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1.
World Neurosurg ; 137: 389-392, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32084620

RESUMEN

BACKGROUND: Pediatric isolated penetrating traumatic vertebral artery injuries require urgent multidisciplinary management as they may lead to potentially fatal posterior circulation ischemia. CASE DESCRIPTION: We present a 19-month-old patient with an isolated penetrating vertebral artery injuries at the V2 segment of the right vertebral artery and report our strategy for her endovascular treatment which involved simultaneous coil embolization and foreign body removal. CONCLUSION: Endovascular treatment can be considered first line treatment of oral penetrating injuries to the vertebral artery, where the penetrating object has an anterior to posterior trajectory.


Asunto(s)
Procedimientos Endovasculares/métodos , Cuerpos Extraños/cirugía , Orofaringe/cirugía , Lesiones del Sistema Vascular/cirugía , Arteria Vertebral/cirugía , Heridas Penetrantes/cirugía , Angiografía por Tomografía Computarizada , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Lactante , Orofaringe/diagnóstico por imagen , Arteria Vertebral/lesiones
2.
Spine (Phila Pa 1976) ; 45(2): 103-108, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31415467

RESUMEN

STUDY DESIGN: Videoflurographic swallowing study in asymptomatic volunteers. OBJECTIVE: The purpose of this study was to investigate the relationship between the severity of dysphagia and various parameters of the subjects. SUMMARY OF BACKGROUND DATA: Occipitocervical fixation is associated with several potential complications. Malalignment of craniovertebral junction and associated dysphagia have been well described in the literature. However, there has been little attention given to investigate the association between the degree of swallowing dysfunction and various patient's parameters. METHODS: Thirty-nine healthy asymptomatic volunteers, 18 males and 21 females, were enrolled in this study. Based on videofluorographic swallowing study (VFSS), two scoring systems of swallowing dysfunction (dysphagia rating scale [DRS], dysphagia outcome and severity scale [DOSS]) were measured in neutral and retraction position. Multiple linear regression analysis was performed to evaluate the relationship between the degree of swallowing dysfunction and various factors of the subjects such as radiological and clinical parameters. RESULTS: There was statistically significant correlation between DRS and DOSS (r = -0.354, P < 0.05). Multiple regression analysis showed that there was a significant association of the dysphagia severity (DRS and DOSS) with the percentile change of the narrowest oropharyngeal diameter (OD) (%dn OD) (r = 0.121, P < 0.01 and r = 0.020, P < 0.01, respectively). Percentile change of OD (neutral and retraction position) was positively associated with the difference of C0-2 angle (r = 1.676, P < 0.01). None of the other variables such as age, sex, C0-1 angle, C1-2 angle, and C2-7 angle were significantly associated with the degree of dysphagia or %dn OD. CONCLUSION: This study demonstrated that the severity of dysphagia is significantly associated with the percentile change of OD and the C0-2 angle has considerable effect on the OD after O-C fusion. Therefore, C0-2 angle could be the most critical radiological parameter not only for predicting the stricture of oropharyngeal space but also for preventing postoperative dysphagia. LEVEL OF EVIDENCE: 4.


Asunto(s)
Trastornos de Deglución/diagnóstico por imagen , Deglución , Orofaringe/diagnóstico por imagen , Orofaringe/patología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Vértebras Cervicales/diagnóstico por imagen , Femenino , Fluoroscopía , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Postura , Adulto Joven
3.
BMC Pregnancy Childbirth ; 19(1): 453, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783734

RESUMEN

BACKGROUD: Fetus in fetu (FIF) is a rare malformation in which a parasitic twin within its more mature twin. Most of the FIF locate in the retroperitoneum and are acardiac and anencephalic. CASE PRESENTATION: Here, we describe a unique case of oropharyngeal fetus in fetu with a rudimentary two-chambered heart detected by prenatal ultrasonography. The parents terminated this pregnancy after counseling. Macroscopic examination found a solid mass between the oral and fetal chest, with a rudimentary two-chambered heart at the lowest part of the mass. Microscopic findings showed amniotic membrane, skin, cartilage, gastrointestinal and neural tissue. CONCLUSIONS: Prenatal ultrasound can identify rudimentary organs suspecting FIF from early pregnancy. Detection of fetal heart beat facilitates differential diagnosis with teratomas, providing essential information for parental consulting and management.


