Posterior Pharyngeal Wall Research Articles

Risk Stratification of Dysphagia After Surgical Treatment of Hypopharyngeal Cancer.

ObjectiveHypopharyngeal cancer is managed by either surgical resection or radiation therapy-based treatment. In choosing the treatment modality, the patient’s swallowing function should be considered to achieve optimal treatment outcomes. This study aimed to stratify the risk factors predictive of postoperative dysphagia in hypopharyngeal cancer.Study DesignRetrospective study.SettingTertiary referral center.MethodsWe enrolled 100 patients who were diagnosed with hypopharyngeal cancer and underwent curative surgery between January 2010 and December 2019, and retrospectively reviewed their medical records.ResultsPostoperative dysphagia occurred in 29 patients (29%) who required a tracheostomy tube or percutaneous gastrostomy tube for feeding or preventing aspiration; additionally, the overall survival rate was lower in those patients than in those without dysphagia. The univariate analysis revealed that postoperative dysphagia was associated with clinical T stage (p = 0.016), N stage (p = 0.002), and surgical resection extent of the larynx and pharynx (p < 0.001). Patients who underwent total laryngectomy with total/partial pharyngectomy were more likely to have dysphagia than those in the larynx-preserving pharyngectomy groups (odds ratio [OR] = 3.208, 95% confidence interval [CI] 1.283–8.024, p = 0.011). Concerning the posterior pharyngeal wall (PPW), which has an important role in swallowing, patients who underwent resection of ≥1/2 of the PPW were more likely to have dysphagia (OR = 7.467, 95% CI 1.799–30.994, p = 0.003).ConclusionsSurgical resection extent was proportionally associated with dysphagia in hypopharyngeal cancer patients. Patients with smaller lesions but no laryngeal invasion had better postoperative swallowing function than patients with larger lesions or laryngeal involved lesions. Preserving the larynx and hypopharyngeal mucosa (especially the PPW) as much as possible can help preserve postoperative swallowing function.

Accidental ingestion of large foreign body retained at recto sigmoid junction: A rare case report

: Large Foreign Bodies in recto-sigmoid are very rare. Foreign bodies found in rectum are usually are inserted as a part of erotic activities . Very rarely foreign bodies reach upto rectum due to oral ingestion; e.g. of the latter include toothpicks, bones. These patients commonly present with pain, discomfort or foreign body sensation. After failure to remove by local methods they present to doctor. Patient fail to present early due to social embarrassment and stigmas. Patient might not present with original mode of insertion due to stigma and present with unusual stories. A 52 year male presented with a complaint of abdominal pain colicky in nature since 12 hours and abdominal mass of following an episode of accidental ingestion of pestle while he was scratching his posterior pharyngeal wall.. At laparotomy, pestle was found at rectosigmoid junction, The pestle in rectosigmoid colon was removed by bimanual technique, i.e foreign body was pulled through anus and pushed through abdomen.This was a rare case of such a large foreign body ingestion and retained in rectosigmoid colon.

Posterior pharyngeal wall augmentation in post-adenoidectomy velopharyngeal insufficiency

PurposeTo assess the efficacy of posterior pharyngeal wall augmentation using septal or conchal cartilages with other bulks—according to the persistent gap and the individual anatomy of each patient—in improving velopharyngeal function in patients who acquired persistent velopharyngeal insufficiency (VPI) post-adenoidectomy.MethodsObservational descriptive prospective case series of 24 patients (their ages ranged between 3 and 26 years) who developed persistent VPI post-adenoidectomy (more than 3 months) although they had normal speech resonance before adenoidectomy.ResultsThe present study demonstrated that statistically significant improvement in auditory perceptual assessment (APA) was found regarding all obligatory speech disorders and unintelligibility of speech. Significant improvement was observed in the degree of velar mobility, size of the persistent gap, and the gap distance between velum and posterior pharyngeal wall at rest and during phonation in post-operative evaluation versus pre-operative. A significant change was observed in the closure pattern of the velopharyngeal port (VPP) as all patients turned to coronal closure.ConclusionsPosterior pharyngeal wall augmentation could be used in VPI post-adenoidectomy up to 7 mm and lead to better speech outcomes. Also, it revealed that using conchal and/or septal cartilage as a graft regardless of the patient’s age is a safe procedure.

