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1.
Artigo em Chinês | MEDLINE | ID: mdl-32086898

RESUMO

Objective:To determine whether taking spirolactone orally after H-UPPP may relieve laryngeal edema and complications for patients with obstructive sleep apnea(OSA). Method:Fifty patients with OSA to undergo H-UPPP operation were randomly divided equally to the intervention group(taking spirolactone 20 mg orally twice a day for 7 days after H-UPPP) or the control group, all patients received conventional therapy after H-UPPP including anti-infection, hemostatic treatment, fluid replacement and expectorant by fogged absorption. The pharyngeal wound, diet, sleep and speaking pronunciation of all patients in each group were evaluated every other day in 7 days postoperation. The minimum oxygen saturation of blood(SaO2) during sleep at night each day and the period needed for staphyledema resolution of all patients were recorded and compared between each group. Result:Postoperatively, the intervention group had significantly slighter bleeding at wound site, better sleep and more legible speaking pronunciation than the control group after 3 days to 5 days(P<0.05). The wound dehiscence of the intervention group was significantly slighter than the control group within 7 days after operation(P<0.05). During 3 days to 7days after operation, the intervention group had a significantly better diet than the control group(P<0.05). The average minimum SaO2during sleep at night in the intervention group was significantly higher than that in the control group from 3 days to 5 days post operation(P<0.05). Period needed for staphyledema resolution in the intervention group(4.1±1.5) days was significantly shorter than that in the control group(5.9±1.8) days (P<0.05). Conclusion:Taking spirolactone orally after H-UPPP may relieve laryngeal edema and complications for OSA patients, and it will also shorten the period needed for staphyledema resolution.


Assuntos
Edema Laríngeo/tratamento farmacológico , Apneia Obstrutiva do Sono/cirurgia , Espironolactona/uso terapêutico , Humanos , Palato Mole/cirurgia , Faringe/cirurgia , Úvula/cirurgia
2.
Medicine (Baltimore) ; 99(4): e18648, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977854

RESUMO

RATIONALE: Micrognathia is a subtle facial malformation characterized by a small mandible and receding chin. Fetal micrognathia is often associated with chromosomal abnormalities, skeletal dysplasia, and various syndromes. Once it is dignosised, detailed fetal malformation screening and chromosome examination should be carried out. PATIENT CONCERN: One pregnant woman with suspicion of fetal micrognathia was referred from her local hospital to our hospital for detailed fetal malformation screening and fetal echocardiography. Examination of the fetus was performed using a two-dimensional and three-dimensional ultrasound probe in multiple planes. The fetus showed micrognathia without glossoptosis with features of the inferior facial angle (IFA) ≤50° and his tongue reached anterior mandibular border box during normal movement. DIAGNOSES: The fetus was diagnosed as isolated micrognathia prenatally without multisystem abnormalities. INTERVENTIONS: Amniocentesis was performed and the fetus was found to carry 46XN with 6q14.1 duplication, the significance of which was unclear. OUTCOMES: The fetus was labored through vagina at 38 weeks gestation. A small soft cleft palate was diagnosed after delivery. LESSONS: This case suggests that once prenatal diagnosis of the fetal micrognathia has been made, we should carefully examine the presence of fetus's multisystem developmental abnormalities and due consideration should be given for associated soft cleft palate.


Assuntos
Micrognatismo/diagnóstico , Ultrassonografia Pré-Natal/métodos , Amniocentese , Fissura Palatina/complicações , Fissura Palatina/diagnóstico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Micrognatismo/complicações , Micrognatismo/diagnóstico por imagem , Palato Mole/anormalidades , Gravidez
3.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 37(6): 626-630, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31875441

