.
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Affiliation(s)
- Mohammad Ashraful Amin
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Public Health Professional Development Society (PPDS)DhakaBangladesh
| | - Taraque Ahamed Shawon
- Department of Pediatric, Maternal and Child Health Training Institute (MCHTI)Ministry of Health and Family WelfareDhakaBangladesh
| | - Naushad Khan Shaon
- Department of AnesthesiaBangabandhu Sheikh Mujib Medical University HospitalDhakaBangladesh
| | - Sabrina Nahin
- Department of PhysiologyGreen Life Medical College HospitalDhakaBangladesh
| | - Jannatul Fardous
- Department of Paediatric NephrologyNational Institute of Kidney Diseases & Urology (NIKDU)DhakaBangladesh
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27
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Frawley G, Wilkes C, Hallett B, Chong D. Prediction of Early Postoperative Pain in Infants Undergoing Primary Cleft Palate Repair. Cleft Palate Craniofac J 2023:10556656231172303. [PMID: 37101364 DOI: 10.1177/10556656231172303] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVE Identification of at risk patients before surgery could facilitate improved clinical communication, care pathways and postoperative pain management. DESIGN A retrospective cohort study was performed in all infants who had undergone cleft palate repair. SETTING Tertiary Institutional. PARTICIPANTS Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and July 2022. INTERVENTION Requirement for analgesic intervention in the post operative care unit. MAIN OUTCOME MEASURE Adverse perioperative event defined as pain or distress. Secondary outcomes were the incidence of airway obstruction, hypoxemia or unplanned intensive care admission. RESULTS Two hundred and ninety one patients (14.6 months,10.1 kg weight) were included. Cleft distribution included submucous (5.2%), Veau I (23.4%), Veau 2 (38.1%), Veau 3 (24.4%), and Veau 4 (8.9%). Overall 35% of 291 infants undergoing cleft palate repair experienced pain or distress requiring opiate intervention in the first hour after surgery. Infants with a Veau 4 cleft palate had 1.8 times and Veau 2 cleft palate had 1.5 times the risk of postoperative pain compared to infants with Veau 1 cleft palate (relative risk 1.82, 95%CI 1.04-3.18 and 1.49, 95%CI 0.96-2.32 respectively). The use of bilateral above elbow arm splints was significantly associated with postoperative pain or distress (odds ratio 2.23, 95%CI 1.01-5.16). CONCLUSIONS Post operative pain requiring intervention in PACU is common despite adequate intraoperative multimodal analgesia, local anaesthesia infiltration and postoperative opiate infusions. Infants undergoing soft palate alone or submucous palate repair may require less perioperative opiates.
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Affiliation(s)
- Geoff Frawley
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Critical Care and Neurosciences Theme, Parkville, Australia
| | - Courtney Wilkes
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia
| | - Ben Hallett
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Australia
| | - David Chong
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia
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28
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Kumar N, Gothwal RS, Lakhera KK, Chatterjee A, Singh S, Sharma RG, Patel P. Can a diagnosis of Leiomyosarcoma soft palate be missed in the era of commoner oral carcinomas? - Rare case report and review of literature. J Cancer Res Ther 2023; 19:835-838. [PMID: 37470623 DOI: 10.4103/jcrt.jcrt_1024_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Leiomyosarcomas (LMSs) of the head and neck are an extremely rare entity. Of all smooth muscle tumors, 4%-10% occur in the head and neck and only 0.06% in the oral cavity. Because of its infrequency, it has been associated with both delayed diagnosis and misdiagnosis. Here, we report the clinicopathological findings of a case of primary LMS of the soft palate in a 42-year-old male patient with an emphasis on the judicious use of ancillary diagnostic modalities to arrive at a definitive diagnosis. Intraorally, LMSs present as painless, lobulated, fixed masses of the submucosal tissues in middle-aged or older individuals. The treatment modalities and lymph nodal dissection criteria are dissimilar to more common oral carcinomas. Hence, definitive diagnosis is necessary.
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Affiliation(s)
- Naina Kumar
- Department of Surgical Oncology, SMS Medical College, Jaipur, Rajasthan, India
| | | | | | | | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College, Jaipur, Rajasthan, India
| | - Raj Govind Sharma
- Department of Surgical Oncology, SMS Medical College, Jaipur, Rajasthan, India
| | - Pinakin Patel
- Department of Surgical Oncology, SMS Medical College, Jaipur, Rajasthan, India
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Badaoui JN, Choby G, McMillan RA, Goates AJ, Cofer SA. Triple Layer Oronasal Fistula Repair Using Local Endonasal Flaps: Case Series of Three Patients. Cleft Palate Craniofac J 2023; 60:359-366. [PMID: 35244480 DOI: 10.1177/10556656211062040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect.
