Tensor Veli Palatini Research Articles

Effects of Maxillary Expansion on the Ear - A Review

Rapid maxillary expansion is a commonly used treatment modality for the correction of maxillary transverse deficiency in cleft and non-cleft patients. Additional beneficial effects of rapid maxillry expansion includes improvement in nasal stenosis, abnormal breathing pattern and conductive hearing loss. The improvements in the hearing have been linked to the improved function of the two soft palatal muscles, the tensor veli palatini and the levator veli palatini muscles. This study aims to explore the different studies which have evaluated the effects of rapid maxillary expansion on hearing in cleft and non cleft patients.

Using Geometric Morphometric Analysis of Magnetic Resonance Imaging to Assess the Anatomy of the Eustachian Tube in Children with and without Otitis Media.

Otitis media (OM) is among the most common of childhood illnesses. It has long been hypothesized that children under age two are predisposed to OM due to differences in the anatomy of the Eustachian tube (ET), including the angle of the ET. OM in later childhood is less common but does occur, begging the question, are there shape differences in the ET that persist underlying later occurrences of OM? To answer this question, a novel method, which applied geometric and morphometric shape analysis to landmarks obtained from MRI data, was used. MRI scans were performed on 16 children (5 control, 3 cOME, and 8 rAOM) between 2011 and 2015. Sixteen landmarks representing the shape of the ET, cranial base, and palate were analyzed. The results of a Procrustes ANOVA indicate that the shape of the ET varies significantly (p < 0.01) between the OM and control groups. The shape differences between the OM group and the control are a medial and low attachment site of the tensor veli palatini (TVP) muscle, a posterior and high torus tubarius, and an anteriorly projected palate. These results support previous findings that a relatively horizontal ET is associated with a predisposition for OM. This study used a novel approach to examine anatomical differences in children with and without OM. First, the data set is unique in that it includes MRI scans of children with a confirmed OM diagnosis. Second, the use of MRI scans in craniofacial anatomy OM research is novel and allows for the collection of soft tissue landmarks and the visualization of soft tissue structures. Third, geometric morphometric shape analysis is a statistical method that captures shape differences, offering a more universal picture of nuanced changes within the entire set of landmarks, in contrast to more traditional linear and angular measurements used in prior OM studies examining craniofacial anatomy.

The regulation of expression and splicing of transcription factors are related to the muscle damage caused by radiation in tree shrews

Radiotherapy-induced muscle injury (RIMI) is a major complication of radiotherapy for nasopharyngeal carcinoma. Transcription factor (TF) expression and alternative splicing are crucial events in transcriptional and posttranscriptional regulation, respectively, and are known to be involved in key signaling pathways contributing to a variety of human disorders, including radiation injury. To investigate the TFs and alternative splicing events involved in RIMI, we constructed a tree shrew model as described previously in which the RIMI group received 20 Gy of irradiation on the tensor veli palatini (TVP) muscles. The irradiated muscles were evaluated by RNA sequencing (RNA-seq) 6 months later, and the results compared with those for normal TVP muscles. The alt5p and alt3p events were the two main types of differentially regulated alternative splicing events (RASEs) identified via the Splice sites Usage Variation Analysis (SUVA) software, and these RASEs were highly conserved in RIMI. According to functional enrichment analysis, the differentially RASEs were primarily enriched in pathways related to transcriptional regulation. Furthermore, we identified 16 alternative splicing TFs (ASTFs) in ASTF–differentially expressed gene (DEG) networks based on co-expression analysis, and the regulatory networks were chiefly enriched in pathways linked to cell proliferation and differentiation. This study revealed that RASEs and ASTF–DEG networks may both play important regulatory roles in gene expression network alteration in RIMI. Future studies on the targeting mechanisms and early interventions directed at RASEs and ASTF–DEG networks may aid in the treatment of RIMI.

Impact of a Modified Restoration of Tensor Veli Palatini on Hearing and Middle Ear Function in Cleft Palate Children-a Retrospective Study.

