Palatoglossal Arch Research Articles

Oropharyngeal stenosis in patient with oral submucous fibrosis: a case report with 8-year follow-up

Oral submucous fibrosis (OSF) is a chronic, progressive condition affecting the oral mucosa associated with areca nut consumption. It leads to restricted tongue movement, loss of papillae, blanching and stiffening of the mucosa, difficulty in opening the mouth, and challenges in eating due to inflammation and fibrosis. This report presents a rare case of oropharyngeal stenosis secondary to OSF in a 43-year-old male with a history of chewing betel nut. A surgical procedure similar to Uvulopalatopharyngoplasty was performed to excise the submucous oropharyngeal stenosis and to reconstruct the uvula, palatoglossal arch, and palatopharyngeal arch. At 8 years postoperatively, the patient exhibited a normal mouth opening and oropharyngeal aperture.

Exploring the Use of the Current Perception Threshold in Pharyngeal Paresthesia Patients.

To explore pharyngeal sensory function by current perception threshold (CPT) measurement in paresthetic pharynx. In total, 58 healthy participants and 66 patients with pharyngeal paresthetic symptoms underwent CPT evaluation. Pharyngeal paresthesia (n = 66) was classified into three categories based on aetiologies: six cases with pain in pharynx; 34 neuropathic patients with glossopharyngeal nerve and/or vagus nerve or recurrent laryngeal nerve injury; and 26 patients with globus pharyngeus. CPT measurements were obtained from bilateral palatoglossal arch and tongue base at 2000, 250 and 5Hz stimulation frequencies. Ranked from high to low, the CPT values for the bilateral palatoglossal arches and tongue bases were: lower cranial neuropathic patients, globus pharyngeus, healthy participants and patients with pain. The CPT values for neuropathic patients on the injured side were significantly higher than those on the healthy side (P < 0.05). The CPT values for patients with pain in pharynx were significantly lower than those of healthy participants (P < 0.05) when the bilateral tongue bases were stimulated. The CPT measurement is a reliable method for quantitatively assessing pharyngeal sensory function and able to differentiate pharyngeal paresthesia between lower cranial neuropathic and subjective discomfort. Pharyngeal sensory function is more sensitive in patients with pain in pharynx. Pharyngeal sensory function is significantly reduced in lower cranialneuropathic patients, especially on the injured side. Patients with globus pharyngeus have pharyngeal hyposensitivity.

Detection of oropharyngeal sensory function in normal population

Objective: To study the oropharyngeal sensory function by Current Perception Threshold(CPT) detection, to explore the detection method of oropharyngeal sensory function in normal population, and to analyze the possible influencing factors. Methods: Fifty-eight normal subjects were included prospectively in this study. Age, gender, body mass index (BMI) were collected. The age of the subjects ranged from 20 to 76 (43.27±13.52) years old. There were 34 females with 17 in childbearing period and 17 in menopause; and 24 males were included.In all the cases, 6 cases were in low BMI, 39 cases were in normal BMI, 10 cases were overweight and 3 cases were suffering from obesity. The CPT system of Neurometer was used to stimulate bilateral palatoglossal arch and tongue base.The current used was 2000 Hz, 250 Hz and 5 Hz respectively.The function of type Aβ, Aδ and C sensory nerve fibers were tested and the CPT values were recorded.The values were inversely proportional to pharyngeal sensation function.To evaluate the oropharyngeal sensory function of the subjects, the CPT values of each frequency at each testing point were compared. SPSS 25.0 software was used for statistical analysis. Results: The CPT value of palatoglossal arch was significantly lower than that of tongue base (t=-2.58,-2.65,-2.54,-2.47,-2.37,-2.77,P<0.05), 2 000 Hz>250 Hz>5 Hz, and there was no significant difference between left and right sides(t=-0.03,-0.51,-0.49,0.06,-0.16,0.13,P>0.05). The CPT value of male was slightly higher than that of female (t=0.92,1.55,0.27,0.78,1.44,1.26,0.35,0.77,1.27,0.24,0.78,0.96,P>0.05). The CPT values of women in childbearing period were significantly less than those in menopausal women (t=-3.90,-3.64,-2.14,-4.20,-4.28,-4.28,-3.52,-4.46,-3.41,-3.63,-4.66,-2.86,P<0.05). The CPT value increased with age, and the values of all frequency of 20 to 30 years old group was significantly lower than those of subjects over 40 years old at each point (The t values of bilateral palatoglossal arch at 2 000 Hz were -5.57,-6.22,-10.18,-11.00;the t values of bilateral palatoglossal arch at 250 Hz were -6.39,-8.79,-6.39,-15.61;the t values of bilateral palatoglossal arch at 5 Hz were -7.09, -5.57, -9.26, -15.23;the t values of tongue base at 2 000 Hz were -3.11,-3.88,-7.60,-8.55;the t values of tongue base at 250 Hz were -6.31,-10.59,-8.52,-10.60;the t values of tongue baseat 5 Hz were -6.69,-5.09,-8.70,-7.07,P<0.05).The values at all frequencies and testing points of 30-40 years old group were significantly lower than those of all subjects over 60 years old (The t values of bilateral palatoglossal arch at 2 000 Hz were -10.91,-12.42;the t values of bilateral palatoglossal arch at 250 Hz were -6.25,-10.87;the t values of bilateral palatoglossal arch at 5 Hz were -5.53,-11.01;the t values of tongue base at 2 000 Hz were -8.62,-10.12;the t values of tongue base at 250 Hz were -6.89,-7.82;the t values of tongue base at 5 Hz were -6.13,-6.48,P<0.05). Conclusions: CPT can be used to evaluate oropharyngeal sensory function. The sensitivity of tongue base is lower than that of palatoglossal arch, there is no significant difference in oropharyngeal sensory function between male and female,between left and right sides. There are many factors influencing oropharyngeal sensory function. Age, hormone level changes may affect the sensitivity of oropharyngeal sensory function.