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Affiliation(s)
- Joseph N Badaoui
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan A McMillan
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Goates
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Shelagh A Cofer
- Department of Otorhinolaryngology - Head and Neck Surgery, 6915Mayo Clinic, Rochester, Minnesota, USA
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Kimia R, Solot CB, McCormack SM, Cohen M, Blum JD, Villavisanis DF, Vora N, Valenzuela Z, Taylor JA, Low DW, Jackson OA. Speech Outcomes Following Operative Management of Velopharyngeal Dysfunction (VPD) in Non-Syndromic Post-Palatoplasty Cleft Palate Patients. Cleft Palate Craniofac J 2023:10556656231154808. [PMID: 36749038 DOI: 10.1177/10556656231154808] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Approximately 30% of patients with a history of repaired cleft palate (CP) go on to suffer from velopharyngeal dysfunction (VPD). This study discusses the operative management of VPD and postoperative speech outcomes in a cohort of CP patients. SETTING An academic tertiary pediatric care center. METHODS Retrospective cohort study. PATIENTS Patients with history of repaired CP (Veau I-IV) who underwent operative management of VPD between January 1st, 2010 and December 31st, 2020. Operative modalities were posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), Furlow palate re-repair, and buccal myomucosal flap palate lengthening (PL). OUTCOME MEASURES The primary outcome measure is postoperative speech improvement evaluated by the Pittsburgh Weighted Speech Scale (PWSS). RESULTS 97 patients met inclusion criteria. 38 patients with previous straight-line primary palatoplasty underwent Furlow re-repair; these patients were significantly younger (7.62 vs 11.14, P < .001) and were more likely to have severe VPD per PWSS (OR 4.28, P < .01, 95% CI 1.46-12.56) when compared to VPD patients with previous Furlow repair. 21.1% of these patients required an additional non-revisional VPD procedure. The remaining patients underwent a non-revision procedure (26 PPF, 22 SPP, 11 PL); all experienced significant (P < .001 on paired t-test) reductions in PWSS total and subgroup VPD severity scores without difference in improvement between operation types. SPP was statistically associated with all-cause complication (OR 2.79, 95% CI 1.03-7.59, P < .05) and hyponasality (OR 3.27, 95% CI 1.112-9.630, P < .05). CONCLUSION Furlow re-repair reduced need for additional VPD operations. Speech outcomes between non-revisional operations are comparable, but increased complications were seen in SPP.
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Affiliation(s)
- Rotem Kimia
- Division of Plastic and Reconstructive Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Cynthia B Solot
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Speech-Language Pathology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan M McCormack
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Speech-Language Pathology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marilyn Cohen
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Speech-Language Pathology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica D Blum
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dillan F Villavisanis
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nisha Vora
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary Valenzuela
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David W Low
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Oksana A Jackson
- Division of Reconstructive and Plastic Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Su T, Li C, Zhang Y, Yue L, Chen Y, Qian X, Shi S. Upregulation of HMGB1 promotes vascular dysfunction in the soft palate of patients with obstructive sleep apnea via the TLR4/NF-κB/VEGF pathway. FEBS Open Bio 2023; 13:246-256. [PMID: 36479843 PMCID: PMC9900083 DOI: 10.1002/2211-5463.13533] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by the collapse of the soft palate in the upper airway, resulting in chronic intermittent hypoxia during sleep. Therefore, an understanding of the molecular mechanisms underlying pathophysiological dysfunction of the soft palate in OSA is necessary for the development of new therapeutic strategies. In the present study, we observed that high mobility group protein box 1 (HMGB1) was released by a large infiltration of macrophages in the soft palate of OSA patients. The toll-like receptor 4/nuclear factor kappa B pathway was observed to be activated by the release of HMGB1, and this was accompanied by an increased expression of pro-inflammatory factors, including tumor necrosis factor-α and interleukin-6. Importantly, increased expression of toll-like receptor 4 was observed in endothelial cells, contributing to upregulation of the angiogenesis-related factors vascular endothelial-derived growth factor and matrix metalloproteinase 9. Moreover, we confirmed the effect of the HMGB1-mediated toll-like receptor 4/nuclear factor kappa B pathway on cell proliferation and angiogenesis in an in vitro cell model of human umbilical vein endothelial cells. We conclude that HMGB1 may be a potential therapeutic target for preventing angiogenesis and pathology in OSA.
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Affiliation(s)
- Tiantian Su
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
| | - Cong Li
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
| | - Yu Zhang
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
| | - Lei Yue
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
| | - Yuqin Chen
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
| | - Xiaoqiong Qian
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
| | - Song Shi
- ENT DepartmentTongren Hospital, Shanghai Jiao Tong University School of MedicineChina
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Hirai H, Kayamori K, Noji R, Kuroshima T, Ikeda T, Harada H. A rare case of solitary intraoral superficial angiomyxoma arising in the soft palate. J Oral Sci 2023; 65:69-71. [PMID: 36385052 DOI: 10.2334/josnusd.22-0334] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Superficial angiomyxomas are myxoid mesenchymal tumors, and intraoral superficial angiomyxoma is extremely rare. This paper reports a novel case of a 41-year-old Japanese male patient with a 32 × 22 mm superficial angiomyxoma in the right soft palate. Tumor resection was performed and a polyglycolic acid sheet was attached. Over a 28-month follow-up, there was no evidence of disease recurrence. This paper also reviewed 11 cases of intraoral superficial angiomyxomas reported in previous literature. The condition was more common among middle-aged men. Surgical resection was the most common treatment, and local recurrence was observed in only one case.
