Determinación de factores relacionados al desarrollo de fístulas palatinas posterior a una palatoplastia primaria / Determination of factors related to the development of palatal fistula after a primary palatoplasty

INTRODUCCION. La fistula palatina es la persistencia de comunicación anormal entre la cavidad nasal y oral post palatoplastia, es la complicación frecuente con: alta morbilidad, problemas para la alimentación, articulación de las palabras inapropiada, halitosis hasta problemas psicosociales como baja autoestima y rechazo social. OBJETIVO. Determinar los factores asociados al desarrollo de fístula palatina. MATERIALES Y MÉTODOS. Estudio observacional, analítico de casos y controles. De una población de 334 Historias Clínicas se tomó muestra de 89 en la Unidad de Plástica y Reconstructiva del Hospital de Especialidades Carlos Andrade Marín de enero 2010 a julio 2019. Criterios de inclusión: datos de pacientes con paladar fisurado reparado por palatoplastia. Criterios de Exclusión: pacientes sin buen seguimiento postquirúrgico y con paladar hendido sin reparación quirúrgica. Los datos fueron obtenidos del sistema AS400, el análisis se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS. El uso de ortopedia prequirúrgica (OR: 0,014; p<0,000) y la alimentación con leche materna (OR: 0,033; p<0,003) fueron factores protectores. DISCUSIÓN. La ortopedia prequirúrgica fue la mejor opción de moldeamiento en pacientes con hendiduras amplias para la aproximación de los segmentos óseos hendidos, como factor protector significativo se encontró a la lactancia materna exclusiva dato que coincide con el estudio de López YD., donde mencionó que produjo mayor estimulación para la fusión de las crestas palatinas a pesar de que no fue estadísticamente significativa. CONCLUSION. Los factores asociados al desarrollo de fístula palatina estadísticamente significativos fueron el uso de ortopedia prequirúrgica y la alimentación con leche materna, catalogados como protectores.

INTRODUCTION. Palatal fistula is the persistence of abnormal communication between the nasal and oral cavity post palatoplasty, it ́s the frequent complication with: high morbidity, feeding problems, inappropriate articulation of words, halitosis and psychosocial problems such as low self-esteem and social rejection. OBJECTIVE. Determine the factors associated with the development of palatal fistula. MATERIALS AND METHODS. Observational, analytical case-control study. From a population of 334 Clinical Histories, a sample of 89 was taken in the Plastic and Reconstructive Unit of the Carlos Andrade Marín Specialty Hospital from january 2010 to july 2019. Inclusion criteria: data from patients with cleft palate repaired by palatoplasty. Exclusion Criteria: patients without good postsurgical follow-up and with a cleft palate without surgical repair. The data were obtained from the AS400 system, the analysis was performed using the International Business Machines Statistical Package for the Social Sciences statistical program. RESULTS. The use of presurgical orthopedics (OR: 0,014; p<0,000) and feeding with breast milk (OR: 0,033; p<0,003) were protective factors. DISCUSSION. Presurgical orthopedics was the best molding option in patients with wide clefts for the approximation of the cleft bone segments, as a significant protective factor, exclusive breastfeeding was found, data that coincides with the study by López YD., where he mentioned that it produced greater stimulation for palatine ridge fusion although it was not statistically significant. CONCLUSION. Statistically significant factors associated with the development of palatal fistula were the use of pre-surgical orthopedics and feeding with breast milk, classified as protective.

Palatoplastia primária pela técnica de Von Langenbeck: experiência e resultados morfológicos obtidos em 278 casos operados / Primary palatoplasty using the von Langenbeck technique: surgical experience and aesthetic results of 278 cases