RESUMO

OBJECTIVE: To explore the prognostic factors affecting the primary surgical management of aged patients with cleft palate. METHODS: This study reviewed aged patients with cleft palate who received Furlow palatoplasty (surgical age≥5 years) at the cleft center at West China Hospital of Stomatology from 2009 to 2014. The study retrieved intraoperative mea-surements, including velar length, pharyngeal depth, cleft width, maxillary width, cleft palate index, and palatopharyngeal ratio. Speech evaluation results at follow-up at least a year after surgery were also obtained. Logistic regression and retrospec-tive analyses were performed to identify correlative prognostic factors. RESULTS: One hundred and thirty-one patients were included (70 males and 61 females). Dichotomy logistic regression analysis revealed that pharyngeal depth was the only mea-surement considerably associated with postoperative velopharyngeal function. Pharyngeal depth deeper than 16 mm indicated high risk of postoperative velopharyngeal insufficiency. CONCLUSIONS: Pharyn-geal depth is a significant prognostic factor for the primary surgical management of aged patients with cleft palate. Pharyn-goplasty might be considered when planning the primary management of aged patients.


Assuntos
Fissura Palatina , Insuficiência Velofaríngea , Pré-Escolar , China , Feminino , Humanos , Masculino , Palato Mole , Faringe , Estudos Retrospectivos , Resultado do Tratamento
4.
Vet J ; 253: 105392, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685131

RESUMO

Brachycephalic dog breeds are prone to breathing difficulties because of their upper airway anatomy. Several surgical techniques exist to correct anatomical pathologies and common surgical approaches aim to correct functional abnormalities in the nares and/or the soft palate. However, further research is needed to improve clinical outcomes. This study evaluated air pressure and airflow resistance in the upper airways and trachea in nine sedated, sternally recumbent dogs of different skull types (dolichocephalic, n=3; mesocephalic, n=3; brachycephalic, n=3). CT images were acquired from the nostrils to the caudal border of the lungs and geometrical reconstruction of the upper airway and trachea was performed. Analysis of computational fluid dynamics was performed using inspiratory flow adapted to bodyweight for each dog. Flow (L/min) and pressure (cmH2O) were computed for the entire upper airway and trachea. Resistance (cmH2O/L/min) was calculated using pressure differences between the nose, larynx, and trachea. In this pilot study, statistical comparisons were not performed. Pressure maps, airflow, and resistance were similar in dolichocephalic and mesocephalic breeds. Median pressure difference (3.76cmH2O) and resistance (0.154cmH2O/L/min) between the nose and larynx were numerically higher in brachycephalic dogs than in other breeds (0.45cmH2O and 0.016cmH2O/L/min, respectively). Median pressure difference (0.205cmH2O) and resistance (0.009cmH2O/L/min) between the larynx and trachea was numerically similar in all dogs, except for the English bulldog. The methodology used in this preliminary study to quantify airflow characteristics such as pressure and resistance could improve the understanding of brachycephalic obstruction airway syndrome.


Assuntos
Obstrução das Vias Respiratórias/veterinária , Resistência das Vias Respiratórias , Craniossinostoses/veterinária , Doenças do Cão/fisiopatologia , Palato Mole/anormalidades , Obstrução das Vias Respiratórias/fisiopatologia , Animais , Craniossinostoses/fisiopatologia , Cães , Feminino , Masculino , Palato Mole/fisiopatologia , Linhagem
5.
Vet J ; 253: 105391, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685136

RESUMO

Brachycephalic obstructive airway syndrome (BOAS) is a common disorder presenting enlarged soft palate, stenotic nares and abnormal turbinate growth. Surgical correction of BOAS abnormalities with caudal palatoplasty is an elective therapy. This prospective study aimed to compare the effect of an air plasma device and diode laser in dogs undergoing palatoplasty. Outcome measures were as follows: (1) intra-operative and immediate post-operative complications; (2) evaluation of thermal injury in histological tissue sections of the excised soft palate. Twenty dogs with enlarged soft palates underwent palatoplasty, using an air plasma device (n=10) and diode laser (n=10). Soft palate specimens underwent masked histopathological analysis to assess post-operative thermal injury. In this pilot study, no differences were observed in surgical times; all dogs were discharged 24h after surgery and had stable respiration. In the air plasma group, post-operative bleeding occurred in two cases and revision surgery was performed. No difference in thermal injury was observed using the two devices (P>0.05). The air-plasma device was a viable surgical option for palatoplasty in dogs with BOAS.


