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1.
BMC Biol ; 22(1): 63, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481317

RESUMO

BACKGROUND: Obligate blood-feeding insects obtain the nutrients and water necessary to ensure survival from the vertebrate blood. The internal taste sensilla, situated in the pharynx, evaluate the suitability of the ingested food. Here, through multiple approaches, we characterized the pharyngeal organ (PO) of the hematophagous kissing bug Rhodnius prolixus to determine its role in food assessment. The PO, located antero-dorsally in the pharynx, comprises eight taste sensilla that become bathed with the incoming blood. RESULTS: We showed that these taste sensilla house gustatory receptor neurons projecting their axons through the labral nerves to reach the subesophageal zone in the brain. We found that these neurons are electrically activated by relevant appetitive and aversive gustatory stimuli such as NaCl, ATP, and caffeine. Using RNA-Seq, we examined the expression of sensory-related gene families in the PO. We identified gustatory receptors, ionotropic receptors, transient receptor potential channels, pickpocket channels, opsins, takeouts, neuropeptide precursors, neuropeptide receptors, and biogenic amine receptors. RNA interference assays demonstrated that the salt-related pickpocket channel Rproppk014276 is required during feeding of an appetitive solution of NaCl and ATP. CONCLUSIONS: We provide evidence of the role of the pharyngeal organ in food evaluation. This work shows a comprehensive characterization of a pharyngeal taste organ in a hematophagous insect.


Assuntos
Cloreto de Sódio , Paladar , Animais , Paladar/fisiologia , Cloreto de Sódio/farmacologia , Faringe , Insetos , Trifosfato de Adenosina
2.
Sensors (Basel) ; 24(5)2024 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-38475029

RESUMO

In recent years, there has been a notable rise in the number of patients afflicted with laryngeal diseases, including cancer, trauma, and other ailments leading to voice loss. Currently, the market is witnessing a pressing demand for medical and healthcare products designed to assist individuals with voice defects, prompting the invention of the artificial throat (AT). This user-friendly device eliminates the need for complex procedures like phonation reconstruction surgery. Therefore, in this review, we will initially give a careful introduction to the intelligent AT, which can act not only as a sound sensor but also as a thin-film sound emitter. Then, the sensing principle to detect sound will be discussed carefully, including capacitive, piezoelectric, electromagnetic, and piezoresistive components employed in the realm of sound sensing. Following this, the development of thermoacoustic theory and different materials made of sound emitters will also be analyzed. After that, various algorithms utilized by the intelligent AT for speech pattern recognition will be reviewed, including some classical algorithms and neural network algorithms. Finally, the outlook, challenge, and conclusion of the intelligent AT will be stated. The intelligent AT presents clear advantages for patients with voice impairments, demonstrating significant social values.


Assuntos
Faringe , Voz , Humanos , Som , Algoritmos , Redes Neurais de Computação
3.
Vestn Otorinolaringol ; 89(1): 4-9, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38506018

RESUMO

Paratonsillar abscess (PTA) stands out among all otorhinolaryngological diseases, since it can cause life-threatening complications that develop in the shortest possible time due to the close connection of the cellular spaces of the head, neck and mediastinum. In addition to physical examination, computed tomography and magnetic resonance imaging are routinely used to diagnose PTA, sonography is less often used. With the help of the latter, it is possible to reliably distinguish PTA from both paratonsillitis and a number of other diseases, including an aneurysm of the internal carotid artery, using the Doppler mode. However, there are significant gaps in the ultrasound diagnosis of PTA and paratonsillitis: the use of a percutaneous convex sensor is not described, there is no description of clear anatomical landmarks for reliable and rapid recognition of PTA, and diagnostically complete algorithms for verification and visualization of paratonsillitis and PTA using sonographic examination have not been developed. Our work is aimed at filling these gaps.


