Impaired knee extension muscle strength in adolescents but not in children with Fontan circulation.

INTRODUCTION: Impaired isometric muscle strength was previously reported in adults with Fontan circulation. However, it is unclear if this impairment is present in children and adolescents with Fontan circulation. We investigated isometric muscle strength of the lower limb in patients (6-18 years) with Fontan circulation in comparison with healthy controls. METHOD: In this cross-sectional study, 43 patients (6-18 years) with Fontan circulation and 43 age- and sex-matched controls were included. Isometric knee extension and plantar flexion muscle strength were assessed using dynamometry (Newton, N). Lean mass of the legs was assessed with dual-energy X-ray absorptiometry. Analyses were performed on group level (n = 43), and for subgroups that included children aged 6-12 years (n = 18) and adolescents aged 13-18 years (n = 25). RESULTS: On group level, the patients with Fontan circulation had impaired isometric knee extension strength in comparison with the controls (p = 0.03). In subgroup analyses, impaired isometric knee extension strength was present in the adolescents (p = 0.009) but not in the children groups. For plantar flexion, there was no difference between patients and controls. There was no difference in lean mass between patients and controls (9.6 ± 4.3 kg vs. 10.8 ± 5.6 kg, p = 0.31). However, the lean mass was highly correlated to isometric knee extension strength (patients r = 0.89, controls r = 0.96, p < 0.001) and isometric plantar flexion strength (patients r = 0.7, controls r = 0.81, p < 0.001). CONCLUSION: The finding of impaired isometric knee extension muscle strength in adolescents (13-18 years) with Fontan circulation and no corresponding impairment in the children group (6-12 years) could imply that isometric muscle strength gets more impaired with age.

Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death.

AIMS: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. METHODS: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. RESULTS: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more often than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. CONCLUSION: The clinician's awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom.

Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study.

We recently found craniofacial pain to be the sole symptom of an acute myocardial infarction (AMI) in 4% of patients. We hypothesized that this scenario is also true for symptoms of prodromal (pre-infarction) angina. We studied 326 consecutive patients who experienced myocardial ischemia. Intra-individual variability analyses with respect to ECG findings and pain characteristics were performed for those 150 patients who experienced at least one recurrent ischemic episode. AMI patients (n=113) were categorized into two subgroups: "abrupt onset" (n=81) and "prodromal angina" (n=32). Age, gender and risk factor comparisons were performed between groups. Craniofacial pain constituted the sole prodromal symptom of an AMI in 5% of patients. In those who experienced two ischemic episodes, women were more likely than men to experience craniofacial pain in both episodes (p<0.01). There was no statistically significant difference between episodes regarding either ECG findings or the use of the two typical pain quality descriptors "pressure" and "burning". This study is to our knowledge the first to report that craniofacial pain can be the only symptom of a pre-infarction angina. Craniofacial pain constitutes the sole prodromal AMI symptom in one out of 20 AMI patients. Recognition of this atypical symptom presentation is low because research on prodromal AMI symptoms has to date studied only patients with chest pain. To avoid a potentially fatal misdiagnosis, awareness of this clinical presentation needs to be brought to the attention of clinicians, researchers and the general public.

