Pharyngeal Space Research Articles

Immediate or delayed retrieval of the displaced third molar: A review.

BackgroundThe displacement of a third molar is a rare occurrence, but it could lead to serious and/or life threatening complication. Aim of this review is to understand the most correlated causes of displacement and the possible solutions proposed in literature to avoid and solve this complication for maxillary and mandibular third molars at the appropriate time.Material and MethodsA search for “third molar displacement” was performed by using Pubmed database. Articles referred to soft tissues displacement, from 1957 to 2018, were included in the review. The references lists of all eligible articles were examined and additional studies were added to the review only if indexed on Pubmed. All the articles on maxillary sinus displacement and the dislocation of dental fragments or surgical equipment were excluded.ResultsFrom a total of 134 results, 68 articles were examined for satisfying inclusion criteria. 18 articles were excluded because not inherent with the topic; 19 articles on infratemporal space, 11 on sublingual space, 9 on submandibular space, 11 on lateral pharyngeal space displacement were considered congruent for the review and included.ConclusionsThe displacement of the third molar in deeper tissues could be avoided by the use of proper surgical procedures and instrumentarium. If displacement occurs, and the operator could not reach the tooth in safe conditions, the patient should be immediately referred to a maxillo-facial surgeon, because of the possibility of further displacement or the onset of hazardous or potentially fatal infections in vital regions. Key words:Third molar, wisdom tooth, maxillary, mandibular, displacement.

Synovial sarcoma of the para pharyngeal space: a case report and literature review

Synovial sarcoma (SS) is a malignant neoplasm that arises from primitive pluripotential mesenchymal cells . It is a high-grade histological variety of sarcoma and it accounts for 7-10% of all soft tissue sarcomas. Head and neck locations represent only 0.7% to 10% of all cases. Primary parapharyngeal synovial sarcoma (PPSS) is rare representing only 0.5% of all tumors of the head and neck region. We describe through a clinical case the clinical, radiological and histological features of PPSS and we discuss its therapeutic management.

High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications.

The use of the heated and humidified high-flow nasal cannula has become increasingly popular in the treatment of patients with respiratory failure through all age groups. This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period). It is unclear which of the mechanisms of action is the most important, but it may depend on the cause of the patient’s respiratory failure. This article describes the mechanism of action in an easy to remember mnemonic (HIFLOW); Heated and humidified, meets Inspiratory demands, increases Functional residual capacity (FRC), Lighter, minimizes Oxygen dilution, and Washout of pharyngeal dead space. We will also examine some of the main indications for its use in both the adult and pediatric age groups. The data for the use of high-flow nasal cannula is growing, and currently, some of the main adult indications include hypoxemic respiratory failure due to pneumonia, post-extubation, pre-oxygenation prior to intubation, acute pulmonary edema, and use in patients who are "do not resuscitate or intubate". The main pediatric indication is in infants with bronchiolitis, but other indications are being studied, such as its use in asthma, croup, pneumonia, transport of a critically ill child, and post-extubation.

Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in-vitro assessment.

Endotracheal tube (ETT) cuffs are designed to seal the lower airway for precise ventilation and to protect against ingress of pathogens from the pharyngeal space. Therefore, a minimal continuous cuff pressure must be maintained. Aim of this study was to analyse the course of cuff pressure in an in-vitro model during manual cuff pressure control manoeuvres. An artificial trachea was intubated with an appropriately sized ETT and cuff pressure set to 20 cm H2 O. Thirty-two experienced ICU nurses each performed six cuff pressure control manoeuvres (three times in two different ETTs) using a manual cuff pressure manometer. Course of cuff pressure from connecting the manometer to disconnecting it from the cuff pilot balloon was recorded using a pressure transducer. There were 190 cuff pressure control manoeuvres suitable for analysis. In all control manoeuvres a cuff pressure below 20 cm H2 O was noted. In 20.0% of the control manoeuvres the cuff pressure dropped below 10 cm H2 O. Cuff pressure drops were mainly caused by initially connecting the manometer to the pilot balloon, less frequently by manipulating the pressure gauge of the manometer. Disconnecting the manometer after the control manoeuvre caused a cuff pressure drop in 78.1% of cases, contributing to a final cuff pressure below 20 cm H2 O in 31.3% of control manoeuvres. Routine manual cuff pressure control manoeuvres in ETT cuffs result in considerable cuff pressure drops. This may have an impact on silent aspiration of pharyngeal contents passing along the cuff into the lower airway.

