Pharyngeal Wall Research Articles

Spatial relationships of oropharyngeal structures during respiration, chewing, and swallowing.

Spatial relationships between oropharyngeal structures and their coordinated dynamics ensure proper adaptations in functions such as respiration, chewing, and swallowing. Thus, the aim of this study is to analyze spatial changes in the normal oropharynx during respiration and mastication. For this purpose, eight 7-8 months old Yucatan minipigs, four of each sex were used. X-ray fluoroscopy was recorded with the field of view focused on the oropharyngeal region. The x-ray video clips showing respiratory cycles and masticatory sequences were digitized and traced. Points to be digitized and traced were located on the soft palate, epiglottis, tongue base, and pharyngeal wall. An X-Y coordinate system was established to trace distances and directions of each structure (structural), and between structures (inter-structural) during phases of respiration, chewing stages, and swallowing episodes. During respiration, the soft palate showed the largest X-Y movements with the largest distance change (1.32 ± 0.64 mm). In contrast, distance changes in the tongue base were significantly smaller (0.32 ± 0.21 mm, p < 0.05). Notably, during chewing the tongue base and epiglottis showed major changes in distance and direction. Similarly, during swallowing the tongue base showed the largest changes (2.94 ± 1.28 mm) followed by the pharyngeal wall and epiglottis. Thus, although coordinated, each pharyngeal structure plays specific roles. Understanding of these spatial and specific dynamics in different oropharyngeal structures would provide the baseline to analyze the potential mechanisms of various swallowing and breathing disorders such as dysphagia and obstructive sleep apnea.

Interrater reliability of different scoring systems for drug-induced sleep endoscopy

PurposeTo explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.MethodsDISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss’ kappa for categorical data and linearly weighted kappa for ordinal data.ResultsIn total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.ConclusionThe interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.

Scanning Electron Microscopy of the Oropharyngeal Floor of Northern Bobwhite (Colinus virginianus, Linnaeus, 1758) Focusing on the Numerical and Regional Distribution of the Taste Buds

ABSTRACTThe architecture of the avian oropharynx corresponds to the feeding pattern. The present study aims to provide data on morphology, morphometry, and spatial distribution of taste buds in the oropharyngeal floor of the northern bobwhite (Colinus virginianus) using gross anatomy, morphometric, and scanning electron microscopy. The lower beak tip and tomia revealed the presence of variably‐sized dermal papillae. The prefrenular part of the oral floor had an interrupted median groove. Numerous taste buds and rostral submandibular salivary gland openings were detected alongside this groove. The tongue partially filled the oral floor. Its rostral end formed a median pointed process, the lingual nail. The dorsolateral aspects of the lingual apex and body showed hair‐like and rosette‐shaped filiform papillae of variable densities and sizes. However, these parts were devoid of taste buds. On the other hand, the surface mucosa of the lingual root presented numerous scale‐like cellular elevations and a large number of taste buds. Examination of cross sections in the lingual root suggested the presence of two groups of caudal lingual salivary glands, central and lateral. The laryngeal mound contained taste buds that protruded from the surface epithelium into the lumen. The mucosa of the pharyngeal floor contained many taste buds that appeared similar to those detected on the laryngeal mound, except for the large taste pores, excessive cellular porosity, and denser microvilli. The total proportions of the taste buds in the oral and pharyngeal floors were 34.1% and 65.81%, respectively. The proportions of taste buds were 34.1%, 57.26%, 4.27%, and 4.27% in the sublingual floor, lingual root, laryngeal mound, and pharyngeal wall, respectively. In conclusion, this study provides comprehensive data on the oropharynx of northern bobwhite and will help to understand mechanisms governing food gustation in the studied bird and other related birds.

Evaluation of Oropharyngeal Structure and DISE Findings for Successful Soft Palatal Webbing Flap Pharyngoplasty.