Asunto(s)
Feto/anomalías , Feto/diagnóstico por imagen , Orofaringe/anomalías , Orofaringe/diagnóstico por imagen , Adulto , Femenino , Humanos , Embarazo , Ultrasonografía Prenatal
4.
Acta otorrinolaringol. esp ; 70(6): 327-335, nov.-dic. 2019. tab, ilus, graf
Artículo en Español | IBECS | ID: ibc-184877

RESUMEN

Introducción y objetivos: El objetivo de este trabajo es mostrar nuestra experiencia y consideraciones al cuantificar el desplazamiento hioideo, así como observar su correlación con las escalas cualitativas de valoración de la disfagia. Métodos: Se mide el desplazamiento hioideo mediante el método descrito por el grupo de Molfenter y Steele 2014 en una serie de 14 pacientes con disfagia orofaríngea antes y después del tratamiento, y se valora su correlación con la Escala de penetración y aspiración de Rosenbek de 1996, y con la Functional Oral Intake Scale de Crary de 2005. Resultados: Todos los pacientes variaron el desplazamiento total del hioides tras el tratamiento aplicado. Esta variación se correlacionó con las variaciones de la Escala de penetración y aspiración en todos los pacientes que presentaban aspiración o penetración. Sin embargo, las modificaciones del desplazamiento total hioideo no se correlacionaron con las variaciones de la Functional Oral Intake Scale. Conclusiones: La mejora en el desplazamiento total del hioides es un indicador clínico de la mejora en la aspiración del paciente con disfagia orofaríngea, y puede ser utilizado en su diagnóstico y seguimiento. Sin embargo, no lo es como indicador de la tolerancia de la dieta oral


Introduction and objectives: The objective of this paper was to show our experience and considerations when quantifying hyoid bone displacement and to observe its correlation with the qualitative scales that evaluate dysphagia. Methods: Hyoid displacement was assessed using the method described by Molfenter and Steele's group in 2014 in a series of 14 patients affected by oropharyngeal dysphagia. The degree of dysphagia was also qualitatively assessed with the Rosenbek Penetration and Aspiration Scale (PAS) of 1996 and with the Functional Oral Intake Scale (FOIS) of Crary of 2005. All assessments were done before and after treatment. Results: All patients increased their hyoid bone total displacement after the treatment. These variations were highly correlated with the variations in the PAS scale with aspiration or penetration. However, the variations of hyoid bone displacement did not correlate with the FOIS scale. Conclusions: The improvement in total hyoid bone displacement is a clinical indicator of improved aspiration of patients suffering dysphagia. However, the improvement of this displacement is not related to the oral intake tolerance of the patients


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Trastornos de Deglución/diagnóstico por imagen , Evaluación de la Discapacidad , Orofaringe/fisiopatología , Trastornos de Deglución/etiología , Orofaringe/diagnóstico por imagen , Fluoroscopía , Grabación en Video
5.
Am J Orthod Dentofacial Orthop ; 156(1): 53-60, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256838