Many children with cleft palate also exhibit hearing loss and middle ear dysfunction, which could last for years. There are still arguments on how to treat this problem. This study aimed to evaluate the impact of a modified restoration of tensor veli palatine (TVP) on hearing and middle ear function in the cleft palate children. This retrospective study was completed using records of the cleft palate children who received surgery in Peking Union Medical College Hospital from May 2013 to December 2020. They were divided into 2 groups: Group 1: children who received cleft palate surgery without specific restoration of TVP; Group 2: children who received palate surgery with a specific TVP restoration technique. Perioperative information was collected. The conductive auditory brainstem response and the 226-Hz tympanometry before and after the cleft surgery were compared intragroup and intergroup. Totally 42 children were included in this study, 21 children in each group. There were no significant differences considering clinical characteristics between the 2 groups. The modified TVP restoration didn't increase operation time or complication compared with no TVP restoration. Statistically, neither the auditory brainstem response air conduction hearing thresholds nor the 226-Hz tympanometry results had significant differences between the 2 groups after the surgery. This modified restoration of TVP was not time-consuming and did not increase complications. The beneficial effect of the modified TVP restoration on the hearing or the middle ear function of cleft palate children was uncertain around 6 months after surgery compared with no restoration.

Otopathy secondary to trigeminal schwannoma in a Quarter Horse

SummaryOtitis media secondary to trigeminal nerve (CN‐V) paralysis is described in dogs and humans but not in horses. An 18‐month‐old Quarter Horse colt was presented with history of mastication difficulties and a nonhealing corneal ulcer. Clinical findings were consistent with paralysis of the right CN‐V. Computed tomography imaging showed otopathy media and a mass at the root of the CN‐V. The colt was euthanised due to poor prognosis. Post‐mortem magnetic resonance imaging showed enlargement of the right CN‐V which was slightly hyperintense on T2W. Histopathology of the mass revealed fusiform tumoural cells, positive on vimentin‐ and S100 immunohistochemistry, consistent with a schwannoma. Otitis media was presumed secondary to CN‐V paralysis and denervation of the right tensor veli palatini muscle involved in opening of the Eustachian tube. This is the first case of trigeminal schwannoma and secondary otopathy media described in a horse, which highlights the importance of imaging in investigating trigeminal nerve paralysis.

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

BackgroundTo summarize the characteristics of local invasion and distribution of metastatic lymph nodes in unilateral nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI) to provide references for the optimization of clinical target volume.MethodsMRI and clinical data of 176 cases of unilateral NPC admitted to the Hunan Cancer Hospital from January 2019 to December 2019 were collected. Unilateral NPC was defined as a lesion confined to the one side of the nasopharynx and had not exceeded the midline as judged by MRI.ResultsIpsilateral levator veli muscle (63.1%, 111/176), tensor veli palatini muscle (55.7%, 98/176), parapharyngeal space (50.0%, 88/176), and prevertebral muscle (43.7%, 77/176) were more likely to be invaded. Contralateral parapharyngeal space and skull base foramina were not invaded. All local invasions presented as continuous invasion from gross lesions and discontinuous invasions were not observed. The overall lymph node metastatic rate was 89.8% (158/176), of which bilateral metastasis accounted for 56.3% (89/158), and ipsilateral metastasis accounted for 88.1% (155/176), which was higher than the contralateral metastatic rate (55.4%, 94/176) (P < 0.001). The most common regions of lymph node metastasis were level IIb (82.4%), VIIa (69.9%), IIa (54.0%), and III (54.0%). Only one patient had skipping lymph node metastasis (0.6%).ConclusionLocal invasion of unilateral NPC was characterized by continuous invasion from proximal to distal sites, and lymph node metastasis occurred from the upper to lower neck. Contralateral parapharyngeal space and skull base foramina had a very low probability of invasion, and routine prophylactic radiation may not be necessary.

Surgical Parapharyngeal Space Tumor Analysis with Case Series Study.

