Muscular and neuronal control of voice production - forgotten findings, current concepts, and new developments.

Voice production has been an area of interest in science since ancient times, and although advancing research has improved our understanding of the anatomy and function of the larynx, there is still little general consensus on these two topics. This review aims to outline the main developments in this field and highlight the areas where further research is needed. The most important hypotheses are presented and discussed highlighting the four main lines of research in the anatomy of the human larynx and their most important findings: (1) the arrangement of the muscle fibers of the thyroarytenoid muscle is not parallel to the vocal folds in the internal part (vocalis muscle), leading to altered properties during contraction; (2) the histological structure of the human vocal cords differs from other striated muscles; (3) there is a specialized type of heavy myosin chains in the larynx; and (4) the neuromuscular system of the larynx has specific structures that form the basis of an intrinsic laryngeal nervous system. These approaches are discussed in the context of current physiological models of vocal fold vibration, and new avenues of investigation are proposed.

Personalized Research on the Aging Face-A Narrative History.

Throughout history, people have struggled to find out the secret of youth. The aim of the manuscript is to review the main achievements regarding the exploration of the aging face phenomenon. It should be very important to know the evolution in this field due to the increase in life expectancy among the population. Our purpose is for the current study to serve as a starting point towards exploring novel research avenues in molecular biology and the confocal immunofluorescence of cervicofacial soft tissues, employing cutting-edge techniques. All changes in the shape of the facial skeleton, soft tissue, retaining ligaments, fat compartments, and the skin envelope contribute to facial aging to varying degrees.

Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis.

The thymus is a lymphoid organ involved in the differentiation of T cells, and has a central role in the physiopathogenesis of Myasthenia Gravis (MG). This connection is proved by a series of changes in the level of neuromuscular junctions, which leads to a decrease in the amplitude of the action potential in the post-synaptic membrane. Because of this, the presence of anti-cholinergic receptor antibodies (AChR), characteristic of MG, is found, which causes the progressive regression of the effect of acetylcholine at the level of neuromuscular junctions, with the appearance of muscle weakness. The thymectomy is a surgical variant of drug therapy administered to patients with MG. In the case of patients with nonthymomatous MG, thymectomy has become a therapeutic standard, despite the fact that there is no solid scientific evidence to explain its positive effect. Videothoracoscopic surgery or robotic surgery led to a decrease in the length of hospital stay for these patients. This paper aims to synthesize the information presented in the literature in order to create a background for the perspectives of thymectomy.

Morphofunctional and histological patterns of blood vessels in the superficial cervicofacial musculoaponeurotic system in midlateral face regions.

OBJECTIVE: The superficial cervicofacial musculoaponeurotic system (SMAS) is a complex network formed by mimic muscles and conjunctive tissue of the superficial fascia of the face.This study aimed to introduce new anatomofunctional data on the importance of the trans-SMAS distribution pattern of the skin microperfusion of the face and to underline the role of SMAS in maintaining the homeostasis of the vascular network that crosses it. Considering the fibrous and muscular matrix of the SMAS, using COLIII and MyoH2 antibodies, together with endothelial immunohistochemistry(IHC)intercellular adhesion molecule 2 marker, we determined the correlation of these structures and their interaction. METHODS: This study included 33donors of SMAS tissues, which have been stained withregular hematoxylin and eosin (HE), and three different IHC markers have been used (collagen III, muscular tissue, and blood vessels). The samples were collected from parotid, masseteric, jugal, and zygomatic regions. Magnetic resonance angiography was used to identify the main vascular sources of the midlateral regions of the face of another 47 patients. RESULTS: Significant differences in topographic arrangement, density, and relations of the microsopic vasculature were observed between each of the four regions. Major differences were identified between the role of SMAS in each of these regions, from the parotid capsule to masseteric fascia, transition mobile part, and attaching manners in the zygomatic subunit. CONCLUSIONS: Blood vessel topography must be related with the surrounding conjunctive and muscular tissue, especially regarding facial SMAS. Intrinsic relations between these three components of the SMAS and nervous fibers can provide us important hints on the functionality of the whole system.

Clinical and morphofunctional identity of the nasal SMAS.

