Speech assessment following microsurgical soft palate repair.

The aim of this study was to analyze speech intelligibility of children, who had undergone microsurgical soft palate repair according to Sommerlad. Cleft palate patients were treated by closure of the soft palate according to Sommerlad at about 6 months of age. At the age of 11, their speech was evaluated through automatic speech recognition. Word recognition rate (WR) was used as the outcome parameter of automatic speech recognition. To validate automatic speech results, an institute for speech therapy evaluated the speech samples for perceptual intelligibility. The results of this study group were compared to an age-matched control group. A total of 61 children were evaluated in this study, 29 in the study group and 32 in the control group. Study group patients had a lower word recognition rate (mean 43.03, SD 12.31) compared to the control group (mean 49.98, SD 12.54, p = 0.033). The magnitude of the difference was considered small (95% CI of the difference 0.6-13.3). The study group patients received significantly lower scores in the perceptual evaluation (mean 1.82, SD 0.58) compared to the control group mean (mean 1.51, SD 0.48, p = 0.028). Again, the magnitude of the difference was small (95% CI of the difference 0.03-0.57). Within the limitations of the study it seems that microsurgical soft palate repair according to Sommerlad at the age of 6 months might be a relevant alternative to other well established surgical techniques.

Assessment of the number of mast cells in the soft palate of dogs affected by brachycephalic obstructive airway syndrome.

BACKGROUND: Oedema is described in the soft palate of dogs affected by brachycephalic obstructive airway syndrome (BOAS). Activated mast cells (MCs) release vasoactive mediators that temporarily increase vascular permeability. METHODS: Data and caudal soft palate tissue were prospectively collected from a population of dogs undergoing surgical management of BOAS and a control group of greyhound cadavers with no previous history of respiratory signs. Histological assessment was performed to quantify the number of MCs within the lamina propria of each group. RESULTS: The mean number of MCs in the BOAS group (53 MCs/10 400× high-power fields [HPF]; standard deviation [SD] = 23) was significantly greater than that in the greyhound group (24 MCs/10 400×HPF; SD = 10). LIMITATIONS: The small size of the control group and the heterogeneous nature of the dogs in the BOAS group limit the generalisability of the findings. The use of different surgical techniques in the BOAS group may have also affected the degree of inflammation present within the samples. The cohort was not screened for concurrent disease processes that could potentially increase the number of circulating MCs. CONCLUSION: This study demonstrated a statistically significant difference between the numbers of MCs in the soft palate of brachycephalic dogs with clinically significant BOAS and the greyhound control group.

Videofluoroscopy Versus Nasopharyngoscopy of Lateral Pharyngeal Wall Movement for Assessment of Velopharyngeal Insufficiency.

BACKGROUND: Competent speech requires closure of the velopharyngeal sphincter by dynamic apposition of the velum and posterior and lateral pharyngeal walls. An accurate estimation of lateral pharyngeal wall motion is an important determinant in the planning and the outcome of any operation to correct velopharyngeal insufficiency (VPI). The purpose was to compare the assessment of lateral pharyngeal wall movement by videofluoroscopy (VP) versus nasopharyngoscopy (NP). METHODS: The authors retrospectively reviewed the charts of 269 consecutive patients in our cleft lip/palate clinic from 1982 to 2008 and culled those treated with a pharyngeal flap for VPI. The authors included patients who were evaluated preoperatively by both VP and NP, and had studies of suitable quality. Percentage of lateral pharyngeal wall motion was estimated with each technique and compared for each patient. RESULTS: The authors identified 25 patients who underwent both VP and NP at the same median age (4.7 years). The estimated percentage of lateral pharyngeal wall motion between the 2 techniques was significantly different ( P <0.001). Average lateral pharyngeal wall motion was estimated to be 59±25% (range: 5%-90%) by VP and only 40%±25% (range: 0%-95%) during NP. CONCLUSIONS: VP and NP are complementary, but assessment of lateral pharyngeal wall motion can vary between the 2 methods. The surgeon should be aware of the difference in estimated lateral pharyngeal wall movement when planning a procedure to correct VPI.