Background The parapharyngeal space is a hypothetical region in the neck that stretches from the base of the skull to the bigger corner of the hyoid bone. The fascia that connects the styloid process to the tensor veli palatini separates the compartment into prestyloid and poststyloid compartments, with the prestyloid compartment being larger. In the general population, tumors of the parapharyngeal area are very uncommon, accounting for less than 1% of all head and neck neoplasms in the population. In this location, CT scanning and magnetic resonance imaging (MRI) exams are complimentary, and both tests should be performed to examine any lesions found. The most critical component of treatment is the total surgical removal of all the cancerous tissue. Identifying and treating primary parapharyngeal space (PPS) tumors are among the most challenging tasks in the treatment of head and neck cancer. They are also among the most aggressive ones. The primary goal of this study is to review our current knowledge at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, which serves as an academic tertiary referral center and a major teaching center. We will focus on clinical findings, tumor structure, tumor histological distribution, and surgical approaches. Materials and Methods The processing starts with two modules. The first module starts with the input images obtained from various patients and collected as a database. The second module starts with the collection of case series of nine patients undergoing excision via multiple different approaches: transoral, transcervical, transparotid, transmandibular, or infratemporal approach. All cases were conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, between 2014 and 2018. All operative interventions were performed by an otolaryngology-head and neck surgeon. Results Our study comprised nine patients, of which two underwent transparotid and seven transcervical and combined transcervical/transparotid approach. Complications faced included a hematoma in one of our cases. Conclusion The transcervical approach appeared to be the superior surgical approach when facing a pleomorphic adenoma within the parapharyngeal space, arising from the deep lobe of the parotid gland or parapharyngeal space-occupying paraganglioma.

The cranial base and related internal anatomical features in Homo neanderthalensis and Homo sapiens.

The cranial anatomy of Homo neanderthalensis and Homo sapiens is well documented in the paleoanthropological and medical literature. However, there are few high-quality visual guides of their comparative morphology. We give here a detailed description of the anatomy of two important fossil specimens, La Chapelle-aux-Saints 1 and abri Pataud 1, based on high-resolution imaging data with each specimen representing the respective morphologies of H. neanderthalensis and H. sapiens. We describe the comparative morphology of external, endocranial, and internal characteristics of the cranium, with a focus on the petrous and tympanic portions of the temporal bone. This descriptive approach shows differences between our specimens, including in positions of cerebral components relative to cranial structures and patterns of dural sinus drainage. Numerous external and internal differences in the shape of the petrous temporal are also described, including its articulation with the tympanic bone and the orientation of the petrotympanic crest. The presence of a large protuberance between the osseous Eustachian tube orifice and carotid foramen in H. neanderthalensis suggests that the levator veli palatini muscle took origin more laterally than the dilator tubae arm of the tensor veli palatini muscle, a feature shared with H. sapiens. The overall pattern that emerges is one in which two species have undergone large-scale evolutionary changes in a functionally critical region. Such differences necessitate high-quality visualization and consideration of both internal and external morphology.

An Investigation of the Mechanisms of Radiation-Induced Muscle Injury in a Tree Shrew (Tupaia belangeri) Model

BackgroundAnimal models suitable for investigating mechanisms behind radiation-induced muscle injury are lacking. We developed a tree shrew model of such injury and investigated pathological changes and mechanisms.MethodsAnimals were divided into control (n = 5), radiation-induced acute injury (n = 5), and radiation-induced chronic injury (n = 5) groups. Tensor veli palatini (TVP) muscles of acute injury and chronic injury groups were dissected under a microscope at 1 and 24 weeks after radiation therapy, respectively. TVP muscles were stained with HE and Masson to visualize pathological changes. ELISA was performed to measure oxidative injury. RT-qPCR and immunohistochemical staining was performed to measure expression levels of miR-206 and histone deacetylase 4 (HDAC4).ResultsCompared to the control group, acute injury group showed a significant decrease in miR-206 expression (.061 ± .38, P < .05) and a significant increase in HDAC4 expression (37.05 ± 20.68, P < .05). Chronic injury group showed a significant decrease in miR-206 expression (.23 ± .19, P < .05) and a significant increase in HDAC4 expression (9.66 ± 6.12, P < .05).DiscussionA tree shrew model of radiation-induced muscle injury was established by exposing TVP muscle region to radiation of 20-Gy. Experimental results indicated that injury caused by radiation persisted despite gradual healing of the TVP muscle and miR-206 regulatory pathway plays a key role in regulating radiation-induced muscle injury.