Assuntos
Faringe , Tomografia Computadorizada por Raios X , Humanos , Ultrassonografia , Imageamento por Ressonância Magnética
4.
Proc Natl Acad Sci U S A ; 121(11): e2312136121, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38446848

RESUMO

Anxiety is a remarkably common condition among patients with pharyngitis, but the relationship between these disorders has received little research attention, and the underlying neural mechanisms remain unknown. Here, we show that the densely innervated pharynx transmits signals induced by pharyngeal inflammation to glossopharyngeal and vagal sensory neurons of the nodose/jugular/petrosal (NJP) superganglia in mice. Specifically, the NJP superganglia project to norepinephrinergic neurons in the nucleus of the solitary tract (NTSNE). These NTSNE neurons project to the ventral bed nucleus of the stria terminalis (vBNST) that induces anxiety-like behaviors in a murine model of pharyngeal inflammation. Inhibiting this pharynx→NJP→NTSNE→vBNST circuit can alleviate anxiety-like behaviors associated with pharyngeal inflammation. This study thus defines a pharynx-to-brain axis that mechanistically links pharyngeal inflammation and emotional response.


Assuntos
Faringite , Faringe , Humanos , Animais , Camundongos , Ansiedade , Encéfalo , Células Receptoras Sensoriais , Inflamação
5.
BMC Infect Dis ; 24(1): 286, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38443838

RESUMO

BACKGROUND: Invasive meningococcal disease (IMD), including sepsis and meningitis, can develop when Neisseria meningitidis bacteria breach the barrier and gain access to the circulation. While IMD is a rare outcome of bacterial exposure, colonization of the oropharynx is present in approximately 10% of the human population. This asymptomatic carriage can be long or short term, and it is unknown which determining factors regulate bacterial colonization. Despite descriptions of many bacterial virulence factors and recent advances in detailed genetic identification and characterization of bacteria, the factors mediating invasion and disease vs. asymptomatic carriage following bacterial colonization remain unknown. The pharyngeal epithelia play a role in the innate immune defense against pathogens, and the aim of this study was to investigate the proinflammatory response of pharyngeal epithelial cells following meningococcal exposure to describe the potential inflammatory mediation performed during the initial host‒pathogen interaction. Clinically relevant isolates of serogroups B, C, W and Y, derived from patients with meningococcal disease as well as asymptomatic carriers, were included in the study. RESULTS: The most potent cellular response with proinflammatory secretion of TNF, IL-6, CXCL8, CCL2, IL-1ß and IL-18 was found in response to invasive serogroup B isolates. This potent response pattern was also mirrored by increased bacterial adhesion to cells as well as induced cell death. It was, however, only with serogroup B isolates where the most potent cellular response was toward the IMD isolates. In contrast, the most potent cellular response using serogroup Y isolates was directed toward the carriage isolates rather than the IMD isolates. In addition, by comparing isolates from outbreaks in Sweden (epidemiologically linked and highly genetically similar), we found the most potent proinflammatory response in cells exposed to carriage isolates rather than the IMD isolates. CONCLUSION: Although certain expected correlations between host‒pathogen interactions and cellular proinflammatory responses were found using IMD serogroup B isolates, our data indicate that carriage isolates invoke stronger proinflammatory activation of the epithelial lining than IMD isolates.


Assuntos
Infecções Meningocócicas , Neisseria meningitidis , Humanos , Células Epiteliais , Faringe , Epitélio
6.
Arq Gastroenterol ; 61: e23092, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38511792