RESUMEN

INTRODUCTION: Pharyngeal airway space (PAS) assessment has been used in the past for a better understanding of orthodontic and surgical outcomes; however, this analysis could be unreliable. Our objective was to evaluate possible changes in the PAS reading in the same patient from their consecutive cone-beam computed tomography (CBCT) scans. METHODS: We evaluated a total of 27 patients' CBCT scans obtained at 2 time points with the use of a standardized acquisition protocol. The mean age at T0 was 31 years (range 17-62 years) and the follow-up records (T1) were taken after 4-6 months. Dolphin Imaging software was used to measure the volumes of the nasopharynx, oropharynx, and hypopharynx. We also evaluated the craniocervical position with the use of a lateral cephalogram. RESULTS: The variables exhibited high intraclass correlation coefficients (ICCs) when measuring the same CBCT scan twice (T0 and T0). However, The ICC between the measurements performed on the first and second CBCT scans (T0 and T1) showed that the only variable with high reproducibility between the 2 scans was cranial base, with an ICC >0.97. Average differences of 682.1 mm3, 2255.3 mm3, and 517.4 mm3 were found for the nasopharynx, oropharynx, and hypopharynx, respectively. Regarding the cephalometric angles, average differences between T0 and T1 scans were 0.6°, 2.7°, and 0.4° for OPT.CVT, OPT.SN, and cranial base, respectively. CONCLUSIONS: Different CBCT exams with equal scanning and patient positioning protocols can result in different 3D PAS readings. A more careful interpretation of CBCT volumetric data to achieve adequate conclusions of the clinical outcomes is necessary.


Asunto(s)
Tomografía Computarizada de Haz Cónico/métodos , Tomografía Computarizada de Haz Cónico/normas , Posicionamiento del Paciente/métodos , Posicionamiento del Paciente/normas , Faringe/anatomía & histología , Faringe/diagnóstico por imagen , Adolescente , Adulto , Cefalometría/métodos , Femenino , Estudios de Seguimiento , Humanos , Hipofaringe/anatomía & histología , Hipofaringe/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Nasofaringe/anatomía & histología , Nasofaringe/diagnóstico por imagen , Variaciones Dependientes del Observador , Orofaringe/anatomía & histología , Orofaringe/diagnóstico por imagen , Procedimientos Quirúrgicos Ortognáticos , Valores de Referencia , Reproducibilidad de los Resultados , Programas Informáticos , Adulto Joven
6.
PLoS One ; 14(7): e0213328, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31361754

RESUMEN

INTRODUCTION: The aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L). METHODS: CBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 8 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison. RESULTS: There was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group. CONCLUSION: The findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.


Asunto(s)
Labio Leporino/terapia , Fisura del Paladar/terapia , Orofaringe/diagnóstico por imagen , Técnica de Expansión Palatina , Niño , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Aparatos de Tracción Extraoral , Femenino , Humanos , Imagenología Tridimensional , Masculino , Maxilar/diagnóstico por imagen
7.
Turk J Ophthalmol ; 49(3): 164-167, 2019 06 27.
Artículo en Inglés | MEDLINE | ID: mdl-31245979

RESUMEN

Tularemia is a zoonotic disease caused by Francisella tularensis, a highly virulent gram-negative coccobacillus. Oropharyngeal tularemia, one of the clinical subtypes, is the most common clinical form of the disease in Eastern Europe, including Turkey. This clinical form affects mostly the head and neck region and the most common complaints of patients are mass in the neck, sore throat, and fever. This form of tularemia may be confused with tonsillitis, pharyngitis, or cervical lymphadenitis caused by other microbial agents due to the nonspecific clinical and laboratory features. In this study, we present a patient with nasolacrimal duct obstruction and dacryocystitis caused by oropharyngeal tularemia.


Asunto(s)
Dacriocistitis/etiología , Infecciones Bacterianas del Ojo/etiología , Francisella tularensis/aislamiento & purificación , Obstrucción del Conducto Lagrimal/etiología , Orofaringe/microbiología , Faringitis/complicaciones , Tularemia/complicaciones , Adulto , Dacriocistitis/diagnóstico , Dacriocistitis/microbiología , Diagnóstico Diferencial , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Humanos , Obstrucción del Conducto Lagrimal/diagnóstico , Obstrucción del Conducto Lagrimal/microbiología , Imagen por Resonancia Magnética , Masculino , Conducto Nasolagrimal/microbiología , Conducto Nasolagrimal/patología , Orofaringe/diagnóstico por imagen , Faringitis/diagnóstico , Faringitis/microbiología , Enfermedades Raras , Tularemia/diagnóstico
8.
J Robot Surg ; 13(4): 581-584, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30945096

