Epignathus with oropharynx destruction

Epignathus, is a rare oropharyngeal teratoma arising from the head and neck region. Sporadic cases have been described with associated intracerebral teratoma. Even more infrequent and extraordinary is the circumstance of a teratoma with oropharynx destruction. We describe the case of a fetus with pharyngeal mass that completely destroyed the oral cavity. The histological examination revealed an immature teratoma (G3); only one other G3 case has been described.

Quistes epidermoides de cabeza y cuello / Epidermoid cysts of the head and neck

Los quistes epidermoides localizados en cabeza y cuello son poco comunes y pueden ser difíciles de diagnosticar. Se describen los casos de cuatro pacientes con quistes epidermoides de cabeza y cuello, dos con localización en la región sublingual y extensión suprahioidea, otro localizado en la pared orofaríngea posterolateral y otro en la región submaxilar y submentoniana. Fueron tratados con éxito mediante abordajes transorales y transcervical, respectivamente. Se realizó una revisión de la bibliografía y se describieron las características anatómicas, clínicas e histológicas y el tratamiento de estas infrecuentes lesiones. (AU)

Epidermoid cysts of the head and neck are rare and can be difficult to diagnose. Two cases of patients with epidermoid cysts of the floor of the mouth with suprahyoid extension, other located at posterolateral oropharynx wall andother located at the submandibular and submental space with extention to midline are described. They were successfully treated by a transoral and transcervical approach respectively. A review of the literature was performed, and the anatomical, clinical and histological aspects and treatment of these uncommon tumors were reported. (AU)

Evaluation of morphological changes in pharynx with dynamic CT and MRI in snoring patients / Anomalías morfológicas de la faringe en roncadores

Background: Identifying the craniofacial abnormalities that cause snoring and the narrowest area of the upper airway creating obstructions can help to determine the proper method of treatment. Aim: To identify the factors that can cause snoring and the areas of the airway that are the most likely to collapse with upper airway imaging. Material and Methods: Axial pharynx examinations with CT (computerized tomography) and magnetic resonance imaging (MRI) were performed to 38 patients complaining of snoring and 12 patients who did not complain of snoring. The narrowest areas of nasopharynx, hypophraynx, oropharynx, bilateral para-pharyngeal fat pad and para-pharyngeal muscle thickness were measured. Results: In snoring patients, the narrowest part of the upper airway was the retro-palatal region in the oropharynx, as measured with both imaging methods. When patients with and without snoring were compared, the former that a higher body mass index and neck diameter and a narrower oropharynx area. In dynamic examinations, we determined that as para-pharyngeal muscle thickness increased, medial-lateral airway diameter and the oropharynx area decreased. Conclusions: The narrowest section of the airway is the retro-palatal region of the oropharynx, measured both with CT and MRI.

Antecedentes: La identificación de las anomalías craneofaciales que causan el ronquido es importante para decidir la terapia adecuada. Objetivo: Identificar los factores que causan el ronquido y las zonas de la vía aérea superior que son más susceptibles de colapsar, usando imágenes. Material y Métodos: Se efectuaron exámenes axiales de la faringe con tomografía computada (TC) y resonancia magnética (RM) en 38 pacientes que roncaban y 12 que no lo hacían. Se determinaron las zonas más estrechas de la nasofaringe, hipofaringe, orofaringe y el grosor del tejido adiposo y musculatura parafaríngeos. Resultados: En los pacientes que roncaban la zona más estrecha de la vía aérea superior fue la zona retro-palatal en la orofaringe. Los pacientes roncadores tenían un índice de masa corporal y diámetro cuello mayores y un área orofaríngea menor. En los exámenes dinámicos observamos que a medida que el grosor de los músculos parafaríngeos aumentó, disminuyó el área medial y lateral de la vía aérea y el área de la orofaringe. Conclusiones: La zona más estrecha de la vía aérea superior es la región retropalatal de la orofaringe, medida tanto con TC como con RM.

Oropharyngeal styloids: An unusual presentation.

The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant. The styloid process is said to be elongated if it is longer than 3.0 cm in length. Anatomical variations are very common and clinical symptoms arising from such variations have to be recognized. Elongated styloid processes may cause chronic throat pain along with foreign body sensation, dysphagia, vague facial pain, and otalgia. Surgical excision of an elongated styloid is considered as a satisfactory treatment for such cases. Here, we present a unique case of bilaterally elongated styloids that could be visualized just by depressing the tongue, when they appeared like the tusks of an elephant in the oropharyngeal region.

