Soft Palate Area Research Articles

Clinical efficacy and mechanism study of mid-frequency anti-snoring device in treating moderate obstructive sleep apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is primarily caused by airway obstruction due to narrowing and blockage in the nasal and nasopharyngeal, oropharyngeal, soft palate, and tongue base areas. The mid-frequency anti-snoring device is a new technology based on sublingual nerve stimulation. Its principle is to improve the degree of oropharyngeal airway stenosis in OSAHS patients under mid-frequency wave stimulation. Nevertheless, there is a lack of clinical application and imaging evidence. To investigate the clinical efficacy and mechanisms of a mid-frequency anti-snoring device in treating moderate OSAHS. We selected 50 patients diagnosed with moderate OSAHS in our hospital between July 2022 and August 2023. They underwent a 4-wk treatment regimen involving the mid-frequency anti-snoring device during nighttime sleep. Following the treatment, we monitored and assessed the sleep apnea quality of life index and Epworth Sleepiness Scale scores. Additionally, we performed computed tomography scans of the oropharynx in the awake state, during snoring, and while using the mid-frequency anti-snoring device. Cross-sectional area measurements in different states were taken at the narrowest airway point in the soft palate posterior and retrolingual areas. Compared to pretreatment measurements, patients exhibited a significant reduction in the apnea-hypopnea index, the percentage of time with oxygen saturation below 90%, snoring frequency, and the duration of the most prolonged apnea event. The lowest oxygen saturation showed a notable increase, and both sleep apnea quality of life index and Epworth Sleepiness Scale scores improved. Oropharyngeal computed tomography scans revealed that in OSAHS patients cross-sectional areas of the oropharyngeal airway in the soft palate posterior area and retrolingual area decreased during snoring compared to the awake state. Conversely, during mid-frequency anti-snoring device treatment, these areas increased compared to snoring. The mid-frequency anti-snoring device demonstrates the potential to enhance various sleep parameters in patients with moderate OSAHS, thereby improving their quality of life and reducing daytime sleepiness. These therapeutic effects are attributed to the device's ability to ameliorate the narrowing of the oropharynx in OSAHS patients.

Assessment of upper airway changes after interpositional arthroplasty: a cephalometric analysis

This prospective cohort study examined the changes in airway area and soft tissue parameters following interpositional arthroplasty for temporomandibular joint (TMJ) ankylosis. Ten patients with TMJ ankylosis underwent surgery, and preoperative and postoperative skeletal and soft tissue measurements were obtained. A significant rise in soft tissue parameters was observed following surgery, although only minor changes in skeletal parameters were seen. The nasoropharyngeal area, oral area, soft palate area, and tongue area were examined. After the surgery, increases in values were observed in the nasoropharyngeal area (from 3482.4 mm2 to 3618.7 mm2), the oral area (from 2731.8 mm2 to 2840.8 mm2), the soft palate area (from 204.9 mm2 to 217.3 mm2), and the tongue area (from 2577.5 mm2 to 2600.8 mm2). These findings suggest that interpositional arthroplasty can improve airway area and soft tissue dimensions, affecting the stomatognathic system's aesthetic and functional aspects. Further research is needed to validate these results and assess long-term stability.

Extranodal natural killer T cell lymphoma of the oropharyx: case report

BackgroundT cell lymphoma of the upper aerodigestive tract is a rare entity usually presenting as midfacial ulcerative lesion. It is extremely rare to present as non-healing erosive lesion of the oropharynx.Case presentationA 29-year-old female patient presented with odynophagia and trismus for several months. An “inflammatory” oropharyngeal ulcer was diagnosed and she was treated with repeated courses of antibiotics and corticosteroids without response. Recently, she had some blood stained saliva and vomited fresh blood. When seen, she had extensive painful ulcer eroding the right side of the soft palate and right tonsillar area. The ulcer had a whitish floor and ragged border without any tendency to heal. A second biopsy was taken and proved the lesion to be extranodal natural killer T cell lymphoma (ENKTL). The patient was treated with a modified SMILE (steroid, methotrexate, ifosfamide, l-asparaginase, and etoposide) protocol.ConclusionsExtranodal natural killer T cell lymphoma can manifest first in the oropharynx. If left untreated it may lead to deep erosive lesion and major oral bleeding. SMILE chemotherapy protocol was used in our patient with good early response.