RESUMEN

Advances in three-dimensional (3D) video recording and playback have expanded the availability of stereoscopic videos for consumption with specialized televisions, computer monitors, and virtual reality (VR) headsets. The built-in stereoscopic vision of the da vinci surgical system (Intuitive Surgical, Sunnyvale, CA) enables the recording of both camera views. However, medical-grade devices for direct stereoscopic video recording can be cost-prohibitive. We describe methods of producing and viewing 3D videos in transoral robotic surgery (TORS) without acquisition of dedicated 3D recording equipment. The video output from the left and right cameras of the da Vinci Si endoscope were recorded during a TORS radical tonsillectomy using non-stereoscopic media devices. Raw video was processed using commercially available video-editing software to create stereoscopic videos clips. 3D videos were successfully observed using a low-cost mobile phone VR headset. 3D stereoscopic surgical videos were successfully developed using widely available software, applications, computer peripherals, and mobile devices. The methods described confer significant cost savings when compared to the purchase of specialized recording equipment despite the requirements of time and intermediate computer skills. Future studies will investigate the utility of stereoscopic videos in medical student and resident education.


Asunto(s)
Imagenología Tridimensional/métodos , Procedimientos Quirúrgicos Otorrinolaringológicos/educación , Procedimientos Quirúrgicos Robotizados/educación , Grabación en Video/métodos , Humanos , Laringe/diagnóstico por imagen , Orofaringe/diagnóstico por imagen , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Realidad Virtual
10.
Ann Otol Rhinol Laryngol ; 128(7): 681-684, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30895800

RESUMEN

OBJECTIVES: This paper reports the utilization of intraoperative ultrasound in the removal of an accidentally ingested wire grill-brush bristle from the pharyngeal space of a child. METHODS: Standard procedures for obtaining imaging of an accidentally ingested foreign body were performed, including radiograph, computed tomography (CT) imaging, and preoperative ultrasonography. Despite preoperative imaging, the object could neither be located nor removed. Ultrasonography was performed intraoperatively for real-time localization. RESULTS: Intraoperative ultrasonography was required to successfully locate and remove the wire grill-brush bristle from the patient's oropharyngeal space. CONCLUSIONS: Intraoperative ultrasound serves as a useful tool to guide surgical removal of aerodigestive foreign bodies and may offer an opportunity to reduce the need for CT imaging.


Asunto(s)
Cuerpos Extraños/cirugía , Laringoscopía/métodos , Orofaringe/cirugía , Ultrasonografía/métodos , Niño , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Orofaringe/diagnóstico por imagen , Radiografía , Cirugía Asistida por Computador/métodos
11.
Dysphagia ; 34(1): 34-42, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30635777

RESUMEN

The modified  barium swallow (MBS) study is a videofluoroscopic evaluation of oropharyngeal swallow function. Esophageal imaging is not routinely performed during an MBS, and few guidelines for implementation or interpretation exist. Aims of the current investigation were to (1) delineate the percentage of normal, oropharyngeal, esophageal, and mixed swallowing dysfunction, (2) develop operational definitions for rating our standardization cursory view of esophageal bolus flow, and (3) determine inter-rater reliability between speech pathology (SLP) and physician raters for categorizing esophageal abnormalities. A two-phase retrospective review of 358 patient charts and MBS studies was conducted. Esophageal bolus flow was operationally defined as (1) normal, (2) anatomic abnormality, (3) dysmotility and (4) combined. Descriptive statistics, a Chi square with alpha set at 0.05, and Kappa analysis were performed. Esophageal dysfunction was identified in 80 (26%) patients and included: anatomic abnormality (69%), dysmotility (17%), and combined abnormality (14%). Phase one reliability testing yielded fair agreement between SLP and MD raters k = 0.5. Following revision of definitions and consensus training, phase two reliability testing resulted in excellent agreement between the same raters k = 0.9. Multiphase or primary esophageal dysphagia was found in 26% of our sample using a standardized protocol rating esophageal bolus flow from the upper esophageal sphincter through the lower esophageal sphincter during the MBS. Improved agreement between SLP and MD raters after definition revision and training suggests these operational definitions are concise, objective and reliable. An expanded MBS study may lead to early identification of esophageal disorders, encourage multidisciplinary patient care, and improve patient health outcomes.