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy.

BACKGROUNDTonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome. Postoperative hemorrhage of tonsillectomy is a life-threatening complication.AIMTo identify the risk factors that may contribute to primary and secondary post-operative hemorrhage in pediatric tonsillectomy.METHODSThe clinical data from 5015 children, 3443 males and 1572 females, aged 1.92-17.08 years, with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected. The variables including sex, age, time of onset, diagnosis, method of tonsillectomy, experience of surgeon, time when the surgery started and monthly average air temperature were abstracted. The patients with postoperative hemorrhage were classified into two groups, the primary bleeding group and the secondary bleeding group, and their characteristics were compared with those of the nonbleeding group separately. Statistical analysis was performed by chi-square test with SPSS 20.RESULTSNinety-two patients had post-tonsillectomy hemorrhage, and the incidence rate of post-tonsillectomy hemorrhage was 1.83%. The mean age was 5.75 years. Cases of primary hemorrhage accounted for approximately 33.70% (31/92), and cases of secondary hemorrhage occurred in 66.30% (61/92). The rate of reoperation for bleeding was 0.92%, and the rate of rehospitalization for bleeding was 0.88% in all patients. Multiple hemostasis surgery was performed in 6.52% (3/46) of patients. The method of tonsillectomy (coblation tonsillectomy) and experience of the surgeon (junior surgeon with less than 5 years of experience) were significantly associated with primary hemorrhage (χ2 = 5.830, P = 0.016, χ2= 6.621, P = 0.010, respectively). Age (over 6 years old) and time of onset (more than a 1-year history) were significantly associated with secondary hemorrhage (χ2= 15.242, P = 0.000, χ2=4.293, P = 0.038, respectively). There was no significant difference in sex, diagnosis, time when the surgery started or monthly average air temperature. There was a significant difference in the intervention measures between the primary bleeding group and the secondary bleeding group (χ2= 10.947, P = 0.001). The lower pole and middle portion were the common bleeding sites, followed by the upper pole and palatoglossal arch.CONCLUSIONThe incidence rate of post-tonsillectomy hemorrhage is low. Coblation tonsillectomy and less than 5 years’ experience of surgeon contribute to the tendency for primary hemorrhage. Age and time of onset are responsible for secondary hemorrhage.

Comparison of pre-analytical characteristics for molecular and serological diagnostics of COVID-19.