Effect of CT localization of upper airway obstruction site after inducing sleep on the value of obstructive sleep apnea hypopnea syndrome and the effect of surgery

Objective:To explore the value of CT location of the upper airway obstruction site after inducing sleep on the condition of obstructive sleep apnea（OSA） and its surgical efficacy. Methods:Forty patients with moderate-to-severe OSA diagnosed by polysomnography, first performed awake CT scan, then, the patient was slowly injected intravenously with dexmedetomidine to induce sleep, when the patient was apnea during sleep, CT scan of the corresponding part of the upper airway was performed. Compare and measure the cross-sectional area of the upper airway stenosis level in the two states, and evaluate the correlation between the cross-sectional area of the stenosis level after induction of sleep and the patient's AHI, blood oxygen saturation<90% of the time（CT90）. According to the change value of the cross-sectional area of each plane, it was divided into 2 groups, 22 cases in first group underwent hypothermia plasma uvulapalatopharyngoplasty, and 18 cases in second group underwent multi-plane combined surgery. After 12 months of follow-up, compare the post-long-term efficacy, changes in cross-sectional area values of various narrow planes before and after surgery, and changes in indicators related to sleep quality between the two groups. Results:Compared with the cross-sectional area of the nasopharyngeal area, posterior soft palate area, the posterior tongue area, and the epiglottis area measured by upper airway CT under awake breathing state, the cross-sectional area of each obstruction plane during sleep state decreased（P<0.01）. The minimum cross-sectional area of the upper airway plane sleep phase was negatively correlated with AHI and CT90, and the posterior soft palate and the posterior lingual base were highly correlated with AHI and CT90.12 months after treatment, the minimum cross-sectional area of each phase of the sleep phase in the experimental group 1 was significantly improved（P<0.01） compared with that before treatment, followed by the posterior tongue area（P<0.05）. There was no statistical difference between the nasopharyngeal area and the epiglottis area. The differences in nasopharyngeal area, posterior soft palate area, posterior tongue area, and epiglottis area in experimental group 2 after treatment were statistically significant（P<0.01 or P<0.05）, compared with that before treatment. The sleep-related indexes ESS, CT90, AHI, and LSaO₂ of the two groups were better than those before treatment after 12 months of treatment（P<0.01）. Comparison of experiment group 1 and 2, the effective rates were 72.72% and 95.23%（χ²=10.62, P<0.01）, the significant efficiency was 58.33% and 80.45%（χ²=8.62, P<0.01）, and the cure rates were 12.37% and 17.48%（x²=7.62, P<0.01）. Conclusion:CT examination of OSA patients after drug-induced sleep is safe and feasible, and it has important value for the accurate location of the upper airway obstruction site. 64-slice spiral CT upper airway scanning under induced sleep has guiding significance for the evaluation of OSA patients' condition and long-term surgical efficacy.

Evaluation of Central Obesity, Increased Body Mass Index, and its Relation to Oropharyngeal Airway Space Using Lateral Cephalogram in Risk Prediction of Obstructive Sleep Apnea.

Introduction:Maxillofacial radiologists play a significant role in detecting airway changes using radiographic tools. Clinical examination parameters and lateral cephalogram parameters play a vital role in diagnosing obstructive sleep apnea (OSA) and dreadful consequences.Aim and Objectives:This study aims to evaluate central obesity, increased body mass index (BMI), and its relation to oropharyngeal airway space using lateral cephalogram in risk prediction of OSA. Objectives are to measure central obesity and BMI.Methodology:BMI is measured using World Health Organization guidelines to measure oropharyngeal airway space and the tongue and soft palate area using lateral cephalogram to predict OSA's risk using Berlin's questionnaire. Age group between 18 and 60 years with 20 individuals in each group will be present in the study.Conclusion:Cephalometric upper airway space and soft-tissue variables in different BMI groups were compared, and it was found that there was a decrease in SPAS, MAS with an increase in BMI, and in patients with BMI <24, there was narrower nasopharynx and oropharynx.

Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment

Sleep apnea is a sleep disorder that occurs when the breathing of a person is interrupted during the sleep. This interruption occurs because of the patient has narrowed airways and the upper airways muscles relax, closes in and blocks the airway. Therefore, any forces or reaction originated by the air flow dynamics over the relaxed upper airways muscles could make to close the upper airways, and consequently the air could not flow into your lungs, provoking sleep apnea. Fully describing the dynamic behavior of the airflow in this area is a severe challenge for the physicians. In this paper we explore the dynamic behavior of airflow in the upper airways of 6 patients suffering obstructive sleep apnea with/without a mandibular advancement device using computational fluid dynamics. The development of flow unsteadiness from a laminar state at entry to the pharynx through to the turbulent character in the soft palate area is resolved using an accurate numerical model. Combining the airflow solution with a geometrical analysis of the upper airways reveals the positive effects of mandibular advance device in the air flow behavior (pressure drop). Improved modeling of airflow and positioning of mandibular advance device could be applied to improve diagnosis and treatment of obstructive sleep apnea.

Reliability of lateral cephalometric radiographs in the assessment of the upper airway in children: A retrospective study.

To test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue. The records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and F-test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined. Measurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar). The measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.

Research on upper airway compliance in OSAHS patients with MSMSMS

Objective To investigate the application of fiberoscope on upper airway compliance in OSAHS patients with MSMSMS. Methods From May 2014 to December 2015, 93 patients with OSAHS in Jinhua Central Hospital were detected by MSMSMS[including 32 mild cases (MI), 31 moderate cases (MO), and 30 severe cases (SE)] underwent electronic nasopharyngeal examination combined with the Muller test.The course of 93 OSAHS patients were recorded, including body mass index (BMI), sleep apnea index (AHI), mean oxygen saturation.The degree of collapse in the patients' soft palate area, tongue, epiglottis after area were calculated by the software.The results were analyzed by SPSS15.0 statistical software. Results The disease courses between the mild group and moderate group [(4.93±2.91)years, (8.91±4.87)years], as well as between the moderate group and severe group[(4.93±2.91)years, (9.27±4.75)years], had statistically significant differences (t=-3.97, P=0.001; t=-4.33, P 0.05). There were statistically significant differences between the mild group and moderate group[(63.84±8.81)% vs.(75.06±5.07)%], the mild group and severe group[(63.84±8.81)% vs.(76.40±7.94)]in the collapse of epiglottic area (t=11.22, P=0.000; t=-12.56, P=0.000). There was no statistically significant difference between the moderate group and severe group in the collapse of epiglottic area(P>0.05). Conclusion Fiberoscope combined with Muller test can respond better upper airway compliance in OSAHS patients with MSMSMS.It is worth to promote in clinic. Key words: Sleep apnea, obstructive; Micro-movement sensitive mattress sleep monitoring system; Electronic nasopharyngeal; Compliance; Muller maneuver

Three-dimensional evaluation of airway volume changes in two expansion activation protocols

The purpose of this study was to evaluate the airway volume changes associated with rapid maxillary expansion (RME) protocols using different activation rates. A sample of forty RME treated cases was classified into two groups according to the rate of RME activation (Group A: 0.8mm per day and Group B: 0.5mm per day). Three-dimensional images were obtained for each case before and three months after expansion. Dolphin imaging software was used to identify landmarks and calculate airway volumes. Intraclass correlation coefficient was used to confirm reliability and Wilcoxon signed rank tests were used for comparison between the initial and final measurements within each group and between groups. Significant increase in the nasal cavity volume for both groups was observed (P<0.0001 and P=0.001 for groups A and B respectively). The increase in nasopharynx volume was significant in the group with a more rapid activation rate (P=0.0006). Significant differences between the two groups in post-treatment changes were detected in the nasal cavity volume (P<0.0001), nasopharynx volume (P=0.0035), and soft palate area (P=0.0081). A more rapid activation rate results in a higher volume increase for the nasal cavity and nasopharynx than a slower activation rate.