Assuntos
Obstrução das Vias Respiratórias/veterinária , Queimaduras/veterinária , Craniossinostoses/veterinária , Doenças do Cão/cirurgia , Lasers Semicondutores/efeitos adversos , Palato Mole/anormalidades , Obstrução das Vias Respiratórias/cirurgia , Animais , Craniossinostoses/cirurgia , Cães , Feminino , Masculino , Palato Mole/patologia , Projetos Piloto , Complicações Pós-Operatórias/veterinária , Estudos Prospectivos , Resultado do Tratamento
6.
Plast Reconstr Surg ; 144(5): 1150-1157, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688762

RESUMO

BACKGROUND: The present study examined risk factors associated with 30-day palatoplasty complications based on analysis of national data. METHODS: Primary palatoplasties were identified in the 2012 to 2015 Pediatric National Surgical Quality Improvement Program database. Cases were analyzed with multivariate regression to investigate predictors for wound healing complications, additional ventilation requirement, prolonged stay (>3 days), and readmission. RESULTS: In 3616 operations, mean age was 12.2 months and operative time was 135.4 minutes. The 30-day complication rate was 7.6 percent overall, including wound dehiscence/infection (3.4 percent), additional ventilation requirement (2.0 percent), and readmission (2.4 percent); 5.1 percent of patients required prolonged stays. Wound healing complications were not predicted by comorbidities. American Society of Anesthesiologists class 3 or greater (OR, 2.8; p = 0.033), neuromuscular disorder (OR, 3.5; p = 0.029), and nutritional support (OR, 2.9; p = 0.035) predicted additional ventilation requirement. Prolonged stays were predicted by requiring additional ventilation (OR, 14.7; p < 0.001) or American Society of Anesthesiologists class 3 or greater (OR, 1.8; p = 0.047), but preoperative ventilator dependence was protective (OR, 0.1; p = 0.012). Mean hospital stay was 1.6 days without an airway complication versus 5.0 days with. Readmissions were increased for patients requiring nutritional support (OR, 2.6; p = 0.025). CONCLUSIONS: This study represents one of the largest cohorts of palatoplasty patients analyzed to date. It identifies what can be learned from a nonspecific 30-day registry regarding cleft outcomes and, from its limitations, discusses what the future of cleft outcomes research might entail. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Fissura Palatina/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Respiração Artificial/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Fissura Palatina/diagnóstico , Estudos de Coortes , Bases de Dados Factuais , Análise Fatorial , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação , Modelos Logísticos , Masculino , Análise Multivariada , Palato Duro/cirurgia , Palato Mole/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(47): e17958, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764797

RESUMO

STUDY DESIGN: clinical results of A STROBE-compliant retrospective study OBJECTIVE:: To achieving adequate pharyngeal closure and improve the pharyngeal function by a modified two-flap palatoplasty. SUMMARY OF BACKGROUND: Excessive tension in soft palate is the main factor causing the dysphonia after cleft palate. The tension-free suture of the soft palate is the key to achieving adequate pharyngeal closure. In this paper, a modified two-flap palatoplasty improved the pharyngeal function METHODS:: From August 2016 to December 2017, 20 patients with cleft palate were treated with a modified two-flap palatoplasty of the posterolateral symmetrical mucosal relaxation incision. The mucosal relaxation incision was performed on both posterolateral sides of the soft palate. RESULTS: All cases had good healing of mucosal flap and the palate. All patients underwent endoscopic examination at 6 months after operation. The postoperative results were satisfactory, with no complications. Twelve patients had bilateral exudative otitis media before operation, 4 patients returned to normal postoperatively, and 8 patients underwent bilateral tympanic membrane catheterization; 2 patients had abnormal function of bilateral eustachian tube before operation and returned to normal postoperatively; 3 patients had unilateral exudative otitis media before operation, and all of them returned to normal; the acoustic impedance test was normal in 3 children before operation. Most children begin to learn to speak, parents are satisfied with their pronunciation, and 3 children are in speech rehabilitation due to unclear pronunciation. CONCLUSIONS: We propose a technique to improve the function of the velopharyngeal closure which effectively reduces the incidence of pharyngeal insufficiency and occurrence of operative correction of pharyngeal closure dysfunction. The modifed two-flap palatoplasty with posterior lateral symmetric mucosal relaxation incision is beneficial for better velopharyngeal closure.