RESUMO

BACKGROUND: People recurrently have difficulties swallowing solid medications, which can be associated with the size of the medication and the age and gender of individuals. OBJECTIVE: To evaluate the impact of capsule size and adults' age and gender on oral and pharyngeal capsule transit during capsule swallows. METHODS: Videofluoroscopy was used to measure capsule oral and pharyngeal transit during swallows in 49 healthy individuals (17 men and 32 women), with a mean age of 46 years (ranging from 23 to 88 years). Smaller capsules were filled with 0.50 mL of barium sulfate, and larger capsules were filled with 0.95 mL of barium sulfate; the volume of liquid ingested with the capsules was also quantified in each ingestion. The measurements included the oral preparation time, oral transit time, swallowing reaction time, time to laryngeal vestibule closure, laryngeal vestibule closure duration, pharyngeal transit time, and upper esophageal sphincter opening duration. RESULTS: The capsule size did not influence either the oral or pharyngeal transit time. Increased liquid volume was ingested with larger capsules and by people older than 40 years. The oral transit time was shorter in older adults (60-88 years), and the time to laryngeal vestibule closure was longer in women. CONCLUSION: The size of large capsules did not make a difference in oral or pharyngeal transit when compared with smaller capsules. The capsule size and the participant's age influenced the volume of liquid ingested - larger capsules and older individuals required a larger volume. The capsule oral transit was faster in individuals older than 60 years. BACKGROUND: •Swallowing is influenced by the characteristics of what is being swallowed. BACKGROUND: •There was no difference in swallowing capsules containing 0.50 mL or 0.95 mL. BACKGROUND: •Larger capsules need more liquid ingestion to make swallowing easier. BACKGROUND: •Individuals older than 40 years need a greater volume of liquid to swallow capsules than younger adults.


Assuntos
Transtornos de Deglutição , Laringe , Masculino , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Deglutição , Sulfato de Bário , Transtornos de Deglutição/diagnóstico por imagem , Faringe/diagnóstico por imagem , Fluoroscopia
7.
Tidsskr Nor Laegeforen ; 144(3)2024 Feb 27.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-38415574

RESUMO

Background: Healthcare workers colonised with methicillin-resistant Staphylococcus aureus (MRSA) experience negative consequences due to work restrictions, long-term sick leave, stigmatisation, eradication failures and psychosocial stress. Throat colonisation is associated with prolonged carriage and non-successful treatment. Case presentation: We describe two Norwegian healthcare students with persistent MRSA throat carriage. After several eradication failures, MRSA eradication was successful only after tonsillectomy. Interpretation: Tonsillectomy is not the solution for persistent MRSA throat carriage in healthcare workers. However, their stories illustrate the challenges they faced during repeated eradication attempts. They suffered considerable psychological stress due to the risk of study disruption and limited career options. The impact of laws and strict guidelines for MRSA-colonised healthcare workers, needs to be re-assessed in order to reduce transmission. We argue that healthcare workers without individual risk factors should be able to work in units considered to pose no risk as long as they undergo individual training in basic infection control measures.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Humanos , Faringe , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/prevenção & controle , Pessoal de Saúde , Controle de Infecções , Portador Sadio
8.
Artigo em Chinês | MEDLINE | ID: mdl-38297855

RESUMO

Objective:To explore the feasibility of using self-made visual throat forceps to remove hypopharyngeal foreign bodies. Methods:The throat forceps were combined with the endoscope and connected to a monitor via a data cable resulting in a visual throat forceps apparatus. This device was utilized to examine and treat the hypopharyngeal foreign bodies. Results:Among 53 patients, foreign bodies were detected in 51,with 48 cases involving hypopharyngeal foreign bodies. All were successfully extracted using the visual throat forceps. Three cases, diagnosed as esophageal foreign bodies by electronic gastroscopy, were treated using the same method. Conclusion:Visual throat forceps can be used to examine the hypopharynx and remove foreign bodies. It has the advantages of simple operation, rapid operation, and high success rate of foreign body removal from the hypopharynx. It is worthy of clinical application.