Assessment of Fat Fractions in the Tongue, Soft Palate, Pharyngeal Wall, and Parapharyngeal Fat Pad by the GOOSE and DIXON Methods.

OBJECTIVE: The 2-point DIXON method is widely used to assess fat fractions (FFs) in magnetic resonance images (MRIs) of the tongue, pharyngeal wall, and surrounding tissues in patients with obstructive sleep apnea (OSA). However, the method is semiquantitative and is susceptible to B0 field inhomogeneities and R2* confounding factors. Using the method, although several studies have shown that patients with OSA have increased fat deposition around the pharyngeal cavity, conflicting findings was also reported in 1 study. This discrepancy necessitates that we examine the FF estimation method used in the earlier studies and seek a more accurate method to measure FFs. MATERIALS AND METHODS: We examined the advantages of using the GOOSE (globally optimal surface estimation) method to replace the 2-point DIXON method for quantifying fat in the tongue and surrounding tissues on MRIs. We first used phantoms with known FFs (true FFs) to validate the GOOSE method and examine the errors in the DIXON method. Then, we compared the 2 methods in the tongue, soft palate, pharyngeal wall, and parapharyngeal fat pad of 63 healthy participants to further assess the errors caused by the DIXON method. Six participants were excluded from the comparison of the tongue FFs because of technical failures. Paired Student t tests were performed on FFs to detect significant differences between the 2 methods. All measures were obtained using 3 T Siemens MRI scanners. RESULTS: In the phantoms, the FFs measured by GOOSE agreed with the true FF, with only a 1.2% mean absolute error. However, the same measure by DIXON had a 10.5% mean absolute error. The FFs obtained by DIXON were significantly lower than those obtained by GOOSE (P < 0.0001) in the human participants. We found strong correlations between GOOSE and DIXON in the tongue (R2 = 0.90), soft palate (R2 = 0.66), and parapharyngeal fat pad (R2 = 0.88), but the correlation was weaker in the posterior pharyngeal walls (R2 = 0.32) in participants. CONCLUSIONS: The widely used 2-point DIXON underestimated FFs, relative to GOOSE, in phantom measurements and tissues studied in vivo. Thus, an advanced method, such as GOOSE, that uses multiecho complex data is preferred for estimating FF.

Fully automated identification of cephalometric landmarks for upper airway assessment using cascaded convolutional neural networks.

OBJECTIVES: The aim of the study was to evaluate the accuracy of a cascaded two-stage convolutional neural network (CNN) model in detecting upper airway (UA) soft tissue landmarks in comparison with the skeletal landmarks on the lateral cephalometric images. MATERIALS AND METHODS: The dataset contained 600 lateral cephalograms of adult orthodontic patients, and the ground-truth positions of 16 landmarks (7 skeletal and 9 UA landmarks) were obtained from 500 learning dataset. We trained a UNet with EfficientNetB0 model through the region of interest-centred circular segmentation labelling process. Mean distance errors (MDEs, mm) of the CNN algorithm was compared with those from human examiners. Successful detection rates (SDRs, per cent) assessed within 1-4 mm precision ranges were compared between skeletal and UA landmarks. RESULTS: The proposed model achieved MDEs of 0.80 ± 0.55 mm for skeletal landmarks and 1.78 ± 1.21 mm for UA landmarks. The mean SDRs for UA landmarks were 72.22 per cent for 2 mm range, and 92.78 per cent for 4 mm range, contrasted with those for skeletal landmarks amounting to 93.43 and 98.71 per cent, respectively. As compared with mean interexaminer difference, however, this model showed higher detection accuracies for geometrically constructed UA landmarks on the nasopharynx (AD2 and Ss), while lower accuracies for anatomically located UA landmarks on the tongue (Td) and soft palate (Sb and St). CONCLUSION: The proposed CNN model suggests the availability of an automated cephalometric UA assessment to be integrated with dentoskeletal and facial analysis.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency.