Assuntos
Fissura Palatina/cirurgia , Palato Mole/cirurgia , Retalhos Cirúrgicos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Muco , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos
9.
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1525-1530, set.-out. 2019. graf
Artigo em Português | LILACS, VETINDEX | ID: biblio-1038645

RESUMO

A fenda palatina é a comunicação entre a cavidade oral e a nasal através de um orifício no palato. Tem diversas etiologias, podendo ser congênita, traumática, por deficiência mineral ou por fatores hormonais. O diagnóstico é realizado por meio de exame físico da cavidade oral, e a correção cirúrgica é o tratamento de escolha. Em animais adultos, pode ser corrigida com o auxílio de retalho mucoperiosteal, apresentando bons resultados. Já em filhotes, a correção cirúrgica é mais complicada, com prognóstico menos favorável. Este trabalho relata o caso de um canino, fêmea, sem raça definida, adulta, com histórico de fenda palatina secundária, de origem traumática, no palato mole por ingestão de osso. Para a correção cirúrgica, primeiramente foi utilizada membrana biológica de pericárdio bovino, mas não se obteve êxito. O segundo procedimento foi realizado com retalho mucoperiosteal simples autólogo e, dois meses após o procedimento, já havia cicatrização completa. A técnica de retalho mucoperiosteal simples autólogo se mostrou eficaz no tratamento da fenda palatina, aliada aos cuidados adequados no pós-operatório.(AU)


The cleft palate is the communication between the oral and nasal cavity through an aperture in the palate, it's causes include an infinitude of factors: congenital, traumatic, mineral deficiency or hormonal. Examination of the oral cavity determines if the diagnosis and treatment is surgical. Correction in adult animals is performed with mucoperiosteal flap showing good results. However, surgical correction in puppies is more complicated with less favorable prognosis. This current work reports a case of an adult, female dog of undefined breed, with a history of secondary clef palate of traumatic origin in the soft palate due to bone ingestion. For correction, a biological membrane of bovine pericardium was used, but it was not successful, requiring a second surgical procedure performed with autologous simple mucoperiosteal flap. The last technique combined with adequate postoperative care was effective.(AU)


Assuntos
Animais , Feminino , Cães , Palato Mole/lesões , Retalhos Cirúrgicos/cirurgia , Retalhos Cirúrgicos/veterinária , Fissura Palatina/cirurgia , Fissura Palatina/reabilitação , Fissura Palatina/veterinária
10.
J Craniofac Surg ; 30(7): 2245-2248, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31513038

RESUMO

BACKGROUND: In cleft palate, surgery is necessary for recovering important functions of the normal palate, such as speech and feeding. Herein, a three-dimensional (3D) scanning program with an intraoral scanner was used to evaluate the palate status of patients with cleft palate before palatoplasty. Further, a 3D cleft palate printed model of the patients' palate using 3D printing technology was produced. METHODS: Three patients with cleft palate were included (1 male and 2 female patients with a mean age of 13 months). Extended scanning from the maxillary arch to the soft palate was conducted, without any direct contact of the scanner with the tissues of the palatal area. The maxillary arch dimensions and cleft size of the scanned data were measured using a 3D analysis software. After all 3D analyses, the scanned data were printed to a 3D cleft model, which was used as a training and simulation model. RESULTS: The overall contour and size of the cleft were observed on the scanned 3D images. There was a large inter-individual range in the cleft dimensions among the subjects. Double-opposing Z-plasty was then simulated on the printed 3D cleft palate model completely. CONCLUSIONS: The present study concentrated on the possibility of an intraoral scanner as a novel diagnostic tool for recording data of patients with cleft palate; 3D cleft palate models created using 3D printers can be used as training models for surgical trainees.