Background: The diagnosis of SARS-CoV-2 infection relies on RT-PCR from nasopharyngeal swabs. The pre-analytical value of different methods of material harvesting for SARS-CoV-2 are unknown. Methods: We conducted a comprehensive investigation of the pre-analytical performance for different pharyngeal sampling procedures in hospitalized patients with confirmed SARS-CoV-2 infection. In addition to swabs taken simultaneously from different locations, saliva and pharyngeal lavages were also analyzed using RT-PCR.Results: In 10 COVID-19 patients, standard nasopharyngeal swabs detected 8 out of 10 positive patients, whereas swabs taken from the palatoglossal arch resulted in 9 correct-positive results. Brushing the posterior pharynx wall with swabs resulted in detection of 9 out of 10 positive patients with no difference using either dry swabs or liquid Amies medium. A strong correlation between Ct values of both swab materials was observed. Pharyngeal lavages yielded 6 out of 10 positive results in concordance with 85% of nasopharyngeal swabs in late-stage COVID-19 patients. Investigating 23 patients with early SARS-CoV-2 infection, pharyngeal lavages showed a concordance rate of 100% compared to nasopharyngeal swabs.Conclusions: The diagnostic performance of swabs taken from the palatoglossal arch in detecting SARS-CoV-2 infection is similar to that of specimens taken from the nasopharyngeal region. However, the former sampling method is associated with less discomfort and much easier to perform. Pharyngeal lavages may replace swabs for mass screening in early stages of SARS-CoV-2 infection. The predictive values are comparable, and the procedure is performed without exposing healthcare workers to transmission risks.

References Values for the Current Perception Threshold in the Pharynx Based on a Study of a Healthy Population.

The application of the current perception threshold (CPT) in the diagnosis of pharyngeal sensory abnormalities has rarely been studied, and there is a lack of reference values for this application. This study established a normal reference range for CPT in the pharynx based on a study of a healthy population. The CPT values of the palatoglossal arch, posterior 1/3 of the lingual body and hard palate were measured in 60 healthy individuals at 2000, 250, and 5 Hz. The influencing factors were analyzed, and reference values for the CPT were established. There was no correlation between the CPT value and gender. Age was only correlated at 250 Hz level in the hard palate. The CPT values of the palatoglossal arch were 324.95 ± 82.422 at 2000 Hz, 66.90 ± 38.622 at 250 Hz, and 13 ± 14.93 (7.83-22.75) at 5 Hz. The CPT values of the posterior 1/3 of the lingual body were 359.17 ± 76.299 at 2000 Hz, 86.92 ± 35.151 at 250 Hz, and 19 ± 15.73 (13.03-28.75) at 5 Hz. The CPT values of the hard palate were 157.5 ± 61.75 (124-185.75) at 2000 Hz, 57.63 ± 28.785 at 250 Hz, and 22 ± 25.73 (11.03-36.75) at 5 Hz. The CPT values of the pharynx in healthy people were not related to gender. The CPT values of the hard palate for 250 Hz stimulation were related to age, and there were no relationships between the CPT values and age for the other frequencies and loci. We established a normal reference range of CPT values in the pharynx from measurements obtained from healthy populations.

Anatomy of the lingual nerve: Application to oral surgery.

The purpose of this research is to obtain morphological information about the traveling route, branching pattern, and distribution within the tongue of the lingual nerve, all of which are important for oral surgical procedures. Using 20 sides from 10 Japanese cadaveric heads, we followed the lingual nerve from its merging point with the chorda tympani to its peripheral terminal in the tongue. We focused on the collateral branches in the area before reaching the tongue and the communication between the lingual and hypoglossal nerves reaching the tongue. The collateral branches of the lingual nerve were distributed in the oral mucosa between the palatoglossal arch and the mandibular molar region. Two to eight collateral branches arose from the main trunk of the nerve, and the configuration of branching was classified into three types. More distally, the lingual nerve started to communicate with the hypoglossal nerve before passing the anterior border of the hyoglossus muscle. Nerve communications were also found in the main body and near the apex of the tongue. A thorough understanding of the collateral branches near the tongue, and the communication with the hypoglossal nerve inside the tongue, will help to prevent functional disorders from local anesthesia and oral surgical procedures associated with the lingual nerve. Clin. Anat. 32:635-641, 2019. © 2019 Wiley Periodicals, Inc.

Malignant peripheral ameloblastoma arising from the gingiva: A case report

Ameloblastomas account for 9%-11% of all odontogenic tumors and usually arise from the mandible. Peripherally arising ameloblastomas are exceedingly rare, comprising 1%-2% of all ameloblastomas. We present a case of peripheral ameloblastoma with malignant differentiation in a 72-year-old male patient. The patient underwent a biopsy of the left palatoglossal fold, and histological examination of the specimen demonstrated a well differentiated squamous cell carcinoma in situ with at least superficially invasive growth and features suggestive of peripheral ameloblastic carcinoma. The patient chose radiation therapy as opposed to surgical excision.