OBJECTIVE: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). METHODS: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. RESULTS: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. CONCLUSION: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

A new two-dimensional sonographic approach to the assessment of the fetal hard and soft palates.

Facial clefts are among the most common congenital defects. Ultrasound (US) imaging of secondary fetal palate, especially the detection of isolated defects, remains challenging. Currently described two-dimensional (2D) and three-dimensional methods are technically demanding and impractical for application during routine fetal anatomy evaluation. As an adjunct method, magnetic resonance imaging can provide additional information but has its limitations. We present a novel 2D US approach using axial and sagittal planes to evaluate the fetal palate and demonstrate the main differences between an intact palate, isolated cleft palate, and a cleft lip with cleft palate.

The endoscopic endonasal eustachian tube anterolateral mobilization strategy: minimizing the cost of the extreme-medial approach.

OBJECTIVE: The ventral jugular foramen and the infrapetrous region are difficult to access through conventional lateral and posterolateral approaches. Endoscopic endonasal approaches to this region are obstructed by the eustachian tube (ET). This study presents a novel strategy for mobilizing the ET while preserving its integrity. Qualitative and quantitative comparisons with previous ET management paradigms are also presented. METHODS: Ten dry skulls were analyzed. Four ET management strategies were sequentially performed on a total of 6 sides of cadaveric head specimens. Four measurement groups were generated: in group A, the ET was intact and not mobilized; in group B, the ET was mobilized inferolaterally; in group C, the ET underwent anterolateral mobilization; and in group D, the ET was resected. ET range of mobilization, surgical exposure area, and surgical freedom were measured and compared among the groups. RESULTS: Wide exposure of the infrapetrous region and jugular foramen was achieved by removing the pterygoid process, unroofing the cartilaginous ET up to the level of the posterior aspect of the foramen ovale, and detaching the ET from the skull base and soft palate. Anterolateral mobilization of the ET facilitated significantly more retraction (a 126% increase) of the ET than inferolateral mobilization (mean ± SD: 20.8 ± 11.2 mm vs 9.2 ± 3.6 mm [p = 0.02]). Compared with group A, groups C and D had enhanced surgical exposure (142.5% [1176.9 ± 935.7 mm2] and 155.9% [1242.0 ± 1096.2 mm2], respectively, vs 485.4 ± 377.6 mm2 for group A [both p = 0.02]). Furthermore, group C had a significantly larger surgical exposure area than group B (p = 0.02). No statistically significant difference was found between the area of exposure obtained by ET removal and anterolateral mobilization. Anterolateral mobilization of the ET resulted in a 39.5% increase in surgical freedom toward the exocranial jugular foramen compared with that obtained through inferolateral mobilization of the ET (67.2° ± 20.5° vs 48.1° ± 6.7° [p = 0.047]) and a 65.4% increase compared with that afforded by an intact ET position (67.2° ± 20.5° vs 40.6° ± 14.3° [p = 0.03]). CONCLUSIONS: Anterolateral mobilization of the ET provides excellent access to the ventral jugular foramen and infrapetrous region. The surgical exposure obtained is superior to that achieved with other ET management strategies and is comparable to that obtained by ET resection.

Role of ultrasonography in assessment of anatomic upper airway changes in patients with obstructive sleep apnea.

Instroduction: Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation. Ultrasound imaging of the airways has advantages of being safe, quick, repeatable, portable and widely available. Airway ultrasound can visualize and assess the mouth and tongue, oropharynx, hypopharynx, epiglottis, larynx, vocal cords, cricothyroid membrane, cricoid cartilage, trachea, and cervical esophagus. MATERIAL AND METHODS: This study assessed the role of ultrasonography in detecting the level and degree of obstruction of airway passages in patients with obstructive sleep apnea (OSA) and its relation to OSA severity. It included thirty-three patients diagnosed as OSA, and ten healthy subjects as a control group. All participants were ≥ 18 years and were subjected to full medical history, Epworth sleepiness score (ESS), thorough clinical examination, complete overnight polysomnography and neck ultrasonography. RESULTS: Ultrasonography findings showed a statistically significant increase in lateral parapharyngeal wall thickness (LPWT) (P < 0.001) and a significant increase in distance between lingual arteries (DLA) (P < 0.01) among OSA patients. Moreover, there was a significant statistical decrease in the retropalatal pharynx transverse diameter (RPD) (P < 0.05) in the OSA group compared to those without OSA. LPWT and DLA are parameters that can be used to predict the severity of OSA. Combination of LPWT and RPD can achieve a 100% sensitivity and specificity. CONCLUSIONS: Ultrasound is more objective and convenient than the questionnaire because it doesn't require overnight time consumption. It is also more relevant than pulse oximetry for examining pharyngeal airspace. Also, this study demonstrated that submental ultrasonography is sufficiently sensitive for differentiating OSA severity.