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Affiliation(s)
- Hideaki Hirai
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Kou Kayamori
- Department of Oral Pathology, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Rika Noji
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Takeshi Kuroshima
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Ikeda
- Department of Oral Pathology, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Maina G, Pollock D, Lockwood C, Cook L, Ooi E. Managing Chronic otitis media with Effusion in Children with non-Syndromic Cleft Palate: Short-Term Ventilation Tubes Versus Surveillance. Cleft Palate Craniofac J 2023:10556656221148368. [PMID: 36600676 DOI: 10.1177/10556656221148368] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of short-term ventilation tubes compared to surveillance on conductive hearing loss in children with non-syndromic orofacial clefting involving the muscular palate. INTRODUCTION Chronic otitis media with effusion is a common finding in children with cleft palate. The accepted convention is insertion of short-term ventilation tubes at the time of palate repair, but some centres are choosing conservative management. Each approach has its advantages but there is currently no consensus on the most appropriate management in children with non-syndromic cleft palate. INCLUSION CRITERIA Children <18 years with cleft lip and palate, or isolated cleft palate, not associated with a genetic syndrome, who have been diagnosed with chronic otitis media with effusion. METHODS A systematic search of MEDLINE, CINAHL, Embase and Scopus databases was conducted. Grey literature searches were conducted through Central Register of Controlled Trials, Clinicaltrials.gov and ProQuest. Two reviewers screened the studies, conducted critical appraisal, assessed the methodological quality, and extracted the data. Where possible, studies were pooled in statistical meta-analysis with heterogeneity being assessed using the standard Chi-squared and I2 tests. RESULTS Four studies met the inclusion criteria but were of low quality with a moderate risk of bias. Only data on hearing thresholds could be pooled for analysis which found no statistically significant difference. Other outcomes were presented in narrative form. Certainty of evidence for all outcomes was deemed low to very low using GRADE criteria. CONCLUSIONS No definitive conclusions can be drawn regarding most effective management at improving conductive hearing loss. Missing data and inconsistent reporting of outcomes limited capacity for pooled analysis.
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Affiliation(s)
- Grace Maina
- JBI, Faculty of Health and Medical Sciences, 1066The University of Adelaide, Adelaide, Australia
- Department of Otolaryngology and Head and Neck Surgery, 14351Flinders Medical Centre, Adelaide, Australia
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, 1066The University of Adelaide, Adelaide, Australia
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, 1066The University of Adelaide, Adelaide, Australia
| | - Lachlan Cook
- JBI, Faculty of Health and Medical Sciences, 1066The University of Adelaide, Adelaide, Australia
- Department of Otolaryngology and Head and Neck Surgery, 14351Flinders Medical Centre, Adelaide, Australia
| | - Eng Ooi
- Department of Otolaryngology and Head and Neck Surgery, 14351Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Green J, Lignieres A, Obinero CG, Nguyen PD, Greives MR. Repeat Buccal Flaps Successfully Reduce Hypernasality in a Patient with Cleft Palate. Cleft Palate Craniofac J 2023:10556656221149520. [PMID: 36594190 DOI: 10.1177/10556656221149520] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Surgical intervention can contribute to the development of velopharyngeal insufficiency (VPI) leading to hypernasality and regurgitation. In this case, a patient with a history of bilateral buccal flaps used for her primary CP repair presented to clinic with hypernasality and VPI as assessed by speech exam and imaging. She underwent repeat bilateral buccal flap palatal lengthening with division of the pedicles 3 months later. Three months after her division, her hypernasality score improved from moderate to mild and her posterior gap decreased. This study concluded buccal flaps can be used a second time for patients needing palatal revisions for VPI.
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Affiliation(s)
- Jackson Green
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Austin Lignieres
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chioma G Obinero
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Phuong D Nguyen
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Matthew R Greives
- Division of Plastic Surgery, Department of Surgery, 12339McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
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35
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Knyazkov VB, Prazdnikov EN, Daikhes NA. [Optimization of laser exposure parameters during surgical correction of soft palate tissues in patients with ronchopathy and obstructive sleep apnea syndrome]. Vestn Otorinolaringol 2023; 88:34-40. [PMID: 37970768 DOI: 10.17116/otorino20238805134] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Substantiation of optimization of laser radiation parameters when performing surgery on the soft palate to improve the results of treatment of patients with ronchopathy and obstructive sleep apnea syndrome. MATERIAL AND METHODS Based on the experience of performing laser sculptural uvulopalatoplasty in 309 patients with ronchopathy and obstructive sleep apnea syndrome, a rational choice of parameters of laser radiation used during the operation is justified. RESULTS Optimization of laser radiation parameters during laser sculptural uvulopalatoplasty allowed to improve the positive results of treatment of patients with ronchopathy and obstructive sleep apnea syndrome in 98.4% of cases (304 out of 309 operated patients). CONCLUSION Optimization of laser radiation parameters when performing laser sculptural uvulopalatoplasty increases the effectiveness of treatment of patients with ronchopathy and obstructive sleep apnea syndrome.