Assuntos
Corpos Estranhos , Hipofaringe , Humanos , Hipofaringe/cirurgia , Faringe/cirurgia , Endoscópios , Instrumentos Cirúrgicos , Corpos Estranhos/diagnóstico
9.
Ital J Pediatr ; 50(1): 29, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38355651

RESUMO

Notifications of invasive group A streptococcal (iGAS) infections have significantly increased in many European Countries compared to the previous season. In Italy, there has been an increase in streptococcal pharyngitis and scarlet fever cases since January 2023, which sparked concerns about a GAS epidemic in the pediatric population. This rise may be ascribed to the GAS infection season that began earlier than usual (off-season outbreak) and the increase in the spread of respiratory viruses and viral coinfections that raised the risk of iGAS disease. Moreover, this phenomenon was also facilitated by increased travel after reduced GAS circulation during the COVID-19 pandemic.The increase in cases of GAS disease has raised some critical issues regarding the potential reactions to administering amoxicillin, the first-line antibiotic therapy, many of which have been erroneously labeled as "allergy."For these reasons, the Italian Society of Pediatric Allergy and Immunology (SIAIP) intends to provide simple clinical indications to help pediatricians manage GAS pharyngitis, discerning the allergic from non-allergic drug hypersensitivity.


Assuntos
Hipersensibilidade a Drogas , Hipersensibilidade , Faringite , Escarlatina , Infecções Estreptocócicas , Criança , Humanos , Escarlatina/tratamento farmacológico , Faringe , Pandemias , Faringite/tratamento farmacológico , Penicilinas/uso terapêutico , Antibacterianos/efeitos adversos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade/tratamento farmacológico
10.
Int Wound J ; 21(3): e14728, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38385835

RESUMO

Pediatric otolaryngology surgeries are crucial interventions requiring careful consideration of surgical methods to optimize outcomes. The choice between open and minimally invasive surgical approaches in this context warrants thorough investigation. While both methods aim to address ear, nose, and throat conditions in children, a comparative study assessing their impact on crucial factors such as intraoperative parameters, wound healing, complications, and postoperative pain is essential. This study aims to compare the effects of open and minimally invasive surgical methods on wound healing and infection in pediatric otolaryngology surgery, and provide a scientific basis for the selection of surgical methods. Two groups of patients were selected, with 90 people in each group. One group received open surgery and the other received minimally invasive surgery. Recording the intraoperative time, anesthesia time, and intraoperative blood loss; the number of days required for wound healing; the occurrence of wound-related complications; the comparison of pain on postoperative Days 1, 3, and 7; and the factors influencing postoperative wound healing were analyzed. In the minimally invasive surgery group, the intraoperative time was shorter, the anesthesia time was relatively reduced, and the amount of bleeding was significantly reduced. Wounds also take fewer days to heal and have lower rates of wound-related complications. When comparing the pain on 1, 3, and 7 days after surgery, the minimally invasive surgery group had relatively mild pain. Analysis of postoperative wound healing factors showed that minimally invasive surgical methods have a positive impact on healing. In pediatric otolaryngology surgery, minimally invasive surgery performs better than open surgery in terms of intraoperative operation time, anesthesia time, blood loss, wound healing time, complication rate, and postoperative pain. Therefore, minimally invasive surgery may be a safer and more effective surgical method.


Assuntos
Otolaringologia , Faringe , Criança , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Dor Pós-Operatória , Cicatrização
11.
Int J Mol Sci ; 25(4)2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38396656

RESUMO

A wide variety of bioactive peptides have been identified in the central nervous system and several peripheral tissues in the ascidian Ciona intestinalis type A (Ciona robusta). However, hemocyte endocrine peptides have yet to be explored. Here, we report a novel 14-amino-acid peptide, CiEMa, that is predominant in the granular hemocytes and unilocular refractile granulocytes of Ciona. RNA-seq and qRT-PCR revealed the high CiEma expression in the adult pharynx and stomach. Immunohistochemistry further revealed the highly concentrated CiEMa in the hemolymph of the pharynx and epithelial cells of the stomach, suggesting biological roles in the immune response. Notably, bacterial lipopolysaccharide stimulation of isolated hemocytes for 1-4 h resulted in 1.9- to 2.4-fold increased CiEMa secretion. Furthermore, CiEMa-stimulated pharynx exhibited mRNA upregulation of the growth factor (Fgf3/7/10/22), vanadium binding proteins (CiVanabin1 and CiVanabin3), and forkhead and homeobox transcription factors (Foxl2, Hox3, and Dbx) but not antimicrobial peptides (CrPap-a and CrMam-a) or immune-related genes (Tgfbtun3, Tnfa, and Il17-2). Collectively, these results suggest that CiEMa plays roles in signal transduction involving tissue development or repair in the immune response, rather than in the direct regulation of immune response genes. The present study identified a novel Ciona hemocyte peptide, CiEMa, which paves the way for research on the biological roles of hemocyte peptides in chordates.