The fascial system of the face (superficial musculo-aponeurotic system, SMAS) in the nasal part is a sustained layer that connects the nearby regions. In this paper, we aimed to emphasize the presence of SMAS in different areas of the nasal region: ala nasi, nasolabial fold, nasal dorsum and radix. We performed three studies (anatomical, histological, and radiological) to demonstrate the existence of nasal SMAS. The study group consisted of cadaveric analyses and retrospective analysis of the patient radiological data. The nasal SMAS was identified as a superficial fascia and a subcutaneous adipose layer. The anatomical dissection study together with histological and radiological evaluations demonstrated the presence of SMAS in the nasal region. We identified peculiarities of the nasal SMAS in two areas: in the ala nasi where it is thinner, and the deep part of the dermis does not adhere to the underlying structures and at the radix and dorsum nasi, where the adipose layer is very thin. The results of our research define nasal SMAS as a unit of great value in facial surgeries, such as facial rejuvenation, the resolution of malformations, or tumor removal.

Omphalocele and Cardiac Abnormalities-The Importance of the Association.

Omphalocele is the most common ventral abdominal wall defect. Omphalocele is associated with other significant anomalies in up to 80% of cases, among which the cardiac ones are the most frequent. The aim of our paper is to highlight, through a review of the literature, the importance and frequency of association between the two malformations and what impact this association has on the management and evolution of patients with these pathologies. We reviewed the titles, the available abstracts, and the full texts of 244 papers from the last 23 years, from three medical databases, to extract data for our review. Due to the frequent association of the two malformations and the unfavorable effect of the major cardiac anomaly on the prognosis of the newborn, the electrocardiogram and echocardiography must be included in the first postnatal investigations. The timing of surgery for abdominal wall defect closure is mostly dictated by the cardiac defect severity, and usually the cardiac defect takes priority. After the cardiac defect is medically stabilized or surgically repaired, the omphalocele reduction and closure of the abdominal defect are performed in a more controlled setting, with improved outcomes. Compared to omphalocele patients without cardiac defects, children with this association are more likely to experience prolonged hospitalizations, neurologic, and cognitive impairments. Major cardiac abnormalities such as structural defects that require surgical treatment or result in developmental delay will significantly increase the death rate of patients with omphalocele. In conclusion, the prenatal diagnosis of omphalocele and early detection of other associated structural or chromosomal anomalies are of overwhelming importance, contributing to the establishment of antenatal and postnatal prognosis.

H-FABP Levels and Psycho-Emotional Improvement of CABG Patients during Cardiac Rehabilitation.

(1) Background: The heart-type fatty acid-binding protein (H-FABP) is a specific myocardial biomarker and high levels indicate ischemia regardless of patient-reported symptoms. Concurrently, major adverse cardiovascular events and surgery such as coronary artery by-pass grafting (CABG) cause substantial psycho-emotional distress e.g., depression and anxiety. Comprehensive cardiac rehabilitation is, therefore, essential to both physical and psychological recovery. (2) Methods: This is a unicentric, prospective study on 120 consecutive post-CABG patients undergoing a 6-month cardiac rehabilitation program based on physical exercise, Mediterranean diet principles, and Q10 coenzyme antioxidant supplements. H-FABP levels, depression, and anxiety scores (Hamilton HAM-D and HAM-A scales) were monitored after surgery and at 6 months. (3) Results: Mean H-FABP dropped from 60.56 to 4.81. Physical ability increased from 1-2 to 4-5 METS. Mean depression and anxiety improved from 15.88 to 6.96 and from 25.13 to 15.68, respectively. Median scores went down 50% for depression and 9% for anxiety. Explored associations between H-FABP and psycho-emotional status were statistically insignificant. (4) Conclusions: patients adhered to the program and improved significantly in all studied aspects. Clinical significance is discussed in the context of countries like Romania, where such programs are limited by systemic and financial constraints. Further research directions are identified.

Hidden Anatomy of Opera Singers.

The history of research on the voice of opera soloists shows that there are certain functional features of the cranial nerves and cortical nerve centers. In this chapter, we review the most important findings in the field of canto voice neuroanatomy, which we corroborate with the results of our team research and experience. Our study focuses on the nerve structures involved in phonation at each level of the vocal formants: infraglottic, glottic, and oropharyngeal. We consider this research to have direct applicability in the fields of neurolaryngology, neuroscience, phoniatry, but also in the academic teaching. At the same time, the present study is a starting point for future research works on the anatomical and functional particularities of the structures involved during the act of phonation in canto soloists.

Morpho-functional and radiological approach of poststroke seizures.