Traumatic Bull Gore Injuries to Oropharynx- A Case Report

Bull gore injury is not an uncommon injury comprises 2% among the traumatic injuries, especially in the rural area. The damage is predominantly caused by the animal's horn tip. The abdomen and perineum are the most commonly affected organs; additional organs include the lower limb, upper limb, chest, and others. Palatal lacerations are more common in children when they put objects in their mouth or by falling down with the object inside, but oropharyngeal injuries due to bull gore are scarce. Authors hereby reports two cases, in first case, a 3-year-old female child was brought with alleged history of injury to the soft palate by the horn of a cow. The tensor veli palatine muscle tear was repaired, submucosa and mucosal layer was sutured. In second case, a 62-year-old male came with alleged history of trauma, hit by a bull while driving two wheeler following which patient had deep laceration in the submental region, laceration in the floor of mouth and ventral surface of tongue. The mylohyoid muscle injury was identified and repaired. The wound was closed in layers from muscle to skin. Thus, bull gore injuries have a wide range of presentation from minor lacerations to life threatening injuries to oral cavity, neck, chest and abdomen. Timely admission and prompt treatment, repair of lacerations under proper sterile environment is important.

Morphometric and Immunohistochemical Characteristics of the Adult Human Soft Palate Muscles.

The soft palate is the only structure that reversibly separates the respiratory and gastrointestinal systems. Most species can eat and breathe at the same time. Humans cannot do this and malfunction of the soft palate may allow food to enter the lungs and cause fatal aspiration pneumonia. Speech is the most defining characteristic of humans and the soft palate, along with the larynx and tongue, plays the key roles. In addition, palatal muscles are involved in snoring and obstructive sleep apnea. Considering the significance of the soft palate, its function is insufficiently understood. The objectives of this study were to document morphometric and immunohistochemical characteristics of adult human soft palate muscles, including fiber size, the fiber type, and myosin heavy chain (MyHC) composition for better understanding muscle functions. In this study, 15 soft palates were obtained from human autopsies. The palatal muscles were separated, cryosectioned, and stained using histological and immunohistochemical techniques. The results showed that there was a fast type II predominance in the musculus uvulae and palatopharyngeus and a slow type I predominance in the levator veli palatine. Approximately equal proportions of type I and type II fibers existed in both the palatoglossus and tensor veli palatine. Soft palate muscles also contained hybrid fibers and some specialized myofibers expressing slow-tonic and embryonic MyHC isoforms. These findings would help better understand muscle functions.

Cadaveric Study and Micro-Computed Tomography of the Anatomy of Palatine Aponeurosis and its Link to the Soft Palate Muscles and Pharyngeal Muscles.

There have been few studies on the anatomy of palatine aponeurosis (PA). Herein, we elucidated the relationship between the PA and soft palate muscles and pharyngeal muscles. Two cadaveric specimens were dissected to observe the gross anatomy of the PA. Six cadaveric specimens were processed and scanned by micro-computed tomography to determine the elaborate anatomy. Images were exported to Mimics software to reconstruct a three-dimensional model. The PA covered the anterior (32.1%-38.8%) of the soft palate, extending from the tensor veli palatini (TVP) and connecting to 3 muscles: palatopharyngeus (PP), uvula muscle, and superior pharyngeal constrictor (SC). The SC and PP are attached to the PA on the medial side of the pterygoid hamulus. SC muscle fibers were attached to the hamulus, forming a distinct gap between the hamulus. Some muscle fibers of the PP and uvula originated from the PA. The PA extended from the TVP to the midline and the posterior edge of the hard palate. The PA was not uniformly distributed, which was complementary to the attached muscles in thickness. PA, as a flexible fibrous membrane, maintains the shape of the soft palate. It extends from the TVP and covers anteriorly about one-third of the soft palate. The PA provides a platform for the soft palate muscles and pharyngeal muscles, connecting to the PP, uvula muscle, and SC. These muscles are important for palatopharyngeal closure and middle-ear function. It is necessary to minimize the damage to the PA during surgical interventions.

Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers.

Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VParea), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VParea) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VParea, HN, and ModelKataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of ModelKataoka, A 3-P 0, and B F1 for the objective measurement of VPI or HN.