Introdução: A palatoplastia com elevação de retalhos mucoperiostais bipediculados pela técnica de Von Langenbeck associada a veloplastia intravelar é técnica mais utilizadas na atualidade apresentando na literatura baixa taxa de fístula oronasal e de insuficiência velofaríngea. O objetivo é apresentar a experiência acumulada do autor e avaliar a incidência de fístula oronasal após 278 casos de palatoplastia primária, pela técnica de Von Langenbeck associada a veloplastia intravelar. Métodos: Estudo retrospectivo de 278 prontuários de pacientes submetidos à palatoplastia primária no Centro de Tratamento de Malformações Craniofaciais Mário Covas - Hospital Guilherme Álvaro - Santos/SP, entre de maio de 2010 a maio de 2018. Resultados: 278 procedimentos de palatoplastia primária pela técnica relatada, 225 (80,9%) em duas etapas cirúrgicas e 53 (19,1%) em única etapa. Masculino 182 (65,5%) e feminino 96 (34,5%). Fissuras labiopalatais esquerda e bilaterais (26,3% e 27%, respetivamente). As fissuras palatais completas corresponderam a 37,4% e a fissura labiopalatal direita com 7,6%. 61 pacientes apresentaram fístula oronasal (21,94%) observando-se uma diminuição progressiva da incidência em cada período. Conclusão: A palatoplastia primária pela técnica de Von Langenbeck associada à veloplastia intravelar é uma técnica reprodutível em uma ou duas etapas cirúrgicas e pode ser considerada segura quando alcançada uma adequada curva de aprendizado apresentando um índice de complicações acorde com a literatura mundial.

Introduction: Palatoplasty with elevated bilateral mucoperiosteal flaps using the von Langenbeck technique associated with intravelar veloplasty is a common procedure with low rates of oronasal fistula (ONF) and velopharyngeal insufficiency. The objective is to present the author's surgical experience and the incidence of ONF among 278 patients who underwent primary palatoplasty using the von Langenbeck technique associated with intravelar veloplasty. Methods: This retrospective study analyzed the medical records of 278 patients who underwent primary palatoplasty at the Mário Covas Treatment Center for Craniofacial Malformations of the Guilherme Álvaro Hospital located in the municipality of Santos, São Paulo, Brazil, between May 2010 and May 2018. Results: A total of 278 primary palatoplasty procedures were performed; of them, 225 (80.9%) were performed in two surgical stages and 53 (19.1%) in one surgical stage. The study population included 182 men (65.5%) and 96 women (34.5%). The prevalence of left and bilateral cleft lip and palate was 26.3% and 27%, respectively, and the prevalence of bilateral cleft palate, and right cleft lip and palate was 37.4% and 7.6%, respectively. Sixty-one patients had ONF (21.94%), the incidence of which decreased progressively throughout the study period. Conclusion: Primary palatoplasty, using the von Langenbeck technique associated with intravelar veloplasty, is reproducible when performed in one or two surgical stages, and considered safe when the learning curve is reached with a complication rate similar to those in the literature.

Geographic stomatitis with palate involvement

Abstract: Benign migratory glossitis or geographic tongue is a benign condition that usually manifests as asymptomatic erythematous and migratory circinate patches, involving the lateral and dorsal aspects of the tongue. Extra-lingual lesions uncommonly occur and are mainly located on labial and buccal mucosae, lips and floor of the mouth. The present report describes one patient with a geographic lesion on the hard palate associated with lingual lesions and another patient who had multiple geographic lesions both in the hard and soft palate without lingual lesions. We found 64 cases in the English literature of ectopic locations with 22 palate involvement. No case of simultaneous involvement of the hard and the soft palate was found.

Morphological variation of the velum in children and adults using magnetic resonance imaging

PURPOSE: The purpose of this study was to investigate variations in velar shape according to age, sex, and race using magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study sample consisted of 170 participants (85 children, 85 adults) between 4 and 34 years of age. Velar morphology was visually classified using midsagittal MRI scans for each participant by 2 independent raters. Inter- and intra-rater reliability was assessed. Statistical analyses were performed to identify correlations of velar shape with sex, age, and race. RESULTS: The most frequent velar shape was “buttf” for both adults (41%) and children (58%) in this study. The least common shapes for adults were “leaf” and “S.f” The children did not exhibit any “leaff” or “straightf” velar shapes. A statistically significant difference was noted for age with respect to velar shape (P=0.014). Sex and race were found to have no significant impact on velar shape in this study. CONCLUSION: When using MRI to evaluate velar morphology, the “buttf” shape was most common in both children and adults. Velar shape varied significantly with age, while race and sex did not have a significant impact.