Mucoepidermoid Carcinoma: A Chance Finding in Localized Gingival Overgrowth

IntroductionGingival hyperplasia is a frequent feature of gingival diseases. However, due to their varied presentations, diagnosis of these entities becomes challenging for the clinician. Mucoepidermoid carcinomas (MECs) are neoplasms of salivary glands that occur mainly on the hard and soft palate, buccal mucosa, and retromolar area. This malignant tumor less commonly involves the minor salivary glands and very rarely involves gingiva.Case PresentationA 35‐year‐old male patient reported with a soft, painless, localized, and recurrent gingival overgrowth in the region of tooth #15. The tissue was excised and submitted for histopathologic examination. Histopathologic examination established a definitive diagnosis of MEC. Healing after excision was uneventful.ConclusionsThis case report emphasizes the importance of histopathologic examination of even a small lesion. Gingival enlargement could be the primary sign of potentially lethal diseases. Therefore, a correct diagnosis of these enlargements could prove lifesaving and improve the quality of life of the patient.

Upper Airway Morphology and Head Posture in Healthy Men and Women

Objective: The aim of our study was to investigate morphological differences in the upper airway of healthy men and women on lateral cephalometric radiographs. Material-Method: In our study, we evaluated 76 lateral cephalometric radiographs of adult subjects (38 men and 38 women) with class I skeletal pattern taken in natural head posture. In order to determine natural head posture, we used self-balance position, which was transferred to the cephalostat by means of a fluid level device. All lateral cephalograms were traced manually. The effect of gender on upper airway morphology and natural head posture was evaluated using Student’s t-test. Results: We found that measurements used in the determination of natural head posture were similar for men and women. Linear measurements regarding the position of bony structures (MP-AH, AH-AH1, C3ia-AH, and Ba-C3ia), soft tissue (PNS-P, MPT, PNS-Et, TGL, and TGH), tongue area, soft palate area, and oropharynx area were statistically significant, with respect to gender. Conclusions: The hyocervical relation is affected by gender differences whereas hyomandibular relation is well balanced in subjects with normal occlusion and class I skeletal pattern and was not affected by gender. Natural head posture was not affected by gender differences. Tongue area, soft palate area, and oropharyx area are larger in men. However, no statistically significant differences were observed between genders for nasopharynx and hypopharyx areas.

Lateral teleradiography of the head as a diagnostic tool used to predict obstructive sleep apnea.

To (1) assess the relationship between obstructive sleep apnea (OSA) and craniofacial, pharyngeal anatomy and (2) to submit the recommendations for clinicians for increasing the sensitivity in the diagnostics of OSA. A review of the relevant literature linking OSA in adults with cephalometric analysis was performed. In total, 11 articles with similar procedural criteria were selected. The data were analysed using the Comprehensive Meta-Analysis Software (Biostat Inc., Englewood, NJ) and Statistica 12.0 (StatSoft Inc., Dell Software, Tulsa, OK). Adults with OSA did not show statistically significant differences in the sagittal and vertical skeletal planes in comparison with the controls (p > 0.05). The patients with OSA had soft palate length, width and area increased accordingly by 4.21, 1.99 mm and 0.86 cm(2), tongue area increased by 2.02 cm(2), the upper posterior pharyngeal space (SPAS) and lower posterior pharyngeal space reduced accordingly by 4.53 and 1.32 mm, mandibular plane to the hyoid bone (MP-H) distance increased by 4.14 mm compared with the controls (p < 0.05). The SPAS parameter of the patients with OSA did not show statistically significant differences between the studies, with the mean value being 5.69 mm. Analysed cephalometric data totally supported the concept of soft-tissue abnormalities in subjects with OSA, skeletal-only halfway; MP-H and SPAS being the most reliable parameters. Increased MP-H may serve as a predictor when differentiating normal subjects and patients with OSA. Reduced SPAS width could be a prognostic parameter for suspecting OSA. These two values should be kept in mind by dentists and can also be used as a simple auxiliary method by physicians; nevertheless, it is still underestimated and more studies are needed.