Individuals’ quality of life in periodontal maintenance therapy - critical literature review.

Cervical necrotizing fasciitis (NF) is a soft tissue infection with a low incidence, characterized by rapid progression and high morbidity and mortality. The purpose of this report is to communicate the case of a patient diagnosed with cervical NF and its successful management. A 54-year-old male consulted after suffering from the condition for seven days. It was characterized by bilateral submandibular swelling, accompanied by fever, dysphagia, odynophagia, which were severely affecting the patient’s general health. Physical examination revealed a painful, erythematous cervical swelling. A cervical computed tomography scan was performed, revealing a gaseous collection in the left mucosal pharyngeal space, extending to the glottis, associated with significant deep plane soft tissue emphysema onon the left side of the neck and with possible involvement of the danger space; pertinent lab findings include 19,190/uL leukocytes and 219mg/L CRP. Broad-spectrum antibiotic therapy was initiated with ceftriaxone and clindamycin. Exploratory surgery, lavage and drainage of the collected material were performed. Streptococcus anginosus was isolated by culture. The patient recovered appropriately showing improvement in clinical as well as in inflammatory parameters, being discharged on the ninth day. He is currently receiving periodical checkups in the surgery polyclinic.

Reliability and main findings of the flexible endoscopic evaluation of swallowing-Tensilon test in patients with myasthenia gravis and dysphagia.

Diagnosis of pharyngeal dysphagia caused by myasthenia gravis (MG) based on clinical examination alone is often challenging. Flexible endoscopic evaluation of swallowing (FEES) combined with Tensilon (edrophonium) application, referred to as the FEES-Tensilon test, was developed to improve diagnostic accuracy and to detect the main symptoms of pharyngeal dysphagia in MG. Here we investigated inter- and intra-rater reliability of the FEES-Tensilon test and analyzed the main endoscopic findings. Four experienced raters reviewed a total of 20 FEES-Tensilon test videos in randomized order. Residue severity was graded at four different pharyngeal spaces before and after Tensilon administration. All interpretations were performed twice per rater, 4 weeks apart (a total of 160 scorings). Intra-rater test-retest reliability and inter-rater reliability levels were calculated. The most frequent FEES findings in patients with MG before Tensilon application were prominent residues of semi-solids spread all over the hypopharynx in varying locations. The reliability level of the interpretation of the FEES-Tensilon test was excellent regardless of the rater's profession or years of experience with FEES. All four raters showed high inter- and intra-reliability levels in interpreting the FEES-Tensilon test based on residue clearance (kappa = 0.922, 0.981). The degree of residue normalization in the vallecular space after Tensilon application showed the highest inter- and intra-rater reliability level (kappa = 0.863, 0.957) followed by the epiglottis (kappa = 0.813, 0.946) and pyriform sinuses (kappa = 0.836, 0.929). Interpretation of the FEES-Tensilon test based on residue severity and degree of Tensilon clearance, especially in the vallecular space, is consistent and reliable.

Evaluation of pharyngeal space and its correlation with mandible and hyoid bone in patients with different skeletal classes and facial types.