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Affiliation(s)
- V B Knyazkov
- Rehabilitation clinic in Khamovniki, Moscow, Russia
| | - E N Prazdnikov
- Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russia, Moscow, Russia
| | - N A Daikhes
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia
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Saluja IP, Bhargava A, Bhargava A, Hiremutt DRP, Saxena S, Agrawal A. Application of Berlin questionnaire in obstructive sleep apnea syndrome through soft palate morphology types. J Educ Health Promot 2022; 11:377. [PMID: 36618455 PMCID: PMC9818753 DOI: 10.4103/jehp.jehp_555_22] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a sleep disorder characterized by intermittent complete and partial airway collapse, resulting in frequent episodes of apnea and hypopnea. The Berlin questionnaire (BQ) is a simple, inexpensive instrument used to screen for OSA, which is about risk factors for sleep apnea, namely, snoring behavior, daytime sleepiness or fatigue, and the presence of obesity or hypertension. This 10-question test has since then become well known for its accuracy in predicting the presence of sleep apnea in patients. Cephalometry is a relatively inexpensive method and it permits a good assessment of the soft tissue elements that define the soft palate and its surrounding structures. Therefore, the present study aims to study the morphology of the soft palate using lateral cephalometry and classify it into various types. And to identify the individuals with OSA syndrome through a particular type of soft palate and correlate it with the BQ. MATERIAL AND METHODS This prospective study was conducted in the Department of Oral Medicine and Radiology of D.Y.Patil Dental College, Pune. About 150 subjects for the study were selected by random sampling from the outpatient department of Oral Medicine and Radiology and the patients were referred from the orthodontics department. Lateral cephalograms were assessed for soft palate morphology types, and all participants filled the BQ. A Chi-square test was applied. The level of significance was set at P < 0.05. RESULTS Among six types of the soft palate, the maximum number of participants had type 2 (rat-tail type) of the soft palate (26.0%). A highly significant association was found between the BQ (positive and negative response) and soft palate morphology types (i.e., P < 0.01). A maximum number of participants who responded to the BQ had type 5 (S type) of the soft palate (76.47%). CONCLUSION The type 2 (rat-tail) soft palate was the most frequent type, while the type 4 (straight-line) shape was the least common among all the six types. The persons with type 5 (S-shape) soft palate responded more positively to the BQ as compared to other types of soft palate. This shows that a particular type of soft palate could be responsible for causing OSA syndrome. CLINICAL SIGNIFICANCE Lateral cephalogram and BQ, which are relatively inexpensive and widely available, can be used in resource-limited and thickly populated countries like India to correctly identify patients with OSA syndrome.
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Affiliation(s)
- Imit P. Saluja
- MDS, Oral Medicine and Radiology, Associate Professor (Department of Dentistry), Ruxmaniben Deepchand Gardi Medical College, Ujjain (M.P), India
| | - Ananya Bhargava
- MDS, Orthodontics and Dentofacial Orthopedics, Senior Resident (Department of Dentistry), Ruxmaniben Deepchand Gardi Medical College, Ujjain (M.P), India
| | - Apoorva Bhargava
- MDS, Conservative Dentistry and Endodontics, Consultant Endodontist, Delhi, India
| | - Darshan R. Prasad Hiremutt
- MDS, Oral Medicine and Radiology, Assistant Professor, Bharati Vidhyapeeth Dental College and Hospital, Pune (Maharashta), India
| | - Shobhit Saxena
- MDS, Orthodontics and Dentofacial Orthopedics, Professor, College of Dental Sciences and Hospital, Bhavnagar (Gujarat) India
| | - Anagha Agrawal
- MDS, Public Health Dentistry, Reader, College of Dental Sciences and Hospital, Bhavnagar (Gujarat) India
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Lee MK, Liu C, Leslie EJ, Shaffer JR, Perry JL, Weinberg SM. Heritability Analysis in Twins Indicates a Genetic Basis for Velopharyngeal Morphology. Cleft Palate Craniofac J 2022; 59:1340-1345. [PMID: 34605288 PMCID: PMC9710355 DOI: 10.1177/10556656211045530] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The velopharyngeal mechanism is comprised of several muscular components that act in a coordinated manner to control airflow through the nose and mouth. Proper velopharyngeal function is essential for normal speech, swallowing, and breathing. The genetic basis of normal-range velopharyngeal morphology is poorly understood. The purpose of this study was to estimate the heritability of velopharyngeal dimensions. We measured five velopharyngeal variables (velar length, velar thickness, effective velar length, levator muscle length and pharyngeal depth) from MRIs of 155 monozygotic and 208 dizygotic twin pairs and then calculated heritability for these traits using a structural equation modeling approach. The heritability estimates were statistically significant (95% confidence intervals excluded zero) and ranged from 0.19 to 0.46. There was also evidence of significant genetic correlations between pairs of traits, pointing to the influence of common genetic effects. These results indicate that genetic factors influence variation in clinically relevant velopharyngeal structures.