Lateral pharyngeal wall collapse, linked to weak pharyngeal wall stability, is characteristic of severe obstructive sleep apnea (OSA) patients. Soft palate webbing flap palatopharyngoplasty (SPWFPP) has been introduced to enhance the stability of the lateral pharyngeal wall with minimal postoperative complications by eliminating the need for tonsillectomy. This study analyzed the anatomic findings of oropharynx for determination of outcome in OSA patients requiring SPWFPP. Twenty-eight OSA patients who underwent SPWFPP combined with septoturbinoplasty were included in this study. Patient medical records, including endoscopic findings, polysomnography (PSG) data, and drug-induced sleep endoscopy (DISE), were analyzed. PSG data revealed that SPWFPP provided significant improvements of AHI scores in severe OSA patients with lateral pharyngeal wall collapse, whereas AHI scores of mild and moderate OSA cases minimally declined after SPWFPP. Notably, among the patients who underwent SPWFPP, some experienced abrupt increases in AHI levels after surgery, particularly in mild OSA cases, and those patients showed collapse of the epiglottis before surgery according to DISE findings. The outcome of SPWFPP was successful in severe OSA patients whose epiglottis was not collapsible on preoperative DISE findings and in patients with palatal collapse of grade III or higher. SPWFPP provides good surgical outcomes even in severe OSA patients with lateral pharyngeal wall collapse. However, the surgical results may be worse in certain patients depending on epiglottis collapsibility. A close analysis of DISE findings before SPWFPP reveals important indicators for predicting better surgical results and selecting OSA patients suitable for SPWFPP.

A Computational Model Reveals How Varying Muscle Activation in the Lateral Pharyngeal Wall and Soft Palate Differentiates Velopharyngeal Closure Patterns.

Finite element (FE) models have emerged as a powerful method to study biomechanical complexities of velopharyngeal (VP) function. However, existing models have overlooked the active contributions of the lateral pharyngeal wall (LPW) in VP closure. This study aimed to develop and validate a more comprehensive FE model of VP closure to include the superior pharyngeal constrictor (SPC) muscle within the LPW as an active component of VP closure. The geometry of the velum and the lateral and posterior pharyngeal walls with biomechanical activation governed by the levator veli palatini (LVP) and SPC muscles were incorporated into an FE model of VP closure. Differing muscle activations were employed to identify the impact of anatomic contributions from the SPC muscle, LVP muscle, and/or velum for achieving VP closure. The model was validated against normative magnetic resonance imaging data at rest and during speech production. A highly accurate and validated biomechanical model of VP function was developed. Differing combinations and activation of muscles within the LPW and velum provided insight into the relationship between muscle activation and closure patterns, with objective quantification of anatomic change necessary to achieve VP closure. This model is the first to include the anatomic properties and active contributions of the LPW and SPC muscle for achieving VP closure. Now validated, this method can be utilized to build robust, comprehensive models to understand VP dysfunction. This represents an important advancement in patient-specific modeling of VP function and provides a foundation to support development of computational tools to meet clinical demand.

The disappearing lesion in the cricopharynx: A hypopharyngeal cushion.

A 2-year-old girl presented to our aero-digestive clinic with complaints of dysphagia to solids. On awake endoscopy, a bluish, expansile lesion was noticed. posterior to the arytenoids, which became prominent when crying. During the airway evaluation under general anesthesia, the lesion completely disappeared, revealing a normal posterior cricoid region. Upon closer examination, a small venous malformation was noted in the posterior pharyngeal wall. A diagnosis of a "hypopharyngeal cushion" was made.

Detection of hypertension from pharyngeal images using deep learning algorithm in primary care settings in Japan

BackgroundThe early detection of hypertension using simple visual images in a way that does not require physical interaction or additional devices may improve quality of care in the era of...

Speech Outcomes After Primary Palatoplasty and Presurgical Cleft Characteristics: Is There a Predictive Association?