Noggin Overexpression Impairs the Development of Muscles, Tendons, and Aponeurosis in Soft Palates by Disrupting BMP-Smad and Shh-Gli1 Signaling.

The roles of bone morphogenetic protein (BMP) signaling in palatogenesis were well documented in the developing hard palate; however, little is known about how BMP signaling regulates the development of soft palate. In this study, we overexpressed Noggin transgene via Osr2-creKI allele to suppress BMP signaling in the developing soft palate. We found that BMP-Smad signaling was detected in the palatal muscles and surrounding mesenchyme. When BMP-Smad signaling was suppressed by the overexpressed Noggin, the soft palatal shelves were reduced in size with the hypoplastic muscles and the extroversive hypophosphatasia (HPP). The downregulated cell proliferation and survival in the Osr2-creKI;pMes-Noggin soft palates were suggested to result from the repressed Shh transcription and Gli1 activity, implicating that the BMP-Shh-Gli1 network played a similar role in soft palate development as in the hard palate. The downregulated Sox9, Tenascin-C (TnC), and Col1 expression in Osr2-creKI;pMes-Noggin soft palate indicated the impaired differentiation of the aponeurosis and tendons, which was suggested to result in the hypoplasia of palatal muscles. Intriguingly, in the Myf5-creKI;pMes-Noggin and the Myf5-creKI;Rosa26R-DTA soft palates, the hypoplastic or abrogated muscles affected little the fusion of soft palate. Although the Scx, Tnc, and Co1 transcription was significantly repressed in the tenogenic mesenchyme of the Myf5-creKI;pMes-Noggin soft palate, the Sox9 expression, and the Tnc and Col1 transcription in aponeurosis mesenchyme were almost unaffected. It implicated that the fusion of soft palate was controlled by the mesenchymal clues at the tensor veli palatini (TVP) and levator veli palatini (LVP) levels, but by the myogenic components at the palatopharyngeus (PLP) level.

Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus

Palatoplasty would involve the structures around the pterygoid hamulus. However, clinicians hold different opinions on the optimal approach for the muscles and palatine aponeurosis around the pterygoid hamulus. The absence of a consensus regarding this point can be attributed to the lack of investigations on the exact anatomy of this region. Therefore, we used micro-computed tomography to examine the anatomical structure of the region surrounding the pterygoid hamulus. Cadaveric specimens were stained with iodine-potassium iodide and scanned by micro-computed tomography to study the structures of the tissues, particularly the muscle fibers. We imported Digital Imaging and Communications in Medicine images to Mimics to reconstruct a 3-dimensional model and simplified the model. Three muscles were present around the pterygoid hamulus, namely the palatopharyngeus (PP), superior constrictor (SC), and tensor veli palatini (TVP). The hamulus connects these muscles as a key pivot. The TVP extended to the palatine aponeurosis, which bypassed the pterygoid hamulus, and linked the PP and SC. Some muscle fibers of the SC originated from the hamulus, the aponeurosis of which was wrapped around the hamulus. There was a distinct gap between the pterygoid hamulus and the palatine aponeurosis. This formed a pulley-like structure around the pterygoid hamulus. Transection or fracture of the palatine aponeurosis or pterygoid hamulus, respectively, may have detrimental effects on the muscles around the pterygoid hamulus, which play essential roles in the velopharyngeal function and middle ear ventilation. Currently, cleft palate repair has limited treatment options with proven successful outcomes.

An Innovative Palatoplasty for Primary Cleft Palate Repair

Summary: Many surgical techniques have been developed to restore function in patients with cleft palate. Despite the development of many surgical techniques for primary cleft palate repair there is no standard procedure that ensures palatal function as that in normal children. Furlow’s and intravelar veloplasty are the most common methods for velar repair in patients with cleft palate; however, some limitations have been described by different authors. The objective of this study was to present an innovative method for primary cleft palate repair that addresses the shortcomings of conventional methods. Since 2017, 88 consecutive patients with nonsyndromic unilateral cleft palate have undergone primary anatomical repair of palatal deformity using this technique. This method combines nasal mucosa Z plasty and muscular overlapping with the use of one hemiuvula for uvular repair (unilateral uvuloplasty). The nasal mucosa Z plasty produces velar lengthening by transposition of nasal mucosa and myomucosal flaps. The unilateral uvuloplasty reduces anatomically the velopharyngeal gap and increases the velar length, thus reducing velopharyngeal distance. This innovative palatoplasty, achieves proper anatomical and functional reconstruction of the repaired palate. Only four patients (4.54%) developed mild or severe hypernasality and one patient (1.13%) had postoperative palatal fistula in this group of patients. This innovative technique results in low rates of nondesirable outcomes, improving limitations of conventional methods. Reduced oral mucosa incisions, limited velar muscle dissection, and preservation of the tensor veli palatini anatomy are some of the benefits of this technique.