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Affiliation(s)
- Myoung Keun Lee
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, 212605University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - Chenxing Liu
- Department of Human Genetics, 51303University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Elizabeth J Leslie
- Department of Human Genetics, 1371Emory University, Atlanta, GA, 30322, USA
| | - John R Shaffer
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, 212605University of Pittsburgh, Pittsburgh, PA, 15219, USA.,Department of Human Genetics, 51303University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, 27834, USA
| | - Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, 212605University of Pittsburgh, Pittsburgh, PA, 15219, USA.,Department of Human Genetics, 51303University of Pittsburgh, Pittsburgh, PA, 15261, USA
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Muacevic A, Adler JR, Abdenbitsen A, Elayoubi F. A Giant Nodule of the Soft Palate Mimicking a Tumor: A Case of Oropharyngeal Tuberculosis. Cureus 2022; 14:e31891. [PMID: 36579274 PMCID: PMC9790182 DOI: 10.7759/cureus.31891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
Tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. According to the World Health Organization, tuberculosis is the leading cause of death by an infectious disease worldwide. We describe here a rare case of tuberculosis that presented as a giant nodule of the soft palate mimicking a tumor. A 50-year-old man was admitted to the oral and facial surgery department for odynophagia and nocturnal snoring. The clinical examination of the oral cavity revealed a mass on the right side of the soft palate, pushing back the uvula on the left, measuring 3 cm in length, nodular in appearance, hard to palpate, and painless with no inflammatory sign of the mucosa opposite. A contrast-injected cervicofacial scan and magnetic resonance imaging were requested that showed a heterogeneous mass on the right side of the soft palate. The therapeutic decision was to perform a biopsy under general anaesthesia, with a histopathological study of the mass. Intraoperatively, the mass was detachable and completely removable. The definite histopathological examination of the surgical specimen was in favour of tuberculosis of the soft palate.
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Han S, Kim JS, Chung MJ. Endoscopic finding of leiomyosarcoma in a neurofibromatosis patient. Ear Nose Throat J 2022:1455613221127488. [PMID: 36134445 DOI: 10.1177/01455613221127488] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A man with a history of neurofibromatosis presented to our hospital with a soft palate mass. Since the patient had neurofibromatosis, we diagnosed the mass as a neurofibroma and planned annual regular follow-up without any treatment. Five months later, the patient visited our emergency department because of uncontrolled epistaxis, and the mass was enlarged to the extent of the airway obstruction. Endoscopic resection was performed and the tumor was confirmed to be a leiomyosarcoma. The malignant potential of the new lesion in a neurofibromatosis patient should be actively evaluated and treated, if required.
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Affiliation(s)
- Sola Han
- Department of Otorhinolaryngology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jong Seung Kim
- Department of Otorhinolaryngology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Korea
| | - Myung-Ja Chung
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Department of Pathology, Jeonbuk National University Medical School, Jeonju, Korea
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40
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Krishnapura SG, Holliday D, Rohde SL. Papillary Squamous Cell Carcinoma of the Oropharynx Arising within Cleft Palate Surgical Scar. Ear Nose Throat J 2022:1455613221101086. [PMID: 35522272 DOI: 10.1177/01455613221101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Dean Holliday
- Department of Pathology, Microbiology, and Immunology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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Baalann KP, Gurunathan N. Soft palate hematoma. Pan Afr Med J 2022; 41:144. [PMID: 35519169 PMCID: PMC9046860 DOI: 10.11604/pamj.2022.41.144.32021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Krishna Prasanth Baalann
- Department of Community Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Nishanth Gurunathan
- Department of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India,Corresponding author: Nishanth Gurunathan, Department of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
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P NV, Jain V, Sharma DN, Koli DK, Nanda A, Thimmarayappa A. High-dose-rate remote brachytherapy for metachronous second primary carcinoma of soft palate by iridium 192 isotope in an afterload surface mold. Spec Care Dentist 2022; 42:536-540. [PMID: 35152444 DOI: 10.1111/scd.12704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
Conservative management of metachronous second primary carcinoma of head and neck is preferred in order to preserve form and function. The purpose of the case report is to describe the treatment of metachronous second primary carcinoma of soft palate by high-dose-rate, remote, afterload brachytherapy. The brachytherapy was done in remote settings by afterloading Iridium 192 isotope carried through a custom fabricated surface mold. The mold enabled good adaptation, stability, and repeatable positioning of the radiation source at each treatment session of fractionated brachytherapy offering consistent dosimetric advantage through a single dosimetry calculation. Collaborative efforts of radiation oncologist and prosthodontist ensured conservative treatment in outpatient set up with minimal adverse effects.