Speech disorders related to cleft lip and palate exhibit different degrees of involvement and can occur even after primary palate repair. Hypernasality can be present as a result of velopharyngeal insufficiency, as well as nasal emission, weak pressure, articulatory errors and facial grimace, affecting speech intelligibility. Palatoplasty outcomes can be variable, and among the influencing factors are the surgical technique, the surgeon's experience, the postoperative care, and the patient/cleft characteristics. The aim of this study was to correlate speech results after primary palate repair with surgical technique and cleft characteristics, using anthropometric measurements and speech assessment in patients diagnosed with cleft lip and palate. A longitudinal, retrospective study with patients who underwent primary palatoplasty between 2015 and 2019 and still attend Craniomaxillofacial Surgery Outpatient Clinic was conducted. Patients were operated on by a single surgeon using the intravelar technique veloplasty with maximal retropositioning of the soft palate elevator muscle. Patients who underwent primary palatoplasty after 2018 had the measurements before and immediately after palatoplasty recorded: length of palate, and the distances from cleft and uvula to posterior pharyngeal wall, and uvula to adenoid. Considering the total of 39 patients, 30 (76.9%) were male, with a mean age of 20.9 months (9-53mo). All patients had their speech recorded between ages of 60 and 120 months. Speech samples were assessed by 3 different speech pathologists experienced in cleft speech, with an intrarater and inter-rater reliability >80%. The most frequent cleft type was unilateral complete cleft lip and palate (59%). One patient had mild hyponasality, 1 isolated obligatory disorder (nasal turbulence), and 3 patients presented compensatory articulation (2 isolated and 1 also presented obligatory disorder). Only 1 patient had marginal velopharyngeal insufficiency. Postoperatively, there was a mean increase in palate length from 5.4 to 5.6cm, and a statistically significant decrease in the distance from the uvula to the pharynx wall, with a mean of 1.7 to 1.1cm (P<0.001). In general, patients analyzed did not have significant alterations in speech assessment, which did not allow further comparisons and correlation. Therefore, regardless of the anatomic characteristics of the palate, it is possible to achieve good results depending on the handling experience and the technique used.

6575 From Tonsils to the Thyroid: A Rare Case of Acute Suppurative Thyroiditis in an Immunocompetent Adult

Abstract Disclosure: F. Sajid: None. A. Mubashir: None. F. Mohsin: None. M. Sattar: None. Introduction: Acute suppurative thyroiditis (AST) is a rare infection of the thyroid gland due to its high vascularity, protective encapsulation, and high iodine content. Most AST cases occur in children with anatomical aberrations or in immunosuppressed adults. Here, we describe a case of AST in an immunocompetent woman. Case: A 54-year-old woman with no medical history presented to the emergency department due to dyspnea, dysphagia, and odynophagia for two days. She reported a four-day history of sore throat, fever, and chills. She was saturating well on room air but was sitting in a tripod position. She had erythema, swelling, tenderness to palpation in the anterior neck with a hoarse voice, and moderate trismus. Nasopharyngoscopy revealed no mass, but the scope could not pass beyond the velum due to edema. The patient’s condition quickly deteriorated, necessitating emergent intubation for acute hypoxic respiratory failure. After intubation, the patient had cardiac arrest with asystole requiring resuscitation and successful ROSC. The initial CT scan showed extensive soft tissue abnormalities in the nasopharynx and parapharyngeal tissues, extending to the thyroid gland and mediastinum with the possibility of developing abscesses. A thyroid ultrasound showed a heterogeneous thyroid gland without nodules or increased vascularity. Treatment commenced with ampicillin-sulbactam. Laboratory results showed Free T4 of 4.74 ng/dL (0.58-1.64), TSH 0.03 MCIU/mL (0.39-4.08), Total T3 1.56 ng/dL (0.72-1.35), WBC 19.3 K/UL (4.8-10.8), and elevated ESR and CRP levels. Thyroid-stimulating Immunoglobulin (TSI), Thyroid Peroxidase (TPO) Antibody, and Thyrotropin Binding Inhibitory Immunoglobulin (TBII) were negative, making AST the top differential. Methimazole was initiated due to concerns of thyroid storm, but it was quickly tapered due to a significant decrease in Free T4 levels and suspicion of AST. A repeat CT scan revealed more defined abscesses along the bilateral pharyngeal walls extending to the thyroid bed. The patient underwent bilateral tonsillectomy and drainage of the abscesses. She was extubated the following day. Cultures from the abscesses grew rare Klebsiella pneumoniae, susceptible to Ampicillin-sulbactam. A barium swallow on day 14 showed no evidence of a pyriform sinus fistula. She was discharged on day 15 with Augmentin for 7 days. On discharge, free T4 decreased to half (2.39 ng/dL), and Total T3 normalized (1.08ng/dL). Conclusion: This case presents a rare instance of AST in an immunocompetent patient without anatomical anomalies, stemming from the spread of peritonsillar and parapharyngeal abscesses into the thyroid bed. AST should be considered in cases of deep neck infections, as it is a potentially life-threatening disease. It is crucial to identify and treat AST early to prevent complications. The primary treatment involves antibiotics, incision, and drainage. Presentation: 6/1/2024

