Predictors of Success of Pharyngeal Surgery in the Treatment of Obstructive Sleep Apnea: A Narrative Review.

(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.

The possible association between the types of soft palate and gag reflex: a preliminary study / A possível associação entre os tipos de palato mole e o reflexo de vômito: um estudo preliminar

Objective: whether gag reflex, a common problem encountered during dental procedures, is associated with the different types of the soft palate has not been addressed so far. This preliminary study sought to assess the potential association between the different types of soft palate and gag reflex. Material and Methods: one hundred dental patients were recruited. The type of soft palate was determined. Subjective (self-reported) gag reflex was recorded based on many questions and past experience and on a 0-6 VAS. Objective assessment of gag reflex was done using different maneuvers where the posterior part of the tongue and the soft palate were touched by dental mirror, and by taking impression for the upper arch. The association between the types of soft palate and the subjective and objective recorded gag reflex were statistically tested. Results: there were 53 (53%), 33 (33%) and 14 (14%) of the participants with class I, class II and class III soft palate, respectively. A significant association was found between the type of the soft palate and gag reflex in response to one of the subjective items (P= 0.039), more prominent among females (P= 0.009). Concerning the objective assessment, no significant associations were found among males. Meanwhile more females with class II and class III suffered gag reflex and/or actual gagging upon taking the impression (P = 0.001). Conclusion: this study illustrated an association between the type of soft palate and gag reflex, and its severity in females (more specifically soft palate types II and III) more than in males (AU)

Objetivo: o reflexo de vômito, um problema comum encontrado durante procedimentos odontológicos, está ou não associado aos diferentes tipos de palato mole, não foi ainda abordado até o momento. Este estudo preliminar procurou avaliar a possível associação entre os diferentes tipos de palato mole e o reflexo de vômito. Material e Métodos:cem pacientes odontológicos foram recrutados. O tipo de palato mole foi determinado. O reflexo de vômito subjetivo (auto-relatado) foi registrado com base em muitas perguntas e experiências anteriores e em um VAS de 0-6. A avaliação objetiva do reflexo de vômito foi feita por meio de diferentes manobras onde a parte posterior da língua e o palato mole foram tocados por espelho dental e por meio de moldagem da arcada superior. A associação entre os tipos de palato mole e o reflexo de vômito subjetivo e objetivo registrado foi testada estatisticamente. Resultados: houve 53 (53%), 33 (33%) e 14 (14%) participantes com palato mole classe I, classe II e classe III, respectivamente. Foi encontrada associação significativa entre o tipo de palato mole e o reflexo de vômito em resposta a um dos itens subjetivos (P= 0,039), mais proeminente no sexo feminino (P= 0,009). Em relação à avaliação objetiva, não foram encontradas associações significativas entre os homens. Enquanto isso, mais mulheres com classe II e classe III sofreram reflexo de vômito e/ou engasgo real ao receber a impressão (P = 0,001). Conclusão: este estudo ilustrou uma associação entre o tipo de palato mole e reflexo de vômito e sua gravidade em mulheres (mais especificamente palato mole tipos II e III) mais do que em homens. (AU)

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

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.

Structural and Ultrastructural Characteristics of the Red-Rumped Agouti (Dasyprocta leporina-Linnaeus, 1758) Palatine Epithelium.

The palate is a fundamental region in food swallowing and presents different adaptations in species. This research aimed to describe structural and ultrastructural characteristics of the palatine epithelium and the connective tissue cores (CTCs) of ten red-rumped agoutis (Dasyprocta leporina­Linnaeus, 1758) using macroscopic, light microscopy, scanning electron microscopy, and transmission electron microscopy. We found nine palatine ridges in the diastema and hard palate, and a smooth surface in the soft palate. Stratified squamous keratinized epithelium with projections of lamina propria and soft palate had gland clusters. Epithelial removal revealed CTCs with a conical shape with high density in the hard palate and the sides of the soft palate. Near the CTCs were nerve fibers in the hard palate, and the soft palate had muscular tissue below the gland clusters. The structural and ultrastructural characteristics enable stability of the hard palate and fixation to the soft palate sides, while the soft palate center has greater mobility thus assisting in food swallowing. We concluded that structural characteristics are similar to other mammals, although the morphology of agouti's palate differs in the amount and disposition of palatine ridges, and the conical CTC's morphology.