Correlation analysis of standardized palatal sensory threshold with airway obstruction and hypoxia during sleep / 中华耳鼻咽喉头颈外科杂志

Objective@#To study the correlation between the standardized palatal sensory threshold and airway obstruction and hypoxia during sleep, and to infer its role in the pathogenesis of OSAHS.@*Methods@#From August 2016 to May 2017, 92 OSAHS patients as experimental group and 48 non-OSAHS volunteers as control group were recruited in Department of Otorhinolaryngology Head and Neck Surgery, Changhai Hospital Affiliated to the Naval Medical University. The tactile sense was measured by Smmes-Weinstein Monofilaments in the middle of uvula and both side of hard palate,then the threshold of the uvula minus, the average threshold of the hard palate as the standardized palatal sensory threshold(SPST). The control point of both groups was located in the central underlip. Mann-Whitney U test for comparing two independent samplesand partial correlation analysis.@*Results@#There was no difference in tactile threshold of underlip between the experimental group and the control group(0.020[0.008,0.020] g/mm2 vs. [0.020(0.008,0.020] g/mm2, Z=293.0, P=0.221); the tactile sense of the experimental group was larger than that of the control group in thehardpalate(0.040[0.140,0.055] g/mm2 vs. 0.138[0.064,0.400] g/mm2, Z=4.5, P=0.000), soft palate(0.400[0.280,0.400] g/mm2 vs. 1.400[1.000,4.000] g/mm2, Z=0, P=0.000) and SPST(0.355[0.125,0.373] g/mm2 vs. 1.285[0.896,3.025] g/mm2, Z=0, P=0.000). The SPST was positive correlation with apnea hypopneaindex(AHI)(r=0.835, P=0.000) and negative correlation with the nadir oxyhemoglobin saturation (r=-0.636, P=0.000).@*Conclusion@#The greater the standardized palatal sensory threshold, the worse the condition of OSAHS, the lower, the lowest blood oxygen at night, and the impaired upper airway sensory function plays an important role in the pathogenesis of OSAHS.

Therapeutic effectiveness of the soft palate fold surgery in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the relationships between anatomical changes and treatment outcomes after modified velopharyngeal surgery in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with the soft palate drooping.@*Methods@#From November 2011 to November 2015, 44 OSHS patients (AHI 5-30 times/h) with the soft palate drooping determined by Muller test and drug-induced sleep endoscopy (DISE) were randomly selected. Treatment group included 23 patients who underwent modified velopharyngeal surgery, in which uvula was preserved and soft palate was shortened and advanced. Control group included 21 patients who received conventional UPPP surgery.Compared the differences in preoperative and postoperative Epworth Sleepiness Scale (ESS), Numeric Rating Scale (NRS), lowest arterial blood oxygen saturation (LSaO2), and apnea hypoventilation index (AHI) between the two groups. Each data rows normality test. The two groups' preoperative and postoperative data row intra-group comparison and matching t test. Used the independent sample t test after homogeneity of variance test to compare the two groups. The difference was statistically significant when P<0.05.@*Results@#There were statistically significant differences in AHI , LSaO2 and ESS score between before and after surgery in individual groups. There were not significant differences in preoperative AHI and LSaO2 between the two groups, but with a higher ESS in treatment group compared to control group. There were no statistically significant differences in postoperative AHI, LSaO2 or ESS between the two groups. Compared with control group, treatment group had a lower postoperative pain scale score (4.3±1.3 vs 6.3±0.8, P=0.000) and a shorter time to resume normal eating ((6.7±1.6) d vs (15.5±3.5) d, P=0.000).@*Conclusion@#OSAHS patients (AHI 5-30 times/h) with the soft palate drooping are more likely to have favorable anatomical changes after revised velopharyngeal surgery.

Assessment of Change in Palatal Sensation in Obstructive Sleep Apnea Patients by Using Two-Point Palatal Discrimination