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Affiliation(s)
- Nallaiah Venkatraman P
- Division of Prosthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Veena Jain
- Division of Prosthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dheeraj Kumar Koli
- Division of Prosthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aditi Nanda
- Department of Prosthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Arun Thimmarayappa
- Department of Radiotherpy, Gujarati Cancer Research Institute, Ahmedabad, Gujarat, India
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Potemkin MN, Ovchinnikov AY, Edzhe MA. [Influence of the soft palate structure in patients with snoring and obstructive sleep apnea syndrome on the results of surgical treatment]. Vestn Otorinolaringol 2022; 87:19-24. [PMID: 35818941 DOI: 10.17116/otorino20228703119] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the variants of the anatomical structure of the soft palate in patients with snoring and obstructive sleep apnea (OSA) syndrome and their relationship with the severity of OSA syndrome. MATERIAL AND METHODS The study included patients (n=71) with snoring and sleep apnea. For the purpose of treatment, patients underwent reconstructive interventions on the soft palate. All patients underwent a comprehensive examination, including the collection of complaints and anamnesis, examination of the upper respiratory tract, night respiratory monitoring. There are 5 types of soft palate structure, depending on which all patients are divided into 5 groups. The 1st and 2nd groups mainly included patients with simple snoring and mild OSA syndrome, the 3rd and 5th groups were evenly distributed with all degrees of severity of the same pathology, and the 4th group consisted mainly of patients with severe OSA syndrome. The procedure of the operation varied in different groups. 1 month after surgical treatment, there was a decrease in the anpoe/hypopnea index compared with preoperative values in patients of the 1st and 2nd groups by 71.9% and 76.2%, respectively, in patients of the 3rd group by 51.4%, in patients of the 5th group by 65.3%, in patients of the 4th group by 39.6%. CONCLUSIONS The presented original classification of anatomical variants of the soft palate in patients with snoring and OSA syndrome makes it possible to determine the scope of intervention, predict the feasibility of surgery and can be recommended for practical use. Surgical treatment is indicated for types 1, 2, 3 and 5 of the structure of the soft palate. In patients with type 4, reconstructive operations on the soft palate do not lead to a satisfactory result and can only be used in combination with other methods of treatment.
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Affiliation(s)
- M N Potemkin
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Yu Ovchinnikov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M A Edzhe
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Feng J, Han X, Yuan Y, Cho CK, Janečková E, Guo T, Pareek S, Rahman MS, Zheng B, Bi J, Jing J, Zhang M, Xu J, Ho TV, Chai Y. TGF-β signaling and Creb5 cooperatively regulate Fgf18 to control pharyngeal muscle development. eLife 2022; 11:80405. [PMID: 36542062 PMCID: PMC9771365 DOI: 10.7554/elife.80405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
The communication between myogenic cells and their surrounding connective tissues is indispensable for muscle morphogenesis. During late embryonic development in mice, myogenic progenitors migrate to discrete sites to form individual muscles. The detailed mechanism of this process remains unclear. Using mouse levator veli palatini (LVP) development as a model, we systematically investigated how a distinct connective tissue subpopulation, perimysial fibroblasts, communicates with myogenic cells to regulate mouse pharyngeal myogenesis. Using single-cell RNAseq data analysis, we identified that TGF-β signaling is a key regulator for the perimysial fibroblasts. Loss of TGF-β signaling in the neural crest-derived palatal mesenchyme leads to defects in perimysial fibroblasts and muscle malformation in the soft palate in Osr2Cre;Tgfbr1fl/fl mice. In particular, Creb5, a transcription factor expressed in the perimysial fibroblasts, cooperates with TGF-β signaling to activate expression of Fgf18. Moreover, Fgf18 supports pharyngeal muscle development in vivo and exogenous Fgf18 can partially rescue myogenic cell numbers in Osr2Cre;Tgfbr1fl/fl samples, illustrating that TGF-β-regulated Fgf18 signaling is required for LVP development. Collectively, our findings reveal the mechanism by which TGF-β signaling achieves its functional specificity in defining the perimysial-to-myogenic signals for pharyngeal myogenesis.