The purpose of this article was to evaluate the pharyngeal space volume, and the size and shape of the mandible and the hyoid bone, as well as their relationships, in patients with different facial types and skeletal classes. Furthermore, we estimated the volume of the pharyngeal space with a formula using only linear measurements. A total of 161 i-CAT Next Generation (Imaging Sciences International, Hatfield, Pa) cone-beam computed tomography images (80 men, 81 women; ages, 21-58years; mean age, 27years) were retrospectively studied. Skeletal class and facial type were determined for each patient from multiplanar reconstructions using the NemoCeph software (Nemotec, Madrid, Spain). Linear and angular measurements were performed using 3D imaging software (version 3.4.3; Carestream Health, Rochester, NY), and volumetric analysis of the pharyngeal space was carried out with ITK-SNAP (version 2.4.0; Cognitica, Philadelphia, Pa) segmentation software. For the statistics, analysis of variance and the Tukey test with a significance level of 0.05, Pearson correlation, and linear regression were used. The pharyngeal space volume, when correlated with mandible and hyoid bone linear and angular measurements, showed significant correlations with skeletal class or facial type. The linear regression performed to estimate the volume of the pharyngeal space showed an R of 0.92 and an adjusted R2 of 0.8362. There were significant correlations between pharyngeal space volume, and the mandible and hyoid bone measurements, suggesting that the stomatognathic system should be evaluated in an integral and nonindividualized way. Furthermore, it was possible to develop a linear regression model, resulting in a useful formula for estimating the volume of the pharyngeal space.

Effects of rapid palatal expansion (RPE) and twin block mandibular advancement device (MAD) on pharyngeal structures in Class II pediatric patients from Cluj-Napoca, Romania

Objective: To compare cephalometric changes of pharyngeal structures after rapid palatal expansion (RPE) with those induced by a twin block mandibular advancement device (MAD) with palatal expansion capability. Methods: This retrospective study investigated 55 Class II pediatric patients, divided into two groups: 29 patients treated with RPE and 26 patients treated with MAD. Lateral cephalometric measurements were compared before and after treatment. Results: Changes in pharyngeal airway space were statistically significant in both groups (p < 0.001) from a pre-treatment mean distance measured between the lower posterior pharyngeal wall and the hyoid bone (LPF-H) of 25.42 mm in the MAD group and 28.62 mm in the RPE group, to a post-treatment mean LPF-H of 27.96 mm in the MAD group and 31.52 mm in the RPE group. Conclusion: Significant changes in pharyngeal space may be obtained in Class II patients through both rapid palatal expansion and mandibular advancement devices with palatal expansion capability.

Childhood Nasopharyngeal Carcinoma (NPC): A Review of Clinical-Imaging Features and Recent Trends in Management

Introduction: Nasopharyngeal carcinoma (NPC) in children and adolescents is a relatively rare yet highly malignant disease. Clinical presentation of NPC in this age group is non-specific and varied leading to a predominantly late diagnosis. The objective of this paper is to explore and clarify the tumour’s ambiguity and assess the precision of imaging in mapping its morphology and loco-regional extension and possible distant metastases. Treatment regimes that minimize adverse radio-therapeutic effects on surrounding structures will be highlighted. Method: Retrospective analysis and observations of literature (in English) between 2004 to December 2017 was performed. A search was performed using the Medline data-base. The following are the search terms: “children”, “nasopharyngeal carcinoma”, “symptoms’, “imaging” and “therapy”. Material: Of the 43 papers found on the primary search only 36 satisfied the search criteria. Four review papers of the primary search were retained as sources of reference. The core material comprised 22 papers on NPC’s clinical presentation and the role of imaging in diagnosis and prognostication. There were three papers on advanced imaging in adults. The rest of the seven comprised selected articles on chemo-radiation, radiotherapy and related late toxicities. Results: The clinical presentations range from nasal stuffiness, otalgia to unilateral or bilateral neck masses. Symptoms can last from a few weeks to 6 months; by then disease can be advanced. A WHO high-grade undifferentiated squamous cell carcinoma is the commonest lesion in clinical practice. Data from magnetic resonance imaging (MRI) focusing on tumour extensions and tumour volume are markers of long-term prognosis. Diffusion weighted MRI by assessing microscopic changes of NPC can determine the ultimate outlook of adults afflicted with NPC. Treatment of paediatric NPC consists of induction chemotherapy followed by radiotherapy with dosage up to 65-70 Gy. Morphologically, the main mimicker of childhood NPC is an embryonic parameningeal rhabdomyosarcoma arising from the pharyngeal and nasal space. Both have inclination to invade the skull base. Conclusion: Despite NPC’s varied and nonspecific presentations, the clinician must be vigilant because treatment of the disease in different stages of severity has a higher response rate than its adult counterpart. Contrast MRI and computed tomography (CT) are precise in showing skull base invasion, loco-regional and distant metastases. The application of diffusion weighted MRI has a role in determining the tumour’s microscopic contents and long-term prognosis. Use of intensity modulated radiation therapy (IMRT) in addition to induction chemotherapy and irradiation treatment regime has decreased the incidence of the dreaded late sequelae.