OBJECTIVES: Patients with obstructive sleep apnea syndrome (OSAS) have impaired responses to inspiratory resistive loading during sleep. This may be due, in part, to a change in the upper airway sensation. Therefore, we hypothesized that patients with OSAS have diminished upper airway sensation due to snoring. METHODS: A total of 53 participants were selected based on clinical evaluation and polysomnography. Two-point discrimination was measured with modified calipers in the tongue and soft palate. RESULTS: A total of 10 participants were included in the control group, 12 participants in the simple snoring group, and 27 participants in the OSAS group. There were 12 patients in the impaired sensation group of the OSAS group. On comparing polysomnography, patients with impairment of their palatal sensory input in two-point discrimination (TPD) had a more protracted duration of the longest snoring episode than those with simple snoring and normal sensation. Patients with decreased sensory input in TPD had longer average duration of snoring episodes and relative snoring time than those with simple snoring and normal sensory input in cold uvular TPD. Comparison of the cold uvular TPD for normal sensation and impaired sensation in patients with OSAS after treatment showed a different trend. CONCLUSION: Impaired sensation of the soft palate was correlated with the longest snoring episode duration, average snoring episode duration, and relative snoring time. It is helpful in detecting the early stage of neural degradation in OSAS patients by assessing snoring components of polysomnography and TPD in the soft palate.

Effect of p38MAPK inhibitor on the soft palate reconstruction of the rats with chronic intermittent hypoxia / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the role of P38MAPK inhibitor on the soft palate reconstruction of the rats with chronic intermittent hypoxia. METHODS The animals were divided into normal control group, hypoxia control group and SB203580+hypoxia group (every group 20 rats). After 5 weeks, the expressions of p38MAPK and p-p38MAPK protein on the soft palate of the rats were detected with immunohistochemical techniques and western blot. RESULTS Compared with the normal control group, the soft palate tissue thickness of the hypoxia group were increased most obviously; Levels of p38MAPK were increased in hypoxia control group; Compared with the hypoxia control group, the levels of p-p38MAPK group were decreased in SB203580+hypoxia group. CONCLUSION p38MAPK may play important roles in the soft palate reconstruction of the rats with chronic intermittent hypoxia.

Changes in pharyngeal airway space and soft tissue after maxillary advancement and bimaxillary surgery

AIM: To evaluate changes in pharyngeal airway space (nasopharynx and oropharynx), soft palate and lingual vallecula after maxillary advancement surgery and maxillary advancement and mandibular setback surgery (bimaxillary surgery). METHODS: Twenty Class III adult patients were included in the study. Ten patients were treated with maxillary advancement and ten with bimaxillary surgery (maxillary advancement and mandibular setback). Cephalometric landmark measurements were recorded at 3 different time intervals: pre-surgical, post-surgical and six months after surgery. Data collected were subjected to one-way ANOVA (p<0.05). RESULTS: Nasopharyngeal airway space increased after maxillary advancement and decreased after bimaxillary surgery. There was increase in oropharyngeal dimensions in the region around the uvula and loss of space for lingual vallecula, while in Group 2 there was diminished space for both uvula and vallecula. The uvula and vallecula were moved forward in Group 1, whereas these structures were moved in the posterior direction in Group 2. CONCLUSIONS: After maxillary advancement surgery there was an increased in space in the nasopharyngeal region. The oropharyngeal region related to the uvula presented an increase in space, whereas there was a reduction in relation to the lingual vallecula. The uvula and lingual vallecula were moved forward. Bimaxillary surgery promoted a reduction in the nasopharyngeal and oropharyngeal regions as regards both the uvula and lingual vallecula. The uvula and lingual vallecula were moved in the posterior direction...

Caracterização do padrão de fechamento velofaríngeo em pacientes com fissura palatina / Characterization of the pattern of velopharyngeal closure in cleft palate patients

OBJETIVO: Caracterizar o padrão de fechamento velofaríngeo de pacientes operados de fissura palatina e sua relação com gênero, faixa etária, tipo de fissura e diagnóstico da função velofaríngea. MÉTODOS: Estudo retrospectivo realizado a partir de 89 exames de nasofaringoscopia de pacientes operados de fissura palatina, entre 4 e 47 anos (média=17,32±10,50). Os dados foram analisados quanto ao gênero; faixa etária (4 a 8, 9 a 12 anos, 13 a 18 e acima de 18 anos); tipo de fissura (pós-forame e transforame); diagnóstico da função velofaríngea (adequada, marginal e inadequada) e padrão de fechamento velofaríngeo (coronal, circular, circular com prega de Passavant e sagital). Os resultados foram analisados estatisticamente. RESULTADOS: Na amostra estudada, 59,55% eram do gênero feminino; 39,33% tinham mais de 18 anos de idade; 44,94% apresentavam fissura pós-forame e 55,06% transforame; 14,61% fechamento adequado, 53,93% marginal e 31,46% inadequado. Quanto ao padrão de fechamento, 37,08% apresentaram fechamento coronal, 33,71% circular, 15,73% circular com Passavant e 13,48% sagital. Houve relação do padrão de fechamento com o diagnóstico da função velofaríngea (p=0,05). CONCLUSÃO: A maior parte da amostra apresentou fechamento velofaríngeo coronal, seguido pelo circular, circular com Passavant e sagital. Não houve relação entre o padrão de fechamento e as variáveis gênero, faixa etária e tipo de fissura, mas observou-se influência relacionada ao diagnóstico da função velofaríngea.