Patterns of velopharyngeal closure during speech in individuals with normal habitual resonance: A nasoendoscopic analysis

ObjectiveVelopharyngeal valve closure is essential for adequate speech intelligibility as well as for other activities. The variations in the contribution of different components of the velopharyngeal port walls produce different closure patterns. The aim of this cross-sectional study is to identify the prevalence of the different velopharyngeal closure patterns in Arabic-speaking individuals with no perceived hypernasality or velopharyngeal dysfunction. MethodsAfter verification of selection criteria, 100 subjects with age range between 15 and 60 years underwent nasoendoscopic examination and both the extent of movement of the different velopharyngeal walls as well as closure pattern were observed. ResultsAlmost all participants had grade 4 (full range) velar mobility, most participants had grade 3 lateral pharyngeal wall movement, and none showed any observable posterior pharyngeal wall movement. Coronal closure pattern was the most frequent (75%) among participants followed by circular pattern (25%). There was no statistically significant difference between both genders in the extent of velar and lateral pharyngeal wall movements, yet the frequency of closure patterns differed statistically significantly between males and females. ConclusionCoronal pattern was the most prevalent type of velopharyngeal closure in subjects with normal habitual resonance, of both sexes, yet it occurred more frequently in males.

Evaluation and Correlation Between Pharyngeal Space, Mandible, and Tongue in Two Different Facial Patterns

Introduction: Respiratory function has a direct relationship with the pharyngeal airway dimension and mandibular morphology. The objective of the present study was to compare and correlate pharyngeal airway, mandibular morphology, and tongue position in hyperdivergent and normodivergent patterns using standard cephalometric radiographs. Materials and Methods: A total of 130 individuals with age 13 to 19 years, with no craniofacial skeletal abnormalities, were taken. The individuals were divided into 2 groups based on their Frankfort mandibular angle (FMA). Group I consist of 65 hyperdivergent individuals (34 males, 31 females) with FMA &gt;28. Group II consisted of 65 normodivergent individuals (28 males, 37 females) with FMA &gt;25 to &lt;28. For statistical analysis, variables were analyzed by unpaired t-test, with P value &lt;.05. Correlation between the pharyngeal space and the other variables was analyzed with the Pearson correlation test. Results: Upper pharyngeal airway space in hyperdivergent growth pattern exhibited a significant negative correlation with ramus width (r = −0.02 and P = .028). Gonial angle showed a statistically significant inverse correlation with lower pharyngeal airway space (r = −0.398 and P = .029). A-point-nasion-B-point (ANB), saddle angle, posterior tongue space, tongue gap, and pharyngeal airway among normodivergent subjects, showed a statistically significant negative correlation. Conclusion: The present study showed a significant relationship between pharyngeal airway space, craniofacial morphology, and tongue position suggesting that narrower airway space may be a causative factor for altered dentofacial skeletal patterns. Reduced ramus width, lowered tongue, and narrower posterior pharyngeal wall might be a balancing mechanism set for morphological imbalance in hyperdivergent pattern.

Variations in the appearance of posterior pharyngeal wall follicles in individuals with viral upper respiratory infections according to the virus and the stage of infection: A case series

From August 2021 to January 2022, four patients presented to our hospital with short-term throat pain. The cause could not be determined from the symptoms. These included a 24-year-old vaccinated man with SARS-CoV-2 infection, presumably the Delta variant (B.1.617.2) (Case 1), a 31-year-old woman with rhinovirus/enterovirus infection (confirmed on a BioFire Respiratory 2.1 Panel) (Case 2), a 26-year-old non-vaccinated man with SARS-CoV-2 infection, confirmed as the Omicron variant (B.1.1.529) (Case 3), and a 39-year-old vaccinated woman with SARS-CoV-2 infection, presumably the Omicron variant (Case 4).

Prosthodontic management of velopharyngeal incompetence with palatal lift prosthesis: A case series

Velopharyngeal dysfunction is a palatal defect that occurs when the soft palate or the velum fails to close an opening called the velopharyngeal port or lift adequately to posterior pharyngeal wall. It primarily affects the articulation and resonance of speech and often leads to nasal intonation due to escape of air through the nose. This article presents a series of such cases that have been treated by prosthodontic rehabilitation.