Efficacy of Autologous Cartilage Augmentation of Posterior Pharyngeal Wall in Management of Velopharyngeal Insufficiency A Meta-Analysis study

Abstract Background Velopharyngeal dysfunction is a disorder of the velopharyngeal sphincter or valve, which functions to separate the nasal and oral cavities during speech, swallowing, vomiting, blowing, and sucking. When the soft palate and pharyngeal walls are unable to form an effective seal, an abnormal connection between the nasal and oral cavities leads to hypernasal speech, increased nasal resonance, nasal regurgitation, nasal emission, and decreased intraoral pressure during speech. The overall result is decreased speech intelligibility and significant functional and social impairment. Objective To assess the efficacy of autologous cartilage augmentation of posterior pharyngeal wall in the treatment of velopharyngeal insufficiency. Patients and Methods An electronic database search (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted with the goal of identifying all available studies related to use of cartilage graft in posterior pharyngeal wall augmentation in Velopharyngeal insufficiency to 2022. Results Rate of improvement in nasal hyper resonance was 82%. Rate of improvement in speech intelligibility was 85%. Rate of improvement in velopharyngeal closure was 76%. Rate of improvement in nasal emission was 61%. Conclusion We conclude that cartilage augmentation of posterior pharyngeal wall is appropriate for patients with minimal velopharyngeal gap and is effective for improvement of velopharyngeal closure and speech.

Efficacy of Posterior Pharyngeal Wall Injection for Velopharyngeal Dysfunction in Adults.

Posterior pharyngeal wall (PPW) injection is often employed to treat velopharyngeal deficiency (VPD). We sought to analyze the impact of PPW injection on severity of dysphagia and dysphonia. Retrospective chart review was conducted of patients undergoing PPW injection from 2018 to 2023 at a tertiary laryngology center. Effects on Voice Handicap Index-10 (VHI-10), Eating Assessment Tool-10 (EAT-10), soft palate closure on modified barium swallow, and auditory-perceptual measures of hypernasality and audible nasal air emission were analyzed. 67 PPW injections were performed in 29 patients (11 female). Mean age was 59.4 ± 17.0 years. Etiologies were head and neck cancer (n = 23) and neurologic conditions (n = 6). 30 PPW injections were performed concurrent with intervention on the upper esophageal sphincter (25 dilations, 3 myotomies, 2 botulinum toxin injections), and 8 with a glottic procedure (6 vocal fold injections, 2 thyroplasties). Change scores were 3.87 (-6.85 to -0.89, p = .012) for VHI-10 and -3.00 (-4.75 to -1.25, p = 0.001) for EAT-10. These were statistically different from 0 for the whole cohort but not in the subset of patients undergoing concurrent voice and/or swallow surgery. Soft palate closure scores tended to be better (but not statistically significant) on MBS after PPW injection. Hypernasality and audible nasal air emission both improved after injection. PPW injection appears to have a therapeutic effect on dysphagia/dysphonia in patients with VPD; however, many patients have multifactorial impairment. Additional study is needed to determine benefit of PPW when performed in conjunction with other procedures in this complex patient population. Level 4 (Case series) Laryngoscope, 2024.

The clinical characteristics of pharyngeal and laryngeal lesions in anti-MDA5-positive dermatomyositis patients.