Assuntos
Ciona intestinalis , Animais , Ciona intestinalis/genética , Hemócitos/metabolismo , Peptídeos/metabolismo , Faringe , Imunidade
12.
AAPS PharmSciTech ; 25(2): 31, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326518

RESUMO

Drug delivery to the buccal mucosa is one of the most convenient ways to treat common mouth problems. Here, we propose a spray-dried re-dispersible mucoadhesive controlled release gargle formulation to improve the efficacy of chlorhexidine. The present investigation portrays an approach to get stable and free-flowing spray-dried porous aggregates of chlorhexidine-loaded sodium alginate nanoparticles. The ionic gelation technique aided with the chlorhexidine's positive surface charge-based crosslinking, followed by spray drying of the nanoparticle's dispersion in the presence of lactose- and leucine-yielded nano-aggregates with good flow properties and with a size range of about 120-350 nm. Provided with the high entrapment efficiency (87%), the particles showed sustained drug release behaviors over a duration of 10 h, where 87% of the released drug got permeated within 12 h. The antimicrobial activity of the prepared formulation was tested on S. aureus, provided with a higher zone of growth inhibition than the marketed formulation. Aided with an appropriate mucoadhesive strength, this product exhibited extended retention of nanoparticles in the throat region, as shown by in vivo imaging results. In conclusion, the technology, provided with high drug retention and extended effect, could be a potential candidate for treating several types of throat infections.


Assuntos
Clorexidina , Faringe , Staphylococcus aureus , Sistemas de Liberação de Medicamentos/métodos , Preparações de Ação Retardada , Antissépticos Bucais , Tamanho da Partícula
13.
Microsurgery ; 44(2): e31149, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38363100

RESUMO

There is minimal information regarding free tissue transfers in very young infants, especially those less than a year old. It is often thought that that age remains a limit to free tissue transfers, with younger patients having smaller vessels, making the operation technically challenging. In this case report, we discuss the youngest and smallest recorded case of a free flap reconstruction. A 3-month-old patient with a malignant parapharyngeal undifferentiated round cell sarcoma underwent a resection and reconstruction with a radial forearm free flap (RFFF). The defect was 35 by 20 by 15 mm, and required a pharyngeal "patch," as opposed to a "tube," reconstruction. The defect was templated, and the RFFF then raised in a standard subfascial fashion, and inset with resorbable sutures. The patient was observed in the ICU postoperatively. The patient was subsequently diagnosed with Stage IV primary undifferentiated sarcoma with regional metastasis and received adjuvant chemotherapy. Fifteen-month follow up revealed no signs of recurrence, full oral intake, a well-reconstructed pharynx on nasoendoscopic examination, and minimal donor site morbidity. This report illustrates several unique adaptations of free flap transfer in infants and adds to the emerging body of evidence that age is not a contraindication for head and neck reconstruction.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Lactente , Faringe , Pescoço , Sarcoma/cirurgia
14.
J Infect ; 88(3): 106104, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38360357

RESUMO

Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection. OBJECTIVE: Our systematic review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals. METHODS: We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias. RESULTS: Of 1166 unique records identified, three RCTs were included in the review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias. CONCLUSIONS: Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin.