PURPOSE: To characterize the velopharyngeal closure pattern in patients submitted to cleft palate surgery and its relation with gender, age, cleft type, and diagnosis of velopharyngeal function. METHODS: Retrospective study based on 89 nasopharyngoscopy studies of operated cleft palate patients with ages between 4 and 47 years (mean=17.32±10.50). Data were analyzed regarding gender, age range (4 to 8, 9 to 12, 13 to 18 and >18 years), cleft type (postforamen or transforamen), diagnosis of velopharyngeal function (adequate, borderline, and inadequate), and velopharyngeal closure patterns (coronal, circular, circular with Passavant's ridge, and sagittal). Results were statistically analyzed. RESULTS: In the study sample, 59.55% of the patients were women; 39.33% were above 18 years of age; 44.94% had post-foramen cleft and 55.06%, transforamen cleft; 14.61% showed adequate, 53.93% borderline, and 31.46% inadequate velopharyngeal closure. With regards to the velopharyngeal closure pattern, 37.08% of the subjects presented coronal closure; 33.71%, circular closure, 15.73% circular with Passavant's ridge; and 13.48%, sagittal closure pattern. There was a relation between pattern of closure and diagnosis of velopharyngeal function (p=0.05). CONCLUSION: Most of the sample presented coronal pattern of velopharyngeal closure, followed by circular, circular with Passavant's ridge and sagittal patterns. There was no relationship between closure pattern and the variables gender, age, and cleft type, but there was a related influence to the diagnosis of velopharyngeal function.

Effect of soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection in treatment OSAHS / 中国基层医药

ObjectiveTo observe the postoperational curative effect and complicational occuring status by using soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection to treat(obstructive sleep apnea hyponea syndrome,OSAHS).Methods59 cases with type Ⅰ OSAHS were divided into experimental group(39 cases)using soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection,control group( 20 cases)carrying out UPPP or keeping uvula UPPP.ResultsTow groups postoperational total effective rate 84.75％ (50/59),PSG survey's analysis( x2 =6.348,P ＜0.05 ) with preoperation,postoperation,without obvious discrepancy,the degree of postoperational pharyngeal ache,after follow-up visit 6-12 months,comparing the changes of snore,nasopharynx's backflow or missing deglutition and appearing cavum pharyngis coarctation( U =3.426,P ＜ 0.05 ),having outstanding discrepancy.ConclusionIt was not only to completely keeping uvula by using soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection to treat OSAHS,but to enlarge soft palate shaping confines,not only effectively enlarging the ventilate's sectional area of cavum oropharyngeum,but preferably keeping the normal physiological morphology and function of cavum pharynges,avoiding the happening such as palatepharynx insufficiency complication etc.

Reconstruction of a Total Soft Palatal Defect Using a Folded Radial Forearm Free Flap and Palmaris Longus Tendon Sling

BACKGROUND: The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate. METHODS: Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation. RESULTS: Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function. CONCLUSIONS: The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

Efeito da veloplastia intravelar sobre o fechamento velofaríngeo avaliado por meio da técnica fluxo-pressão / Effect of intravelar veloplasty on velopharyngeal closure assessed by pressure-flow technique

