Posterior Pharyngeal Wall Thickness Research Articles

Cephalometric Pharyngeal Morphology in Adults with Unoperated Cleft Palate.

The aim of this study was to cephalometrically evaluate the pharyngeal morphology in adults with unoperated Submucous Cleft Palate (SMCP), adults with unoperated Overt Cleft Palate (OCP), and adults without clefts. This study employed a retrospective cross-sectional design. Lateral cephalometric radiography was performed on three groups of adults: 1) 29 with unrepaired SMCP; 2) 41 with unrepaired OCP; and 3) 39 without clefts, who served as controls. One-way ANOVA and rank-sum tests were used for intergroup comparisons. P value was set at .05. The soft palate length and the ratio of soft palate length to pharyngeal depth were significantly lower in subjects with unoperated SMCP and OCP than in non-cleft controls. Significant differences were also observed in pharyngeal depth, nasopharyngeal depth, and posterior pharyngeal wall thickness between subjects with unoperated OCP and non-cleft controls. Pharyngeal morphology differs significantly between individuals with and without clefts, particularly in soft palate length and the ratio of soft palate length to pharyngeal depth.

Effect of twin block and forsus on Pharyngeal airway dimensions: A comparative study

The objective of this study was to evaluate and compare the effects of Twin Block and Forsus on the Posterior Airway Passage (PAP) and Posterior pharyngeal wall Thickness (PPWT) in the treatment of Class II division 1 malocclusion. This was a 2-arm parallel, randomized controlled trial. A total of 24 Class II division 1 malocclusion patients indicated for treatment with functional appliances were randomized and equally divided among Twin Block and Forsus (3M Unitek Corp, Monrovia, Calif) groups. Skeletal changes, PAP changes and PPWT were compared using Twin Block and Forsus. Block randomization was determined by a computer-generated random number table. Blinding was performed for both participants and data analyser. 24 patients were analysed and statistical analysis were carried out using Student’s t-test and T test of Equality of Means (P <0.05). Significant increase in oropharyngeal and hypopharyngeal dimensions with no dimensional changes of nasopharynx, dimensional changes in soft palate thickness and length, and decompensatory action in thickness in the posterior pharyngeal wall was seen with both the appliances. On intergroup comparison insignificant results were observed between both the appliances indicating similar effect on PAP and PPWT. Both Twin Block and Forsus are effective in improving PAP and PPWT while correcting Class II malocclusion.

Post-Treatment Evaluation of Swallowing Function Using Quantitative Videofluoroscopy in Head and Neck Patients Undergoing Immunoradiotherapy or Chemoradiotherapy

<h3>Purpose/Objective(s)</h3> To evaluate post-treatment swallowing function in head and neck squamous cell carcinoma (HNSCC) patients undergoing definitive chemoradiotherapy (CRT) vs. immunoradiotherapy (IRT) using quantitative videofluoroscopic swallow studies (qVFSS). <h3>Materials/Methods</h3> We conducted a cross-sectional study of 23 patients with previously untreated locoregionally advanced HNSCC using qVFSS 4-6 and/or 12-24 months after CRT or IRT. RT consisted of 70 Gy to the primary and 54-63 Gy to the neck in 35 fractions over 7 weeks. Systemic therapy consisted of concurrent cisplatin (N=14) or cetuximab (N=2) in the CRT group and concurrent + adjuvant pembrolizumab only in the IRT group. qVFSS studies were performed by a certified speech-language pathologist using C-arm fluoroscopy with standardized bolus protocol. Quantitative metrics (Pharyngeal Constriction Ratio (PCR), Total Pharyngeal Transit Time (TPT), Bolus Clearance Ratio (BCR), and Posterior Pharyngeal Wall Thickness (PPWT)) were calculated using Swallowtail® software (Belldev Medical LCC, Arlington Heights, IL), with raters blinded to treatment. Higher values of each metric indicate worse swallowing function. For patients undergoing multiple qVFSS, maximum values of each metric were used. Two sample <i>t</i> tests and Mann-Whitney U tests were used to compare metrics by treatment group. Paired <i>t</i> tests were used to compare pre vs. post-treatment qVFSS metrics. <h3>Results</h3> Two patients did not complete post-treatment qVFSS, leaving 21 for analysis (16 CRT, 5 IRT). Disease sites were: oropharynx-15, larynx-4, hypopharynx-1, unknown primary-1. Overall mean (SD) PCR, TPT, BCR, and PPWT were 0.15 (0.13), 0.96 (0.27), 14.4 (13.4), and 0.73 (0.24), respectively. Mean post-treatment PCR and BCR were significantly higher for patients receiving IRT vs. CRT (0.21 vs. 0.13, t test p<0.01 and 20.0 vs. 12.7, p=0.019, respectively) (<b>Table</b>). No significant differences were found in TPT or PPWT between groups (<b>Table</b>). Mean (SD) pre-treatment PCR, TPT, BCR, and PPWT were 0.18 (0.19), 0.91 (0.28), 11.6 (11.8), and 0.54 (0.16) respectively. No significant differences were observed comparing post- minus pre-treatment PCR (-0.042, p=0.36), TPT (+0.094, p=0.24), or BCR (+1.38, p=0.54); however, PPWT was significantly worse after treatment (+0.24, p=0.03). <h3>Conclusion</h3> Preliminary results indicate dysphagia is worse in patients treated with IRT; however, the analysis is limited by small sample and cross-sectional design. Future studies are needed to define effects of alternative treatments on dysphagia.