Assuntos
Antibacterianos , Infecções Estreptocócicas , Criança , Adulto , Humanos , Antibacterianos/uso terapêutico , Streptococcus pyogenes , Clindamicina/uso terapêutico , Penicilina G Benzatina , Faringe/microbiologia , Rifampina , Infecções Estreptocócicas/tratamento farmacológico
15.
Am J Nurs ; 124(3): 61, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38386837

RESUMO

According to this study.


Assuntos
COVID-19 , Faringe , Humanos , COVID-19/diagnóstico , Sensibilidade e Especificidade
16.
Proc Natl Acad Sci U S A ; 121(7): e2302660121, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38315866

RESUMO

The pharynx of the nematode Caenorhabditis elegans is a neuromuscular organ that exhibits typical pumping motions, which result in the intake of food particles from the environment. In-depth inspection reveals slightly different dynamics at the various pharyngeal areas, rather than synchronous pumping motions of the whole organ, which are important for its effective functioning. While the different pumping dynamics are well characterized, the underlying mechanisms that generate them are not known. In this study, the C. elegans pharynx was modeled in a bottom-up fashion, including all of the underlying biological processes that lead to, and including, its end function, food intake. The mathematical modeling of all processes allowed performing comprehensive, quantitative analyses of the system as a whole. Our analyses provided detailed explanations for the various pumping dynamics generated at the different pharyngeal areas; a fine-resolution description of muscle dynamics, both between and within different pharyngeal areas; a quantitative assessment of the values of many parameters of the system that are unavailable in the literature; and support for a functional role of the marginal cells, which are currently assumed to mainly have a structural role in the pharynx. In addition, our model predicted that in tiny organisms such as C. elegans, the generation of long-lasting action potentials must involve ions other than calcium. Our study exemplifies the power of mathematical models, which allow a more accurate, higher-resolution inspection of the studied system, and an easier and faster execution of in silico experiments than feasible in the lab.


Assuntos
Proteínas de Caenorhabditis elegans , Nematoides , Animais , Caenorhabditis elegans/fisiologia , Faringe/fisiologia , Proteínas de Caenorhabditis elegans/fisiologia , Comportamento Alimentar/fisiologia
18.
Eur Arch Otorhinolaryngol ; 281(4): 1991-2000, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38170209

RESUMO

OBJECTIVES: To compare functional outcomes and complication rates of anterolateral advancement pharyngoplasty (ALA) versus barbed reposition pharyngoplasty (BRP) in the treatment of obstructive sleep apnea patients with palatal and lateral pharyngeal wall collapse. STUDY DESIGN: Prospective study. SETTING: University hospitals. SUBJECTS AND METHODS: Forty-six patients were included in this study. Patients were divided into two groups randomly, group 1 (23 cases) underwent anterolateral advancement pharyngoplasty and group 2 (23 cases) underwent barbed relocation pharyngoplasty. According to the following criteria: both sex, age between 18 and 65 years, body mass index ≤ 32 kg/m2, Friedman stage II or III, type I Fujita, nocturnal polysomnography study diagnostic for OSA, retropalatal and lateral pharyngeal wall collapse, diagnosis with flexible nasoendoscopy during a Muller's maneuver based on a 5-point scale and drug-induced sleep endoscopy. Patients who suffered from retroglossal airway collapse were rolled out. RESULTS: Apnea-hypopnea index decreased from 27.50 ± 11.56 to 11.22 ± 7.63 (P ≤ .001) in group 1 and from 33.18 ± 10.94 to 12.38 ± 6.77 (P ≤ .001) in group 2. Retropalatal posterior airway space increased from 9.84 ± 1.29 mm to 21.48 ± 2.8 mm (P ≤ .001) in group 1 and increased from 10.26 ± 1.2 mm to 22.86 ± 2.62 mm (P ≤ .001) in group 2. Retropalatal space volume increased from 1.9 ± 0.68 cm3 to 2.75 ± 0.7 cm3 (P ≤ .001) in group 1 and increased from 1.96 ± 0.88 cm3 to 2.82 ± 0.83 cm3 (P ≤ .001) in group 2. Surgical success was 86.95% in group 1 compared to 82.6% in group 2. CONCLUSIONS: Both techniques appear to be effective with a high surgical success rate in the treatment of OSA patients with retropalatal and lateral pharyngeal wall collapse.