En un estudio previo encontramos que un dolor en la región cráneo-facial puede ser el único síntoma de un infarto agudo de miocardio (IAM) en el 4% de los casos. En el presente trabajo la hipótesis fue que este escenario es cierto también para la angina pre-infarto o angina prodrómica. En el estudio se incluyeron 326 pacientes consecutivos con isquemia cardiaca sintomática. Se realizó un análisis intraindividual con respecto a características del dolor y hallazgos electrocardiográficos en los 150 pacientes que presentaron episodios recurrentes de isquemia cardiaca. Los pacientes con infarto agudo se categorizaron en dos grupos: "comienzo abrupto" (n=81) y "angina prodrómica" (n=32). Se realizaron comparaciones entre grupos con respecto a edad, género y factores de riesgo cardiovasculares. El dolor en la región cráneofacial constituyó el único síntoma prodrómico (pre-infarto) de un IAM en el 5% de los casos. En aquellos pacientes que experimentaron dos episodios isquémicos, las mujeres tuvieron una mayor prevalencia de dolor cráneo-facial en los dos episodios (p<0.01). No se detectaron diferencias estadísti cas entre episodios con respecto a hallazgos electrocar dio grá ficos o al empleo de los descriptores verbales del dolor de origen cardíaco "opresivo" y "quemante". Este es el primer estudio de investigación en documentar que el dolor en la región cráneo-facial puede ser el único síntoma de una angina pre-infarto. En efecto, esto ocurre en uno de cada 20 casos de IAM. El reconocimiento de esta presentación clínica es baja debido a que históricamente los criterios de inclusión de los estudios de angina pre-infarto incluyeron únicamente pacientes con dolor de pecho. Para evitar el error diagnóstico con consecuencias fatales para el paciente, es importante que esta información llegue tanto a los clínicos como al público en general.

Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study / El dolor cráneo-facial puede ser el único síntoma prodrómico de un infarto agudo de miocárdio: estudio interdisciplinario

We recently found craniofacial pain to be the sole symptom of anacute myocardial infarction (AMI) in 4% of patients. Wehypothesized that this scenario is also true for symptoms ofprodromal (pre-infarction) angina. We studied 326 consecutivepatients who experienced myocardial ischemia. Intra-individualvariability analyses with respect to ECG findings and paincharacteristics were performed for those 150 patients whoexperienced at least one recurrent ischemic episode. AMI patients(n=113) were categorized into two subgroups: “abrupt onset”(n=81) and “prodromal angina” (n=32). Age, gender and riskfactor comparisons were performed between groups. Craniofacialpain constituted the sole prodromal symptom of an AMI in 5% ofpatients. In those who experienced two ischemic episodes, womenwere more likely than men to experience craniofacial pain in bothepisodes (p<0.01). There was no statistically significant differencebetween episodes regarding either ECG findings or the use of thetwo typical pain quality descriptors “pressure” and “burning”. This study is to our knowledge the first to report that craniofacialpain can be the only symptom of a pre-infarction angina.Craniofacial pain constitutes the sole prodromal AMI symptomin one out of 20 AMI patients. Recognition of this atypicalsymptom presentation is low because research on prodromalAMI symptoms has to date studied only patients with chest pain.To avoid a potentially fatal misdiagnosis, awareness of thisclinical presentation needs to be brought to the attention ofclinicians, researchers and the general public.

En un estudio previo encontramos que un dolor en la región cráneo-facial puede ser el único síntoma de un infarto agudo de miocardio (IAM) en el 4 por ciento de los casos. En el presentetrabajo la hipótesis fue que este escenario es cierto también para la angina pre-infarto o angina prodrómica.En el estudio se incluyeron 326 pacientes consecutivos con isquemia cardiaca sintomática. Se realizó un análisis intraindividual con respecto a características del dolor y hallazgoselectrocardiográficos en los 150 pacientes que presentaron episodios recurrentes de isquemia cardiaca. Los pacientes con infarto agudo se categorizaron en dos grupos: “comienzoabrupto” (n=81) y “angina prodrómica” (n=32). Se realizaron comparaciones entre grupos con respecto a edad, género y factores de riesgo cardiovasculares. El dolor en la región cráneofacial constituyó el único síntoma prodrómico (pre-infarto) de un IAM en el 5 por ciento de los casos. En aquellos pacientes que experimentaron dos episodios isquémicos, las mujeres tuvieron una mayor prevalencia de dolor cráneo-facial en los dos episodios (p<0.01). No se detectaron diferencias estadísticas entre episodios con respecto a hallazgos electrocardiográ ficos o al empleo de los descriptores verbales del dolor de origen cardíaco “opresivo” y “quemante”.Este es el primer estudio de investigación en documentar queel dolor en la región cráneo-facial puede ser el único síntoma de una angina pre-infarto. En efecto, esto ocurre en uno decada 20 casos de IAM. El reconocimiento de esta presentación clínica es baja debido a que históricamente los criterios de inclusión de los estudios de angina pre-infarto incluyeron únicamente pacientes con dolor de pecho. Para evitar el error diagnóstico con consecuencias fatales para el paciente, es importante que esta información llegue tanto a los clínicos como al público en general.