Functional analysis of the rat soft palate by real-time wireless electromyography.

OBJECTIVE: The aim of this study was to analyze the function of the palatal muscles in vivo by real-time wireless electromyography in rats. The effects of palatal wounding were also analyzed. METHODS: Microelectrodes were implanted six rats; in the masseter muscle (two-rats) for comparison, in the unwounded soft palate (two-rats) and the soft palate that received a surgical wound (two-rats). Two weeks after implantation, a wound was made in the soft palate using a 1 mm biopsy-punch. Electromyographic measurements and video-recordings were taken weekly to monitor train-duration and peak-amplitude during eating, grooming and drinking. RESULTS: The train-duration of the masseter muscle during eating was 0.49 ±â€¯0.11 s (rat-1) and 0.56 ±â€¯0.09 s (rat-2), which was higher than during grooming. In the unwounded soft palate the train-duration during eating was 0.63 ±â€¯0.12 s (rat-1) and 0.69 ±â€¯0.069 s (rat-2), which was higher than during grooming and drinking. The peak-amplitude for eating in the normal soft palate before surgery was 0.31 ±â€¯0.001 mV (rat-1) and 0.33 ±â€¯0.02 mV (rat-2). This decreased to 0.23 ±â€¯0.03 mV and 0.25 ±â€¯0.11 mV respectively, after surgery. For drinking the peak-amplitude was 0.30 ±â€¯0.01 mV (rat-1) and 0.39 ±â€¯0.01 mV (rat-2) before surgery, which decreased to 0.23 ±â€¯0.09 mV and 0.20 ±â€¯0.14 mV respectively, after surgery. CONCLUSION: The reduced peak-amplitude suggests impaired soft palate function after wounding. This is the first study into the in vivo function of the soft palate after surgical wounding. This model will contribute to develop strategies to improve soft palate function in patients.

Cephalometric predictors of hypernasality and nasal air emission

Abstract During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate. Objective Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD). Methodology Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission. Results For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD. Conclusion Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.

About a "New" Technique for Uvular Repair.

This letter is about a recent publication in the Cleft Palate Craniofacial Journal titled: "The significance of uvula after palatoplasty: A new technique to improve the aesthetic outcome" published by Elsherbiny et al (Cleft Palate Craniofacial J 2018;55(3):451-455). The authors present the use of one hemi-uvula for uvular repair during primary palatoplasty as their "new technique." The method of primary uvuloplasty using one-hemiuvula was extensively used by different surgeons in south America and presented and published in different scientific meetings and indexed scientific journals since the 90s. The original concept was described by Carlos Navarro in Perú and published by me in different scientific indexed journals and a textbook.

Voz hipernasal y regurgitación nasal aguda: reporte de un caso clínico y revisión de la literatura / Hypernasal speech and acute nasal regurgitation: a case report and a review of the literature

RESUMEN La voz hipernasal y la regurgitación nasal son síntomas de disfunción velofaríngea. Ésta puede tener múltiples causas: anatómicas, neurológicas o funcionales. Se describe el caso de una paciente de sexo femenino, de 13 años, que se presenta con voz hipernasal y regurgitación nasal aguda. Al examen físico se evidencia inmovilidad del velo del paladar derecho sin otros hallazgos neurológicos. El estudio con resonancia nuclear magnética de cerebro y punción lumbar fueron normales. Se diagnosticó una incompetencia velofaríngea aguda transitoria, de probable etiología viral. La paciente evolucionó de forma favorable con mejoría clínica progresiva. La incompetencia velofaríngea a causa de una paresia o parálisis del nervio vago y/o nervio glosofaríngeo es una causa poco frecuente de disfunción velofaríngea.

ABSTRACT Hypernasal speech and nasal regurgitation are symptoms of velopharyngeal dysfunction. This may have multiple causes, including velopharyngeal incompetence due to paresis or paralysis of the vagus nerve and/or glossopharyngeal nerve. We describe the case of a 13 year-old female patient, with hypernasal speech and acute nasal regurgitation, with a physical examination showing immobility of the right palate with no other neurological findings. Magnetic resonance imaging of the brain and lumbar puncture was normal. Transient acute velopharyngeal incompetence was diagnosed, probably of viral etiology. The patient evolved favorably with progressive clinical improvement. Velopharyngeal incompetence due to paresis or paralysis of the vagus and/or glossopharyngeal nerves is a rare cause of velopharyngeal dysfunction.