Assuntos
Faringe , Apneia Obstrutiva do Sono , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Resultado do Tratamento , Faringe/cirurgia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/etiologia , Palato
19.
Ann Otol Rhinol Laryngol ; 133(4): 375-383, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38197379

RESUMO

OBJECTIVE: To describe the phenotypic characteristics of the epiglottis at rest and their impact on vallecular residue. METHODS: Videofluoroscopic studies (VFSS) were pooled from 2 Laryngology practices, and Image J was used to measure epiglottic anatomic features at rest. Studies were rated by the MBSImp and presence of vallecular residue following swallow of thin and puree boluses. A conditional inference tree analysis was performed to isolate which epiglottic parameters were risk factors for presence of vallecular reside followed by logistic regression. RESULTS: The majority of patients had a normal shaped epiglottis, followed by omega shape. The mean angle of the epiglottis from the hyoid was approximately 90°. Only abnormal epiglottic movement was associated with increased risk of residue for thin boluses (OR 35.09, CI 10.93-158.66, P < .001). However, in those with normal epiglottic movement, age >70 years old was associated with increased risk of residue (OR 3.98, CI 1.73-9.23, P = .001). For puree boluses, a normal or omega shaped epiglottis was associated with residue (OR 5.19, CI 2.41-11.51, P < .001), and this relationship was further modulated by increased distance of the epiglottic tip from the posterior pharyngeal wall. No other anatomic features of the resting epiglottis were associated with residue. Comorbidities potentially affecting swallow were infrequent in the cohort and were not associated with residue. CONCLUSION: Abnormal epiglottic movement is associated with aspiration, and in this study we find that abnormal epiglottic movement increases the risk of vallecular residue and that older age is a risk factor for residue. The resting properties of the epiglottis do not appear to be associated with abnormal epiglottic movement or residue.


Assuntos
Transtornos de Deglutição , Epiglote , Humanos , Idoso , Epiglote/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Deglutição , Estudos de Coortes , Faringe/diagnóstico por imagem
20.
Head Neck ; 46(4): 740-748, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38168752

RESUMO

BACKGROUND: We aimed to assess the effectiveness of a single-institution protocol of videofluoroscopic swallowing study (VFSS) for the detection of pharyngeal leak (PL) and its usefulness to mitigate evolution into subsequent pharyngocutaneous fistula (PCF) after total (pharyngo-) laryngectomy (TL). METHODS: This retrospective single-center study was conducted between February 2014 and December 2022. We included all patients who underwent TL and performed a VFSS between Day 7 and Day 14 postoperatively to detect a subclinical PL. RESULTS: Two-hundred and forty-eight patients met the inclusion criteria. Among the 186 patients (75%) with a negative VFSS, 11 patients (5.9%) developed a secondary PCF after oral intake resumption (false negative of VFSS). Among the 62 patients (25%) with a positive VFSS, the occurrence of a PCF was avoided in 59.7% of cases. CONCLUSION: This study showed a good effectiveness of VFSS in the detection of PL after TL, alongside a usefulness to mitigate evolution into subsequent PCF.


Assuntos
Fístula Cutânea , Neoplasias Laríngeas , Doenças Faríngeas , Humanos , Estudos Retrospectivos , Laringectomia/efeitos adversos , Deglutição , Neoplasias Laríngeas/cirurgia , Faringe/diagnóstico por imagem , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/etiologia , Fístula Cutânea/diagnóstico por imagem , Fístula Cutânea/etiologia , Fístula Cutânea/epidemiologia , Complicações Pós-Operatórias/epidemiologia
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