Craniofacial pain of cardiac origin is associated with inferior wall ischemia.

AIMS: To investigate possible associations between the presence of craniofacial pain of cardiac origin and the location of cardiac ischemia and conventional risk factors. METHODS: A total of 326 consecutive patients with confirmed myocardial ischemia (192 males, 134 females, mean age 64 years) were studied. Demographic details, health history, factors, prodromal symptoms, electrocardiogram (ECG) findings, and pain characteristics during the ischemic episode were assessed. The location of the ischemia according to the ECG findings was categorized as anterior, inferior, or lateral. Univariate chi-square analyses and a multivariate logistic regression model were used for data analysis. Two age subgroups (< 65 and > 65) were established when controlling for covariates. RESULTS: Craniofacial pain of cardiac origin was significantly associated with an inferior localization of cardiac ischemia (P < .001) and was more frequently reported in diabetic patients (P = .014). Thirty-eight patients (12%) did not experience chest pain during the myocardial ischemia. Nine patients (3%) experienced a prodromal angina episode without chest pain. CONCLUSION: The occurrence of craniofacial pain during myocardial ischemia, with or without an acute myocardial infarction, was associated with ischemia within the inferior wall. This result suggests the involvement of the vagal afferent system in the mechanisms of craniofacial pain of cardiac origin.

A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study.

OBJECTIVE: This study aimed to determine the incidence, prevalence, and progression of temporomandibular joint (TMJ) magnetic resonance (MR) imaging findings and symptoms in patients over a 15-year period after whiplash trauma, compared with control participants. STUDY DESIGN: Sixty consecutive patients were enrolled directly after whiplash trauma. The study protocol included TMJ MR imaging at inception and 15 years later, as well as a questionnaire and interview at inception, at 1-year follow-up, and at 15-year follow-up. Fifty-seven patients (95%) participated in all three examinations (85% for MR imaging). Fifty matched control participants were examined. RESULTS: The prevalence of TMJ symptoms was significantly higher in patients compared with control participants at inception (44% vs 20%, P = .0055) and remained significantly higher throughout the study period. The prevalence of disk displacement did not differ significantly between groups either at inception (63% vs 53%) or at 15-year follow-up (63% vs 55%). CONCLUSIONS: This prospective 15-year follow-up suggests that the development of TMJ symptoms, both immediate and delayed, is common in whiplash patients.

Temporomandibular joints in asymptomatic and symptomatic nonpatient volunteers: a prospective 15-year follow-up clinical and MR imaging study.