Head and neck amyloidosis – report of two cases

Amyloidosis in the head and neck area is a rare, benign condition that affects mainly the larynx. Two types of amyloidosis are described in the literature, i.e., systemic and localized, with the latter being more common in the head and neck area. We report two cases of localized amyloidosis in the region of the arytenoid cartilage and palatoglossal arch. Both patients were women and had a sensation of a foreign body on swallowing. They were treated successfully surgically, and the lesions did not recur.

Морфологічні особливості деяких органів головної кишки коня

Complex classical morphological methods of studies were used in investigation. Pneumatic saccus is placed over the dorsal side of the pharynx and aside of it. Extended basis is attached to the ventral surface of the body and alar processes of sphenoid bone. Lateral wall of the pneumatic saccus is connected with the medial stylohyoid by loose connective tissue. In front, the dorsal wall is adjacent to the alar processes of sphenoid bone. Palatine processes of incisive bone are the basis of the hard palate in front part, maxillary palatine processes – in the middle part and horizontal plates of the palatine bones in the back part. Macroscopically tonsils are clusters of lymphoid tissue limited by connective tissue capsule under the epithelium of the tongue, soft palate and pharynx. Oral cavity mucosa in the tonsils area of cattle and small ruminants forms sinuses or numerous folds, which are separated by furrows of tongue and pharyngeal tonsils in other animal species. The cluster of separate lymphoid nodules and diffuse lymphoid tissue located at the root of the tongue between secretory units of serous mucous glands form the lingual tonsils. In the pharyngeal mucosa between secretory units of mucous glands lymphoid nodules of odd pharyngeal tonsil are located. Even palatine tonsils are located caudal to the palatoglossal arch and from sides of the tongue root. In horse diffuse tonsils crypts are located on the side of the tongue. Clusters of lymphoid nodules form tonsils of pharyngeal lymphoid ring. They have crypts, which look like hollow of the epithelium into lamina propria of mucosa, surrounded by lymphoid nodules and diffuse lymphoid tissue. The epithelium of the mucous membrane is flat non-keratinized stratified, infiltrated with lymphoid cells. Lamina propria of mucosa in the tonsil area forms a connective tissue membrane, from which layers of connective tissue with blood vessels depart to the middle. Glands’ secretory units are found in the connective tissue base, glands’ excretory ducts open into the lumen of the crypts. Lymphoid tissue is the basis of parenchyma, which is formed by reticular tissue and lymphoid cells.

Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study

OBJECTIVE The goal of this study was to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) when used for patients with intractable idiopathic glossopharyngeal neuralgia. METHODS Six participating centers of the International Gamma Knife Research Foundation identified 22 patients who underwent SRS for intractable glossopharyngeal neuralgia between 1998 and 2015. The median patient age was 60 years (range 34-83 years). The median duration of symptoms before SRS was 46 months (range 1-240 months). Three patients had unsuccessful prior surgical procedures, including microvascular decompression (MVD) (n = 2) and balloon compression (n = 1). The radiosurgical target was the glossopharyngeal meatus. The median maximum dose was 80 Gy. RESULTS The median follow-up was 45 months after SRS (range 6-120 months). Twelve patients (55%) had < 4 years of follow-up. Thirteen patients (59%) had initial complete pain relief at a median of 12 days after SRS (range 1-60 days). Three patients (14%) had partial pain relief at a median of 70 days after SRS (range 60-90 days). Six patients (27%) had no pain relief. Among 16 patients with initial pain relief, 5 maintained complete pain relief without medication (Barrow Neurological Institute [BNI] pain intensity score Grade I), 1 maintained occasional pain relief without medication (BNI Grade II), 3 maintained complete pain relief with medication (BNI Grade IIIb), and 7 patients had pain recurrence at a median of 20 months after SRS (range 6-120 months). The rates of maintenance of adequate pain relief (BNI Grades I-IIIb) were 63% at 1 year, 49% at 2 years, 38% at 3 years, 38% at 5 years, and 28% at 7 years. When 7 patients without pain recurrence within 4 years of follow-up were excluded, the rates of maintenance of adequate pain relief were 38% at 5 years and 28% at 7 years. Ten patients required additional procedures (MVD, n = 4; repeat SRS, n = 5; glossopharyngeal nerve block, n = 1). Four of 5 patients who underwent repeat SRS maintained pain relief (BNI Grade I, n = 3; and BNI Grade IIIb, n = 1). No adverse effects of radiation were observed after a single SRS. Two patients developed hyperesthesia in the palatoglossal arch 5 and 8 months after repeat SRS, respectively. CONCLUSIONS Stereotactic radiosurgery for intractable, medically refractory glossopharyngeal neuralgia provided lasting pain reduction in 55% of patients after 1 or 2 SRS procedures. Patients who had a poor response or pain recurrence may require additional procedures such as repeat SRS, MVD, nerve blocks, or nerve section. No patient developed changes in vocal cord function or swallowing disorders after SRS in this study.