Asunto(s)
Radioisótopos de Bario , Cinerradiografía/normas , Protocolos Clínicos/normas , Trastornos de Deglución/diagnóstico por imagen , Fluoroscopía/normas , Cinerradiografía/métodos , Bases de Datos Factuales , Deglución , Esófago/diagnóstico por imagen , Femenino , Fluoroscopía/métodos , Humanos , Masculino , Variaciones Dependientes del Observador , Orofaringe/diagnóstico por imagen , Reproducibilidad de los Resultados , Estudios Retrospectivos , Patología del Habla y Lenguaje/métodos , Grabación en Video
12.
BMJ Case Rep ; 12(1)2019 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-30665932

RESUMEN

A 30-year-old woman presented to the accident and emergency department 3 days post-tonsillectomy with bleeding from the tonsillar fossa and left-sided facial swelling. The patient denied any dysphagia or breathing difficulties but experienced pain on neck movement. On examination, although the bleeding had stopped on reaching the emergency department, a small clot was noted in her left tonsillar fossa. A left facial/submandibular swelling was seen, which had been present since her operation and was slowly enlarging. Flexible nasendoscopy showed a mild left sided oropharyngeal swelling but was otherwise normal. She was treated initially with antibiotics and hydrogen peroxide gargles. After 24 hours of observation and a slight worsening of the swelling she underwent a CT of the neck. This showed widespread indurated subcutaneous surgical emphysema, originating from the left tonsillar bed. Following a period of observation and improvement in her symptoms, she was discharged home with safety netting.


Asunto(s)
Orofaringe/diagnóstico por imagen , Enfisema Subcutáneo/diagnóstico por imagen , Tonsilectomía/efectos adversos , Adulto , Tratamiento Conservador , Femenino , Humanos , Tomografía Computarizada por Rayos X
14.
Auris Nasus Larynx ; 46(1): 83-88, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29753584

RESUMEN

OBJECTIVE: Dynamic videofluoroscopic swallow study (VFSS) is used to investigate swallowing movements. However, it requires prolonged radiation exposure and mainly provides qualitative information. Herein, we present a multi-dimensional method for analyzing swallowing based on a pulsed, low-dose fluoroscopy technique that uses serial-shot images and evaluates the size, position, and temporal profile of the bolus to obtain a more comprehensive and realistic analysis of swallowing movements. METHODS: Fifteen healthy adults drank two liquids: 20mL of pure water followed by 20mL of contrast medium mixture in a fluoroscopic study. Data were recorded in serial-shot images (7.5 frames/second, 1024×1024-pixel resolution, DICOM format). The images from the water and contrast swallows were inverted, synchronized, and subtracted to visualize the bolus in each frame. The pathway of the bolus was divided into 15 parts traversing the oropharynx, hypopharynx, and upper esophagus, and the total gray value was measured in each section. The results were presented as contour graphs. RESULTS: The contour graphs allowed for information on the size, anatomical location, and temporal location of the bolus during swallowing to be displayed simultaneously. Two distinct swallowing patterns were observed in the subjects. The bolus showed two peaks-one in the hypopharynx and one in the upper esophagus-in all subjects. However, in nine of the 15 subjects, the two peaks were in different frames, whereas in six of the subjects, the two peaks were in the same frame. CONCLUSION: We developed a new method for quantitatively evaluating swallowing. The technique allows for multidimensional assessment of the size, position, and temporal profile of the movement of the bolus across the pharynx. This method evaluates the swallowing movements using sharp, high-resolution images obtained by serial-shot, pulsed fluoroscopy with low radiation exposure. Additional studies are required to further clarify the variability of swallowing patterns and their clinical relevance in the evaluation of swallowing movements in healthy subjects and in patients with swallowing disorders.