Hemogasometria arterial pré e pós-rinoplastia em cães braquicefálicos portadores de estenose de narina / Arterial hemogasometry pre and post rhinoplasty in brachyphalic dogs with nostril stenosis

Vinte e seis cães braquicefálicos portadores de estenose de narina, 22 machos e quatro fêmeas, foram submetidos à rinoplastia bilateral. Dezesseis cães eram Buldogues Franceses; dois, Buldogues Ingleses; seis, Pugs; e dois, Shih Tzus, com idade variando de seis meses a seis anos. Foram efetuadas coletas de sangue arterial para análises hemogasométricas no pré-operatório e 30 dias após a cirurgia. Para cada avaliação, foi obtida uma amostra de 0,5mL de sangue coletado da artéria femoral, em seringa plástica heparinizada. Em seguida, procedeu-se à avaliação hemogasométrica em analisador de gases sanguíneos (I-stat-Abbot®). Os resultados da hemogasometria pré e pós-rinoplastia mostraram uma redução nos valores médios de pCO2, TCO2 , HCO3- e BEecf, hematócrito e hemoglobina, e aumento de pH, pO2 e SO2, indicando melhora na condição ventilatória dos animais após a correção cirúrgica da estenose de narina. Isso posto, conclui-se que a hemogasometria arterial é um exame importante no diagnóstico da síndrome respiratória dos cães braquicefálicos, e extremamente útil no acompanhamento da resposta do paciente ao tratamento. A rinoplastia mostrou-se eficaz no tratamento da síndrome respiratória, promovendo melhora nos parâmetros hemogasométricos que indicam acidose respiratória secundária à obstrução das vias aéreas, comum nas raças braquicefálicas.(AU)

Twenty-six brachycephalic dogs with nostril stenosis, 22 males and four females, underwent bilateral rhinoplasty. Sixteen dogs were French Bulldogs; two, English Bulldogs; Six, Pugs; and two, Shih tzus, ranging in age from six months to six years. Blood samples were collected for hemogasometric analysis in the preoperative period and 30 days after surgery. For each evaluation, a 0.5ml sample of blood collected from the femoral artery was obtained in a heparinized plastic syringe. Hemogasometric evaluation was then performed on a blood gas analyzer (I-stat-Abbot®). The results of hemogasometry before and after rhinoplasty showed a reduction in the mean values of pCO2, TCO2, HCO3- and BEecf, hematocrit and hemoglobin, and an increase in pH, pO2 and SO2, indicating an improvement in the ventilatory condition of the animals after surgical correction of Nostril stenosis. Therefore, it is concluded that arterial hemogasometry is an important diagnostic tool for the diagnosis of brachycephalic respiratory syndrome and is extremely useful in monitoring the patient's response to treatment. Rhinoplasty was effective in the treatment of respiratory syndrome, promoting improvement in hemogasometric parameters that indicate respiratory acidosis secondary to airway obstruction, common in the brachycephalic races.(AU)

Hemogasometria arterial pré e pós-rinoplastia em cães braquicefálicos portadores de estenose de narina / Arterial hemogasometry pre and post rhinoplasty in brachyphalic dogs with nostril stenosis

Vinte e seis cães braquicefálicos portadores de estenose de narina, 22 machos e quatro fêmeas, foram submetidos à rinoplastia bilateral. Dezesseis cães eram Buldogues Franceses; dois, Buldogues Ingleses; seis, Pugs; e dois, Shih Tzus, com idade variando de seis meses a seis anos. Foram efetuadas coletas de sangue arterial para análises hemogasométricas no pré-operatório e 30 dias após a cirurgia. Para cada avaliação, foi obtida uma amostra de 0,5mL de sangue coletado da artéria femoral, em seringa plástica heparinizada. Em seguida, procedeu-se à avaliação hemogasométrica em analisador de gases sanguíneos (I-stat-Abbot®). Os resultados da hemogasometria pré e pós-rinoplastia mostraram uma redução nos valores médios de pCO2, TCO2 , HCO3- e BEecf, hematócrito e hemoglobina, e aumento de pH, pO2 e SO2, indicando melhora na condição ventilatória dos animais após a correção cirúrgica da estenose de narina. Isso posto, conclui-se que a hemogasometria arterial é um exame importante no diagnóstico da síndrome respiratória dos cães braquicefálicos, e extremamente útil no acompanhamento da resposta do paciente ao tratamento. A rinoplastia mostrou-se eficaz no tratamento da síndrome respiratória, promovendo melhora nos parâmetros hemogasométricos que indicam acidose respiratória secundária à obstrução das vias aéreas, comum nas raças braquicefálicas.(AU)