Epilepsy is characterized by recurrent seizures that cannot be associated with other specific causes. The presence of a single convulsive or tonic seizure after a stroke does not necessarily mean that a person develops a form of epilepsy unless the convulsions become chronic and recurrent poststroke epilepsy. The purpose of our study is to highlight the existence of a connection between the type and the topography of a vascular stroke on the one hand, and on the other hand, the type of seizures that have occurred and how long they have occurred after the stroke. The study was conducted in a total of 165 patients at the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iasi, Romania, diagnosed with stroke and spastic seizures after stroke and who survived for at least one year. In this study, the ideal patient should be the patient diagnosed for the first time with temporal lobe epilepsy, followed longitudinally by high-resolution imaging techniques. Studying topography and morphopathology of poststroke sequelae can lead to an increase in accuracy prediction of epilepsy after it.

Morphopathological particularities of cerebrovascular diseases for patients in the northeastern area of Romania.

Cerebrovascular diseases (CVD) are pathologies caused by the primary or secondary damage of one or more arteries supplying the brain. Our study aims to create a link between the modifiable risk factors, the affected vascular territory and the clinical manifestation of CVD in patients from our geographical area. Our study proposes the retrospective analysis of a group of 70 patients diagnosed with ischemic stroke with spontaneous hemorrhagic transformation over a period of five years, between April 1, 2015 and April 1, 2018, admitted in the 1st Neurology Clinic, "Prof. Dr. Nicolae Oblu" Clinical Emergency Hospital, Iasi, Romania. The pathology of strokes is determined by risk factors and comorbidities, which have a clear demographic pattern. The existence of a correlation between demographic risk factors of CVD and the clinical manifestation allows for the individualization of a clinical examination protocol leading to a rapid diagnosis.

Anatomical considerations on the masseteric fascia and superficial muscular aponeurotic system.

The masseteric region is considered by the most researchers as a subdivision of the parotideomasseteric region. Because of its surgical significance, we emphasize it has distinctive morphofunctional features. The aim of this manuscript is to highlight particular characteristics of the masseteric region and practical applications of this concept. The material used was represented by 12 embalmed cephalic extremities dissected in "Ion Iancu" Institute of Anatomy, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, 10 operating specimens from the Clinics of Maxillofacial Surgery and Plastic Surgery of the "St. Spiridon" University Hospital, Iasi, Romania, and computed tomography (CT) and magnetic resonance (MR) images from the same patients. Our results underline the importance and individual arrangement of the superficial muscular aponeurotic system (SMAS) of the face, at the level of masseteric region. The superficial fascia facilitates adhesion to the dermis of the mimic muscles of the region. This reveals that the masseteric superficial fascia will follow the masticatory movements of the mandible and masseter, but also those of the minor and major zygomaticus muscles. These muscles are the infra-SMAS layer and thus take part in the formation of a unitary complex together with the superficial fascia. The particularities of the SMAS in the masseteric region are especially important in plastic and reconstructive surgery.

Morphofunctional evaluation of buccopharyngeal space using three-dimensional cone-beam computed tomography (3D-CBCT).

The present study aims to identify the anatomical functional changes of the buccopharyngeal space in case of singers with canto voice. The interest in this field is particularly important in view of the relation between the artistic performance level, phoniatry and functional anatomy, as the voice formation mechanism is not completely known yet. We conducted a morphometric study on three soprano voices that differ in type and training level. The anatomical soft structures from the superior vocal formant of each soprano were measured on images captured using the Cone-beam Computed Tomography (CBCT) technique. The results obtained, as well as the 3D reconstructions emphasize the particularities of the individual morphological features, especially in case of the experienced soprano soloist, which are found to be different for each anatomical soft structure, as well as for their integrity. The experimental results are encouraging and suggest further development of this study on soprano voices and also on other types of opera voices.

The existence of labial SMAS - Anatomical, imaging and histological study.

Cutaneous insertion of the facial mimic muscles concerns, at different levels, the superficial fascia of that region. A superficial musculoaponeurotic system is described at face level that facilitates skin insertion of the facial expression muscles through the superficial fascia that acquires particular functional aspects in each region of the face. The existence of a musculofascial system is seen controversial among anatomists, which is why the purpose of this study is to establish its existence at the oral region. The material used in our study consists of twenty-four dissected hemifacies, wherefrom we have recorded images using an operator microscope. Tissue samples have been taken from anatomical specimens examining them by usual staining methods. In parallel, fifteen patients have been investigated with imaging methods (MRI and CT). The results prove the existence of an oral musculoaponeurotic system with a particular organization, similar in the upper and lower part. The superficial fascia disappears into the free margin of the upper and lower lips, as we are emphasizing in the images taken from this level. These findings explain the functional anatomy of this region, but they also form the background of the modern oral plastic surgery.

Morphological changes in support mechanism of superficial face layers in Moebius syndrome.