OBJETIVO: Avaliar o efeito da veloplastia intravelar sobre o fechamento velofaríngeo de pacientes com fissura de palato reparada e insuficiência velofaríngea (IVF), por meio de avaliação aerodinâmica (técnica fluxo-pressão). MÉTODOS: Quarenta e sete indivíduos de ambos os gêneros, com idade entre seis e 48 anos, que apresentavam fissura de palato±lábio reparada e IVF, submetidos à veloplastia intravelar. Os pacientes foram avaliados, por meio da técnica fluxo-pressão, aferindo a medida da área do orifício velofaríngeo antes e, em média, 12 meses após a cirurgia, durante a produção do fonema /p/ inserido na palavra rampa. O fechamento velofaríngeo foi classificado como adequado (0 a 0,049 cm²), marginal (0,050 a 0,199 cm²) ou inadequado (>0,200 cm²). RESULTADOS: Após a cirurgia, verificou-se melhora considerável no grau de fechamento velofaríngeo em 66 por cento dos casos. Do total de pacientes analisados, 47 por cento passaram a apresentar fechamento adequado, 23 por cento, fechamento marginal e 30 por cento permaneceram com fechamento inadequado. CONCLUSÃO: Estes resultados mostraram que a veloplastia intravelar levou à melhora do fechamento velofaríngeo na maioria dos pacientes analisados repercutindo na redução dos sintomas de fala da IVF.

PURPOSE: To evaluate the effect of intravelar veloplasty on velopharyngeal closure of patients with repaired cleft palate and velopharyngeal insufficiency (VPI), using the pressure-flow technique. METHODS: Forty-seven individuals of both genders, with ages between six and 48 years, with repaired cleft palate±lip and residual VPI, submitted to intravelar veloplasty. The pressure-flow technique was used to measure the velopharyngeal orifice area during the production of the phoneme /p/ in the word rampa, before and, in average, 12 months after surgery. Velopharyngeal closure was classified as adequate (0 to 0.049 cm²), borderline (0.050 to 0.199 cm²) or inadequate (>0.200 cm²). RESULTS: After surgery, there was considerable improvement in the velopharyngeal closure degree in 66 percent of the cases. From the patients analyzed, 47 percent presented adequate closure, 23 percent, borderline closure and 30 percent remained with inadequate closure. CONCLUSION: These results showed that intravelar veloplasty led to improvement in velopharyngeal closure in most of the patients studied, consequently decreasing the speech symptoms of VPI.

Dissecção radical da musculatura do véu palatino em casos secundários de pacientes fissurados / Radical undermining of the soft palate muscles in secondary cleft patients

Objetivo: Demonstrar a eficácia do reposicionamento do músculo elevador do véu palatinoem pacientes portadores de fissura lábio-palatina anteriormente submetidos a palatoplastiapor outras técnicas. Método: Foram realizadas, 16 cirurgias de repalatoplastia posterior comdissecção radical da musculatura do véu palatino. A nasofibroscopia foi o instrumento demensuração da voz no período pré e pós-operatório, 3, 9 e 15 meses após a cirurgia. Duasfonoaudiólogas com experiência no tratamento do fissurado participaram na avaliação davoz nos períodos pré e pós-operatórios, sendo a hipernasalidade classificada em equilíbriooronasal, hipernasalidade leve, moderada e importante. O índice de Kappa foi utilizado paraavaliar o grau de concordância entre os observadores. O teste de igualdade proporcional foiutilizado com o objetivo de comparar as diferenças de voz no pré e pós-operatórios de 3,9 e 15 meses. O valor de p < 0,05 foi adotado para a significância estatística. Resultados:Seis pacientes eram do sexo masculino, com idade média de 17,93 anos. Houve uma boaconcordância entre as avaliadoras, sendo a menor de 76,6% (índice de Kappa). Com o retroposicionamentoda musculatura houve melhora no índice da hipernasalidade (p < 0,05),principalmente na hipernasalidade leve e moderada. Conclusão: Houve grande melhorado quadro da insuficiência velofaríngea após a dissecção radical, o que evidencia que talprocedimento é necessário e deve ser incluído no algoritmo dos protocolos em casos secundáriose preconiza-se que seja usado, também, em casos primários.

Objective: To demonstrate the efficacy of the muscular set back in secondary cases. Method:16 soft palate re-repair were performed with muscular set back. To evaluate the results of thesurgeries through the voice, nasal endoscopies were done pre and post operative (3, 9 and15 months). The results were evaluated by two speech pathologists specialized in cleft lipand palate patients. And the hypernasality was graded as equilibrium, mild, moderate andsevere. The Kappa index was used to evaluate the agreement between the two observers andthe equality of two proportion test gave the statistics significance, as p < 0.05. Results: Sixpatients were males. The mean age was 17.93 years. There was a good concordance betweenthe two evaluators. The least was 76.6% according to the Kappa index. With the retropositioningof the muscles` bundle there was an improvement in the velopharingeal insufficiency (p< 0.05) mainly in the mild and moderate cases. Conclusion: There was a great improvementin velopharingeal incompetence after radical muscle dissection, showing that this procedureis necessary and must be part of secondary palatoplasty protocols. And also must be usedduring primary soft palate repair.