Clinical and pathological analysis of 1116 cases of vocal cord polyp

Objective:The aim of this study is to investigate the clinical and pathological features of vocal cord polyp. Method:Retrospective analyzed the clinical and pathological data of 1116 cases in vocal cord polyp patients treated with suspension microlaryngoscopic surgery. Result:The bradycardia was observed in 170 cases(15.2%) during the suspension of laryngoscope under general anesthesia. In this case，the suspension was stopped or the laryngoscope was taken out of mouth and atropine was administrated by intravenous injection. After that, heartbeat gradually accelerated and approached to normal,then the suspension was begun again to complete microlaryngoscopic surgery. Among the 1116 cases,1094(98%) were cured,22(2%) were improved，and no case was invalid. No pharyngeal injury was in 865 cases(77.5%). Mild,moderate and severe palatoglossal arch injury was observed in 139 (12.5%)cases，86(7.7%)cases,and 26 (2.3%) cases，respectively. The incidences of epithelial hyperplasia and dysplasia in vocal cord polyp were 35.3% and 5.0%, respectively. The prevalence rates of epithelial hyperplasia and dysplasia in male and female patients of vocal cord polyp were 76.2%,23.8% (P <0.01) and 78.6%,21.4% (P <0.01),respectively. And the prevalence rates of keratinization and parakeratosis in male and female patients were 93.1%,6.9% (P <0.01) and 93.1%,6.9% (P <0.01),respectively.The incidence of keratinization in patients of no epithelial hyperplasia, epithelial hyperplasia and epithelial dysplasia were 2.1%,18.2% and 30.3%,respectively，with significant difference in pairwise comparison.Conclusion:High incidence of vocal cord polyp is at the age from 31 to 60 years old.Although laryngomicrosurgery is an effective treatment for vocal cord polyp, pharyngeal injury and laryngopharyngeal vagal reflex should be noticed during the operation.In addition,vocal cord polyps in male patients are susceptible to epithelial dysplasia and keratinization.

Clinical, pathological, immunohistochemical and molecular characterization of feline chronic gingivostomatitis.

Objectives This study presents the clinical, pathological, immunohistochemical and molecular characterization of 26 cats with feline chronic gingivostomatitis (FCG). Methods Oral mucosal biopsies, blood and swabs were collected from cats presenting with oral lesions. The tissue sections were submitted for histopathology and immunohistochemical analysis for feline calicivirus (FCV), feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV). The swabs were subjected to PCR analysis for FCV, and blood for FeLV and FIV. Results The main clinical findings were dysphagia (88.2%), halitosis (76.5%), sialorrhea (47.1%), weight loss (41.2%), intense oral discomfort (35.3%), oral hemorrhage (17.6%), and lackluster and fragile coat (11.8%). Gross inspection revealed bilateral lesions across the palatoglossal fold to the lateral tongue base. The lesions were diffuse, proliferative, intensely red and friable, and bled easily upon examination in 80.8% of cases. In 23.1% of cases, the lesions were multifocal to coalescent, at times forming multiple vesicles on a reddened, edematous palatoglossal fold. Microscopic examination showed that 15.4% of lesions had moderate (grade 2) and 84.6% had severe (grade 3) inflammation. Immunohistochemistry revealed the presence of FeLV antigens in the epithelium and the inflammatory infiltrate of 30.8% of the cats with FCG. FCV antigens were not detected in the FCG lesions. Conclusions and relevance The FCG cases analyzed could not be correlated with FCV. It is possible that FeLV plays a role as a causal agent of lesions in cases where the presence of the virus has been confirmed by immunohistochemistry in epithelial samples.