Moebius syndrome, also called congenital facial paralysis is a rare neurological disease, whose etiology is not fully elucidated. It affects especially facial and oculomotor cranial nerves and its clinical feature is peripheral facial paralysis. The objective of the study is to highlight the anatomical and functional changes in the Moebius syndrome and establish certain criteria that should be the basis for reparative surgery in this disease. For this purpose, we used a group of six patients diagnosed with this pathology, in whom we pursued functional anatomical and histological changes of the superficial layers of the face that we have grouped in terms of their clinical impact. All the data obtained were centralized in order to assess anatomical functional changes occurring after evolution in time of lesions caused by Moebius syndrome. The results of the study led us to conclude that the face is made up of three main regions - median, medial and lateral -, which behave differently both in atresia of the facial nerve and in healthy individuals. This has an important echo on the way we emphasized the functional anatomy of superficial layers of the face and in surgery.

The anatomical and functional characteristics of parotid fascia.

Parotid superficial and profound fascias are considered to originate from a bifurcation of the profound fascia. Its relations with the facial nerve, the continuity with platysma, temporal and zygomatic fascias suggest it is related to a superficial fascial complex rather with a profound one. The aim of this study is to add clues which sustain the theory of parotid fascia origin from superficial fascia of the face. The study was conducted on 12 cephalic extremities, which were meticulously dissected in the "Ion Iancu" Anatomy Institute of "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania, and on a group of 10 patients admitted to the Clinic of Maxillofacial Surgery, "St. Spiridon" Emergency Clinical Hospital, Iasi, patients which were clinically and imagistically diagnosed [computed tomography (CT), magnetic resonance imaging (MRI)] with parotid tumors and underwent surgical interventions for total or partial parotidectomy. On each stage of dissection mesoscopic images were acquired, examined and further processed to remark the regional stratigraphic differences. Surgical interventions have allowed us segmental anatomical studies, providing in vivo visualization of the fascial and muscular structures, evaluating the possibilities of dissociating the plans and appreciating their vasculature. The collected specimens were processed by paraffin technique and stained with H special techniques for muscular and connective tissue. The results are clearly showing the belonging of parotid fascia to the superficial fascia of face.

The morphometry of the laryngeal phonatory system - base of the anatomical study of the voice aptitudes.

Speaking is one of the characteristics of the human race and the main factor that has marked our progress over time. The singing voice is the crowning of the speech act and the main component of the lyrical manifestation of personality. Doctors in various fields, but especially anatomists have been concerned about discovering how the voice and the substrate of its variability are formed, but these aspects have not yet been fully deciphered. This study is the starting point in our research on the phonation system, organized on three levels: laryngeal, oral, palatinal, pharyngeal, epiglottal and nasal. We performed the dissection of seven embalmed anatomical parts, on which, we made measurements of the anatomical elements involved in the phonation. We performed the same measurements on a batch of seven adults investigated by magnetic resonance imaging (MRI). The results were entered into the statistical calculation formulas and compared with each other and with the literature. The results of the study show that certain values resulting from the calculation formulas remain constant and others vary greatly from each individuals and gender.

Morphological aspects of the rectal neovascularization in colorectal cancer - anatomical-surgical and imaging implications.

Colorectal neoplasia has an increasing incidence among the population, and this fact compels in achieving an early diagnosis and treatment protocols. The extramural vascular invasion (EMVI) score is a method used for staging cancer. It defines the presence of malignant cells in the blood vessels, outside its own vascular tunic. The purpose of the study is to evaluate the extramural vascular invasion, and thus the impact of this determination in diagnosis, treatment and prognosis of colorectal neoplasia. This was done using magnetic resonance images (MRI) of colonoscopic diagnosed patients with colorectal cancer and subsequently comparing these results with the control group of patients without malignancy. The EMVI criteria taken into account were correlated with the images obtained in patients in the study group. In each of the evaluated patients, we found both, arterial and venous blood vessels in 0 stage - EMVI correlated with T2 or T3 stage tumor. In T3 B stages, we could objectify suggestive images for stage 4 EMVI near and distant from the tumor. Blood and lymph vessels have a high density to their origin area and it decreases anteriorly. This distribution is consistent with a predisposition to the formation of a vascular rectal cancer, especially on the posterior wall. In conclusion, anatomical-imaging staging of colorectal cancers using EMVI score is very close to the colonoscopic diagnosis and to the accuracy of the classic cancer staging. Corroborating EMVI score with a vascular radiology reference pattern improves the accuracy for determining an appropriate treatment and assessment of prognosis.