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

OBJECTIVES: To test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Assessment of velopharyngeal function with dual-planar high-resolution real-time spiral dynamic MRI.

PURPOSE: To develop a real-time dynamic MRI method for comprehensive evaluation of velum movement during speech. METHODS: Dynamic MRI has been used to study velopharyngeal insufficiency (VPI) by imaging the movement of the velum during speech, because it can provide good anatomic details with no exposed radiation. To be able to comprehensively evaluate dynamic velum movement, a real-time spiral non-balanced SSFP sequence was developed with simultaneous dual-planar coverage and improved spatial and temporal resolution using a combination of parallel imaging and spatial and temporal compressed sensing to achieve 6 × acceleration. New off-resonance correction and post-processing methods were also developed to reduce blurring and slice crosstalk. RESULTS: The method demonstrated good image quality for visualizing dynamic velum movement with reduced blurring and improved image homogeneity. Spatial resolution of 1.2*1.2 mm2 with 150 mm FOV and temporal resolution of 20 frames-per-second with simultaneous dual-planar coverage was achieved. CONCLUSIONS: This work describes a new technique for studying speech disorders using dual-planar accelerated spiral dynamic MRI.

Qualitative assessment of awake nasopharyngoscopy for prediction of oral appliance treatment response in obstructive sleep apnoea.

PURPOSE: Clinical methods to identify responders to oral appliance (OA) therapy for obstructive sleep apnoea (OSA) are needed. Awake nasopharyngoscopy during mandibular advancement, with image capture and subsequent processing and analysis, may predict treatment response. A qualitative assessment of awake nasopharyngoscopy would be simpler for clinical practice. We aimed to determine if a qualitative classification system of nasopharyngoscopic observations reflects treatment response. METHODS: OSA patients were recruited for treatment with a customised two-piece OA. A custom scoring sheet was used to record observations of the pharyngeal airway (velopharynx, oropharynx, hypopharynx) during supine nasopharyngoscopy in response to mandibular advancement and performance of the Müller manoeuvre. Qualitative scores for degree (< 25%, 25-50%, 50-75%, > 75%), collapse pattern (concentric, anteroposterior, lateral) and diameter change (uniform, anteroposterior, lateral) were recorded. Treatment outcome was confirmed by polysomnography after a titration period of 14.6 ± 9.8 weeks. Treatment response was defined as (1) Treatment AHI < 5, (2) Treatment AHI < 10 plus > 50% AHI reduction and (3) > 50% AHI reduction. RESULTS: Eighty OSA patients (53.8% male) underwent nasopharyngoscopy. The most common naspharyngoscopic observation with mandibular advancement was a small (< 50%) increase in velopharyngeal lateral diameter (37.5%). The majority of subjects (72.5%) were recorded as having > 75% velopharyngeal collapse on performance of the Müller manoeuvre. Mandibular advancement reduced the observed level of pharyngeal collapse at all three pharyngeal regions (p < 0.001). None of the nasopharyngoscopic qualitative scores differed between responder and non-responder groups. CONCLUSION: Qualitative assessment of awake nasopharyngoscopy appears useful for assessing the effect of mandibular advancement on upper airway collapsibility. However, it is not sensitive enough to predict oral appliance treatment outcome.

A novel technique for superior-based pharyngeal flaps: 10-year results with formal speech outcomes assessment.