Twenty-six brachycephalic dogs with nostril stenosis, 22 males and four females, underwent bilateral rhinoplasty. Sixteen dogs were French Bulldogs; two, English Bulldogs; Six, Pugs; and two, Shih tzus, ranging in age from six months to six years. Blood samples were collected for hemogasometric analysis in the preoperative period and 30 days after surgery. For each evaluation, a 0.5ml sample of blood collected from the femoral artery was obtained in a heparinized plastic syringe. Hemogasometric evaluation was then performed on a blood gas analyzer (I-stat-Abbot®). The results of hemogasometry before and after rhinoplasty showed a reduction in the mean values of pCO2, TCO2, HCO3- and BEecf, hematocrit and hemoglobin, and an increase in pH, pO2 and SO2, indicating an improvement in the ventilatory condition of the animals after surgical correction of Nostril stenosis. Therefore, it is concluded that arterial hemogasometry is an important diagnostic tool for the diagnosis of brachycephalic respiratory syndrome and is extremely useful in monitoring the patient's response to treatment. Rhinoplasty was effective in the treatment of respiratory syndrome, promoting improvement in hemogasometric parameters that indicate respiratory acidosis secondary to airway obstruction, common in the brachycephalic races.(AU)

The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) (p< 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

Obturadores de paladar en el sistema respiratorio-fono-articular. Caso clínico / Palatal obturators in the respiratory-phono-articular system. Clinical case

RESUMEN Los maxilares son los huesos que proveen soporte a la base del cráneo y son esenciales en la caja de resonancia para la producción de la voz, así como el sostén de los músculos del paladar blando por lo que los defectos creados en estas estructuras anatómicas tras la resección de neoplasias o traumatismos, dan como consecuencia la pérdida de algunas funciones como la fonación, deglución, masticación, respiración, estética y la pérdida de la autoestima. El paladar blando es un elemento esencial en los movimientos de la válvula velofaríngea que regula y dirige la transmisión de la energía del sonido y la presión de aire en las cavidades oral y nasal durante el habla, las resecciones de esta estructura involucran un reto en la rehabilitación.

ABSTRACT The maxillaries are the bones that provide support to the base of the skull and are essential in the sounding board for the voice production as well as the support of the muscles of the soft palate so that defects in these anatomical structures created after resection of tumors or trauma, they result in the loss of some features like phonation, swallowing, chewing, breathing, aesthetics and loss of self esteem. The soft palate is an essential element in velopharyngeal movements regulating valve and directs the transmission of sound energy and the air pressure in the oral and nasal cavities during speech, resections that this structure involves a challenge rehabilitation.

The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery.

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) ( p < 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

Atypical angiofibroma in a patient with compromised general health: A case report.

INTRODUCTION: The nasopharyngeal angiofibroma (NA) is a benign tumor that originates from the pterygopalatine fossa and extends to the adjacent anatomical structures and affects frequently young individuals. The basic treatment for NA is surgical resection, but in some cases the tumor is surgically inaccessible. CASE PRESENTATION: We describe the case of a 45-year-old male with respiratory difficulty after the appearance of a soft palate lesion. The clinical appearance of NA was not specific. DISCUSSION: There are still discussions about the best therapeutic strategy and controversies about performing incisional biopsy. To our knowledge, this is the first report of a NA in an adult patient in which the general health conditions prevented the therapeutic approach, besides the extension of the lesion and its complications. CONCLUSION: Our case shows that NA may reach high proportions and its involvement in older patients should be considered. In this report, we showed the limitation of the therapeutic strategy for advanced cases of NA.