Assuntos
Fissura Palatina/diagnóstico por imagem , Impressão Tridimensional , Fissura Palatina/cirurgia , Feminino , Humanos , Imagem Tridimensional/métodos , Lactente , Masculino , Maxila/diagnóstico por imagem , Palato Mole/diagnóstico por imagem , Software
11.
Shanghai Kou Qiang Yi Xue ; 28(3): 317-320, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31489423

RESUMO

PURPOSE: To investigate the difference of radiological measurements between difficult-to-intubate obstructive sleep apnea hypopnea syndrome(OSAHS) patients and easily-to-intubate ones, and explore the feasibility of cephalometry in predicting difficult intubation. METHODS: Thirty male OSAS patients who received general anesthesia underwent cephalometrics before operation. Mallampati grade was used to evaluate the intubating condition of all patients before endotracheal intubation. After awake intubation and general anaesthesia, Cormack and Lehane laryngoscope grade was used to confirm the difficult-to-intubate patients and easily-to-intubate ones. The difficult-to-intubate patients were set into group I (n=13), the easily-to-intubate patients were set into group II (n=17). X-ray cephalometric radiographs were scanned into computer, 22 cephalometric parameters were measured with CASSOS 2001 cephalometric software. The measured items included hard tissue of maxilla and mandible, soft tissue of tongue and soft palate, airway space, hyoid and other parameters. SPSS13.0 software package was used for independent sample t test. RESULTS: The interface length of tongue and soft palate (CL), the tongue length (TGL) and the hyoid-mental distance (H-MP) were significantly different between the two groups (P<0.05). In difficult-to-intubate OSAS patients, the tongue area (TA) was larger, the soft palate length (PNS-U) was longer, the Atlanto-occipital gap (AOG) was shorter, but the difference was not significant. CONCLUTIONS: X-ray cephalometric indicators closest associated with difficult intubation in OSAHS patients are CL, TGL and H-MP, which are instructive for predicting difficult intubation.


Assuntos
Cefalometria , Intubação Intratraqueal , Apneia Obstrutiva do Sono , Humanos , Masculino , Palato Mole , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico por imagem
12.
Shanghai Kou Qiang Yi Xue ; 28(2): 201-203, 2019.
Artigo em Chinês | MEDLINE | ID: mdl-31384910

RESUMO

PURPOSE: To explore a safe, effective and functional surgical treatment for children of Pierre Robin sequence (PRS) with cleft palate. METHODS: Twelve children of PRS with cleft palate underwent mandibular distraction osteogenesis before cleft palate surgery in order to correct severe hypoxia. A modified palatoplasty was then performed, the palatal flaps on both sides were not elevated in the anterior portions to prevent soft palate backward moving, and the levator veli palatini was repositioned simultaneously. RESULTS: All children achieved velopharyngeal closure without dyspnea after follow-up of 10-12 months. CONCLUSIONS: Measures should be taken to avoid backward movement of the soft palate, which may result in dyspnea of children with PRS in palatoplasty.


Assuntos
Fissura Palatina , Osteogênese por Distração , Síndrome de Pierre Robin , Criança , Fissura Palatina/cirurgia , Humanos , Osteogênese por Distração/métodos , Palato Mole , Síndrome de Pierre Robin/cirurgia , Retalhos Cirúrgicos
13.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(7): 801-804, 2019 Jul 28.
Artigo em Chinês | MEDLINE | ID: mdl-31413219