PURPOSE: Describe a novel technique for superior-based pharyngeal flaps allowing restoration of bulk to the soft palate and intraoperative fine-tuning of lateral port size, while avoiding midline palate-splitting. Validated speech assessment tools are employed for quantitative analysis. METHODS: Retrospective review of all patients who underwent superior-based pharyngeal flap in a 10-year period by a single surgeon. Pittsburgh Weighted Values for Speech Symptoms Associated with VPI and the Goldman-Fristoe Test of Articulation were used for formal speech assessment. RESULTS: 78 patients met inclusion criteria with clinical data up to 10years postoperatively. 31 patients had congenital velopharyngeal insufficiency (VPI), and the remainder acquired VPI after cleft palate repair or adenoidectomy. 37 patients had a recognized syndrome. All patients noted subjective improvement in nasality, and evaluation with the validated speech assessment tools demonstrated statistically significant improvement in speech. Only one flap takedown was required in a patient with severe midface hypoplasia who developed sleep apnea several years postoperatively. CONCLUSIONS: This technique is successful in congenital and acquired VPI, and in patients with complex craniofacial syndromes. Customization of lateral ports based on preoperative nasopharyngoscopy, and avoidance of a midline palate splitting incision, make this an attractive option for superior-based flap surgery.

Three-dimensional assessment of anatomical balance and oral appliance treatment outcome in obstructive sleep apnoea.

PURPOSE: Mandibular advancement splints (MAS) are an effective treatment for obstructive sleep apnoea (OSA). However, MAS are not equally efficacious across all patients and the reasons are not well understood. Craniofacial and upper airway structure individually influence MAS response. We aimed to assess anatomical balance, defined as the ratio of upper airway soft tissue (ST) volume to maxillomandibular enclosure volume, between MAS treatment responders and non-responders. METHODS: OSA patients (apnoea-hypopnea index (AHI) >10 h(-1)) were recruited for MAS treatment. Magnetic resonance imaging of the upper airway was performed during wakefulness without and with MAS in situ. Images were processed for volumetric analysis of upper airway soft tissues (tongue, soft palate, paraphayrngeal fat pads and lateral pharyngeal walls) and three-dimensional cephalometry to acquire intra-mandibular space area (IMA) and total maxillomandibular (Mm) volume. Anatomical balance ratios were compared between MAS treatment responders (AHI <10 h(-1) + 50 % reduction) and non-responders. RESULTS: Image analysis was completed in 69 patients (68 % male, age 50.5 ± 10.1 years, BMI 29.6 ± 5.0 kgm(2), AHI 27.0 ± 14.7 h(-1)) including 36 responders. Soft tissue volumes did not differ between MAS responders and non-responders. Non-responders had increased ST/IMA compared to responders (4.9 ± 0.6 vs. 4.6 ± 0.6, p = 0.031). In multivariate logistic regression with AHI and BMI, ST/IMA was the only predictive variable (p = 0.036, ROC AUC 0.7). However, changes in ST/Mm did not directly relate to treatment response. CONCLUSIONS: Anatomical imbalance assessed by intra-mandibular space area was associated with poor MAS treatment response. However, changes in anatomical balance with mandibular advancement did not reflect treatment outcome as static imaging may not adequately capture improvements in upper airway function.

Anthropometric Assessment of Neck Adipose Tissue and Airway Volume Using Multidetector Computed Tomography: An Imaging Approach and Association With Overall Mortality.