Morphologic changes in the upper airway in patients with acute cerebral infarction / 中华神经科杂志

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.

Carcinoma espinocelular de palato mole / Squamous cell carcinoma of the soft palate

Introdução: Câncer de orofaringe tem incidência mundial de 8,3 casos por 100.000 habitantes. Carcinoma espinocelular representa 95% do total de tumores malignos da orofaringe. O palato mole representa 5-12% do total destes tumores. Fatores etiológicos incluem álcool e tabaco. Os tumores são freqüentemente assintomáticos e apresentam-se em estádios avançados ao diagnóstico. Métodos: Trata-se de estudo retrospectivo baseado na análise de prontuários de pacientes com diagnóstico de carcinoma espinocelular de palato mole. Resultados: Dentre 15 pacientes, 13 eram do sexo masculino e 2 do sexo feminino. Idade variou entre 54 a 76, média 63,6 anos. Sintomas mais freqüentes foram odinofagia, disfagia, nódulo cervical e emagrecimento. Pacientes no estádio IV tem prognóstico reservado, demonstrando a importância do diagnóstico precoce que permita tratamentos curativos.

Introduction: The world incidende of oropharyngeal cancer is 8.3 cases/100,000 inhabitants. The squamous cell carcinoma represents 95% of all malign tumors of oropharynx and the soft palate represents 5-12% of those tumors. Etiologic factors include alcohol and tobacco. The tumors are frequently asymptomatic and the diagnosis is usually made in advanced stages of the disease. Methods: This is a retrospective study based on charter review of cases diagnosed as squamous cell carcinoma of the soft palate. Results: From 15 pacients, 13 were men and 2 were women. The ages varied from 54 to 76, average, 63.6 years old. All patients had previous history of alcohol and tobacco use. The most frequent symptoms found were odinophagia, dysphagia, cervical nodule and weight loss. Patients in stage IV have a reserved prognosis, showing the importance of early diagnosis in order to allow healing treatment.

Two treatment methods for obstructive sleep apnea hypopnea syndrome / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the two treatment methods for obstructive sleep apnea hypopnea syndrome(OSAHS)patients.METHODS 1.Four patients with habitual snoring and two patients with mild OSAHS accepted pillar palatal implant.2. Eleven patients with habitual snoring and fifteen patients with mild to moderate OSAHS accepted temperature- controlled bipolar radiofrequency(RF)ablation in both tonsils.RESULTS The postoperative examination was performed after 6 months.Pillar palatal implant: snoring VAS was reduced from 6.9?0.68 preoperatively to 3.8?0.54 postoperatively in 4 patients with habitual snoring,snoring VAS was down from 9.2?1.21 to 3.1?0.52 in 2 patients with mild to moderate OSAHS.Seven of 11 cases with habitual snoring were cured by RF,and 2 cases were effective,the other 2 cases were failed. Ten of fifteen cases with mild to moderate OSAHS were cured,3 cases were effective,and 2 cases were failed. The effective rate was 84.6%(22/26).CONCLUSION 1.The pillar palatal implant system is a safe method for patients with simple snoring and mild OSAHS in a short time observation.2.Temperature-controlled bipolar radiofrequency ablation is effective for mild to moderate OSAHS duo to hypertrophy of the tonsils.3.According to the clinical characteristics of the patients to select suitable method is the key to get a satisfactory curative effect.

Research on the correlation of morphologic changes in oropharynx of OSAHS patients before & after UPPP operation with its therapeutic effectiveness / 中国耳鼻咽喉头颈外科

0.05). CONCLUSION The secar of oropharynx can be regarded as a predictive index for OSAHS severity and guideline for operation, but the change of secar after operation can not be used as a predicitive index for therapeutic effectiveness.