Three-dimensional computed tomography analysis of airway volume changes between open and closed jaw positions

Airway dimensions are closely linked to the bone and soft-tissue craniofacial anatomy. Reduction of the airway is seen with airway disorders and can impair function. The purpose of this retrospective study was to determine whether changing from open to closed jaw position affects the volume of the nasal cavity, nasopharynx, and oropharynx; the soft palate; the soft-tissue thickness of the airway; and the most constricted area of the airway. Following reliability studies, in this retrospective study, we analyzed cone-beam computed tomography scans taken in both closed and open jaw positions of 60 subjects who were undergoing diagnosis and treatment of temporomandibular disorders. On each scan, condyle-fossa measurements, volumes of airway segments (nasal cavity, nasopharynx, oropharynx), soft palate areas, soft tissue thicknesses of the airway, and the most constricted area of the airway and its location were measured using Dolphin imaging software (version 11.5; Patterson Dental Supply, Chatsworth, Calif). Differences between the 2 jaw positions were analyzed with paired t tests, accepting P≤0.05 as significant. Significant changes in airway dimensions were found between the closed and open jaw positions. With jaw opening, the nasopharynx volume increased, whereas the oropharynx volume decreased. Significant decreases were also found for measurements of basion to posterior airway wall, cervical vertebrae to posterior airway wall, most constricted area, nasal cavity volume, and soft palate area when the jaw was open. Changing jaw position significantly affects airway dimensions.

Effect of mandibular advancement splint treatment on tongue shape in obstructive sleep apnea.

Mandibular advancement splints (MAS) can effectively treat obstructive sleep apnea (OSA); however, treatment response is variable, and the mechanisms behind differences in treatment outcomes are still not well understood. The aims of this study were (1) to assess the effects of MAS on tongue shape and (2) to compare tongue shape changes with MAS between treatment responders and nonresponders. Sixty-eight adults with symptomatic mild to severe OSA were included. A custom-made MAS was provided to patients, and treatment outcome was determined by polysomnography. Two-dimensional tongue measurements were evaluated using sagittal and axial MRI image slices without and with MAS in situ. Tongue measurements of height, length, width, area, and shape (height/length) were collected. Additional measurements of surrounding upper airway structures, soft palate length width and area and upper airway area, length and minimum width were measured on sagittal image slices. Based on polysomnography with MAS in situ, 47 patients were classified as responders (≥50% reduction in apnea-hypopnea index [AHI] from baseline), and 21 were nonresponders (<50% AHI reduction). There was no change in sagittal tongue area with insertion of MAS, although there was a change in most of parameters of tongue shape. Responders showed a greater decrease in tongue length with MAS in situ compared to nonresponders (-0.64 ± 0.46 vs -0.32 ± 0.51 cm, p = 0.016). This study reports a detailed two-dimensional analysis of tongue dimensions as well as assessment of adjacentsoft palate shape and upper airway structures without and with MAS treatment for OSA. Our finding suggests that MAS does induce changes in tongue shape. MAS treatment responders showed a greater decrease in tongue length (between the tongue tip and hyoid bone) with MAS in situ; whether differences in alteration of tongue position with MAS explain differences in treatment response requires further investigation.

During development intense Sox2 expression marks not only Prox1-expressing taste bud cell but also perigemmal cell lineages.

Sox2 is proposed to regulate the differentiation of bipotential progenitor cells into taste bud cells. However, detailed expression of Sox2 remains unclear. In this report, Sox2 expression during taste bud development in the fungiform (FF), circumvallate (CV) and soft palate (SP) areas is examined together with Prox1. First, we immunohistochemically checked Prox1 expression in adults and found that almost all taste bud cells are Prox1-positive. During FF development, intense Sox2 expression was restricted to taste bud primordia expressing Prox1 at E12.5. However, at E14.5, Sox2 was intensely expressed outside the developing taste buds resolving to perigemmal Sox2 expression in adults. In the SP, at E14.5, taste bud primordia emerged as Prox1-expressing cell clusters. However, intense Sox2 expression was not restricted to taste bud primordia but was detected widely in the epithelium. During development, Sox2 expression outside developing taste buds was generally down-regulated but was retained in the perigemmal region similarly to that in the FF. In the CV, the initial stage of taste bud development remained unclear because of the lack of taste bud primordia comparable to that in the FF and SP. Here, we show that Prox1-expressing cells appear in the apical epithelium at E12.5, in the inner trench wall at E17.5 and in the outer trench wall at E18.5. Sox2 was again not restricted to developing taste bud cells expressing Prox1 during CV development. The expression patterns support that Sox2 does not serve as a cell fate selector between taste bud cells and surrounding keratinocytes but rather may contribute to them both.