Neck adiposity tissue volume (NATV) accumulation is an indicator for metabolic syndrome and cardiovascular disease (CVD). Neck circumference is a poor measure of NATV, and a quantifier for this entity has not yet been established. To evaluate volumetric quantification by multidetector computed tomography (MDCT) as a reproducible anthropometric tool to measure NATV and airway volume (AWV). A total of 519 patients, including a subset of 70 random patients who underwent head and neck CT scanning in our hospital within 1 year (2013), were studied. Included patients were all those undergoing nonenhanced CT (NECT) or CT angiography (CTA). Neck cross-sectional areas (NCSA) were measured at 2 separate levels of the neck, and 3D postprocessing tissue reconstruction was performed, and NATV and AWVs were quantified volumetrically for all patients within the year. The average NCSA at the level of the soft palate and thyroid cartilage was 22,579 and 14,500 mm, respectively. NATV when compared to the upper and lower levels of NCSA showed correlations of 0.64 and 0.79, respectively (P < 0.001). Interobserver analysis showed mean deviations of 0.46% and 0.32% for NATV and AWV, respectively. A strong correlation between NATV and body mass index (BMI) was found (r = 0.658, P < 0.001), and the top quartile of NATV:AWV patients (out of 519 patients) displayed a statistically significant mortality rate during 670 days of follow-up (d = 7.5%, P = 0.032). After adjustment for age and gender, the association between NATV:AWV and mortality was close to significant (P = 0.072). Volumetric quantification of NATV and AWV is a reproducible and prognostic anthropometric tool, as a high NATV:AWV demonstrated a significant risk factor for mortality; future research may further advance our understanding of this phenomenon.

Relationship between clinical and instrumental assessment of the tongue in healthy young adults.

PURPOSE: To verify the association of tongue clinical evaluation aspects with quantitative evaluation of tongue force. METHODS: A cross-sectional study was conducted with 48 healthy adults, 13 men and 35 women (ages 20-44 years; mean - M=24.8 years; standard deviation - SD=5.3 years). By clinical evaluation, the following aspects were checked: tongue force, alternate movements, snap, suction and vibration of the tongue. The evaluator also checked if the floor of the mouth elevated during tasks of tongue elevation and sucking tongue on palate and the occurrence of lingual tremor. Quantitative evaluation was accomplished using the FORLING instrument. It is composed of a piston/cylinder assembly attached to a mouthguard and to a drive shaft. The force applied by the tongue to the drive shaft is hydraulically transmitted to a pressure sensor. Mann-Whitney's test was used to verify whether there were differences in average and maximum forces according to the characteristics assessed. The test was performed at a 5% level of significance. RESULTS: The aspects with the most frequent alteration were sucking tongue on palate and tongue vibration. Tremor had a higher occurrence during tongue movements. Elevation of the floor of the mouth in sucking tongue on palate was the only aspect associated with quantitative evaluation. CONCLUSION: The association between elevation of the floor of the mouth during sucking tongue on palate and quantitative evaluation can provide insight into the higher participation of the suprahyoid muscles in some participants in both tasks.

Dynamic 1.5-T vs 3-T true fast imaging with steady-state precession (trueFISP)-MRI sequences for assessment of velopharyngeal function.

OBJECTIVES: To compare the image quality of MRI scans produced with 1.5- and 3.0-T devices during functional test condition. METHODS: 65 MRI scans obtained with 1.5- (n = 43) or 3.0-T (n = 22) true fast imaging with steady-state precession (trueFISP) sequences from patients with a history of a cleft palate were evaluated. Two experts assessed the MRI scans, independently of each other, and blinded to the MRI technique used. Subjective ratings were entered on a five-point Likert scale. The median planes of three anatomical structures (velum, tongue and pharyngeal wall) were assessed in three functional states (at rest, during phonation of sustained "e" and during articulation of "kkk"). In addition, MRI scans taken during velopharyngeal closure were evaluated. RESULTS: Under blinded conditions, both observers (radiologist and orthodontist) independently rated the quality of 1.5-T scans higher than that of 3.0 T. Statistical analysis of pooled data showed that the differences were highly significant (p < 0.009) in 4 out of 10 test conditions. The greatest differences in favour of 1.5 T were observed for MRI scans of the velum. CONCLUSIONS: 1.5 T used with trueFISP may be preferable over 3.0-T trueFISP for the evaluation of the velopharyngeal structures in the clinical routine.