PURPOSE: To determine the incidence, prevalence, and progression of temporomandibular joint (TMJ) magnetic resonance (MR) imaging findings and symptoms during 15 years in adult asymptomatic and symptomatic volunteers (nonpatients). MATERIALS AND METHODS: A regional committee for medical research ethics approved the study, and informed volunteer consent was obtained. Fifty-three volunteers were examined at study inception. For clinical assessment, a self-administered questionnaire was given, followed by an interview with each volunteer at study inception, at 1 year later, and at 15 years later. Bilateral TMJ MR imaging and clinical examination were performed at inception and at 15-year follow-up. The MR images were assessed for disk position, bone status, and joint fluid. All 53 volunteers participated at 1-year follow-up, and 50 of 53 volunteers participated at 15-year follow-up; of these 50 volunteers, 47 underwent MR imaging. The Fisher exact test was used to determine differences between groups, and the Wilcoxon signed-rank test was used to determine differences in prevalence of TMJ symptoms among the three examination times. RESULTS: At study inception, TMJ disk displacement was observed in 31% of asymptomatic volunteers (nine of 29) compared with 89% of symptomatic volunteers (16 of 18, P < .001). Inceptive TMJ status was maintained after 15 years in 91% (43 of 47). Unilateral progression was observed in four volunteers (9%); one was symptomatic and three were asymptomatic. Progression involved development of new disk displacement (n = 1), development of new bone changes (n = 2), and aggravation from reducing to nonreducing disk displacement (n = 1). Prevalence of TMJ symptoms did not change significantly between examination times (P = .77). TMJ clicking was the most common clinical symptom. CONCLUSION: Volunteers with mild symptoms had a prevalence of disk displacement of the same magnitude as that reported in patients, although most volunteers, symptomatic as well as asymptomatic, maintained their TMJ status during 15 years.

Dolor cráneo-facial como síntoma aislado de isquemia cardíaca: estudio prospectivo y multicéntrico / Cranifacial pain as the sole system of cardiac ischemia: a prospective multicenter

Antecedentes. El dolor craneofacial puede ser el único síntoma de una isquemia cardíaca. El fracaso en reconocer el origen cardíaco de dicho dolor puede poner en riesgo la vida del paciente. Los autores realizaron un estudio para revelar la prevalencia, la distribución y las diferencias entre sexos en lo que respecta al dolor craneofacial de origen cardíaco. Métodos. Los autores seleccionaron de forma prospectiva pacientes consecutivos (n=186) que habían presentado un episodio isquémico cardíaco verificado. Estudiaron en detalle la localización y distribución del dolor craneofacial e intraoral. Resultados: El dolor cráneofacial fue el único síntoma durante el episodio isquémico en 11 pacientes (6 por ciento), tres de los cuales presentaron un infarto agudo de miocardio (IAM). Otros 60 pacientes (32 por ciento) comunicaron dolor cráneofacial concomitantemente a dolor en otras regiones. Las localizaciones más frecuentes del dolor cráneofacial fueron la garganta, la región mandibular izquierda, la región mandibular derecha, la articulación temporomandibular izquierda / oído y dientes. El dolor cráneofacial se manifestó de forma predominante en mujeres (P=0.031) y fue el síntoma dominante en ambos sexos en ausencia de dolor torácico. Conclusiones: El dolor cráneofacial es inducido frecuentemente por isquemia cardíaca. Esta causa debe tenerse en cuenta en el diagnóstico diferencial del dolor dental y orofacial. Implicaciones clínicas: Debido a que los pacientes que tienen un IAM sin dolor torácico corren un mayor riesgo de no ser correctamente diagnosticados y de muerte, el alerta del clínico sobre esta sintomatología, puede ser crucial para el diagnóstico precoz y un rápido tratamiento.

Background. Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient’s life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. Methods. The authors prospectively selected consecutivepatients (n = 186) with a verified cardiacischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. Results. Craniofacial pain was the only complaintduring the ischemic episode in 11 patients (6 per cent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 per cent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear regionand teeth. Craniofacial pain was preponderantly manifested in female subjects (P = 0.031) and was the dominating symptom in both sexes in theabsence of chest pain. Conclusions. Craniofacial pain commonly is induced by cardiac ischemia. This must beconsidered in differential diagnosis of toothache and orofacial pain. Clinical Implications. Because patients sufferingAMI without chest pain run a higher risk of missed diagnosis and death, the clinician’s awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

Accuracy of patients' recall of temporomandibular joint pain and dysfunction after experiencing whiplash trauma: a prospective study.