Asunto(s)
Trastornos de Deglución/diagnóstico por imagen , Deglución , Esófago/diagnóstico por imagen , Fluoroscopía/métodos , Hipofaringe/diagnóstico por imagen , Orofaringe/diagnóstico por imagen , Adulto , Medios de Contraste , Trastornos de Deglución/fisiopatología , Esófago/fisiología , Femenino , Voluntarios Sanos , Humanos , Hipofaringe/fisiología , Masculino , Orofaringe/fisiología
15.
Eur J Orthod ; 41(1): 101-108, 2019 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-30184085

RESUMEN

Background: Upper airway analysis is an often-cited use of CBCT imaging by orthodontists; however, the reliability of airway measurements using this technology is not fully established. Objective: To determine the intra-examiner and inter-examiner reliability of the complete process of volumetric and cross-sectional area assessments of the upper airway using CBCT imaging. Materials and Methods: Six examiners of varying levels of education and clinical experience performed the steps necessary for airway analysis, including manual orientation, slice and threshold selection and measured nasopharyngeal, oropharyngeal, hypopharyngeal and total upper pharyngeal airway volumes in addition to minimum cross-sectional area on the CBCT images of 10 patients. All measurements were repeated after 4-weeks. Intra- and inter-examiner reliability was calculated using ICC and 95% CI. Results: Threshold selection showed poor intra- and poor inter-examiner reliability, whereas minimum cross-sectional area showed moderate intra- and poor inter-examiner reliability. Intra-examiner reliability of volumetric measurements varied based on the region assessed with ICC ranging from 0.747 to 0.976, and was worst for hypopharynx and best for the oropharynx. Inter-examiner reliability of volume measurements was generally lower, with ICC ranging from 0.175 to 0.945, and was worst for nasopharynx and best for the oropharynx. Conclusions: This study, for the first time, assessed the reliability of upper airway analysis with CBCT when all steps of image processing and measurement are performed by each examiner. Reliability improved with examiner experience, though was generally low for the hypopharynx and nasopharynx volumes and overall minimal cross-sectional area. The oropharyngeal volume was the only parameter to have excellent intra- and inter-examiner reliability.


Asunto(s)
Tomografía Computarizada de Haz Cónico/normas , Faringe/anatomía & histología , Faringe/diagnóstico por imagen , Adulto , Competencia Clínica , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Variaciones Dependientes del Observador , Orofaringe/anatomía & histología , Orofaringe/diagnóstico por imagen , Radiografía Dental/métodos , Reproducibilidad de los Resultados
16.
Vet Radiol Ultrasound ; 60(3): E24-E28, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-28726346

RESUMEN

A 4-year-old Border collie was presented with one episode of collapse, altered mentation, and a suspected pharyngeal stick injury. Magnetic resonance imaging (MRI) and computed tomography showed a linear foreign body penetrating the right oropharynx, through the foramen ovale and the brain parenchyma. The foreign body was surgically removed and medical treatment initiated. Complete resolution of clinical signs was noted at recheck 8 weeks later. Repeat MRI showed chronic secondary changes in the brain parenchyma. To the authors' knowledge, this is the first report of the advanced imaging findings and successful treatment of a penetrating oropharyngeal intracranial foreign body in a dog.