Cephalometric evaluation of the airway space and hyoid bone in children with atypical deglutition: correlations study / Evaluación cefalométrica del espacio de las vías respiratorias y hueso hioides en niños con deglución atípica: estudio correlacional

Although there is a close relationship between swallowing and breathing are no studies that relate to atypical swallowing radiographic anatomy of the airway space and its possible correlation with the radiographic position of the hyoid bone. The aim was to evaluate the possible correlation with the radiographic position of the hyoid bone and airway space in lateral radiographs of children with atypical deglutition. Using cephalometric analysis on lateral teleradiographs, the distances of H-MP (hyoid to mandibular plane) and H-T (hyoid to tuber) were Spearman's correlation analysis was performed with PAS (airway space) in two groups: the experimental group with atypical deglutition and the control group normal deglutition. Both groups included subjects in mixed dentition stage. Thevariable T-H had statistically significant correlation with PAS (0.0286) and the variable MP-H had significant correlation with variable PAS (0.0053). Ourresults show that advanced positive correlation of the radiographic position of the hyoid bone to the airway space only in the group of normal swallowing. The lower airway in patients with atypical swallowing, causing changes in tongue posture which leads to change in the position of the hyoid bone.

Aunque existe una estrecha relación entre la deglución y la respiración, no se dispone de estudios que relacionen la anatomía radiográfica atípica de deglución del espacio de la vía aérea y su posible correlación con la posición radiológica del hueso hioides. El objetivo fue evaluar la posible correlación de la posición radiológica del hueso hioides y las vías aéreas en radiografías laterales de niños con deglución atípica. Utilizando el análisis cefalométrico sobre telerradiografías laterales, fueron analizadas las correlaciones entre las distancias H-MP (hueso hioides al plano mandibular) y HT (hioides al tubérculo) y el PAS (espacio de la vía aérea) en dos grupos: el grupo experimental con la deglución atípica y el grupo control con deglución normal. Ambos grupos estaban en etapa de dentición mixta. Las variables HT y MP-H tuvieron una correlación estadísticamente significativa con la variable PAS, 0,0286 y 0,0053 respectivamente. Nuestros resultados muestran que la correlación positiva de la situación radiológica avanzada del hueso hioides al espacio de las vías respiratorias sólo se observa en el grupo de deglución normal. La vía respiratoria inferior en los pacientes con deglución atípica provoca cambios en la postura de la lengua, lo que conduce a un cambio en la posición del hueso hioides.

Estudo da correlação entre a alteração do espaço aéreo orofaríngeo e as mudanças da posição natural da cabeça e da altura facial ânter-inferior em indivíduos assintomáticos, com maloclusões de classe II de angle, submetidos à desprogramação neuromuscular com placa oclusal / Study of the correlation between the alteration of the lower pharyngeal width and the changes in natural head position and in anterior inferior facial height in asymptomatic individuals, with angle's class II malocclusion, after neuromuscular deprogramming throug the use occlusal splint

Estudos prévios demonstraram alterações cefalométricas significativas no espaço aéreo orofaríngeo, na altura facial antero-inferior e na posição da cabeça após o uso de placa oclusal superior. O propósito da presente pesquisa foi avaliar as possíveis correlações entre estas alterações. Foram analisados 15 indivíduos assintomáticos, com média de idade de 17 anos e 4 meses e com maloclusões de classe II de Angle. Obtiveram-se, de cada indivíduo, duas telerradiografias laterais na posição natural da cabeça (PNC), sendo uma antes, e a outra, após a desprogramação neuromuscular. A análise da orofaringe(ORO) e da altura facial ântero-inferior (AFAi) foi feita de acordo com McNamara (1984). A posição da cabeça foi avaliada por meio dos ângulos craniovertical (SN/VER)n e craniocervical (CVT/SN). As correlções observadas foram: ORO e AFAi: -0,31 (p=0,257); ORO e SN/VER: 0,43 (p=0.104); ORO e CVT/SN: (p=0,915). Concluiu-se que não existiram correlações significativas entre as alterações do espaço aéreo orofaríngeo e as mudanças da posição natural da cabeça e da altura facial antero-inferior após desprogramação neuromuscular em pacientes com maloclusões de classe II.

Previous studies demonstrated significant cephalometrics in lower pharyngeal airway space, anterior inferior facial height and natural head position after the use of use upper oclusal splint. The present research was designed to determine the possible correlation between these alterations. Fifteen asymptomatic individuals, with a mean age of seventeen years and four months, presenting Angle’s Class II malocclusion, were evaluated. Two lateral radiographs in natural head position (NHP) were taken from each patient, one before and the other one after neuromuscular deprogramming. The analysis of lower pharyngeal airway space (LP) and the anterior inferior facial height (ANS-Me) was performed according to McNamara (1984). The NHP analysis was carried out by evaluating the craniovertical (SN/VER) and craniovertival (CVT/SN) angles. The correlations were: LP and ANS-Me: -0,31 (p=0,257); LP and SN/VER: ,43 (p=0.104); LP and CVT/SN: -0,03 (p=0,915). It was concluded that there were no significant correlations between the alteration of the lower pharyngeal width and the changes in natural head position and in anterior inferior facial height neuromuscular deprogramming in patients with Angle’s class II malocclusion.