Adaptive Changes in the Posterior Pharyngeal Wall Following Large Retraction of Incisors During Comprehensive Orthodontic Treatment.

To evaluate the effects of large retraction of incisors on the adaptive changes in the posterior pharyngeal wall and soft palate during comprehensive orthodontic treatment. Twenty-seven females with Class I mild crowding or spacing who required non-extraction treatment (group I) and 34 females with Class I bimaxillary dentoalveolar protrusion who required all first premolars extraction for the retraction of their incisors (group II) were included in the study. The effects of non-extraction and incisor retraction following all first premolars extraction orthodontic treatment on the sagittal dimensions of pharyngeal airway passage and posterior pharyngeal wall thickness were evaluated from pre- and post-treatment cephalograms. The dimensions of pharyngeal airway passage were comparable among the groups. The length of the soft palate increased (P < .01) and the thickness of the soft palate decreased (P < .01) following retraction of incisors, and the difference between the groups was significant (P < .05). The posterior pharyngeal wall thickness was reduced significantly at PPWT2 (P < .05), PPWT3 (P < .001), PPWT4 (P < .001), PPWT5 (P < .001), and PPWT6 (P < .01) regions following retraction of the incisors, and the difference between the groups was statistically highly significant. The large retraction of incisors during comprehensive orthodontic treatment in Class I bimaxillary dentoalveolar protrusion malocclusion subjects did not affect the sagittal dimensions of pharyngeal airway passage, but the thickness of the posterior pharyngeal wall reduced significantly as an adaptation to maintain the patency of the upper airway.

The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy

Background: Dysphagia is a complication following radiation therapy (RT) for head and neck cancers (HNC). Radiologic findings of posterior pharyngeal wall thickening (PPWT) after RT has not been quantified and correlated to swallowing outcomes.Aims/objective: To evaluate PPWT and its impact on swallowing function following RT.Material and methods: Retrospective analysis of pre- and three-month post-RT PPWT, demographics, oncologic history, and swallowing parameters of patients undergoing RT for HNC. Multivariate analysis of variance was performed to evaluate the effect of PPWT on swallowing outcomes.Results: The mean age of the cohort (n = 207) was 61.8 (± 11.29) years. The mean PPWT increased by 0.28 (± 0.19) cm (p = .00) three-months after RT. A significant difference in PPWT score between tumor subsites, χ2(2) = 45.883, p = .00, with the highest mean rank score of 135.97 for nasopharynx and 103.46 for oropharynx. PPWT was significantly associated with increased pyriform sinus retention, higher Penetration-Aspiration Scale (PAS) scores and post-deglutitive aspiration (p < .05).Conclusions and significance: PPWT increase significantly after RT for HNC. Increased PPWT was associated with mean radiation dose to the nasopharynx and oropharynx and was an independent risk factor for increased pharyngeal residue, higher PAS scores, and timing of aspiration (p < .05).