Changes in electrogustometry thresholds, tongue tip vascularization, density and form of the fungiform papillae in smokers

The objective of this study was to evaluate differences in gustatory function in smokers of both sexes and identify any differences in the shape, density and vascularisation of the fungiform papillae (fPap) of smokers' tongue. Additional aim was to investigate any relation between the age, pack years and differences in shape, density, vascularization of fPap and sex. In 166 smokers (81 males, 85 females, age range 20-80 years), divided in age groups, electrogustometry (EGM) thresholds at the chorda tympani area, at the soft palate area and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fPap and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). EGM thresholds of all smoking subjects tended to increase compared to the non-smoking participants. Morphology, vascularization and density of fPap were found to be worse in smokers than in non-smokers. Interestingly, some participants, despite having increased number of pack years, tended to have almost similar EGM thresholds with non-smoking subjects of the same age group. Smoking tends to affect density, morphology and vascularization of the fPap. There is a correlation between the duration of smoking (pack years) and the afore-mentioned parameters. The use of τ-Kendall criterion provided useful information about the different correlation between the EGM thresholds and vascularization, the EGM thresholds and morphology of fPap and EGM thresholds and density of fPap. The majority of smokers had elevated EGM thresholds compared to non-smokers. Smoking is an important factor which can lead to decreased taste acuity. The combination of methods, such as EGM and CE, can provide useful information about the morphology and function of taste buds. Of interest, women are less affected than men, irrespective of the age group.

Modified Folding Radial Forearm Flap in Soft Palate and Tonsillar Fossa Reconstruction

Wide excision of cancer arising from the tonsillar fossa and soft palate has several functional sequelae (e.g., speech, swallowing, chewing, and breathing) that require surgical restoration of the pharyngeo-palatal structure and optimal velopharyngeal function. For this purpose, several kinds of surgical procedures have been introduced. Our method to reconstruct the tonsillar fossa and soft palate entails folding the flaps and reconstructions at the same time as the oral and nasal planes, with some modifications.Patient 1 was a 64-year-old man with left soft palate cancer. After wide excision of the tumor, the defect size of the nasal floor was 3 × 3 cm, and that of soft palate and tonsillar fossa was 8 × 5 cm. Patient 2 was a 49-year-old man with left tonsil cancer. The defect size of the nasal floor was 3 × 3 cm, and that of left lateral wall of the tonsillar fossa was 8 × 3 cm. For reconstruction of oral, nasal, and tonsillar plane, we designed the flap fit to the defect site, especially cutting of the edge of the square plane of the flap to a round shape.Both patients achieved good functional recovery without surgical complications. The average speech intelligibility score in the 2 patients was 10. Swallowing functional score was 4 in both patients. Creative reconstruction with modified radial forearm free flap for tonsillar and soft palate area makes it possible to restore velopharyngeal function to levels close to the preoperative condition.

Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome With Combined Uvulopalatopharyngoplasty and Midline Glossectomy: Outcomes From a 5-Year Study