Role of p63 in Craniofacial Muscles Development

Background The transcription factor p63 gene is part of the p53 family of tumor suppressor genes. P63 is involved in many developmental processes including proliferation, apoptosis, differentiation, cell survival and in maintenance and stratification of epithelial tissues throughout the body. P63-/- mice show a characteristic phenotype with craniofacial malformations, absence of limbs, and epithelial defects. Previous studies have not mentioned head muscle abnormalities. However, we found that p63-/- mice have craniofacial muscle defects. Therefore, we aimed to describe the head muscle development in p63-/- mice and develop hypotheses regarding underlying mechanisms leading to the abnormalities. Methods We dissected E16 to P0 WT (wild-type) and p63-/- mice under a stereomicroscope with camera. A literature search was done to learn about processes that influence the muscle development. Results In p63-/- mice, many craniofacial muscles are thinner (e.g., masseter), without or with changes of their attachments (e.g., cleidotrapezius), or absent (e.g., tensor veli palatini). In WT mice, the levator veli palatini originates from the temporal bone (petrous part) and the tympanic tube cartilage and inserts onto the soft palate. In p63-/- mice, this muscle is thinner and at the insertion indistinguishable from the soft palate. The nasolabialis muscle originates in WT mice from the maxilla (frontal process) and inserts onto the mystacial pad (MP) surrounding vibrissae of the nasal region. In p63-/- mice, vibrissae are absent, nasal cartilage development is delayed, and the insertion of nasolabials extends over the dorsum of the nose. Discussion Some changes are best explained by the ‘nearest neighbor’ hypothesis, i.e., muscles develop towards their attachments and if the attachment is not developed then the muscles will attach on whatever is nearby. For example, in p63-/- mice, the nasolabialis that would attach onto the MP attaches to the dorsum of the nose, because the delayed development of the nasal cartilages which are overlying the MP. The compaction and proliferation of the core of branchial arches, comprised of mesodermal and neural crest cells (NCCs), is regulated by signals from epithelia. If defective epithelia are influencing proliferation of core cells, then late developing muscles might not receive enough material to differentiate (e.g., tensor veli palatini) and earlier muscles might be thinner due to less muscle cells (mesoderm-derived) and / or less connective tissue (NCC-derived). Outlook We will dissect younger p63-/- mice and examine gene expression pattern to test our hypothesis regarding compaction and proliferation in the branchial arch cores. This will result in a detailed description of head muscle development in p63-/- mice and a deepened understanding of tissue interaction during development.

Do morphological differences in orientation of the Eustachian tube and dilator tubae muscle distinguish populations with high rates of middle ear disease?