Scanning Electron Microscopic Studies of the Lingual Papillae in the English Horse

Abstract The purpose of this study was to describe the distribution and surface structure of the lingual papillary system in four male adult English horses by scanning electron microscopy. The animals were supplied from the Jockey Club of Turkey (TJK). Tissue samples were taken from the dorsal, ventral and lateral surface of the apex, corpus and radix of the tongue. Filiform papillae were distributed mainly on the dorsum, being abundant, very long and with a slim cylindrical form with pointed endings or multi-bifurcated terminations at the apex. These papillae were typically conical in shape with a wider base in the corpus of the lingua and absent on the radix of the lingua. Fungiform papillae were mainly on the lateral surfaces and lobulated forms were also observed. The horses have two large vallate papillae, located on the dorsum close to the caudal part of the tongue. These papillae were surrounded by a prominent gustatory groove. The vallate papillae had many taste pores opening into the papillary groove. The foliate papillae were observed just rostral to the palatoglossal arches. These papillae have many variable sized taste pores which open into the grooves between the papillary leaves. The papillary leaves were covered with concentrically arranged cornified cells of variable appearance. However, there were no lingual papillae on the ventral aspect of the horse’s tongue.

Outcome comparison of two methods of pharyngeal cavity reconstruction in uvulopalatopharyngoplasty

Conclusions: The efficacy of uvulopalatopharyngoplasty (UPPP) can be achieved without application of an apposition suture of the palatopharyngeal arch and the palatoglossal arch. Objective: To compare the outcomes of two different methods of pharyngeal cavity reconstruction in UPPP. Methods: Forty-eight patients with obstructive sleep apnoea syndrome (OSAS) underwent UPPP (uvula-preserving). A classical pharyngeal cavity reconstruction was performed in 24 patients in group one, with plastic suture of the inferior nasopharynx and exposure of the tonsillar fossa in 24 patients in group two. The parameters evaluated were the subjective symptom score, the Epworth Sleepiness Scale (ESS), and polysomnography result. The mean operating times and complications of the post-operative pharyngeal cavity were investigated. Results: No significant difference was observed in surgical success (p = 0.54), subjective syndromes (snoring, sleep apnoea, morning headache, daytime sleepiness) (p = 0.16, 0.36, 0.79 and 0.52), ESS (p = 0.41), apnoea-hypopnoea index (AHI) (p = 0.32), and minimum SaO2 (p = 0.13) between the two groups. In group one, the mean operating time was 54.72 ± 6.52 min, 11 suture dehiscence (45.8%), and five scar hypertrophy of the pharyngeal wall (20.8%) were observed post-operatively; while in group two was 38.78 ± 5.75 min, no suture dehiscence resulting from suture cutting of tissue, three scar hypertrophy were observed (12.5%).

The sensory nerves that innervate the area near the K-point

The purpose of this study clarifi ed the sensory nerves that innervate the area near the trigger point of the jaw opening refl ex. The trigger point is located at the midpoint between the palatoglossal arch and pterygomandibular fold and medial to the retromolar pad. For the morphological investigation of sensory innervation in this area, we exposed the cranial nerves in 52 halves of cadaver head and observed their distribution in soft tissue. In all the observed examples, the branches of the lingual nerve together formed mesh networks and distributed to the mucosa near the palatoglossal arch, retromolar pad, and the lingual gingiva of the last molar. It was suggested that the sensory nerves distributing to the area around the trigger point of jaw opening refl ex were the branches of the lingual nerve, namely the branches to isthmus of fauces. We believe that the information herein may be of use to substantial nursing care and dysphagia rehabilitation.

Morphological study of the sensory nerve which induces jaw opening reflex

Abstract Background and objectives: An anatomical site in the oral cavity can be used to trigger the jaw opening reflex in patients with pseudobulbar palsy who have difficulty opening the mouth. The site is located at the midpoint between the palatoglossal arch and pterygomandibular fold and medial to the retromolar pad. However, previous findings on the nerves innervating this particular area are inconsistent. Therefore, in this study, we carefully investigated the sensory nerves that innervate the area near the trigger point of the jaw opening reflex. Materials and methods: For the morphological investigation of sensory innervation in this area, in this study we exposed the cranial nerves in 26 halves of cadaver head and observed their distribution in soft tissue. Results: In all cases, several nerve fibers diverged anteroinferiorly from the lingual nerve located between its junction with the chorda tympani nerve and the junction with the communicating branch of the submandibular ganglion. These nerve fibers, thought to be the facial branches of the lingual nerve, innervated the mucosa in the vicinity of the palatoglossal arch, retromolar pad, and the lingual gingiva of the last molar which were near to the trigger point of the jaw opening reflex. Conclusion: The results suggest that the sensory nerve that induces the jaw opening reflex appears to be the branches to isthmus of fauces diverged from the lingual nerve.