ACE Inhibitor Reaction‐Induced Acute Angioedema Leading to Macroglossia: Two Case Studie

Macroglossia, either congenital or acquired enlargement of the tongue, is a rare condition that leads to functional deficiencies in speech, mastication/deglutition, and airway patency. Acute‐acquired cases of macroglossia are potentially life threatening and have myriad etiologies. Presented here are two cases of macroglossia in adults caused by acute angioedema resulting from reaction to angiotensin‐converting enzyme (ACE) inhibitors. The mechanism of ACE inhibitor‐induced angioedema is attributed to dysfunction in the kallikrien‐kinin system, a protease pathway converting high molecular weight kininogens to kinins such as bradykinin, which can lead to inflammation of the cardiovascular system. This condition, while rare in adults, is more easily diagnosed, monitored, and treated if detected early. However, many clinicians fail to educate patients on the warning signs of acute angioedema: swelling of the tongue, submandibular and pharyngeal spaces, and/or difficulty breathing. Furthermore, patients often do not recognize the symptoms of ACE inhibitor reactions, leading to delays in diagnosis and treatment. Management of acute angioedema and subsequent macroglossia includes hospitalization and intubation for airway maintenance, partial glossectomy, and subsequent glossal rehabilitation and speech therapy. Both cases presented here led to anoxic brain injury and necessitated intensive surgical intervention, demonstrating the need for better patient‐clinician communication for positive outcomes of ACE inhibitor use. Current research on the kinin system and its role in the cardiovascular system is limited, so baseline clinician‐patient education represents the best first‐line defense against life‐threatening cases of acute angioedema.Support or Funding InformationThis research is supported in part by funding from the Texas A&amp;M University College of Dentistry and the Baylor University Medical Center at Dallas.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Impact of Selection for Facial Reduction in Dogs

Through artificial selection, humans have altered the morphology of domestic dogs and produced the broad range of morphological variation seen in modern dog breeds. The purpose of this study was to analyze the effects of artificial selection for short faces in domestic dogs (Canis lupus familiaris). The morphological characteristics associated with years of selection in favor of smushed, paedomorphic faces often result in Brachycephalic Airway Syndrome (BAS), which is characterized by problems with olfaction, respiration, and thermoregulation. We used clinically obtained CT scans of dogs representing brachycephalic breeds (pugs and bulldogs), normocephalic breeds (beagles), and dogs of unknown breed. We established two groups of dogs (brachycephalic and normocephalic) based on cephalic index. In both groups, we recorded a total of 62 cranial and mandibular landmarks. Through geometric morphometric analysis, we determined that the greatest shape variation in this sample was correlated with cephalic index. The shape changes in the crania and mandibles co‐vary, and are both associated with cephalic index. Within the hard palate, the majority of the shape change associated with brachycephaly is centered on the maxilla, specifically at the carnassials. The shape change seen on the hard palate is a unique lateral displacement and rotation of the carnassials, associated with shortening of the hard palate. In contrast, the shape change seen in the mandible is mainly a uniform rostral‐caudal shortening and a medial‐lateral widening. In addition, the soft palate does not appear to be reduced in these breeds. From a functional perspective, the maxillary and mandibular carnassials become malaligned in brachycephalic dogs. The shape change seen in the carnassials demonstrates that morphological integration of the carnassial complex is disrupted in brachycephalic dogs. Despite the facial reduction observed in these breeds, the soft palate does not appear to be reduced, and these soft tissues may crowd the reduced pharyngeal space. Selection for the aesthetic traits associated with brachycephaly in domestic dog breeds results in changes to the carnassial complex and pharynx that are functionally suboptimal and might limit survival outside of a domesticated environment.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Role of Computed Tomography (CT) in Localisation and Characterisation of Suprahyoid Neck Masses.