To investigate the clinical characteristics of pharyngeal and laryngeal lesions in patients with anti-melanoma differentiation-associated gene 5 antibodies-positive dermatomyositis (anti-MDA5-positive DM). Serological indicators of 131 anti-MDA5-positive DM patients were analysed. All 35 patients with pharyngeal and laryngeal symptoms underwent electronic laryngoscopy examinations. Pharyngeal and laryngeal symptoms were observed in 26.7% of anti-MDA5-positive DM patients. Low levels of haemoglobin, albumin, prealbumin, high-density lipoprotein and rapidly progressive interstitial lung disease mainly appeared in patients with pharyngeal and laryngeal involvement compared to those without involvement. However, no significant difference in mortality was found between the two groups. The number of patients with pharyngeal and laryngeal involvement was significantly higher in anti-Ro-52 antibody-positive patients than in anti-Ro-52 antibody-negative patients. Patients with higher serum ferritin levels (1000 ng/ml ≤ serum ferritin ≤ 1500 ng/ml) were more likely to develop pharyngeal and laryngeal involvement compared to those with lower serum ferritin levels (serum ferritin < 500 ng/ml). Electronic laryngoscopy examinations effectively assisted rheumatologists in assessing the conditions of the pharyngeal mucosa, arytenoid area, epiglottis, and vocal cords. Some patients also presented with rare lesions such as pharyngeal posterior wall fistulas, epiglottic ulcers, and vocal cord white lesions. 1. Pharyngeal and laryngeal lesions are not uncommon in anti-MDA5-positive DM, these patients have poorer nutritional status and more severe lung lesions; 2. Positive anti-Ro-52 antibodies and high serum ferritin levels are closely associated with pharyngeal and laryngeal involvement in anti-MDA5-positive DM; 3. Electronic laryngoscopy plays a crucial role in the diagnosis and evaluation of pharyngeal and laryngeal conditions.

Analysis of Diagnosis and Treatment Strategies for Parapharyngeal Space Tumors With Follicular Dendritic Sarcoma

Background: Parapharyngeal space tumor is a tumor that occurs in the parapharyngeal space. Parapharyngeal space tumors are uncommon, accounting for about 0.5% of head and neck tumors. Eighty percent of them are benign and 20% are malignant. The pathologic types of tumors are varied, mainly neurogenic tumors and salivary gland tumors. Follicular dendritic sarcomas are much rarer, with an inert biological behavior and a low-grade malignant sarcoma. Clinicians face difficulties in the management of this lesion. Therefore, a comprehensive analysis of the management of this disease is necessary. Case presentations: In May 2023, a 22-year-old male presented with pharyngeal discomfort, dysphagia, and sleep apnea. The patient underwent MRI which showed a rounded hypodense shadow with a size of 3.2×2.1×4.5 cm in the left lateral pharyngeal wall and a mass located in the posterior aspect of the left submandibular gland. After preliminary diagnosis of left parapharyngeal space tumor and left neck mass, the clinician performed transoral endoscopy-assisted resection of the left parapharyngeal space tumor and transcervical resection of the left cervical mass. The patient has been followed up without recurrence. Conclusions: This case provided a reference for the diagnosis and management of parapharyngeal space tumors. In particular, new insights into the diagnosis and management of a rare pathologic type were presented, which had the potential to improve the overall understanding of this disease.

A study of borderline cases of velopharyngeal insufficiency using cephalometry and nasofibroscopy

BackgroundIdentification of borderline cases of velopharyngeal insufficiency (VPI) due to palatopharyngeal disproportion in the form of short palate or deep posterior pharyngeal wall is necessary particularly in preoperative assessment of adenotonsillectomy to prevent post-adenotonsillectomy velopharyngeal insufficiency and hypernasality.ObjectiveTo evaluate the role of fiberoptic nasopharyngoscopy and cephalometry for assessment of clinically suspected cases of palatopharyngeal disproportion (borderline VPI) cases to identify the craniofacial morphometric measurements of such cases that may be helpful as a prognostic indicator in predicting and preventing post-adenotonsillectomy velopharyngeal dysfunction.DesignThis is an observational cross-sectional study of 38 patients with suspected palatopharyngeal disproportion (24 male and 14 female) with ages ranging from 3 to 7 years who were referred to the phoniatrics unit at Assiut University Hospital for the assessment of the velopharyngeal valve before adenotonsillectomy operation. The control group consisted of 25 normal individuals. They were subjected to (1) auditory perceptual assessment (APA) of the patients’ speech, (2) fiberoptic nasopharyngoscopy, and (3) lateral cephalometry.ResultsAuditory perceptual assessment showed no statistically significant difference between both groups. Fiberoptic nasopharyngoscopic examination revealed a highly significant statistical difference between both groups as regards lateral pharyngeal wall mobility (p = 0.000). Lateral cephalometric assessment showed significant statistical differences for maxillary protrusion (P = 0.04) which was slightly wider in the study group than in the control group and bony pharyngeal depth (Ptm-Ba) (P = 0.03) which was deeper in the study group than in the control group.ConclusionAuditory perceptual assessment of speech, nasopharyngoscopy, and cephalometry are important tools that could be used for pre-adenotonsillectomy assessment of cases with palatopharyngeal disproportion to prevent the post-adenotonsillectomy velopharyngeal insufficiency and its consequences.