Neuroendocrine Neoplasms of the Oropharynx—A Literature Review

<h3>Purpose/Objective(s)</h3> Neuroendocrine neoplasms (NEN) are a diverse group of rare tumors. The most common primary sites are gastrointestinal tract and lung, though these neoplasms can occur throughout the body. Neuroendocrine neoplasms of the head and neck are rare, with those of the oropharynx being especially uncommon. Case studies and small series make up most of the literature on oropharyngeal neuroendocrine tumors, and there is no clear consensus on how to treat these unique cancers. Therefore, we aim to explore the current literature describing neuroendocrine neoplasms of the oropharynx. <h3>Materials/Methods</h3> A comprehensive search of several databases including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus from inception to May 19, 2021 was conducted. Inclusion criteria included diagnosis of neuroendocrine neoplasm of the tonsil, base of tongue, soft palate, or posterior pharyngeal wall with histopathology available for review. Cases with distant metastatic disease at presentation, review papers, large database studies, papers not in English, papers without outcomes of interest reported, and conference abstracts were excluded. Information including patient demographics, symptoms at presentation, radiologic findings, diagnostic approach, treatment approach, and outcomes were recorded. <h3>Results</h3> The search resulted in 1,154 papers. After title and abstract screening, 93 papers qualified for full review, with 28 were included ultimately in our review. In these papers, 52 unique cases were identified. The average age at presentation was 62 years. Of the patients identified, 73% were male (n=38), 25% were female (n=13), and 2%were unspecified (n=1). The most common site was the tonsil at 36% (n= 21). This was followed by 35% in the tongue base (n=18), 17% in the oropharynx (unspecified) (n=10), 2% in the soft palate (n=1), and 3% unknown primary sites (n=2). The most common histology was small cell neuroendocrine carcinoma at 45% (n= 26). HPV status was reported in 24 patients, with 75% being HPV positive (n=18) and 25% HPV negative (n=6). Treatment modalities varied, with definitive therapy being the most common, in 19 cases. <h3>Conclusion</h3> Neuroendocrine neoplasms of the head and neck are a rare subtype of oropharyngeal cancer, and there is limited data available to drive treatment. More work is needed to elucidate guidelines for how to treat these rare tumors.

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.

Residue localization and risk for aspiration in partial laryngectomy: the relevance of assertive therapeutic strategies and resources.

ABSTRACTObjective:To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction.Methods:This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location.Results:The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration.Conclusion:Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.

A Midsagittal-View Magnetic Resonance Imaging Study of the Growth and Involution of the Adenoid Mass and Related Changes in Selected Velopharyngeal Structures.

The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the posterior pharyngeal wall of the nasopharynx. During childhood, the adenoid pad serves as a contact site for the soft palate to assist with velopharyngeal closure during oral speech. During adenoidal involution, most children are able to maintain appropriate velopharyngeal closure necessary for normal speech resonance. The purpose of this study is to determine age-related trends of normal adenoid growth and involution from infancy through adulthood. Lateral view magnetic resonance imaging was used to analyze velopharyngeal variables among 270 participants, between 3 months and 34 years of age. The velopharyngeal measures of interest included velar length, effective velar length, pharyngeal depth, adenoid height, adenoid thickness, adenoid depth, and adenoid area. Participants were divided into four age groups for statistical comparison. There was a statistically significant difference (p < .05) in all linear and area measurements between the four age groups. Adenoid depth reached peak growth at age 4 years, whereas adenoid height and adenoid thickness peaked at 8 years of age. Qualitatively, adenoid growth progresses in an anterior and inferior direction whereas involution occurs in a posterior and superior direction. This study contributes to the knowledge of time specific changes across an age span for adenoid growth and involution and presents a visualization of the shape and growth trends of adenoids. A new sequence of involution is reported beginning first with adenoid depth, followed by adenoid height at a slightly faster rate than adenoid thickness.

Inflammatory diseases of the pharynx in children

Introduction. Inflammatory diseases of the lymphoid ring of the pharynx in children are widespread and account for more than 30% in the structure of ENT pathology. Lymphoid tissue, especially the palatine tonsils, largely determines the formation of local and general protective reactions of the child’s body.The aim of this work is to assess the efficacy and safety of using topical bacterial lysate in chronic tonsillitis of streptococcal and herpes viral etiology in frequently ill children.Materials and methods. The study was conducted on a sample of 31 children aged 7–17 who were treated in the pediatric department of the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech inpatiently or outpatiently, which were divided into 2 groups. Group 1 consisted of 15 children with decompensated chronic tonsillitis of streptococcal etiology, who were prescribed tonsillectomy according to indications. Group 2 consisted of 16 children with chronic compensated tonsillitis, who, after an acute respiratory infection, showed signs of acute pharyngitis in the form of pain and discomfort in the throat, perspiration, low-grade body temperature. In both groups children were prescribed to take topical baclerial lysates.Results. A subjective pain relief of sore throat in patients (groups 1 and 2) was observed from day 2–3 of administration of the topical bacterial lysate. The clinical therapeutic effect resulted in decreased intensity of inflammation of the posterior pharyngeal wall, reduction in size and tenderness of regional lymph nodes from day 4–5 of administration of the drug. The clinical recovery from acute pharyngitis in children of both groups was observed in 98% of cases at visit 3.Conclusion. The persistence of pathogenic viruses and bacteria contributes to the development of secondary immunodeficiency states and participates in the formation of a kind of “vicious circle” In these causes prescription of topical baclerial lysates may be an effective conservation therapy as well as antibiotics and antiviral drugs. The drug showed its efficacy in the treatment of acute and chronic diseases of the pharynx in children of both viral and bacterial etiology.