RESUMO

OBJECTIVE: To evaluate therapeutic effect of combined injection of salvizanolic acid B with triamcinolone acetonide on the treatment of the soft palate with oral submucous fibrosis.
 Methods: Salvizanolic acid B combined with triamcinolone acetonide was consecutively applied once a week for 30 weeks for 33 patients with middle and later periods of oral submucous fibrosis. The response rate of color change in the soft palate and the increase of capillary vessels (determined by degree I-IV visual analog scale) were evaluated at the 12th, 24th, and 36th months after 30 weeks treatment.
 Results: Thirty-three patients were fulfilled the study without obvious adverse reactions and they were followed up for 24 months, while 31 patients were followed up for 36 months. The color change in the soft palatal mucus and the increase of capillary vessels at the 36th month follow-up after treatment were significantly better than those at the 12th month (P=0.004).
 Conclusion: Combined injection of salvizanolic acid B with triamcinolone acetonide in the treatment of the soft palate with oral submucous fibrosis is effective.


Assuntos
Fibrose Oral Submucosa , Triancinolona Acetonida/uso terapêutico , Glucocorticoides , Humanos , Fibrose Oral Submucosa/tratamento farmacológico , Palato Mole , Resultado do Tratamento
14.
J Craniofac Surg ; 30(5): e454-e460, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299813

RESUMO

BACKGROUND: Velopharyngeal insufficiency is a feared complication of adenoidectomies in patients with palatal abnormalities. Thus, the benefits of adenoidectomy in this population are less understood. The techniques of partial adenoidectomy aim to preserve velopharyngeal closure while sufficiently debulking the nasal airway to ameliorate obstruction and snoring. METHODOLOGY: Systematic review of online databases using a combination of search terms including "cleft palate," "submucosal cleft palate," "short palate," "adenoidectomy," "partial adenoidectomy," "subtotal adenoidectomy," and "powered adenoidectomy." Two independent reviewers assessed the eligibility of each study based on predefined inclusion criteria. RESULTS: From 323 studies identified, 8 were included. All were retrospective case series, except 1 prospective study. Study period ranged from 1.1 to 14 years (median 7.5 years). There were 172 patients with a cleft palate (n = 80), submucous cleft palate (n = 67) or another defined palatal abnormality [short soft palate (n = 14), bifid uvula (n = 4), questionable palatal mobility (n = 4) or incomplete CP (n = 3)] identified. Mean age was 5.5 years and just over half were male (58%). Nearly all patients showed improvement in nasal airway obstruction and snoring. The pooled risk for velopharyngeal insufficiency across all studies was 2 out of 122, which approximates to 1.6% of patients. There were very few complications. CONCLUSION: This is the first systematic review of partial adenoidectomy in patients with palatal abnormalities. Sub-total adenoidectomy in patients with submucosal cleft palate or repaired cleft palate appears to be a safe and efficacious procedure. There is; however, a need for prospective data collection using a standardized technique in large patient series required to properly assess outcomes.


Assuntos
Adenoidectomia , Fissura Palatina/cirurgia , Adenoidectomia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Obstrução Nasal/cirurgia , Nasofaringe , Palato Mole , Estudos Prospectivos , Ronco , Insuficiência Velofaríngea/cirurgia
15.
J Craniofac Surg ; 30(5): e469-e474, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299819

RESUMO

BACKGROUND: Respiratory system is an important section in development of maxillofacial components and many studies indicated its effect on normal growth of the jaws. The aim of this study is to evaluate upper airway in different skeletal classifications of jaws in lateral cephalogram and its relation to age and gender. MATERIALS AND METHODS: Study samples were 105 digital cephalometric radiographies, 72 females and 33 males. Lateral cephalograms were hand traced and based on Stainer analysis, there were 30 samples in Class I, 30 samples in Class II and 45 samples in Class III subgroup. Vertical linear measurements, horizontal linear measurements, and angular measurement, proportions and space measurements of the airway in the Cephalograms were analyzed by AutoCAD software. RESULTS: Data were analyzed using SPSS software version 20. Two horizontal linear measurement (the hypo pharyngeal airway depth, the nasopharyngeal airway depth) and one space measurement (soft palate space) were significantly different in skeletal classes. Vertical and horizontal linear measurements in the 3 groups were increased significantly in men rather than women. The developmental age of groups showed some significant differences. CONCLUSION: Upper airway dimension is different in different skeletal classes, developmental ages, and gender.