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Affiliation(s)
- Jifan Feng
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Xia Han
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Yuan Yuan
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Courtney Kyeong Cho
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Eva Janečková
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Tingwei Guo
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Siddhika Pareek
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Md Shaifur Rahman
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Banghong Zheng
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Jing Bi
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Junjun Jing
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Mingyi Zhang
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Jian Xu
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Thach-Vu Ho
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
| | - Yang Chai
- Center for Craniofacial Molecular Biology, University of Southern CaliforniaLos AngelesUnited States
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45
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Anstadt EE, Bruce MK, Ford M, Jabbour N, Pfaff MJ, Bykowski M, Goldstein JA, Losee JE. Tissue Augmenting Palatoplasty for the Treatment of Velopharyngeal Insufficiency. Cleft Palate Craniofac J 2021; 59:1461-1468. [PMID: 34787006 DOI: 10.1177/10556656211053761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Persistent velopharyngeal insufficiency (VPI) following primary palatoplasty remains a difficult problem to treat. This study evaluates speech outcomes following revision palatoplasty with tissue augmentation using buccal myomucosal flaps (BMF) as an alternative to pharyngoplasty for patients with VPI. METHODS A retrospective single-center review of revision palatoplasty with tissue augmentation at a tertiary pediatric hospital Cleft-Craniofacial Center between January 2017 and March 2021 was conducted. Patients with a history of previous palatoplasty, a diagnosis of persistent or recurrent VPI, and comprehensive pre- and postoperative speech evaluations who underwent revision palatoplasty with BMF were included. RESULTS Twenty patients met inclusion criteria (35% female, 20% syndromic). Mean age at the time of revision palatoplasty with BMF was 9.7 years. Preoperatively, all patients had stigmatizing speech and received the recommendation for speech surgery; the mean Pittsburgh Weighted Speech Score (PWSS) was 14.3 ± 4.9. The mean postoperative PWSS at the most recent assessment was 4.2 ± 2.3, representing a statistically significant improvement from preoperative scores (P < .001). Mean follow-up time was 8.9 months. Following revision palatoplasty with BMF, only one patient has received the recommendation for further speech surgery. No complications were noted. CONCLUSION In patients with VPI following primary palatoplasty, revision palatoplasty with tissue augmentation offers an alternative to pharyngoplasty. This approach preserves dynamic velopharyngeal function, improves speech outcomes, and should be considered an option when treating patients with post-primary palatoplasty VPI.
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Affiliation(s)
- Erin E Anstadt
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Madeleine K Bruce
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew Ford
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noel Jabbour
- 6619Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Miles J Pfaff
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Bykowski
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph E Losee
- 6595Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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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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47
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Naidoo S, Roode GJ, Bütow KW, Meer S. Ectomesenchymal Chondromyxoid Tumor: A Rare Association With an Asymmetrical Soft Palate Cleft. Cleft Palate Craniofac J 2021; 59:932-937. [PMID: 34459667 DOI: 10.1177/10556656211035029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ectomesenchymal chondromyxoid tumor (ECT) is a rare oral lesion first described by Smith et al. in 1995. These tumors are typically painless, slow growing and benign masses occurring predominantly on the anterior tongue dorsum. Prior to this seminal report, many ECTs may have been misdiagnosed due to the histological similarities with other lesions. Immunohistochemical stains aid in definitive diagnosis of an ECT. A total of 39 papers since published have reported 96 patients with ECT. Most lesions involve the anterior aspect of the tongue, with only 6 occurring in the posterior tongue and 2 involving the hard palate. ECTs are considered to develop from ectomesenchymal cells of neural crest cells that have migrated to the tongue during embryological development. This paper is of a rare case of ECT of the posterolateral tongue occurring in association with an unusual asymmetrical soft palate cleft. It is postulated that since the tongue develops before the formation of the soft palate, an ECT lesion occurring on the posterior aspect may have a causal contribution to the development of the soft palate cleft.
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Affiliation(s)
- Sharan Naidoo
- Mediclinic Midstream Hospital, Pretoria, Gauteng, South Africa.,Facial Cleft Deformity Clinic, Department of Maxillofacial and Oral Surgery, 56410University of Pretoria, Pretoria, Gauteng, South Africa
| | - Gieljam J Roode
- Department of Anatomy, 72042Faculty of Basic Sciences, 56410University of Pretoria, Pretoria, Gauteng, South Africa
| | - Kurt W Bütow
- Life Wilgers Hospital, Wilgers, Pretoria, Gauteng, South Africa
| | - Shabnum Meer
- Department of Oral Pathology, 37708Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
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48
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Mahdy MAA, Mohammed ESI. Scanning electron microscopy of the palatine mucosa with connective tissue papillae of the Egyptian red fox (Vulpes vulpes aegyptiaca, Linnaeus, 1758). Microsc Res Tech 2021; 84:3191-3203. [PMID: 34288222 DOI: 10.1002/jemt.23877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
The present study investigated the morphological, as well as the histological features of the Egyptian red fox's palate, in addition to the three-dimensional characteristics of the connective tissue papillae (CTP) of the palate by scanning electron microscopy (SEM). The hard palate was narrow rostrally and its width increased caudally. The maximum width was located at the caudal border of the upper fourth premolar tooth. The incisive papilla was represented by a rounded median elevation surrounded on each side by a groove on which the oral openings of the incisive ducts opened. The rostral part of the hard palate had 9-10 caudally concave transverse palatine ridges while the caudal part appeared smooth without ridges. The palatine raphe was indistinct rostrally but formed a groove caudally. By SEM, the palatine ridges had low projections. Different microplicae systems were present on the epithelial surface of the incisive papilla, palatine rugae, interrugal areas, and the smooth part. The CTP of the incisive papilla, palatine ridges, and soft palate were conical-shaped, cylindrical-shaped, and parallel serrated ridges, respectively. Histologically, the hard palate was lined by a cornified stratified squamous epithelium resting on a dense connective layer of lamina propria while the soft palate was lined by a noncornified stratified squamous epithelium. The palatine salivary glands were present in the smooth part of the hard palate and the soft palate. The information presented in the current study might serve as a reference guide for the interpretation of pathological conditions of the palate of red fox.