SummaryBackgroundSuprahyoid neck lesions are difficult to assess only by means of clinical inspection and therefore imaging techniques are required to precisely evaluate suprahyoid neck spaces. The aim of this study was to evaluate the distinctive role of computed tomography in the assessment of anatomical source and pathological type of masses involving the suprahyoid neck spaces.Material/MethodsSixty patients presenting with suprahyoid neck masses underwent computed tomography of the neck. The CT findings were correlated with histopathological findings and a final diagnosis was made.ResultsOverall, male preponderance was seen except in the case of parotid space lesions where female predominance was seen. The most common aetiology was squamous cell carcinoma and the majority of cases (30%) were seen in patients aged 41–50 years. The majority of lesions were found in the pharyngeal mucosal space (n=16) with squamous cell carcinoma being the most common pathology. In the parotid space, pleomorphic adenoma and in the prestyloid parapharyngeal space, squamous cell carcinoma were the most common lesions, respectively. In the retropharyngeal space, an equal incidence of malignant and inflammatory aetiologies was seen. Abscesses were the most common lesions in the prevertebral space. The pleomorphic adenoma was the most common benign tumour and was also the second most common tumour in the suprahyoid neck spaces. CT had an excellent correlation with histopathological findings with sensitivity of 96.4%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 91.67%.ConclusionsComputed tomography definitely has a major role to play in the evaluation of suprahyoid neck masses as it has an excellent correlation with post-operative histopathological diagnosis.

Giant Prolactinoma Complicated by Cerebrospinal Fluid Rhinorrhea, Behavioral and Neurological Changes Following Dopamine Agonist Therapy: A Case Report

Introduction: Giant prolactinomas, defined as pituitary PRL-secreting adenomas whose size exceeds 40 mm and with a PRL level of >1000 ng/ml, are very rare. Their treatment and outcome can be unpredictable and challenging for clinicians. Case Report: A 47-year-old male was referred to the Neuroendocrine Department due to a large pituitary tumor invading the suprasellar region, both cavernous and sphenoidal sinuses, and pharyngeal space. He had been suffering from intensive headaches and visual deterioration for two years; he had also experienced sexual dysfunction. Discussion: We detected extremely high serum PRL levels (Eƒ700000 mU/l) and hypopituitarism. Bromocriptine therapy (BRC) was started with a gradual dose increase. Ten days after the commencement of medical treatment, cerebrospinal fluid (CSF) rhinorrhea appeared. He underwent neurosurgery two months later; the bone erosion was localized and repaired. Tumor biopsy revealed a PRL-secreting tumor with a low proliferative index (Ki67<0.5). After surgery, he continued with BRC and shortly after experienced behavior changes, such as mood oscillations, anxiety, impulsivity, irritability, impaired concentration, and tremor. To control his tumor, pramipexol and levodopa treatment were introduced but with a moderate effect. However, only after the reduction of the BRC dose, his mental and neurological complaints abated significantly. A close follow-up for the next three years detected a low prolactin level and significant tumor shrinkage (MRI), with visual field improvement and reversion of pituitary function. Conclusion: Giant prolactinomas are invasive but respond well to dopamine agonists. However, CSF rhinorrhea, behavioral and neurological changes can occur during medical treatment, suggesting a need for vigilance throughout the dopamine agonist therapy.