What is airflow vibrato?

Vocal vibrato has a number of manifestations. Typically vibrato is first thought of as a variation in fundamental frequency (fo), and secondarily as a variation in intensity and sound quality. Other variations that accompany these three types of vibrato include movement of throat structures (changes in larynx height, alterations in arytenoid adduction, pharyngeal wall movement, tongue movement, etc.), and especially muscle contraction variations that accompany all mentioned vibrato types.

Features of the course of COVID-19 in children with the spread of the Omicron variant

The aim of the study was to assess the symptoms and identify risk factors for prolonged and complicated COVID-19 during the spread of the Omicron variant in children aged 1 month to 18 years. Materials and methods. The study included 110 children with confirmed COVID-19 of mild or moderate severity at the time of the first examination. The average age of the patients was 6.86±5.09 years. The clinical symptoms, duration of each of the identified symptoms, and complications were evaluated. Acomparative analysis of possible risk factors for prolonged course and development of pneumonia was carried out. Results. The most common cases in children with COVID-19 were an increase in body temperature (in93%), runny nose (in65%), cough (in59%), hyperemia of the posterior pharyngeal wall (in95%) and tonsils (in93%), an increase in regional lymph nodes - in 43%. Among children with the duration of COVID-19 for 10 days or more, astatistically significant late request for medical help (onaverage, by 8.26±5.46 days, compared with 3.00 ± 1.32 days with the duration of the disease up to 10 days). Pneumonia is most often registered among preschool children. The average age in the group of children diagnosed with pneumonia is significantly less than in children who did not have signs of pneumonia of this complication (4.66 ±4.78 and 7.17±4.81, respectively). Conclusions: With the spread of the Omicron variant COVID-19 in children, infection with the SARS-CoV-2 coronavirus is accompanied by symptoms of acute respiratory infection with an increase in body temperature, sore throat, hyperemia of the posterior wall of the pharynx and tonsils. Often there is an increase in regional lymph nodes, runny nose, cough, vomiting, less often - diarrhea. The prolonged course is facilitated by the late onset of adequate therapy. During the study, pneumonia was detected in 25% of children.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees-Part 1: Anatomy and Physiology.

The velopharyngeal (VP) port separates the nasopharynx from the oropharynx and is bordered by the velum, lateral pharyngeal walls, and posterior pharyngeal wall. Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the VP port, affecting speech and swallowing. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 1, the authors focus on the anatomy and physiology of the velopharyngeal port, the anatomy of cleft palate, and the causes of VPD. There are 3 types of VPD: velopharyngeal insufficiency, involving structural deficits; velopharyngeal incompetence, resulting from neuromuscular issues; and velopharyngeal mislearning, due to maladaptive speech habits. VPD is commonly associated with cleft palate due to anatomic disruptions that impair velopharyngeal function. However, there are numerous causes of noncleft VPD, including congenital or acquired structural defects, neuromuscular conditions, and developmental/behavioral factors. Diagnosis and management of VPD require a multidisciplinary approach involving, at a minimum, surgeons and speech-language pathologists. Plastic surgery trainees often receive education on the surgical treatment of VPD, but without a foundational knowledge of the disease spectrum and speech pathology, the complex terminology can impede a thorough understanding of its diagnosis and management. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.