Assuntos
Nariz , Cefalometria/métodos , Feminino , Humanos , Arcada Osseodentária , Masculino , Má Oclusão , Nasofaringe , Palato Mole , Faringe
16.
Acta Otolaryngol ; 139(9): 793-797, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268381

RESUMO

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular comorbidities including hypertension, arteriosclerosis, and heart failure. Uvulopalatopharyngoplasty (UPPP) is a frequently performed surgical treatment for OSA. Aims/Objectives: To analyze if UPPP can improve cardiac parameters associated with atherosclerosis and reduce the cardiac burden in OSA patients. Material and methods: A prospective cohort study was performed at a single tertiary care center where OSA patients undergoing UPPP were evaluated. Preoperative and 6-month postoperative cardiac parameters namely carotid artery intima-media thickness (CIMT), arterial stiffness parameters, echocardiography, and polysomnography (PSG) results were compared. Results: Fifty three patients were included in the study. The success and response rate of UPPP was 60.4%. Following the surgery, significant reduction in arterial stiffness index (ß) (12.4 ± 4.1 vs. 11.2 ± 4.0, p = .01), and elasticity modulus (Ep) (172.8 ± 68.3 vs. 156.6 ± 55.3, p = .05) was noticed. Additionally, echocardiographic parameters namely velocity across aortic valve (121.9 ± 22.9 vs. 109.4 ± 17.7, p = .01) and velocity across pulmonary valve (107.4 ± 16.4 vs. 94.2 ± 16.9, p < .01) significantly decreased following UPPP. Conclusions and significance: UPPP significantly improves parameters related to carotid atherosclerosis and has the potential to reduce cardiac burden in OSA patients.


Assuntos
Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia , Adulto , Aterosclerose/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Espessura Intima-Media Carotídea , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole/cirurgia , Faringe/cirurgia , Polissonografia/métodos , Estudos Prospectivos , Medição de Risco , Apneia Obstrutiva do Sono/diagnóstico , Centros de Atenção Terciária , Resultado do Tratamento
17.
J Laryngol Otol ; 133(7): 622-626, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31288877

RESUMO

BACKGROUND: Barbed pharyngoplasty aims to reduce lateral retropalatal obstruction by pulling up the soft palate anterolaterally. However, barbed pharyngoplasty can be less efficient in some cases of obstructive sleep apnoea, especially in the presence of an elongated uvula with redundant tissues over it. This paper describes an attempt to overcome this drawback by modifying barbed pharyngoplasty, using a single continuous suture technique. METHODS: Thirty-four patients were assigned to two groups based on the surgical procedure performed. Those with an elongated uvula were treated with modified barbed pharyngoplasty (n = 17); the others were treated with barbed pharyngoplasty (n = 17). Pre- and post-operative quality of life questionnaires, and questionnaires concerning diet, pain and return to activity, were completed. Pre- and post-operative polysomnography was performed as an objective measurement. RESULTS: There was no significant difference between barbed pharyngoplasty and modified barbed pharyngoplasty in terms of outcomes. However, reductions in the apnoea/hypopnea index, Epworth Sleepiness Scale and snoring visual analogue scale scores were greater in the modified barbed pharyngoplasty group. CONCLUSION: Modified barbed pharyngoplasty is a safe and feasible method, and eliminates the need for surgical resection of the redundant soft tissues around the uvula while lifting up the uvula base.


Assuntos
Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole , Estudos Prospectivos , Qualidade de Vida , Técnicas de Sutura , Resultado do Tratamento
18.
Br J Oral Maxillofac Surg ; 57(7): 694-696, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31239228

RESUMO

Unilateral soft palate paralysis is rare. No cases of unilateral soft palate paralysis with associated velopharyngeal insufficiency (VPI) secondary to minor blunt neck trauma have been reported to date. This case details the presentation of a man with isolated unilateral soft palate paralysis and associated velopharyngeal insufficiency following a collision with an opponent when playing soccer.