Swallowing evaluation after surgery for obstructive sleep apnea syndrome: uvulopalatopharyngoplasty vs. expansion pharyngoplasty.

PURPOSE: To evaluate the effect of pharyngeal surgery on swallowing pattern in patients with obstructive sleep apnea syndrome (OSAS), and to compare two surgical techniques: uvulopalatopharyngoplasty (UPPP) and expansion pharyngoplasty (EP), through videofluoroscopy. METHODS: Longitudinal prospective cohort, in a tertiary referral center. 17 adult patients were enrolled this study, divided into two groups: patients who underwent UPPP (n = 10) or EP (n = 7). Swallowing videofluoroscopy (for both liquid and pasty consistences) was assessed at three different periods: before surgery, and at 14 and 28 days following surgery. Comparisons were performed between pre- and post-operative (PO) swallowing conditions in the same patient, and between surgical techniques. RESULTS: Asymptomatic OSAS patients already presented altered swallowing pattern before surgery. Both surgical procedures led to an increased hyoid movement time and an increased frequency of laryngeal penetration in early PO during liquid ingestion. For pasty consistency, both techniques reduced velum movement time and increased pharyngeal transit time and the rate of stasis in hypopharynx. All these parameters reached or tended to reach the pre-operative indices at day PO 28. CONCLUSIONS: OSAS patients show sub-clinical changes in swallowing pattern before surgery. Both surgical techniques are related to transitory changes in swallowing biomechanics. Complete or partial reversal to pre-operative swallowing parameters occurs 1 month after both surgery techniques.

Immunohistochemical Expression of Nuclear ß-Catenin and STAT-6 in a Solitary Fibrous Tumor of the Soft Palate: A Case Report and Review of the Literature.

The solitary fibrous tumors (SFT) are rare tumors in the head and neck region and there have been only 5 cases reported in the literature in the soft palate. The current paper presents a unique case of a 62-year-old male with TFS arising in the soft palate. The tumor was highly cellular, composed of bland looking haphazardly arranged spindle cells. The signal transducer and activator of transcription (STAT)-6 and nuclear ß-catenin were reactive by immunohistochemistry (IHC). The current case highlights the importance of the STAT-6 and the ß-catenin as IHC markers to make a differential diagnosis with other entities. In summary, the paper presents the first reported case of a SFT of the soft palate in a male patient with nuclear expression of STAT-6 and ß-catenin.

An anatomical study of the arterial supply to the soft palate / Estudio anatómico de la irrigación arterial del paladar blando

This study provides a detailed description of the arteries supplying the soft palate via: (i) ascending palatine; (ii) tonsillar; (iii) ascending pharyngeal; and (iv) lesser palatine arteries. Detailed dissections were performed on each side of thirty fetal and twenty adult head and neck specimens (n=100). This investigation documents the arteries terminating at the respective parts (superior, middle and inferior) of the soft palate and demonstrated that the majority of arteries terminated at the superior (83 percent and middle (63 percent) parts, whereas the inferior part (34 percent) was documented to receive the poorest arterial supply. The present study recognized anastomotic connections in 6 percent of fetal specimens i.e. (i) between the ascending palatine and lesser palatine arteries which terminated at the superior part of the soft palate in 4 percent of fetal cases, and (ii) between the ascending pharyngeal and recurrent pharyngeal arteries which terminated at the inferior part in 2 percent of fetal specimens. The position and relations of the soft palate arteries is of significance to minimize the risk of vascular disruption and myomucosal or mucosal flap failure during cleft palate repair and for the surgical correction of velopharyngeal insufficiency...

Este estudio proporciona una descripción detallada de las arterias que irrigan el paladar blando a través de las arterias: (i) palatina ascendente, (ii) tonsilar, (iii) faríngea ascendente, y (iv) palatinas menores. Se realizaron disecciones bilateralmente en 30 cabezas y cuellos de fetos y 20 de adultos (n = 100). Esta investigación documentó las arterias que terminaron en diferentes partes (superior, media e inferior) del paladar blando y demostró que la mayoría terminaba a nivel superior (83 por ciento) y medio (63 por ciento), mientras que la parte inferior (34 por ciento recibía un escaso suministro arterial. Se reconocieron conexiones anastomóticas en 6 por ciento de las muestras fetales, (i) entre las aa. palatinas ascendentes y las aa. palatinas menores, que terminaron en la parte superior del paladar blando en 4 por ciento de los casos fetales, y (ii) entre las aa. faríngea ascendente y faríngea recurrente, que terminaban en la parte inferior en un 2 por ciento de las muestras fetales. La posición y las relaciones de las arterias del paladar blando es relevante para minimizar el riesgo de interrupción vascular y falla de los colgajos miomucosos o mucosos, durante la reparación de paladar hendido o en la corrección quirúrgica de insuficiencia velofaríngea...