Relationship between clinical and instrumental assessment of the tongue in healthy young adults / Relação entre as avaliações clínica e instrumental da língua em adultos jovens

PURPOSE: To verify the association of tongue clinical evaluation aspects with quantitative evaluation of tongue force. METHODS: A cross-sectional study was conducted with 48 healthy adults, 13 men and 35 women (ages 20-44 years; mean - M=24.8 years; standard deviation - SD=5.3 years). By clinical evaluation, the following aspects were checked: tongue force, alternate movements, snap, suction and vibration of the tongue. The evaluator also checked if the floor of the mouth elevated during tasks of tongue elevation and sucking tongue on palate and the occurrence of lingual tremor. Quantitative evaluation was accomplished using the FORLING instrument. It is composed of a piston/cylinder assembly attached to a mouthguard and to a drive shaft. The force applied by the tongue to the drive shaft is hydraulically transmitted to a pressure sensor. Mann-Whitney's test was used to verify whether there were differences in average and maximum forces according to the characteristics assessed. The test was performed at a 5% level of significance. RESULTS: The aspects with the most frequent alteration were sucking tongue on palate and tongue vibration. Tremor had a higher occurrence during tongue movements. Elevation of the floor of the mouth in sucking tongue on palate was the only aspect associated with quantitative evaluation. CONCLUSION: The association between elevation of the floor of the mouth during sucking tongue on palate and quantitative evaluation can provide insight into the higher participation of the suprahyoid muscles in some participants in both tasks. .

OBJETIVO: Pesquisar a associação entre os aspectos da avaliação clínica da língua e avaliação quantitativa da força de protrusão da língua. Métodos: Foi realizada uma pesquisa transversal com 48 adultos saudáveis, 13 homens e 35 mulheres (idades entre 20 e 44 anos; média - M=24,8 anos; desvio padrão - DP=5,3 anos). Na avaliação clínica, os seguintes aspectos foram avaliados: força da língua, movimentos alternados, estalo, sucção e vibração da língua. O avaliador também verificou se o assoalho da boca elevava-se durante tarefas de elevação e sucção de língua no palato, bem como a ocorrência de tremor lingual. Para avaliação quantitativa da força da língua, utilizou-se o FORLING, o qual é composto por um conjunto pistão/cilindro acoplado a um bocal e a uma haste de acionamento. A força aplicada pela língua à haste é hidraulicamente transmitida a um sensor de pressão. Utilizou-se o teste de Mann-Whitney para verificar se havia diferenças nas forças médias e máximas, de acordo com as características avaliadas. Adotou-se nível de significância de 5%. RESULTADOS: Os aspectos com maior número de indivíduos alterados foram sucção de língua no palato e vibração de língua. Tremor lingual teve alta ocorrência durante tarefas de mobilidade. Elevação do assoalho da boca durante sucção de língua no palato foi o único aspecto da avaliação clínica associado à avaliação quantitativa de força. CONCLUSÃO: A associação entre elevação do assoalho da boca durante sucção de língua no palato com a avaliação quantitativa de força pode indicar uma maior participação da musculatura supra-hióidea em determinados participantes em ambas as tarefas. .

Clinical assessment and C-reactive protein (CRP), haptoglobin (Hp), and cardiac troponin I (cTnI) values of brachycephalic dogs with upper airway obstruction before and after surgery.

Brachycephalic dogs have unique upper respiratory anatomy with abnormal breathing patterns that are similar to those in humans with obstructive sleep apnea syndrome (OSAS). The objectives of this multicenter prospective study were to assess the effects of surgical correction on clinical signs in dogs with brachycephalic airway obstructive syndrome (BAOS) and to evaluate the levels of several biomarkers [C-reactive protein (CRP); haptoglobin (Hp), and cardiac troponin I (cTnI)] used to determine systemic inflammation and myocardial damage. This study was conducted on 33 dogs with BAOS that were evaluated before and 1 to 2 mo after surgical correction. Palatoplasty was carried out by means of 2 different surgical techniques: carbon dioxide (CO2) laser (n = 12) and electrical scalpel (n = 21). Biomarker levels (CRP, Hp, and cTnI) were determined before and after surgery. There was a significant reduction in respiratory and gastrointestinal signs in dogs with BAOS after surgical treatment (P < 0.001). A greater reduction in respiratory signs (P < 0.002) was obtained using the CO2 laser. No statistical differences were found between CRP and cTnI levels, either before or after surgical correction. Haptoglobin concentration did increase significantly in the postsurgical period (P < 0.008). Surgical treatment in dogs with BAOS reduces clinical signs, regardless of the anatomical components present. Surgical treatment for BAOS is not useful to reduce CRP and Hp levels, probably because BAOS does not induce as obvious an inflammatory process in dogs as in human patients with OSAS. No reduction in cTnI levels was observed 1 mo after surgery in dogs with BAOS, which suggests that some degree of myocardial damage remains.