Radiological profiles of nasopharyngeal anatomy as seen in computed tomography scans of normal patients undergoing brain scans for other neurological problems in Konkani population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasopharyngeal carcinoma arises from interactions between underlying genetic and racial predilection and variety environmental factors. It is locally aggressive and presents with occult cervical nodal metastasis. A thorough understanding of radiological regional anatomy of the nasopharynx in Indians particularly Konkani population is important for early detection of nasopharyngeal carcinoma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Routine computed tomography of brain, head and neck for other neurological problems like stroke clearly delineates the loco-regional anatomy of the nasopharynx. Computed tomography (CT) images stored in the computer system were studied to delineate the normal loco-regional anatomy of nasopharynx with special reference to anatomical structure of fossa of Rosenmueller and to find out the normal dimensions of nasopharynx in Konkani population. Nasopharyngeal carcinoma is a hidden and cryptic killer with relatively higher incidence among young population. To develop a local screening CT program for earlier detection of this occult malignancy was another purpose of this endeavour. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Internal carotid artery lies at the depth of around 1 to 1.7 cm from floor of lateral pharyngeal recess (fossa of rosenmuller); this figure has to be borne in mind while doing invasive procedures of nasopharynx like biopsies and adenoidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Posterior pharyngeal wall thickness of more than 2.4 cm and adenoid mass extending to posterior margin of the medial pterygoid plate is suspicious of malignancy. A screening protocol of CT nasopharynx has been suggested as a fruit of this endeavour.&lt;/p&gt;

Analysis of pharyngeal edema post-chemoradiation for head and neck cancer: Impact on swallow function.

ObjectivesEdema is a frequent clinical observation following chemoradiation treatment (CRT) of oral/oropharyngeal cancer and is thought to contribute to post‐CRT swallowing impairment. Our aims were to reliably quantify pharyngeal edema pre‐ and post‐CRT from videofluoroscopic (VF) swallowing studies and to explore the relationship between edema and swallowing impairment. Swallowing impairment was captured using patient‐reported swallowing outcomes (EAT‐10) and with VF confirmation of impairment (DIGEST).Methods40 patients (24 M, age 38–76) with oral/oropharyngeal cancer received radiotherapy (70 Gy, 7 weeks) and 3 weekly doses of cisplatin. VF and EAT‐10 were completed pre‐ and 1‐month post‐CRT. Edema was captured by measuring posterior pharyngeal wall (PPW) thickness, vallecular space, and pharyngeal area (PA) on a single post‐swallow rest frame. Wilcoxon sign rank tests and paired t‐tests evaluated within‐subject changes in impairment and edema respectively. A linear mixed effect regression model explored the influence of time, patient‐reported outcomes, and functional impairment on measures of edema.ResultsSwallowing function (EAT‐10 and DIGEST) was significantly worse post‐CRT. PPW thickness (but not vallecular space and pharyngeal area) was significantly worse post‐CRT. PPW thickness was only significantly influenced by time (pre‐ vs. post‐CRT) but not by measures of swallow function.ConclusionOur findings establish the use of PPW thickness as a reliable measure of acute edema in post‐CRT treatment. In this small, retrospective sample, edema was not significantly correlated with either patient‐reported or measured swallow function. Prospective longitudinal work, examining the relationship between objective measures of edema, patient perception of impairment, and swallow function and biomechanics is warranted.Level of Evidence4.

The posterior pharyngeal wall thickness is associated with OSAHS in patients with acromegaly and correlates with IGF-1 levels.

To evaluate the incidence of obstructive sleep apnea-hypopnea syndrome (OSAHS), explore the structural changes in pharyngeal soft tissue underlying OSAHS development and analyze the correlation between hormone levels and pharyngeal soft tissue changes in patients with untreated acromegaly. Twenty-five patients with untreated acromegaly were prospectively enrolled. Pituitary hormones were tested, sellar magnetic resonance imaging was confirmed, overnight polysomnography was conducted, and upper airway computed tomography was performed on these patients. Patients with untreated acromegaly had a high incidence of OSAHS (52.0%, 13/25). The average age of the patients with OSAHS was 12 years older than that of patients without OSAHS (47.0 ± 8.5 years vs. 35.1 ± 9.5 years, p = 0.003). The posterior pharyngeal soft tissues were thicker in four different planes, including the planes of the soft palate, uvula, tongue and epiglottis (p = 0.003, 0.008, 0.027, and 0.003, respectively), and the soft palate (p = 0.024) was more hypertrophic in patients with acromegaly presenting with OSAHS than patients without OSAHS. The posterior pharyngeal wall thickness (cm) positively correlated with the serum insulin-like growth factor 1 (IGF-1) level (ng/ml) in the planes of the soft palate (slope = 0.001, p = 0.006) and epiglottis (slope = 0.002, p = 0.039). OSAHS is a common complication in patients with untreated acromegaly, and advanced age is a risk factor. Posterior pharyngeal soft tissue thickening and soft palate hypertrophy are structural changes underlying OSAHS development in patients with acromegaly. Higher IGF-1 levels predict an increase in the posterior pharyngeal soft tissue thickness in patients with acromegaly.

Examining Velopharyngeal Closure Patterns Based on Anatomic Variables.