Odynophagia following retained bee stinger

Nearly half of Hymenoptera stings affect the head and neck region of victims, but reports on oropharyngeal bee stings are very few. We describe the case of a patient with odynophagia and suffocation in mass envenomation. He had a retained bee stinger whose removal was delayed for more than 24 hours following the sting, due to persisting angioedema. Odynophagia receded after removal of the stinger and treatment with paracetamol, steroids and metronidazole. The patient also developed rhabdomyolysis, renal failure and hepatitis that were treated with conservative therapy. Oropharyngeal stings can simulate symptoms of persisting angioedema in victims of mass envenomation.(AU)

Odynophagia following retained bee stinger

Nearly half of Hymenoptera stings affect the head and neck region of victims, but reports on oropharyngeal bee stings are very few. We describe the case of a patient with odynophagia and suffocation in mass envenomation. He had a retained bee stinger whose removal was delayed for more than 24 hours following the sting, due to persisting angioedema. Odynophagia receded after removal of the stinger and treatment with paracetamol, steroids and metronidazole. The patient also developed rhabdomyolysis, renal failure and hepatitis that were treated with conservative therapy. Oropharyngeal stings can simulate symptoms of persisting angioedema in victims of mass envenomation.(AU)

Trombose de artéria carótida interna relacionada a trauma de palato em criança / Internal carotid artery thrombosis related to trauma of palate in a child

Relatar um caso de trombose de artéria carótida interna secundária relacionada a trauma de palato mole em criança. DESCRIÇÃO DO CASO: Criança admitida com quadro de alteração do nível de consciência, sonolência, afasia e hemiplegia direita; tinha antecedente de trauma corto contuso leve em palato mole há oito horas. A investigação tomográfica evidenciou acidente vascular isquêmico secundário à interrupção do fluxo sanguíneo em território de artéria cerebral média esquerda. A arteriografia mostrou oclusão da artéria carótida interna imediatamente distal à sua origem, com aspecto radiológico de "ponta de lápis", obstruindo o fluxo sanguíneo na região. A paciente foi submetida à investigação para doença pró-trombótica e cardíaca, contudo, não foi detectada nenhuma alteração. A administração de enoxaparina em dose terapêutica por três semanas conduziu à melhora clínica progressiva. Após três semanas de seguimento, a paciente não mostrava sequelas motoras. COMENTÁRIOS: As lesões intraorais são frequentes em crianças e a maioria evolui sem complicações. A trombose da artéria carótida interna é uma complicação rara, mas bem documentada destas lesões e decorre da compressão do vaso com trombogênese localizada. A taxa de mortalidade relatada é de 30 por cento e as sequelas ocorrem em 85 por cento dos casos.

To describe a child with internal carotid artery thrombosis secondary to trauma of the soft palate. CASE DESCRIPTION: Child presented with altered level of consciousness, drowsiness, aphasia, right hemiplegia, and a history of trauma, with mild concussion of the soft palate eight hours prior to admission. CT scan showed ischemic stroke secondary to interruption of blood flow in the area of the left middle cerebral artery. Arteriography showed occlusion of the carotid artery just distal to its origin, with radiological appearance of "pencil tip", obstructing blood flow in the region. Patient underwent investigation for pro-thrombotic and heart diseases, which was negative. The child received enoxaparin at therapeutic dose for three weeks, showing progressive clinical improvement. After three weeks, the patient did not show motor problems. COMMENTS: Intraoral lesions are common in children, but most of them evolve without complications. However, the internal carotid artery thrombosis is a rare but well documented complication of these lesions and results from the vessel compression with localized thrombogenesis. The mortality rate is about 30 percent, and sequels are seen in 85 percent of cases.