Disseminated Coccidioidomycosis Complicated by Bronchopulmonary Fistula and Viridans Streptococci Empyema

SESSION TITLE: Fungal Infections 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Coccidioidomycosis is typically a self-limited mild disease. Approximately 5-10% of patients with primary pulmonary coccidioidomycosis develop residual pulmonary sequelae such as fibrocavitary disease, which can rarely lead to bronchopulmonary fistulae (BPF). Although viridans streptococci (VS) has been documented to cause empyema, its coinfection in the setting of BPF complicating disseminated coccidioidomycosis infection has not been well described. CASE PRESENTATION: A 62-year-old Latino male farm worker with uncontrolled type II diabetes presented with acute left knee pain, progressively worsening over the course of three weeks. His history was also notable for a left arm nodule and a productive cough. Serum coccidioidal IgM was negative, IgG was positive, and complement fixation was 1:128. Synovial joint fluid from the left knee grew Coccidioides immitis and Coccidioides posadasii. Synovial tissue from the knee showed necrosis and multiple granulomata with coccidioidomycosis. Chest CT demonstrated a left-sided hydropneumothorax with associated BPF and pleural thickening. Additionally seen were innumerable bilateral centrilobular micronodules and left pleural-based cavity. Chest tube thoracostomy revealed purulent material and cultures with positive for VS. He subsequently underwent thoracoscopic debridement and decortication. Histopathology confirmed the presence of coccidioidomycosis. DISCUSSION: VS has been described the main virulent agent in community acquired pneumonia as well as in empyema and lung abscesses. Aspiration of oral secretions is hypothesized to be the etiology of VS respiratory infections. In our patient, rupture of the left-sided coccidial cavity abutting the pleura led to the development of a hydropneumothorax, and ultimately to the formation of a BPF, allowing for a contiguous pathway from the oral pharyngeal space into the pleural space. We hypothesize that the mechanism of VS empyema in our patient was via direct translocation of VS bacteria from the oral cavity through the fistula leading to inoculation of the coccidial pleural effusion. CONCLUSIONS: BPF is a rare complication of disseminated coccidioidomycosis infection. VS empyema has not been previously described in the setting of coccidioidomycosis infection and may be a more important pathogen in pleural pulmonary disease than previously recognized. A BPF may be a potential route of translocation for VS rather than aspiration when it is shown to be the sole pathogen in empyema. Reference #1: Thompson et al. Pulmonary Coccidioidomycosis. Semin Respir Crit Care Med 2011; 32(6): 754-763. 2011 Dec13 Reference #2: Choi SH, Cha SI, Choi KJ, Lim JK, Seo H, Yoo SS, Lee J, Lee SY, Kim CH, Park JY. Clinical Characteristics of Community-Acquired Viridans Streptococcal Pneumonia. Tuberc Respir Dis (Seoul). 2015 Jul;78(3):196-202. Reference #3: Jerng JS, Hsueh PR, Teng LJ, Lee LN, Yang PC, Luh KT. Empyema thoracis and lung abscess caused by viridans streptococci. Am J Respir Crit Care Med. 1997 Nov;156(5):1508-14. DISCLOSURE: The following authors have nothing to disclose: Margaret Wei, Nader Kamangar No Product/Research Disclosure Information

Three-Dimensional Tomographic Analysis of the Dimensions of the Nasal Cavity and Nasal and Upper Pharyngeal Airway Space in Subjects Submitted to Surgically Assisted Rapid Maxillary Expansion