Morphological study of the sensory nerve which induces jaw opening reflex

Background and objectives: An anatomical site in the oral cavity can be used to trigger the jaw opening reflex in patients with pseudobulbar palsy who have difficulty opening the mouth. The site is located at the midpoint between the palatoglossal arch and pterygomandibular fold and medial to the retromolar pad. However, previous findings on the nerves innervating this particular area are inconsistent. Therefore, in this study, we carefully investigated the sensory nerves that innervate the area near the trigger point of the jaw opening reflex. Materials and methods: For the morphological investigation of sensory innervation in this area, in this study we exposed the cranial nerves in 26 halves of cadaver head and observed their distribution in soft tissue. Results: In all cases, several nerve fibers diverged anteroinferiorly from the lingual nerve located between its junction with the chorda tympani nerve and the junction with the communicating branch of the submandibular ganglion. These nerve fibers, thought to be the facial branches of the lingual nerve, innervated the mucosa in the vicinity of the palatoglossal arch, retromolar pad, and the lingual gingiva of the last molar which were near to the trigger point of the jaw opening reflex. Conclusion: The results suggest that the sensory nerve that induces the jaw opening reflex appears to be the branches to isthmus of fauces diverged from the lingual nerve

Preemptive submucosal infiltration with ropivacaine for uvulopalatopharyngoplasty.

To evaluate the preemptive analgesic effect of submucosal infiltration of ropivacaine for uvulopalatopharyngoplasty. Randomized controlled trial. Comprehensive clinical center and academic hospital. Fifty consecutive male patients scheduled for uvulopalatopharyngoplasty were divided randomly into group A and group B. In group A, 4 mL of 0.33% ropivacaine and normal saline with epinephrine was preincisionally injected under the mucosa on both sides of the tonsillar fossa, soft palate, and the lower part of palatoglossal arch, whereas the upper and middle parts of the palatoglossal arch and the upper part of the palatopharyngeal arch were infiltrated with 2 mL of the same mixture. In group B, an identical volume of normal saline with epinephrine was administered. In both groups, postoperative pain was initially controlled by intravenous morphine titration until patient-controlled analgesia with morphine could be used. Cumulative patient-controlled analgesic morphine consumption; visual analog scale scores at 4, 8, 12, 24, and 48 hours postoperatively at rest and during swallowing; and opioid-related adverse effects were recorded. The visual analog score was lower at rest during the 48-hour postoperative period and during swallowing within the first 12 hours for group A versus group B (P < .05). Patients in group A required 44.1%, 38.2%, and 41.1% less morphine during the first 24 hours, 24 hours to 48 hours, and 48 hours postoperatively, respectively, and fewer patients experienced nausea, vomiting, and pruritus (P < .05). Preemptive submucosal infiltration with 0.33% ropivacaine effectively controlled pain after uvulopalato-pharyngoplasty.

The prevalence of human papilloma virus (HPV) infections in oral squamous cell carcinomas: A retrospective analysis of 88 patients and literature overview

In addition to tobacco and alcohol consumption, the two main risk factors for oral squamous cell carcinoma (OSCC), recent studies have revealed infections with human papilloma virus (HPV) as an additional risk factor for OSCC development. In the field of head and neck malignancies, the prevalence of HPV infections in oropharyngeal cancer (OC) ranges in different studies up to 84%. While HPV infection is discussed as an independent risk factor in this region, its distinguished role in carcinogenesis of tumours localized to the oral cavity remains still uncertain.In this study, we analysed the HPV status in 88 consecutive patients with OSCCs localized anterior of the palatoglossal arch who were treated in the Department of Oral and Maxillofacial Surgery at the University Medical Center Mainz. The HPV status analysis was performed using DNA-PCR and immunostaining of p16 protein.The prevalence of HPV-positive OSCCs was about 6% (5 patients). In 3 patients the HPV subtypes 16/18 were found. No significant differences between the HPV positive and negative patients regarding age, gender, smoking and alcohol consumption, localization and TNM level could be detected. Contrary to other studies focussing on cancers of the lingual and palatine tonsil, the prevalence of HPV infections was much lower in the oral cavity. Therefore HPV infection might play a less important role in oral carcinogenesis.