Les chiens brachycéphales ont anatomie des voies respiratoires supérieures unique avec les modèles de respiration anormale similaires à ceux des humains avec obstructive apnée du sommeil (SAOS). Les objectifs de cette étude prospective multicentrique étaient d'évaluer les effets de la correction chirurgicale sur les signes cliniques et sur les niveaux de biomarqueurs [protéine C-réactive (CRP), haptoglobine (Hp) et la troponine I cardiaque (cTnI)] utilisée pour déterminer l'inflammation systémique et l'infarctus dommage. Cette étude a été menée sur 33 chiens atteints du syndrome d'obstruction des voies respiratoires brachycéphales (BAOS) évaluée avant et 1­2 mois après la correction chirurgicale. Palatoplasty a été réalisée au moyen de deux techniques chirurgicales différentes, le laser du dioxyde de carbone (CO2) (n = 12) et avec an scalpel électric (n = 21). Les niveaux de biomarqueurs (CRP, HP et cTnI) ont été déterminés avant et après la chirurgie. Il y avait une réduction significative des signes respiratoires et gastro-intestinaux chez les chiens atteints BAOS après le traitement chirurgical (P < 0,001). Une plus grande réduction des signes respiratoires (P < 0,002) ont été obtenues en utilisant le laser CO2. Aucune différence statistiquement significative a été observée entre CRP et les niveaux de cTnI, soit avant, soit après correction chirurgicale. La concentration du Hp a augmenté de manière significative dans la période postopératoire (P < 0,008). Le traitement chirurgical chez les chiens atteints BAOS réduit les signes cliniques, quels que soient les éléments anatomiques présents. Le traitement chirurgical du BAOS n'est pas utile pour réduire les niveaux de CRP et Hp, probablement parce que BAOS n'induit pas un évidente processus inflammatoire chez les chiens à différence des patients humains en souffrant du SAOS. Aucune réduction des niveaux cTnI ont été observés un mois après la chirurgie chez les chiens atteints BAOS, ce qui suggère qu'ils maintien d'un certain degré de lésion myocardique.(Traduit par les auteurs).

Clinical effects of the use of a bipolar vessel sealing device for soft palate resection and tonsillectomy in dogs, with histological assessment of resected tonsillar tissue.

OBJECTIVE: To investigate whether soft palate resection and tonsillectomy with a bipolar vessel sealing device (BVSD) improves clinical respiratory score. To document histopathological changes to tonsillar tissue following removal with a BVSD. METHODS & RESULTS: Case series of 22 dogs with clinical signs of upper respiratory obstruction related to brachycephalic airway syndrome. Soft palate and tonsils were removed using a BVSD. Alarplasty and saccullectomy were also performed if indicated. A clinical respiratory score was assigned preoperatively, 24-h postoperatively and 5 weeks postoperatively. Excised tonsillar samples were measured and then assessed histologically for depth of tissue damage deemed to be caused by the device. Depth of tissue damage was compared between two power settings of the device. Soft palate resection and tonsillectomy with a BVSD lead to a significant improvement in respiratory scores following surgery. Depth of tissue damage was significantly less for power setting 1 compared with power setting 2. Using power setting 1, median calculated depth of tonsillar tissue damage was 3.4 mm (range 1.2-8.0). One dog experienced major complications. CONCLUSION: Soft palate resection and tonsillectomy with a BVSD led to significant improvement in clinical respiratory score.