BACKGROUND: Researchers have conducted studies regarding whiplash-induced temporomandibular joint (TMJ) pain and dysfunction mainly under the presumption that patients' memory of symptoms remains accurate across time. In this prospective study, the authors aimed to determine the frequency of patients' inaccurate retrospective reports of TMJ pain and dysfunction after whiplash trauma. METHODS: The authors assessed TMJ pain and dysfunction in 60 patients consecutively seen in a hospital emergency department directly after the patients experienced whiplash trauma in rear-end automobile accidents. They followed up with 59 patients one year later. The participants completed a self-administered questionnaire followed by a comprehensive interview during both examinations. The study group consisted of the 40 patients who reported previous or current TMJ pain, dysfunction or both at either examination or at both examinations. RESULTS: The agreement between each patient's inceptive and retrospective reports of TMJ pain and dysfunction yielded a kappa value of 0.41 (95 percent confidence interval [CI] 0.18-0.64). Sixteen patients (40 percent, 95 percent CI 25-57 percent) had inaccurate recall. Recollection errors were addition, omission, and forward and backward telescoping. Seven patients incorrectly referred symptom onset to the accident. CONCLUSIONS: The high frequency of inaccurate recall of TMJ pain and dysfunction one year after whiplash trauma implies that clinicians and researchers should interpret with caution the results of previous studies that relied on retrospective data regarding whiplash-induced TMJ pain and dysfunction. CLINICAL IMPLICATIONS: To achieve valid long-term evaluations in clinical research, the patient's TMJ status should be established at the time of an accident.

Pharyngeal swallowing dysfunction following treatment for oral and pharyngeal cancer--association with diminished intraoral sensation and discrimination ability.

BACKGROUND: Swallowing disorders following treatment for oral and pharyngeal cancer are mainly considered a surgical sequel. The recent finding that radiotherapy-induced decline in intraoral sensory abilities established an incentive to elucidate any association between the degree of sensory decline and the degree of swallowing dysfunction. METHODS: Oral and pharyngeal swallowing was cineradiographically examined in 15 patients with oral or pharyngeal cancer before and after treatment. The patients were also tested for intraoral sensation, shape recognition, and hole size identification. RESULTS: Swallowing function deteriorated in 67% of the patients 6 months posttreatment, with no significant improvement after 12 months. The degree of swallowing dysfunction was statistically significantly associated with the degree of diminished intraoral sensation and shape recognition. CONCLUSION: In the quest for rehabilitation after treatment for oral and pharyngeal cancer, the impact of impaired intraoral sensation and discrimination ability on swallowing function should be taken into consideration.

Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study.

BACKGROUND: The Quebec Task Force on Whiplash-Associated Disorders urged for controlled, prognostic studies of symptoms after whiplash trauma. The authors conducted a study that met the design requirements to enhance knowledge about short-term and long-term temporomandibular joint (TMJ) pain, dysfunction or both induced by whiplash trauma. METHODS: The authors studied 60 consecutive patients who had neck symptoms after whiplash trauma and were seen at a hospital emergency department. They followed up 59 subjects one full year later. At the inceptive examination and at follow-up, each subject completed a self-administered questionnaire, followed by a comprehensive interview. Fifty-three frequency-matched control subjects followed the same protocol concurrently. RESULTS: The incidence of new symptoms of TMJ pain, dysfunction or both between the inceptive examination and follow-up was five times higher in subjects (34 percent) than in control subjects (7 percent). The frequency of TMJ pain increased significantly in female subjects, as did the frequency of TMJ symptoms that were reported to be the main complaint. At the follow-up, 20 percent of all subjects reported that TMJ symptoms were their main complaint. CONCLUSIONS: Our results suggest that one in three people who are exposed to whiplash trauma is at risk of developing delayed TMJ symptoms that may require clinical management. CLINICAL IMPLICATIONS: Awareness of a significant risk for delayed onset of TMJ symptoms after whiplash trauma is crucial for making adequate diagnoses, prognoses and medicolegal decisions.

Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study.

BACKGROUND: Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin. METHODS: The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail. RESULTS: Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was pre-ponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain. CONCLUSIONS: Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain. CLINICAL IMPLICATIONS: Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

Titanium screw implants in optimization of radiographic evaluation of facial growth in longitudinal animal studies.