Extranasopharyngeal Angiofibroma from Hypopharynx: A Rare Case Report

Angiofibroma is a histologically benign mesenchymal tumor though it is a potentially locally destructive fibrovascular tumor. Angiofibroma located in the head and neck comprises nasopharyngeal and extra-nasopharyngeal angiofibroma. The extra-nasopharyngeal angiofibroma itself is extremely rare. There was only two hypopharynx angiofibroma case in the recent literature. The aim of this report is to find out recurrence rate after mass extirpation surgery approach transcervical in this patient. A case of extra-nasopharyngeal angiofibroma from hypopharynx that arising from the left posterior pharyngeal wall was described in this report. A 32 years old man was admitted with 8 years history of lump located around the mouth and left side of the throat. There were no other significant complaints other than the lump itself. Histopathologic microscopic examination showed an angiofibroma. Angiofibroma is a benign and slow-growing mass. The conclusion is management of this case is the same as angiofibroma in general, by surgery approach. The mass was successfully removed surgically and thus far no recurrence or post-surgical complications were found one year after excision.&#x0D; Keywords: angiofibroma, extra-nasopharyngeal, hypopharynx, pharyngeal mass

Effects of oral screen exercise on orofacial and pharyngeal activity: An exploratory study using videofluoroscopy and surface electromyography in healthy adults.

ObjectiveThe oral screen is a device commonly used for treatment of orofacial disorders. The objective of this exploratory study was to examine the effect of oral screen exercise on the muscle activity in the lips, submental complex, masseter muscle, and kinematic activity of the tongue base, soft palate, pharynx, and larynx in healthy adults. This was compared with the kinematic activity during a dry swallow. It was hypothesized that not only the lip musculature but also other structures in the oral and pharyngeal cavities are activated while using an oral screen device.MethodTen healthy subjects used an oral screen during examination with videofluoroscopy and surface electromyography (EMG). Three different instructions for oral screen application and a dry swallow were examined.ResultsThe lip muscles showed the highest activity during oral screen exercise. The other muscle groups were activated to a lesser degree. The pattern of activation differed between individuals. Compared with a dry swallow, the range of motion of the tongue base, posterior pharyngeal wall, and the larynx was significantly smaller during oral screen activation. No major differences were found between three different instructions.ConclusionThis study indicates that the lips and submental complex and, to a lesser degree, oral, pharyngeal, and laryngeal structures are activated with the oral screen, but the pattern of activation varied between individuals. In comparison to the activity during a dry swallow, range of motion during oral screen exercise is small.

Latent changes in the pharyngeal stage of swallowing in non-aspirating older adults.

The characteristic changes in the swallowing mechanism with aging are collectively termed presbyphagia. Although several studies have investigated presbyphagia in older adults, few have assessed oldest-old adults. We aimed to characterize the latent changes of swallowing function in oldest-old adults and to consider risk ages for presbyphagia. We analyzed the records of 85 individuals (44 males and 41 females, aged 25-101years) who underwent videofluoroscopic swallowing studies. The included participants had penetration and aspiration scores of ≤ 2 and no history of aspiration, pneumonia, or diseases that affect swallowing. They were divided into four age groups: 25-64years (non-older), 65-74years (young-old), 75-84years (middle-old), and ≥ 85years (oldest-old). We analyzed and compared the pharyngeal delay time (PDT), duration of tongue base and posterior pharyngeal wall contact, duration and dimension of upper esophageal sphincter opening (UES-O), and maximal hyoid bone displacement between the age groups. Among the older groups, the oldest-old showed significantly longer PDT than younger-old adults, and the UES-O tended to be wider in the former. However, no other remarkable differences were found between the oldest-old and other old groups. Statistical comparisons between the < 75 and ≥ 75-year age groups revealed significant age-related changes in the PDT and duration and dimension of UES-O. On videofluoroscopic evaluation, physiological changes with aging affected few parameters of swallowing in our cohort. These findings indicate that in non-aspirating oldest-old adults, any deterioration may be adjusted for by compensatory changes to maintain swallowing function.