Swallowing hydrodynamics visualization and aspiration quantification in a patient-specific pharyngolaryngeal model with varying epiglottis inversions

Impaired swallowing, or dysphagia, significantly affects patients' well-being and health. Nearly half of the patients with head and neck cancers experience dysphagia or aspiration following radiation therapy or surgery. However, current dysphagia management approaches are primarily symptom-based rather than etiology-specific, owing to a lack of clear understanding of aspiration mechanisms. This study aimed to understand the mechanisms of aspiration in an anatomically accurate pharyngolaryngeal model at different epiglottis angles. A biomechanical swallowing model was developed using transparent casts, and liquid flow dynamics were visualized using fluorescent dye from side and back views. Two liquids and two dispensing conditions were evaluated for their roles in aspiration. The results demonstrated distinct flow dynamics between water and a 1 ​% w/v methylcellulose aqueous solution and, to a lesser extent, between fast and slow dispensing for the same liquid. Three frequent aspiration sites were identified, including the interarytenoid notch, the cuneiform tubercular recess, and the vallecula, corresponding to aspiration mechanisms of notch overflow, recess overflow, and creeping flow, respectively. The angle of the epiglottis influenced flow dynamics in at least three ways: by facilitating gravity-assisted fluid movement, redistributing flow through the gap between the epiglottis tip and pharyngeal wall, and affecting creeping flow via the angle between the epiglottis base and hypopharynx. Slow dispensing of water to the anterior oropharynx resulted in a significantly high aspiration rate with a downward tilted epiglottis due to concurrent tubercle-recess overflow and vallecular creeping flow. The biomechanical model can serve as a testing platform for better understanding aspiration mechanisms and developing etiology-based strategies before and after treatments for head and neck cancers.

Age-related Variation in Sleep-dependent Obstruction in Surgically Naive Children.

Little is known about age-related variations in sites and grade of sleep-dependent airway obstruction in children with obstructive sleep apnea (OSA) or obstructive sleep-disordered breathing (oSDB). The objective was to compare sites and grade of obstruction on drug-induced sleep endoscopy (DISE) across different age groups of surgically naïve children with OSA or oSDB. A retrospective chart review was performed for surgically naïve children aged 0-18 years with OSA/oSDB who underwent DISE from July 2021 to August 2023. Participants were categorized into: infants (aged 0-1 years), younger toddlers (aged 1-2 years), older toddlers (aged 2-3 years), preschool (aged 3-5 years), younger school-aged (aged 5-10 years), and older school-aged (aged 10-18 years). On DISE, obstruction was rated 0 = none/mild, 1 = moderate, 2 = severe for inferior turbinates, adenoid, velum, palatine tonsils/lateral pharyngeal wall, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. A series of multiple regression analyses were used to identify age differences in the grade of obstruction across all sites combined and at each individual site separately. The sample consisted of 252 children aged 1 month to 17 years with 57.9% males. Older patients had greater total obstruction scores (B = 0.42, SE = 0.10, p < 0.01) and greater number of sites that were severely obstructed (B = 0.11, SE = 0.05, p = 0.03). Older age groups had more obstruction at inferior turbinates (p = 0.02), adenoid (p < 0.01), palatine tonsils/lateral pharyngeal wall (p < 0.01), lingual tonsil (p < 0.01), and base of tongue (p < 0.01). Younger age groups had more obstruction at the supra-arytenoid tissue (p < 0.01). Varying patterns of sleep-dependent airway obstruction should be expected across different age groups in children with OSA or oSDB. 3 Laryngoscope, 2024.

Identifying sex from pharyngeal images using deep learning algorithm

The pharynx is one of the few areas in the body where blood vessels and immune tissues can readily be observed from outside the body non-invasively. Although prior studies have found that sex could be identified from retinal images using artificial intelligence, it remains unknown as to whether individuals’ sex could also be identified using pharyngeal images. Demographic information and pharyngeal images were collected from patients who visited 64 primary care clinics in Japan for influenza-like symptoms. We trained a deep learning-based classification model to predict reported sex, which incorporated a multiple instance convolutional neural network, on 20,319 images from 51 clinics. Validation was performed using 4869 images from the remaining 13 clinics not used for the training. The performance of the classification model was assessed using the area under the receiver operating characteristic curve. To interpret the model, we proposed a framework that combines a saliency map and organ segmentation map to quantitatively evaluate salient regions. The model achieved the area under the receiver operating characteristic curve of 0.883 (95% CI 0.866–0.900). In subgroup analyses, a substantial improvement in classification performance was observed for individuals aged 20 and older, indicating that sex-specific patterns between women and men may manifest as humans age (e.g., may manifest after puberty). The saliency map suggested the model primarily focused on the posterior pharyngeal wall and the uvula. Our study revealed the potential utility of pharyngeal images by accurately identifying individuals’ reported sex using deep learning algorithm.