The aim of this study was to develop a method that optimizes the reliability of longitudinal radiographic evaluation of small and fast-growing animals, such as the rabbit. Because the use of conventional cephalometric methods, including superimposition of serial radiographs, is more problematic in small animals than in humans, two titanium-alloy screws were placed 10 mm apart in the sagittal crest of the parietal bone in 10 growing New Zealand white rabbits. The anterior screw served as holder for a steel pin that, in turn, secured the fixation of the rabbit's head to a specially designed cephalostat. A lateral cephalogram of each animal was exposed on four occasions at one-month intervals. Computer-aided superimpositions were made of all four cephalograms from each animal using the screws in the calvarium as reference structures. To evaluate the method, the superimpositions were repeated after three to eight weeks, and the superimposition reproducibility was calculated. From the results, it can be concluded that the method allows congruent positioning of the animal skull relative to the film-focus assembly at repeated radiographic examinations. Furthermore, it introduces readily identified reference structures in the animal skull that can be used at high-precision superimposition of serial radiographs.

Intraoral sensation before and after radiotherapy and surgery for oral and pharyngeal cancer.

BACKGROUND: Patients with unilateral oral or pharyngeal cancer often receive bilateral radiotherapy because of the potential for metastases. Because postoperative sequelae are evident on the tumor side, to date little attention has been paid to sensory alterations after radiotherapy on the healthy, nontumor side. The objective of this study was to investigate possible sensory alterations. METHODS: Intraoral sensation was tested bilaterally at standardized sites in 27 patients and 20 controls. Preoperative radiotherapy was bilateral in 19 patients and unilateral in eight patients. Patients were tested before treatment, after radiotherapy, and after surgery at 6 months and 1 year. Comparisons were performed interindividually and intraindividually and between groups. RESULTS: A delayed deterioration of sensation was revealed on the nontumor side 6 months after radiotherapy. There was no recovery 1 year after treatment. CONCLUSIONS: Intraoral sensation cannot be evaluated directly after radiotherapy. It is plausible that sensory deterioration after radiotherapy has an impact on functional rehabilitation after tumor treatment.

Prediction and risk of dysphagia after uvulopalatopharyngoplasty and uvulopalatoplasty.

OBJECTIVE: To test the hypothesis that preoperative asymptomatic pharyngeal swallowing dysfunction predisposes for the development of symptoms of dysphagia after uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP). MATERIAL AND METHODS: A total of 42 patients who snored were scheduled to undergo UPPP (n = 20) or UPP (n = 22). UPP was performed using either a CO2 laser or a conventional steel scalpel. Preoperatively and 1 year postoperatively all patients were examined videoradiographically to assess pharyngeal swallowing function. They also completed a questionnaire pre- and postoperatively concerning their snoring problems and swallowing function as well as the outcome of surgery. RESULTS: Preoperatively, 7 (17%) patients reported dysphagia. Pharyngeal swallowing dysfunction was demonstrated in 6/7 patients with preoperative dysphagia while pharyngeal swallowing dysfunction was evident preoperatively in 18/35 non-dysphagic patients. Of the 35 patients without preoperative dysphagia, 10 (29%/) developed dysphagia after surgery. There was no significant risk of development of postoperative dysphagia for patients with compared to patients without preoperative pharyngeal swallowing dysfunction. Only one of the seven patients with preoperative dysphagia experienced worsening of the problem. A total of 93% of the patients reported a decrease in snoring and 95% reported a decrease in daytime sleepiness. CONCLUSIONS: Preoperative pharyngeal swallowing dysfunction was not proven to predict the development of dysphagia after UPPP or UPP. The surgical method did not influence the frequency of postoperatively acquired dysphagia. The results do not indicate that patients with preoperative dysphagia should be excluded from treatment with UPPP or UPP.