The main objective of the surgically assisted rapid maxillary expansion (SARME) is to increase the transversal dimension of the upper dental arch in individuals with maxillary atresia. Its effects are not restricted to the maxilla, also acting on the nasal cavity and pharyngeal airway. The present study aimed to evaluate the occurrence of dimensional changes in the nasal cavity and nasal and upper pharyngeal airway space in individuals submitted to surgically assisted maxillary expansion using 2 different osteotomies. Nasal and pharyngeal airway space structures were analyzed by pre-and post-operative cone beam computed tomography scans of 29 adult subjects submitted to surgically assisted maxillary expansion. Volumetric measurement of the nasal and upper pharyngeal airway and linear measurements of the nasal cavity were performed using Dolphin Imaging 11.7 software. The data were tabulated and submitted to statistical analysis by ANOVA analysis of variance and Tukey test (p <0.05). The results showed that both osteotomies were effective in correcting transverse maxillary deficiency and presented similar effects on the nasal cavity and pharyngeal air space, the pharyngeal air space presented increased volume also in the hypopharynx region, which allowed to conclude that the EMCA promotes an increase in the floor width of the nasal cavity after expansion, and, consequently, increase in volume of the nasal cavity itself and nasal airway space, as well as pharyngeal air space.

Rothia mucilaginosa Bacteremia Associated with HIV and Non-Hodgkin’s Lymphoma: A Case Report and Brief Review of Literature

Rothia mucilaginosa is part of the normal flora of the oral cavity and is typically is not associated with acute infection. However, growing evidence suggests that Rothia mucilaginosa can be an opportunistic pathogen in immunocompromised hosts. We present a case of Rothia bacteremia in a patient with a compromised immune system due to human immunodeficiency virus (HIV) and stage IV bulky diffuse large B cell lymphoma affecting the pharyngeal space.

A retrospective cephalometric study on upper airway spaces in different facial types

BackgroundCraniofacial growth pattern has been correlated with variations in size of the upper airway spaces. The objective of this study was to evaluate the nasopharyngeal, oropharyngeal, and hypopharyngeal airway spaces variations according to the craniofacial growth pattern, by comparing brachyfacial, mesofacial, and dolichofacial in Angle Class I individuals.MethodsTo measure the spaces, 45 lateral teleradiographs were used and divided into 3 groups per the craniofacial growth pattern, determined by the Tweed cephalometry angular measurements: FMA and Y-axis. To evaluate the airways, sleep apnea cephalometry was used, containing 28 points that compose 14 factors. Three groups were compared relative to each of the 14 sleep apnea cephalometry measurements. Adherence test to the normal curve was performed. For the non-normally distributed data—measurement of the inferior pharyngeal space—the Kruskal-Wallis test was used for comparison between the groups. For the remaining data, the distribution was normal and ANOVA test was used.ResultsStatistically significant difference was verified among the groups for the measurement of the median posterior-palatal space, with the difference being pointed out by the post hoc test between the brachyfacial and dolichofacial groups. For the other measurements, there was no statistically significant difference.ConclusionsIt could be concluded that there was difference in the median posterior-palatal space measurement, in the oropharynx region, which was reduced for individuals with a dolichofacial pattern.

The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients

BackgroundTwo-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery.MethodsA prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring.ResultsAmong 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers.ConclusionsThis study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.

Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis.

Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA. This prospective study investigated the surgical outcome of patients who suffered from OSA following counterclockwise rotational orthognathic surgery. The patients were skeletal class II patients who underwent orthognathic surgery between March 2013 and December 2014. Cephalometric posterior airway analysis and a questionnaire for facial perception were used to assess pharyngeal airway and patient perception of facial appearance. A total of 14 patients were included. Satisfactory results were achieved without complications in all OSA patients. The airway parameters for anteroposterior length significantly increased. Thirteen patients answered a questionnaire on their facial appearance, and the visual analog scale averaged 7.31 points, indicating a favorable facial appearance. Counterclockwise rotational orthognathic surgery without maxilla advancement for the correction of OSA can effectively increase the posterior pharyngeal space, with favorable aesthetic results. With thoughtful application, this novel approach may be an alternative to standard approaches for the correction of OSA using orthognathic surgery.

Pleomorphic adenoma in para pharyngeal space: a rare presentation

Parapharyngeal space is one of the potential space for neoplasms and infections and represent less than 1% tumours of all head and neck tumours. Pleomorphic adenoma occurrence in para pharyngeal space is rare presentation. The anatomy of the parapharyngeal space is complex. The complex anatomy and wide variety of pathology make the management of these tumours very challenging.