Asunto(s)
Lesiones Encefálicas/diagnóstico por imagen , Perros/lesiones , Cuerpos Extraños/veterinaria , Traumatismos Penetrantes de la Cabeza/veterinaria , Orofaringe/diagnóstico por imagen , Animales , Diagnóstico Diferencial , Cuerpos Extraños/diagnóstico por imagen , Traumatismos Penetrantes de la Cabeza/diagnóstico por imagen , Imagen por Resonancia Magnética/veterinaria , Masculino , Tomografía Computarizada por Rayos X/veterinaria
17.
Braz J Otorhinolaryngol ; 85(2): 213-221, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29764740

RESUMEN

INTRODUCTION: Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. OBJECTIVE: The objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children. METHODS: This retrospective study included 25 mouth-breathing children aged 5-9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements. RESULTS: The intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p<0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p<0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction. CONCLUSIONS: (1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.


Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico por imagen , Respiración por la Boca/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Cavidad Nasal/diagnóstico por imagen , Nasofaringe/diagnóstico por imagen , Orofaringe/diagnóstico por imagen , Puntos Anatómicos de Referencia , Niño , Preescolar , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Cavidad Nasal/anatomía & histología , Nasofaringe/anatomía & histología , Orofaringe/anatomía & histología , Valores de Referencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Estadísticas no Paramétricas
18.
Audiol., Commun. res ; 24: e2114, 2019. tab
Artículo en Portugués | LILACS | ID: biblio-1038762

RESUMEN

RESUMO Este estudo teve por objetivo descrever o desempenho longitudinal da deglutição orofaríngea em indivíduo com distrofia miotônica tipo 1. Estudo de caso único de indivíduo de 66 anos, sexo masculino, com diagnóstico neurológico em 2010. Realizou a primeira avaliação clínica e objetiva da deglutição após quatro anos do diagnóstico neurológico. Foram realizadas sete avaliações objetivas da deglutição, por meio de videoendoscopia de deglutição, nas consistências pastosa, líquida espessada e líquida, com 3, 5, 10 ml, durante o processo de diagnóstico e gerenciamento da deglutição, por um ano e dois meses. Foram analisados sensibilidade laríngea, escape oral posterior, resíduos faríngeos, por meio da Yale Pharyngeal Residue Severity Rating Scale, penetração laríngea e/ou aspiração laringotraqueal, com aplicação da Penetration-Aspiration Scale (PAS). Constatou-se, durante o período de estudo, que não houve alteração na sensibilidade laríngea. Escape oral posterior, resíduos faríngeos e penetração laríngea estiveram presentes desde o início das avaliações objetivas. Após quatro meses da primeira avaliação, na consistência pastosa, o nível de resíduos faríngeos passou de vestígio residual para moderado, em recessos piriformes, já em valéculas, e o aumento no índice da gravidade evidenciou-se no último mês. Houve aumento na PAS em todas as consistências de alimento testadas. A presença de aspiração laringotraqueal ocorreu com líquido ralo, no último mês. Durante o período de acompanhamento da deglutição orofaríngea na distrofia miotônica tipo 1, os resíduos faríngeos e a penetração laríngea estiveram presentes desde o início das avaliações, porém, a aspiração laringotraqueal somente ocorreu no último mês do acompanhamento, com líquido ralo.


ABSTRACT The purpose of the present study was to describe the longitudinal performance of oropharyngeal swallowing in individuals with type 1 myotonic dystrophy. A single case report of a 66-year-old man with a neurological diagnosis in 2010. He was submitted to his first clinical and objective evaluation of swallowing four years after the neurological diagnosis. Seven objective evaluations of swallowing were performed by fiberopitic endoscopic evaluation of swallowing using pureed food, thickened liquid and liquid consistencies (3, 5, and 10 ml) during the diagnosis and management of swallowing over a period of one year and two months. Laryngeal sensitivity, oral spillage and pharyngeal residues were evaluated using the Yale Pharyngeal Residue Severity Rating Scale, and laryngeal penetration and/or laryngotracheal aspiration were determined using the Penetration-Aspiration Scale (PAS). No change in laryngeal sensitivity was observed during the study period, whereas oral spillage, pharyngeal residues and laryngeal penetration were observed since the beginning of the objective evaluations. Four months after the first evaluation, the level of pharyngeal residues of pureed consistency changed from trace to moderate in piriform recess, and in the vallecula the increase in the severity index was demonstrated in the last month. There was an increase in PAS score for all consistencies tested. Laryngotracheal aspiration occurred with thin liquid in the last month. During the follow-up of oropharyngeal swallowing in myotonic dystrophy type 1, pharyngeal residues and laryngeal penetration were present since the beginning of the evaluations, but laryngotracheal aspiration occurred only in the last month of follow-up and with thin liquid.