The aim of this retrospective long-term follow-up study was to assess 5-year outcomes after combined uvulopalatopharyngoplasty (UPPP) and midline glossectomy surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). A total of 34 subjects with OSAHS with combinatory obstructions of posterior soft palate and posterior tongue area who underwent combined midline glossectomy and UPPP were successfully followed for 5 years to examine the therapeutic effect of treatment. All subjects were of Friedman stage II or III and had major stenoses at the base of the tongue. The apnea-hypopnea index (AHI), and mean lowest S(pO(2)) were measured preoperatively and postoperatively to assess therapeutic efficacy. The mean preoperative AHI was 56.0 ± 8.4 episodes/h, while the mean lowest S(pO(2)) was 62.1 ± 10.6%. AHI and mean lowest S(pO(2)) were significantly increased and decreased, respectively, from preoperative levels at each follow-up point after surgery, up to 5 years (P < .05). The average widened pharyngeal space after surgery was 42 mm(2). At 6 months, surgery was classified as being curative in 27/34 (79.41%) of subjects, and markedly effective or effective in the remaining subjects. At 5 years, surgery was classified as being curative in 7/34 (20.59%) subjects, markedly effective or effective in 25/34 (73.53%) subjects, and not effective in 2/34 (5.88%) subjects. Five years after surgery the average body mass index for the subjects who were not cured was slightly higher than those who were cured, but the difference was not statistically significant (31.3 ± 3.7 kg/m(2) vs 29.7 ± 3.6 kg/m(2), P = .29). Subjects who were cured had lower supine AHI values than those who were not cured (2-year postoperative AHI 36.8 ± 9.2 episodes/h vs 43.8 ± 6.9 episodes/h, P = .03, 5-year post-operation AHI 32.1 ± 7.6 episodes/h vs 41.7 ± 8.2 episodes/h, P = .006). These findings suggest that combined midline glossectomy and UPPP can be an effective treatment for subjects with Friedman stage II or III OSAHS and substantial stenosis around the base of the tongue.

Age-related Changes in Electrogustometry Thresholds, Tongue Tip Vascularization, Density, and Form of the Fungiform Papillae in Humans

The aim of the study was to investigate age-related changes in electrogustometry (EGM) thresholds, in morphology and density of the fungiform papillae (fPap) and in vessels' shape and density at the tip of the human tongue.In 156 nonsmokers (74 males, 82 females; age range: 10-80 years), divided in age groups, EGM thresholds at the chorda tympani area, at the soft palate area, and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fPap and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). EGM thresholds at the chorda tympani area were significantly higher in both men and women ←60 years of age than in younger individuals. At the soft-palatine area, EGM thresholds were significantly higher in men aged 20-29 years and ←60 years compared with men of other age groups. In women older than 50 years, thresholds at all 3 areas were significantly higher than in the younger age groups. No significant differences in EGM thresholds between the two sexes at all locations tested were detected. The density of fPap decreased significantly in men aged >50 years and in women aged >60 years compared with younger individuals. Vascular density decreased significantly and vascular morphology worsened at the tip of the tongue in subjects older than 60 years of age compared with younger subjects. The study showed statistically significant differences in EGM thresholds between the right and the left side of the tongue and between the two sexes. Aging is associated with a progressive increase in EGM thresholds. Density of fPap plays an important role for taste acuity in females aged >60 years and males aged ←50 years. Morphology of fPap and vessels' density and morphology at the tip of the tongue, as tested by CE, emerge as factors influencing taste function in subjects of both sexes aged >60 years.

Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion

In this retrospective study with 3-dimensional computed tomography, we evaluated airway volume, soft-palate area, and soft-tissue thickness changes before and after rapid maxillary expansion in adolescents. Another purpose was to determine whether rapid maxillary expansion caused changes in the palatal and mandibular planes and facial height. The sample comprised 20 patients who were treated with rapid maxillary expansion. Spiral tomographs were taken before and 3 months after treatment. Reliability studies were performed, and then volumetric, soft-palate area, soft-tissue thickness, and cephalometric parameters were compared on the tomographs. Intraclass correlations were performed on the reliability measurements. Before and after rapid maxillary expansion measurements were compared by using Wilcoxon signed rank tests. Spearman correlation coefficients were used to evaluate the associations among the airway volume, soft-palate area, soft-tissue thickness, and cephalometric measurements. Significance was accepted at P ≤0.05 for all tests. Intraclass correlation coefficients were ≥0.90 for all reliability measures. Significant increases from before to after rapid maxillary expansion were found in nasal cavity and nasopharynx volumes, and for the measurements of MP-SN, S-PNS, N-ANS, ANS-Me, and N-Me. Significant positive correlations existed between changes in PP-SN and N-ANS, and ANS-Me and N-Me. Rapid maxillary expansion causes significant increases in nasal cavity volume, nasopharynx volume, anterior and posterior facial heights, and palatal and mandibular planes.