Assuntos
Lesões do Pescoço , Palato Mole/fisiopatologia , Paralisia/complicações , Insuficiência Velofaríngea/etiologia , Ferimentos não Penetrantes , Adolescente , Fissura Palatina , Humanos , Masculino , Pescoço
19.
Otolaryngol Head Neck Surg ; 161(3): 401-411, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31184261

RESUMO

OBJECTIVES: To evaluate the long-term efficacy and potential predictors of uvulopalatopharyngoplasty (UPPP) among adult patients with obstructive sleep apnea (OSA). DATA SOURCES: A systematic search was conducted through PubMed/Medline, Embase, Web of Science, and the Cochrane Library until December 2018. REVIEW METHODS: Full-text articles were selected that studied adult patients who underwent single-level UPPP or its modification for OSA and had a long-term follow-up (at least 34 months) with objective sleep study results. Studies that had no objective outcomes or performed other surgical procedures for OSA were excluded. RESULTS: Of 2600 studies, 11 were included. Meta-analysis comparing long-term post- and preoperative outcomes showed significant improvements, with an 15.4 event/h (46.1%) decrease of apnea-hypopnea index. Compared with the short-term outcomes (3-12 months), the long-term outcomes were less effective, with apnea-hypopnea index increasing 12.3 events/h (63.8%) and the surgical response decreasing from 67.3% to 44.35%. Subanalysis of individual patient data showed significant correlations of baseline body mass index, lowest arterial oxygen saturation, and proportion of sleep time with oxygen saturation <90% with long-term surgical response. CONCLUSIONS: Despite the surgical efficacy decreasing over time, UPPP and its modification are an effective surgical method for adult OSA in both the short term and the long term after the surgery. Baseline body mass index, lowest arterial oxygen saturation, and proportion of sleep time with oxygen saturation <90% were potentially predictive for long-term surgical response. Case-control studies of the long-term surgical effect of OSA are needed.


Assuntos
Palato Mole/cirurgia , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia , Adulto , Humanos , Resultado do Tratamento
20.
J Craniofac Surg ; 30(7): 1990-1993, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31205277

RESUMO

Palatal fistulae represent a pathological connection from the oral cavity through the hard or soft palate to the nasal cavity and can present a significant reconstructive dilemma. Surgical correction of palatal fistulae is often limited by prior treatment, including ablative procedures and radiotherapy, or previous reconstructive attempts. In light of these challenges, the nasoseptal flap represents an excellent adjacent source of vascularized tissue which may be suitable for palatal fistula repair with minimal donor site morbidity, low associated risks, and a short recovery period. The purpose of this study was to fully understand the potential utility of this reconstructive option, including the ability to harvest a composite flap including both septal cartilage and contralateral mucoperichondrium. In this single institution prospective study consisting of a series of 5 cadaver dissections, primary outcome measures were the anterior reach of the flap as compared to the anterior nasal spine and the size of the palatal defect that the nasoseptal flap could be used to successfully reconstruct. Composite flaps were successfully harvested in continuity with a disc of septal cartilage and contralateral mucoperichondrium, providing structural integrity to the reconstruction and the ability to anchor the flap to the native hard palate mucosa. The nasoseptal flap's maximum anterior reach was within 2.0 cm (standard deviation of 0.1 cm) from the anterior nasal spine and could reliably reconstruct palate defects of 2.5 cm or less. The nasoseptal flap provides a viable regional option for reconstructing defects of the hard palate. Prospective clinical trials are needed to investigate long-term reconstructive and functional outcomes of the composite nasoseptal flap in palatal reconstruction.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Cadáver , Fissura Palatina/cirurgia , Dissecação , Feminino , Humanos , Masculino , Cavidade Nasal/cirurgia , Nariz/cirurgia , Palato Mole/cirurgia , Estudos Prospectivos
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