Middle ear disease or otitis media (OM) is among the most common pediatric conditions globally. It is nearly ubiquitous among every human population, usually occurring within the first three postnatal years. The etiology of OM is known to be rooted in the short, horizontal cartilaginous Eustachian tubes (CET) of infants which are mechanically inefficient relative to those of adults. Yet, despite the presence of OM among all human populations, Inuit and Aboriginal Australian communities have been documented as exhibiting some of the highest rates globally. Little information exists on the normal morphology of the bony nasopharyngeal boundaries of these groups. We tested whether they could be distinguished from other human populations in the orientation of the cartilaginous Eustachian tube and dilator tubae (DT) belly of the tensor veli palatini muscle (TVP), the sole dilatory apparatus of the CET. Any morphological feature distinguishing groups with higher rates of OM may impact susceptibility. We reconstructed soft tissue CET and DT morphology from adult dry crania. The sample represented eight populations: Alaska (n=156); Aleutian Islands (n=14); China (n=37); Greenland (n=28); Australia (n=39); Germany (n=22); India (n=15); and West Africa (n=19). Alaskans, Aleuts, Greenlanders, and Australians were considered populations with high rates of OM while the remainder were used as comparator populations with relatively lower documented rates of OM. We assessed morphology from coordinate data collected along the posterior edges of the medial pterygoid plates, the hard palate, the basicranial midline, and the osseous orifice of the Eustachian tube. Angular measures were assessed from the coordinate data and Bonferroni-Dunn-adjusted multiple t-tests were performed. Results showed that the Alaskans exhibited the most horizontal orientation of the DT relative to the axis of its common tendon with the TVP palatal sub-belly (an infant-like trait), being significantly more horizontal (P<0.05) than among all other groups. This trait could impact the function of the CET, especially among infants whose DT orientation would be even more horizontal. The only measure that distinguished Alaskans, Greenlanders, and Australians from all other populations was the sagittal orientation of the CET, an additional trait that may impact DT function. The presence of these morphological features may thus be related to increased rates of OM.

Does Ostmann's fat pad size correlate with development of chronic otitis media in children?

ObjectiveTo compare Ostmann's fat pad (OFP) size between healthy ears and ears with chronic otitis media with cholesteatoma (COMwC) in children, to assess its role in the disease. MethodsMRI scans of 29 children with unilateral COMwC with conductive hearing loss were used to measure OFP, represented by the maximal diameter of the high intensity area medial to the tensor veli palatini muscle (TVP): M1. A reference diameter was defined from the medial border of OFP reaching the medial border of the medial pterygoid muscle: M2.Values of M1, M2 and the ratio of M1:M2 were compared between the healthy and pathological ear in each patient. ResultsNo difference in OFP size was observed between healthy (H) ears (mean M1H:M2H ratio 0.72 ± 2.28) compared to ears with COMwC pathology (P) (mean M1P:M2P ratio .68 ± 1.57; P = .943) in children, suggesting that OFP size abnormalities do not have a role in pediatric COMwC. ConclusionOFP size was not correlated to the development of unilateral COMwC in children.

Grading Soft Tissue Involvement in Nasopharyngeal Carcinoma Using Network and Survival Analyses: A Two-Center Retrospective Study.

Soft tissue involvement (STI) indicates poor prognosis in nasopharyngeal carcinoma (NPC). However, only a few studies have systematically assessed this extension using network analysis. To investigate the prognostic value of STI and to propose an improved STI grading system for NPC therapy. Retrospective study. A total of 1225 consecutive patients with pathologically confirmed NPC treated with intensive-modulated radiotherapy from January 2010 to March 2014 were enrolled from two centers. T1- and T2-weighted imaging and enhanced T1-weighted imaging with fast spin echo sequence at 1.5 or 3.0T. The levator veli palatini and tensor veli palatini involvement were graded "mild," prevertebral muscle involvement, "moderate," medial pterygoid, lateral pterygoid, and the infratemporal fossa involvement, "severe" STI. The above STI sites were evaluated separately by three radiologists using MRI images and graded using network analysis. Overall survival (OS) and progression-free survival (PFS) were assessed. Kaplan-Meier method, Cox's proportional hazards model, and concordance index (C-index) were used. Five-year OS and PFS rates between mild and moderate groups (90.5% vs. 81.7%, P < 0.05 and 82.9% vs. 72.5%, P < 0.05, respectively) and between moderate and severe groups (81.7% vs. 70.4%, P < 0.05 and 72.5% vs. 61.2%, P < 0.05, respectively) revealed significant differences. The C-index of the nomogram with STI grading was higher compared with current T-classification (OS 0.641 vs. 0.604, P < 0.05 and PFS 0.605 vs. 0.581, P < 0.05, respectively). Significant OS differences were observed between patients with severe STI who underwent induction chemotherapy (IC) and those who did not (84.5% vs. 70.7%, P < 0.05). STI grading was an independent prognostic factor for OS and PFS in NPC patients and it may be help to improve the accuracy in predicting survival outcomes. Patients with severe STI might benefit from IC to improve OS. 4 TECHNICAL EFFICACY: Stage 2.