Ultrasonic examination in evaluation of cleft palate repair / 中华超声影像学杂志

Objective To study the possibility of ultr asonic examination in evaluation of cleft palate repair. Methods The length, open-close movement of soft palate and velopharyngeal insufficiency were observed by ultrasonography in submaxillary region pre-operation and post-operation in 7 patients. Results After operation- the length of soft palate was longer than that before operation, the mean extended length was 13.7- mm; the movement of soft palate was increased; the velopharyngeal insufficiency was improved. Conclusions The observation of soft palate structure pre-operation and post-operation by ultrasonic examination is an objective index for evaluating the cleft palate repair.

La estomatitis subprótesis en pacientes desdentados totales

Se estudiaron 100 pacientes desdentados totales maxilares y portadores de prótesis desajustadas que acudieron al Servicio de Prótesis de la Facultad de Estomatología del ISCM-H. Los pacientes fueron examinados, y por observación directa de la mucosa palatina se constató si esta mostraba macroscópicamente los signos de estomatitis subprótesis, la cual se clasificó según los criterios de Newton. Se determinó la zona de ubicación de la lesión y por medio del interrogatorio se conoció el hábito de uso de las prótesis en estos pacientes. El 70 % de los pacientes estudiados presentaron una mucosa alterada, con un predominio de estomatitis subprótesis grado II en el 44,3 % y de grado III con menor frecuencia (21,4 %). La lesión se ubicó preferentemente en la zona media y posterior de la bóveda palatina, para el 44,3 y 34,3 %, respectivamente. Presentaban la lesión en la zona media 31 pacientes, para el 44,4 % y en esta zona prevaleció la estomatitis subprótesis grado II, para el 58 %, seguido por 24 pacientes con lesión en la zona posterior (34,2 %) con una prevalencia en esta zona del grado I de la lesión (58,3 %). Con respecto al hábito de uso de las prótesis, de los 100 pacientes estudiados 75 presentaban uso continuo de estas, mientras que solo 25 tenían hábito de uso discontinuo. De los que usaban la prótesis constantemente, 62 presentaron la mucosa alterada, en los que predominó la estomatitis grado II, con el 96,8 % y las lesiones se observaron con mayor frecuencia en las zonas media y posterior, con el 80,6 y 91,6 %, respectivamente. Al relacionar el hábito de uso continuo, las zonas de ubicación de la lesión y el grado de estomatitis subprótesis, se apreció que en la zona media la frecuencia de aparición de la lesión es mayor, con el 35,8 % y mucho menor en la zona anterior, para el 8,5 %. El grado II de la lesión prevaleció en la zona media, para el 38,8 % y en la zona posterior prevaleció el grado I de la lesión, para el 50 %.

100 total maxillary edentelous patients and carriers of maladjusted dentures that received attention at the Prosthesis Service of the Faculty of Stomatology of the Higher Institute of Medical Sciences of Havana City were studied. The patients were examined and the palatal mucosa was directly observed in order to find macroscopic signs of denture stomatitis. Denture stomatitis was classified according to Newton’s criteria. The zone of location of the injury was determined and information about the denture-wearing habit was obtained by interviewing the patients. 70% of the studied patients had an altered mucosa with a predominance of degree II denture stomatitis in 44.3 % and degree III, with less frequency, in 21.4 %. The injury was preferably located in the middle and posterior zone of the palatine vault, for 44.3 and 34.3 %, respectively. 31 patients had the injury in the middle zone for 44.4 %. Degree II denture stomatitis prevailed in this zone for 58 %, followed by 24 patients with injury in the posterior zone (34.2 %), where the degree I predominated (58.3 %). As to the denture-wearing habit, 70 of the 100 studied patients wore thew denture continuously, whereas 25 wore it discontinuously. 62 of those who wore the prosthesis all the time had altered mucosa and among them there was a predominance of degree II stomatitis (96.8 %) and the injuries were more frequent in the middle and posterior zones, for 80.6 and 91.6 %, respectively. On relating the continuous denture-wearing habit, the zone of location of the injuries and the degreee of denture stomatitis, it was observed that in the middle zone the frequency of appareance of the injury was higher (35.8 %) and much lower in the anterior zone (8.5 %). The degree II injury prevailed in the middle zone, for 38.8 %, while the degree I injury predominated in the posterior zone, for 50 %.