The purpose of this study was to use three-dimensional magnetic resonance imaging to correlate velopharyngeal closure patterns with velopharyngeal anatomic structural characteristics. Thirty-eight participants (18 females and 20 males) between 19 and 32 years of age participated in the study. Participants were evaluated using magnetic resonance imaging and nasopharyngoscopy to determine closure pattern type and their relationship to anatomic characteristics believed to influence velopharyngeal closure. Structural anatomic measures were completed in the vertical (nasopharyngeal length) and horizontal (nasopharyngeal width) planes. Anterior to posterior dimensions of pharyngeal depth, posterior pharyngeal wall thickness, velar length, effective velar length, and adenoid thickness were also completed. Velar length and adenoid thickness varied based on closure patterns, with coronal closure pattern demonstrating significantly larger values than circular closure pattern. There were no statistically significant differences for effective velar length, pharyngeal depth, nasopharyngeal length, posterior pharyngeal wall thickness, and nasopharyngeal width based on the type of closure pattern. Closure patterns varied by sex, with females demonstrating more circular closure patterns than males who demonstrated more coronal closure patterns. Nasopharyngeal length, velar length, and nasopharyngeal width also varied by sex, with males demonstrating significantly larger values than females. Statistically significant differences were observed in velopharyngeal anatomic structural measures and sex during evaluations of closure patterns. These preliminary findings indicate that the length of the velum and thickness of the adenoids may have the greatest impact on velopharyngeal closure patterns.

Velopharyngeal Anatomy in Patients With Obstructive Sleep Apnea Versus Normal Subjects

Obesity can cause disturbed breathing and is one of the most significant risk factors for obstructive sleep apnea (OSA). However, the anatomic basis of OSA and, specifically, the anatomic mechanisms leading from obesity to OSA are still unclear. We examined the anatomic features of the velopharynx in patients with OSA versus those without in correlation with the body mass index (BMI), age, history of snoring, and OSA severity and re-evaluated the contribution of adding a frontal view to the cephalometric analysis of patients with OSA. Lateral and frontal cephalometric measurements were taken to assess the velopharyngeal anatomic features of 306 men with various degrees of OSA and 64 men without OSA and without a history of snoring. The demographic, polysomnographic, and cephalometric features were compared. The patients with OSA had an increased pharyngeal length, thicker velum, a thicker posterior pharyngeal wall, a reduced pharyngeal width, and a consequent narrowing of the pharyngeal lumen. As the BMI increased, the OSA severity increased. Also, in parallel, the velum and posterior pharyngeal wall thickness increased and the pharyngeal width decreased. Three types of velopharyngeal narrowing, with an increased occurrence in severe degrees of OSA, were identified: bottle shape, hourglass shape, and tube shape. These aerodynamically unfavorable changes might cause increased upper airway resistance, explaining the development of both OSA and hypoventilation syndrome in obese patients. Velopharyngeal thickening and lumen narrowing were shown to be features of obese men with OSA. However, these features developed only above a threshold BMI value. The combination of frontal and lateral cephalometry is important for comprehensive evaluation of patients with OSA.

Pharyngeal wall Differences between Normal Younger and Older Adults

Previous research has demonstrated differences in pharyngeal size and constriction between normal younger and older adults. The distance between the larynx and the hyoid bone at rest is greater in older persons, as is the anteroposterior width of the pharynx when it is maximally expanded during swallow. In addition, pharyngeal clearing during swallow is reduced with aging. These observations suggest that the aging pharynx undergoes structural changes consistent with atrophy. The purpose of this investigation was to compare pharyngeal wall thickness at rest and when maximally constricted during swallow in younger and older adults. Videofluoroscopic swallow studies were performed on 178 normal adults. Measures of posterior pharyngeal wall thickness were determined at rest and during maximum constriction of the pharynx during a 20-ml bolus swallow. Data were subjected to analysis of variance and Student t test procedures to determine sex and age differences. We found no statistically significant differences between the men and women in either age group, and so we then pooled our data across sex. Mean pharyngeal wall thickness at rest was 0.39 cm (±0.09) in the younger group and 0.30 cm (±0.08) in the older group (p < 0.01). Pharyngeal wall thickness measured at the same point during maximum constriction was 1.08 cm (±0.34) in the younger group and 0.92 cm (±0.36) in the older adults (p<0.01). Our data suggest that the posterior pharyngeal wall is thinner and does not constrict to the same extent in older subjects compared with younger individuals. These findings contribute to our understanding of differences in pharyngeal strength, swallowing efficiency, and safety associated with aging.