Airway obstruction requiring tracheal intubation after fine-needle aspiration of the thyroid gland: a case report

BackgroundThere have been no reports of tracheal intubation for airway obstruction after acute thyroid swelling following fine-needle aspiration (FNA) of the thyroid gland.Case presentationA 58-year-old woman with a 22 mm × 13 mm right hypervascular thyroid nodule underwent FNA once with a 22G needle under ultrasonographic guidance. Shortly after the aspiration, ultrasound revealed hypoechoic swelling with a crack-like pattern. The patient was observed under bed rest in the Fowler position and received intravenous steroids. A computed tomography (CT) scan showed swelling not only of the thyroid but also of the retropharyngeal space, and the patient complained of difficulty swallowing saliva. Laryngeal fiberscopy revealed protrusion of the posterior pharyngeal wall, edematous changes in the mucosa of the pharynx and epiglottis, and retention of saliva. The patient was intubated awake and hydrocortisone was administered every 8 h. She was extubated 3 days after FNA and discharged without any complications.ConclusionsWhen neck swelling is noticed after FNA, ultrasonographic findings are especially important to assess potential causes. If airway obstruction is suspected, CT findings and fiberscope observation of the pharynx provide particularly useful information.

Posterior pharyngeal wall augmentation using autologous tiered costal cartilage for velopharyngeal insufficiency

The aim of this study was to retrospectively estimate intervention outcomes and to establish suitable indications for autogenous tiered cartilage augmentation (ATCA) of the posterior pharyngeal wall for velopharyngeal insufficiency (VPI). The sample cohort comprised 17 consecutive patients with VPI (10 boys, 7 girls), excluding syndromic cases. Pre- and postoperative findings were comprehensively evaluated using a combination of speech assessment and lateral pharyngography (LPG). Hypernasality and consonant distortion were scored (normal: 0; mild: 1; moderate: 2; severe: 3). Velopharyngeal gap size at rest (AC) and at maximum closure (BC) were measured on LPG. All patients displayed improvements in velopharyngeal function and speech score, and no patients required re-operation. Pre- and postoperative hypernasality scores were 1.9±0.5 and 0.6±0.5, respectively (P < .001). Pre- and postoperative consonant distortion scores were 1.9±0.6 and 0.6±0.5, respectively (P < .001). Pre- and postoperative AC distances were 8.2±3.4mm and 5.9±2.6mm, respectively (P < .001). Pre- and postoperative BC distances were 3.9±2.4mm and 0.3±0.8mm, respectively (P < .001). Conclusions: ATCA appears effective for surgical treatment of VPI patients with a gap less than 10mm.

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.

Usefulness of lateral cephalometric radiography for successful blind nasal intubation: a prospective study.

This study aimed to investigate the relationship between pharyngeal morphology and the success or failure of blind nasotracheal intubation using standard lateral cephalometric radiography and to analyze the measurement items affecting the difficulty of blind nasotracheal intubation. Assuming a line perpendicular to the Frankfort horizontal (FH) plane, the reference point (O) was selected 1 cm above the posterior-most end of the hard palate. A line passing through the reference point and parallel to the FH plane is defined as the X-axis, and a line passing through the reference point and perpendicular to the X-axis is defined as the Y-axis. The shortest length between the tip of the uvula and posterior pharyngeal wall (AW), shortest length between the base of the tongue and posterior pharyngeal wall (BW), and width of the glottis (CW) were measured. The midpoints of the lines representing each width are defined as points A, B, and C, and the X and Y coordinates of each point are obtained (AX, BX, CX, AY, BY, and CY). For each measurement, a t-test was performed to compare the tracheal intubation success and failure groups. A binomial logistic regression analysis was performed using clinically relevant items. The items significantly affecting the success rate of blind nasotracheal intubation included the difference in X coordinates at points A and C (Odds ratio, 0.714; P-value, 0.024) and the ∠ABC (Odds ratio, 1.178; P-value, 0.016). Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

Use of mouthpiece for pressurized metered dose inhaler (pMDI) and change in inhalation status

Inhalation therapy using a pressurized metered-dose inhaler (pMDI) is said to be highly effective with few side effects. However, there are cases in which inhalation therapy with pMDI is not sufficiently effective, such as drug adhesion to the oral cavity or dependence on the user's technique. In this study, the use of a mouthpiece was proposed to reduce drug adhesion to the oral cavity and improve the ease of sucking, and the effectiveness of the mouthpiece was verified. The changes in inhalation rate and volume when using the mouthpiece were measured with an applied fine pressure difference sensor. Using an appropriately shaped mouthpiece increased the area of the posterior pharyngeal wall during inhalation and placed the tongue in a position where it was less likely to adhere to the drug. In many subjects, the mouthpiece provided better control of the inhalation rate and made it easier to maintain the target inhalation rate. The mouthpiece also increased the amount of inhalation in many subjects.