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.

Evaluation of morphological changes in pharynx with dynamic CT and MRI in snoring patients.

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.

Assessment of the Effects of Curacel and Bone Wax on the Acute Oroantral Opening Site by means of Computer Tomography and Histopathology.

PURPOSE: In this study, the effects of Curacel TM oxidized regenerated cellulose and bone wax on the healing bone were compared to each other by means of CT based bone density measurement and histopathological evaluation. METHODS: The bone density measurements of the control group were significantly higher than those of both Curacel and bone wax groups. RESULTS: There was no significant difference between Curacel and bone wax. Histopathologically, the bone wax group showed more osteoblastic activation than Curacel group. For all measurement parameters (osteoblastic activation, osteoclastic activation, fibrous connective tissue, osseous trabeculae), Curacel and bone wax groups had worse results than control group. It is concluded that Curacel has no superiority over bone wax in terms of osseous healing in the oroantral region. There is no need to use oxidized regenerated cellulose or bone wax for small oroantral openings since the healing is better without any intervention. In addition, bone density measurement and histopathological evaluation were consistent in terms of osseous healing of the oroantral opening.

Acute lymphoblastic leukemia presented as multiple breast masses.

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.

Antidepressant-like effects of echo-planar magnetic resonance imaging in mice determined using the forced swimming test.

Echo-planar magnetic resonance imaging (EP-MRI), which is novel variant of MRI, is thought to have antidepressant properties in humans and animal models. Using the forced swimming test (FST), we investigated which monoaminergic system in mice is affected by EP-MRI. The short- and long-term effects of EP-MRI on immobility time in the FST and motor activity within a locomotor activity cage were examined. Two groups of mice underwent 20 min of EP-MRI in an MR scanner (Siemens, 1.5 T Symphony) either 23.5 or 1 h before the start of the second session of the FST. In both groups, the immobility duration in the FST was reduced, similar to effective antidepressant drug treatments. Climbing behavior in the 1-h group and swimming behavior in the 23.5-h group increased significantly, similar to that seen after the administration of desipramine (a noradrenaline reuptake inhibitor) and sertraline (a selective serotonin reuptake inhibitor), respectively. The findings support the hypothesis that EP-MRI has an antidepressant-like effect. We suggest that the antidepressant-like effect begins in the early period with noradrenaline systems and is maintained in the late period with serotonin systems.

Dynamic upper airway soft-tissue and caliber changes in healthy subjects and snoring patients.

BACKGROUND AND PURPOSE: The oropharyngeal airways are smaller in those who snore than in those who do not. We sought to determine which soft-tissue component surrounding the airways contributes to upper airway narrowing in those who snore. METHODS: Ten control subjects and 19 snoring patients underwent CT, with 2-mm-thick axial sections obtained every 0.6 seconds during the respiration cycle at the same oropharyngeal level. We selected two sections with the widest and narrowest parts of the oropharyngeal airway to measure the anteroposterior and lateral dimensions of the airway and the thickness of the bilateral parapharyngeal fat pads, pterygoid muscles, and parapharyngeal walls. Mean values were calculated for each phase. For each subject, differences were calculated by subtracting the values in narrowest phase from those in the widest phase. RESULTS: Changes in airway dimension (P < .05) and lateral parapharyngeal wall thickness (P < .01) were significantly different between snorers and control subjects. Changes in parapharyngeal wall thickness and transverse oropharyngeal airway diameter changes were significantly related (P < .01) in those who snored but not in control subjects. CONCLUSION: Airway narrowing predominantly occurs in the lateral dimension in people who snore. Changes in the lateral pharyngeal wall are more important than the parapharyngeal fat pads in airway calibration. Narrowing of the upper airway area at the end of the expirium and the beginning of the inspirium is thought to be the cause of snoring and due to augmented muscle mass and prolonged laxity rather than inadequate activation of the pharyngeal dilating muscles.

Does the oropharyngeal fat tissue influence the oropharyngeal airway in snorers? Dynamic CT study.

OBJECTIVE: The aim of this study was to determine if snorers have a narrower oropharyngeal airway area because of fat infiltration, and an elevated body mass index. MATERIALS AND METHODS: Ten control subjects and 19 patients that snored were evaluated. We obtained 2-mm-thick axial CT scan images every 0.6 seconds during expiration and inspiration at the same level of the oropharynx. We selected the largest and the smallest oropharyngeal airway areas and found the differences. From the slice that had the smallest oropharyngeal airway area, the thickness of the parapharyngeal and subcutaneous fat was measured. The measurements from the left and right side were added together and single values for parapharyngeal and subcutaneous fat tissue thickness were then found. RESULTS: The conventional measure of body mass index was significantly higher in the snorers (p < 0.05). The difference in the smallest oropharyngeal airway area between snorers and the controls was statistically significant (p < 0.01). The average difference between the largest and the smallest oropharyngeal area in the control group and the snorer group was statistically significant (p < 0.05). There was no significant difference in the largest oropharyngeal airway area, the total subcutaneous fat width and the total parapharyngeal fat width between snorers and control subjects (p > 0.05). CONCLUSION: We concluded that the oropharyngeal fat deposition in snorers is not an important factor, and it does not predispose a person to the upper airway narrowing.

The effect of unilateral partial edentulism to muscle thickness.

OBJECTIVE: Teeth and muscles play a very important role for occlusal equilibrium and function. When tooth loss begins, it may also affect the function of the muscle tissues. METHODS: The thickness of the masseter and anterior temporalis muscles were measured bilaterally in 30 healthy fully dentate adults and in 30 unilateral edentulous patients by using ultrasonographic imaging. All scans were carried out by the same radiologist to eliminate the inter-observer difference, using a real time scanner (Toshiba SSA- 270 A Japan). A 7.5 MHz linear transducer was used. The transducer was held against the cheek with light pressure. The effect of age, sex, duration of the partial edentulism, unilateral chewing habits of the individuals to the muscle thickness were also evaluated. In all subjects, facial proportion index was also determined. RESULTS: No study has been found in the literature concerning the masticatory muscle thickness in unilateral partial edentulous patients. Therefore, the main purpose of this study was to compare and establish the differences of the muscle thicknesses between dentate and edentulous sides in unilateral partial edentulous patients with ultrasonography and to test whether the variation in the thickness of the muscle is related to the variation in the facial morphology using the facial proportional indices in the study groups. In the present study, ultrasonography revealed a large variation in the thicknesses of the masseter and temporalis muscles in experimental and control groups, during both relaxed and contracted conditions. The thicknesses of the muscles in females during both relaxed and contracted conditions were less than those in males in both control and experimental groups. In experimental group, a high negative correlation was found between the thickness of the masseter muscle and Facial proportion Index (FPI) in females, however, the statistical analysis showed no significant difference in males. Also, a high negative correlation was found in control group, especially in females. There was no statistically significant relationship between thicknesses of the muscles and age of the subjects in both groups. There was no statistically significant relationship between unilateral chewing habits and muscle thickness. In this study, the duration of partial edentulism did not affect the thickness of the muscles. CONCLUSION: Further research is required to study muscular atrophy for comparison with total edentulism.