S194 – Pharyngeal Thickness in Young and Elderly Normal Subjects

Objectives Previous research has demonstrated pharyngeal size and constriction differences between normal young and elderly adults. Evidence suggests that the pharynx of elderly subjects dilates and does not constrict as well as younger persons. The distance between the larynx and the hyoid at rest is greater in the elderly, as is the anterior-posterior width of the pharynx maximally expanded. We have noticed that the pharynx of elderly persons appears to atrophy with age. The purpose of this investigation was to compare pharyngeal wall thickness in young vs. elderly persons. Methods Videofluoroscopic swallow studies were performed on 82 normal adults under the age of 65 years and on 89 normal adults over the age of 65. Measures of posterior pharyngeal wall thickness (PWT) were determined at rest and at the same point during maximum constriction of the pharynx on a 20-cc bolus swallow. Data were compared with the independent samples t-test. Results No gender differences were identified for the younger or elderly groups. Mean PWT at rest was .40cm (± .08) for the younger group and 30cm (± .08) for the elderly (p &lt;0.01). Pharyngeal wall thickness measured at the same point during maximum constriction was 1.08cm (±38) for the younger group and .92cm (±36) for the elderly (p &lt;0.01). Conclusions Data from the current study suggest that the posterior pharyngeal wall is thinner in elderly individuals older than 65 as compared to younger adults. These differences may help explain differences in pharyngeal strength, swallowing efficiency, and safety in the elderly.

Magnetic resonance imaging evidence of posterior pharynx denervation in pediatric patients with Chiari I malformation and absent gag reflex

The authors hypothesized that children with preoperative Chiari I malformation and an absent gag reflex may harbor pharyngeal musculature atrophy identifiable on magnetic resonance (MR) imaging. Thirty patients with preoperative Chiari I malformation and a functioning gag reflex, five patients with preoperative Chiari I malformation and complete absence of gag reflex, and 50 control individuals underwent radiological measurement of the posterior pharyngeal wall thickness. The thickness of the posterior pharyngeal wall in age-matched controls was significantly thinner (p < 0.0001) than that in patients with Chiari I malformation and no functioning gag reflex. Additionally, in patients with hindbrain herniation and absent gag reflex, the posterior pharyngeal wall thicknesses were comparable to or thinner than those in age-matched controls. A general decrease in the thickness of the posterior pharyngeal wall was found in control individuals who were older compared with patients with Chiari I malformation and a preserved gag reflex in whom the prevertebral soft tissues were found to increase in thickness with age. Analysis of these data showed that in children with a nonfunctioning gag reflex the prevertebral soft tissue, composed primarily of the superior constrictor muscle, is statistically thinner compared with that in age-matched controls and age-matched children with Chiari I malformation and a functioning gag reflex. The authors theorize that the discrepancy between this measurement in controls and patients with hindbrain herniation is due to the thickening of the craniocervical ligaments that is known to occur in this clinical entity. The finding that prevertebral soft tissue thickens with age in patients with Chiari I malformation and functioning gag reflex alone may aid in the interpretation of soft-tissue injury following cervical spine injuries in this group.

Frontal and lateral cephalometry in patients with sleep-disordered breathing.

The traditional lateral-view cephalometric analysis is limited because it provides only two-dimensional analysis of the three-dimensional craniofacial structure. The objectives were to analyze lateral and frontal cephalometric radiographs in a series of normal patients and those with varying degrees of sleep-disordered breathing and to define the degrees of narrowing or other unfavorable anatomical changes that might differentiate the patients with sleep-disordered breathing from normal subjects. A prospective study of 100 adult patients with sleep-disordered breathing and 60 age-matched normal subjects. An analysis of the lateral and frontal cephalometric measurements was performed to assess velopharyngeal anatomical features. A comparison was made between the patients' polysomnographic and cephalometric analyses. The compromised cephalometric parameters that may be found in patients with sleep-disordered breathing include acute skull-base and bony nasopharynx angles, inferior hyoid position, thickening of the velum, reduced retrovelar posterior air space along with thickening of the velum, thickening of the posterior pharyngeal wall, and narrowing of the velopharyngeal lumen. Worsening of sleep-disordered breathing was generally associated with increased numbers of compromised cephalometric parameters. As body mass index increases, there is reduced velopharyngeal width, the velum thickness is increased, and the posterior pharyngeal wall thickness is increased. Sleep-disordered breathing is associated with statistically significant changes in a number of cephalometric measurements. Frontal cephalometric analysis adds further information regarding the anatomical assessment of patients with upper airway obstruction, enhancing the traditional lateral cephalometric view.