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Affiliation(s)
- Mohamed A A Mahdy
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Elsayed S I Mohammed
- Department of Histology and Cytology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
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49
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Van de Perck E, Op de Beeck S, Dieltjens M, Vroegop AV, Verbruggen AE, Willemen M, Verbraecken J, Van de Heyning PH, Braem MJ, Vanderveken OM. The relationship between specific nasopharyngoscopic features and treatment deterioration with mandibular advancement devices: a prospective study. J Clin Sleep Med 2021; 16:1189-1198. [PMID: 32267227 DOI: 10.5664/jcsm.8474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES The variable efficacy of mandibular advancement device (MAD) treatment necessitates both accessible and accurate methods for patient selection. However, the role of awake nasopharyngoscopy for this purpose remains dubious. We introduced an assessment method based on anatomical upper airway features during tidal breathing for nasopharyngoscopy. The current study aimed to relate these features to MAD treatment outcome. METHODS One hundred patients diagnosed with obstructive sleep apnea were prospectively recruited for MAD treatment in a fixed 75% degree of maximal protrusion. Nasopharyngoscopic observations during Müller's maneuver and tidal breathing were recorded both with and without MAD. Treatment outcome, confirmed by 3-month follow-up polysomnography with MAD, was classified as (1) apnea-hypopnea index reduction ≥ 50%, (2) treatment apnea-hypopnea index < 5 events/h, and (3) ≥ 10% increase in apnea-hypopnea index compared with baseline (treatment deterioration). RESULTS A complete dataset was obtained in 65 patients. After adjusting for baseline apnea-hypopnea index, body mass index, and supine dependency, the position of the soft palate (odds ratio, 4.0; 95% confidence interval, 1.3-11.8; P = .013) and crowding of the oropharynx (odds ratio, 7.7; 95% confidence interval, 1.4-41.4; P = .017) were related to treatment deterioration. Addition of both features significantly (P = .031) improved the accuracy of baseline models based on clinical measurements alone. Moreover, with the MAD in situ, a posteriorly located soft palate (odds ratio, 9.8; 95% confidence interval, 1.7-56.3; P = .010) and a posteriorly located tongue base (odds ratio, 7.4; 95% confidence interval, 1.5-35.9; P = .013) were associated with treatment deterioration. CONCLUSIONS Awake nasopharyngoscopy might be a valuable office-based examination to exclude the risk of treatment deterioration and improve patient selection for MAD treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea (PROMAD); URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050.
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Affiliation(s)
- Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Anneclaire V Vroegop
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Annelies E Verbruggen
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.,Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Paul H Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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50
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Eesa M, Hendawy E, El-Anwar MW. Modified Z-Palatoplasty for Correction of Acquired Nasopharyngeal Stenosis Following Palatal Surgery: A Case Series. Cleft Palate Craniofac J 2021; 59:774-778. [PMID: 34155921 DOI: 10.1177/10556656211021702] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of a novel surgical technique in management of nasopharyngeal stenosis (NPS), describing its steps and results. Study Design: Prospective clinical trial. SETTING This study was conducted at the Otolaryngology, Head and Neck Surgery Department, Zagazig University. METHODS This prospective study was conducted on patients with snoring ± obstructive sleep apnea due to acquired postsurgical NPS of grade Ι and ΙΙ. New surgical repair was employed on the patients and the pre and postoperative results were statistically compared. RESULTS The grade of NPS improved significantly postoperatively (P = .00136) throughout a follow-up of 1 year. Postoperatively, there was statistically significant improvement of apnea hypopnea index (P = .0005), Visual Analog Scale (VAS) of nasal obstruction (P < .0001) and VAS of snoring (P < .0001). Dysphagia showed early worsening, but it improved completely at 3 months postoperatively. CONCLUSION The utilized novel procedure appears effective, low cost, and easily applicable, and it does not require implants, special tools, or suture materials. Furthermore, it gives excellent results, with negligible pain, and rapid recovery without significant complications. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mohamed Eesa
- Department of Otorhinolaryngology, Head and Neck Surgery, 68865Zagazig University, Zagazig, Egypt
| | - Ehsan Hendawy
- Department of Otorhinolaryngology, Head and Neck Surgery, 68865Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, 68865Zagazig University, Zagazig, Egypt
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