Asunto(s)
Humanos , Masculino , Anciano , Orofaringe/diagnóstico por imagen , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/diagnóstico por imagen , Endoscopía , Distrofia Miotónica , Estudios Longitudinales , Debilidad Muscular , Enfermedades Neurodegenerativas
19.
Acta Med Okayama ; 72(6): 611-614, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30573918

RESUMEN

The oropharynx is examined with a light source such as an electric light, a penlight, or a forehead mirror based on an acquired visual field using a tongue depressor. However, it is extremely difficult to obtain objective and reproducible images of tissue within the pharynx required in recent years with these methods, and insufficient progress in the examination tools has been made. There is an increasing need to develop a method for display during oropharyngeal examination. We conducted the present study to develop a novel oropharyngeal endoscope as an objective observation method.


Asunto(s)
Endoscopios , Diseño de Equipo , Orofaringe/diagnóstico por imagen , Orofaringe/patología , Otolaringología/instrumentación , Protocolos Clínicos , Humanos
20.
Am J Orthod Dentofacial Orthop ; 154(6): 780-787, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30477775

RESUMEN

INTRODUCTION: Identifying the location and value of the smallest airway dimension can be useful in screening and planning treatment for patients with obstructive sleep apnea. Our objectives in this study were to (1) objectively identify the vertical location and value of the minimum sagittal linear dimension (MSLD) on 2-dimensional reconstructed lateral cephalograms (RLCs), (2) compare the location and value of the MSLD on RLCs with the vertical location and sagittal dimension of the minimum cross-sectional area (MCSA), and (3) investigate the association between the MSLD on RLCs and both the MCSA and the airway volume. METHODS: Cone-beam computed tomography (CBCT) scans of 91 patients, in 3 age groups (<20, 20-40, and >40 years), were used to perform 3-dimensional assessments of the upper airway and reconstruct lateral cephalograms. Airway volume, MCSA, vertical level, and sagittal dimension of MCSA on the CBCT scans were obtained using Dolphin 3D software (version 11.7; Dolphin Imaging, Chatsworth, Calif). Customized software was used to objectively obtain the location and value of the MSLD of the airway on RLCs. RESULTS: In all age groups, correlation tests showed significant correlations between the MSLD on RLCs and both the MCSA (rs ≥0.59; P <0.001) and the airway volume (rs ≥0.37; P <0.05). Additionally, there were significant correlations between the vertical location of the MSLD and the vertical location of the MCSA (rs ≥0.41; P <0.05) and between the MSLD and the sagittal dimension of the MCSA (r ≥0.61; P <0.001). Bland-Altman plots for the MSLD and the sagittal dimension of the MCSA showed much narrower 95% limits of agreement compared with the Bland-Altman plots for the vertical locations of the MSLD and the MCSA. CONCLUSIONS: Two-dimensional images may be used as a screening tool and to identify the sagittal dimension of the smallest airway dimension. However, comprehensive assessment of airway characteristics is better achieved with CBCT-based 3-dimensional evaluation.


Asunto(s)
Cefalometría , Tomografía Computarizada de Haz Cónico , Imagenología Tridimensional , Orofaringe/anatomía & histología , Orofaringe/diagnóstico por imagen , Apnea Obstructiva del Sueño/diagnóstico por imagen , Apnea Obstructiva del Sueño/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Planificación de Atención al Paciente , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos
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