The aim of this study was to evaluate swallowing, speech and quality of life in patients undergoing surgery for malignant tumors involving soft palate. We performed a cross sectional study of 23 patients (aged 32-80 years), submitted to soft palate resection, free of disease for at least 1 year. Primary closure of the surgical defect was performed in 5 patients (21.7 %), adaptation of a palatal obturator prosthesis in 2 (8.7 %), myocutaneous flap in 5 (21.7 %), local flap in 2 (8.7 %) and microsurgical free flap in 9 (39.1 %). All patients were submitted to fibreoptic endoscopic evaluation and completed functional and quality of life questionnaires. Functional evaluation of swallowing showed higher prevalence of pooling of food in the nasopharynx in patients submitted to regional flap reconstruction or primary closure (53.9 %). Swallowing difficulties were predominantly related to solid foods (54.5 %) and were associated with more extensive palatal resections. Most individuals submitted to reconstruction with microsurgical flaps had satisfactory velopharyngeal mobility (87 %). The presence of nasal air escape or velopharyngeal gap was minimal in most of the sample. Hypernasality contributed minimally to imprecisions in speech articulation or intelligibility. Vocal alteration did not impact patients' quality of life. Pharyngeal phase of swallowing was satisfactory in most patients. However, nasal reflux and penetration were present in a few patients. Most patients had minimal phono-articulatory alterations as a global outcome. Scores of swallowing and speech parameters regarding the questionnaires used were high, demonstrating minor impact on quality of life.
The purpose of this study was to identify the risk factors associated with the masticatory dysfunction after maxillectomy using a colour-changing chewing gum. Thirty-nine patients who underwent maxillectomy between January 2002 and May 2010 in the Department of Kobe University Hospital were recruited for this study. There were 20 male and 19 female subjects, with a median age of 73·3 years (range of 44-90) at the time of surgery. The intra-oral conditions after maxillectomy were classified by HS classification, and the masticatory function was evaluated by a colour-changing chewing gum and the results of a modified Sato’s questionnaire. The scores of the colour-changing gum were closely correlated with the scores of the modified Sato’s questionnaire (r = 0·661, P < 0·01). A logistic regression analysis with the outcome variable of the gum test <4 demonstrated that significant predictors for the masticatory dysfunction were the number of anchor teeth ≤2 and a soft palate defect. A colour-changing gum was found to be useful for evaluating the post-operative masticatory function, and it was important to conserve the anchor teeth and the soft palate to avoid masticatory dysfunction.
OBJECTIVE: To determine the feasibility, complications, and clinical outcome of consecutive free trapezius flap transfers in 20 dogs and a wallaby. STUDY DESIGN: Case series. ANIMALS: Dogs (n = 20) and 1 wallaby METHODS: Medical records of 20 dogs and 1 wallaby that had free trapezius flap transfers were evaluated retrospectively for indications, date of transfer, site of flap relocation, flap composition (myocutaneous, muscular, myoosseus), recipient artery and veins, flap ischemia times, surgery time, antithrombotic strategies used, intra- and postoperative complications related to the flap, hospitalization, in hospital duration after flap transfer, and outcome. RESULTS: Free flap transfers (16 muscle, 4 myocutaneous, 1 myoosseus) were used to treat traumatic soft tissue loss (13), neoplasm excision (2), osteomyelitis (4), and soft palate reconstruction (2); all flaps survived. Anti-thrombotic therapy was used in all cases although strategies varied. Postoperative complications were infrequent, generally of low severity, and primarily included donor site seroma formation and infection. CONCLUSIONS: Free trapezius flap was successfully used in 21 consecutive cases for a wide variety of reconstructive techniques with good, functional long-term outcome.
We review the appearance of scleroma in the head and neck on imaging. Scleroma is a chronic granulomatous disease that primarily affects the nasal cavity, but the pharynx and larynx may also be involved. On imaging, nasal scleroma appears as bilateral or unilateral expanded homogeneous nasal masses that may exhibit hyperintense signal on T(1) weighted images. Pharyngeal scleroma commonly narrows the pharyngeal lumen and may involve the soft and hard palate. Imaging is essential to detect the extent of subglottic stenosis in patients with laryngeal scleroma. Rarely, scleroma may involve the orbit or the middle ear. Imaging is essential for the early diagnosis of scleroma and for differentiating it from other granulomatous and neoplastic lesions. Also, imaging is important for treatment planning and follow-up of patients after therapy.
The aim of this prospective study was to characterise patient characteristics and the histories of cats with acquired nasopharyngeal stenosis (ANS), and to describe the use of a removable silicone stent for treatment. ANS was diagnosed in 15 cats with clinical signs present for a median of 4 months. Clinical signs included stertor and inspiratory difficulty, nasal discharge, sneezing, dysphagia, regurgitation, vomiting and anorexia. Radiographs revealed a dorsal deviation or deformation of the caudal part of the soft palate in 10 of the cats, a soft tissue density across the cranial nasopharynx in four and no abnormality in one. The stenosis was initially dilated with a Kelly forceps in 10 of the cats and by balloon dilatation in five. A segment of a 24 Fr silicone thoracic catheter was used for the stent in five cats; in the other 10 cats a segment of a 28 Fr catheter was used. The stent was removed after 3 weeks in 12 cats and after 4 weeks in the other three. Endoscopy revealed an adequate nasopharyngeal diameter in all of the cats. At both 3 and 10 months after surgery the response was considered to be satisfactory, with complete resolution of clinical signs in 14 cats and improvement in the remaining cat. The treatment of ANS by stenosis dilatation followed by temporary stenting with a silicone stent is a rapid, safe, economical and effective procedure.
A 59-year-old woman with a history of diabetes, hypertension, and multiple previous strokes presented for evaluation. She had had acute onset of imbalance and difficulty speaking 2 years earlier. Examination revealed a constant, jerky movement of the soft palate, shown in a video.
Temnospondyls were the morphologically and taxonomically most diverse group of early tetrapods with a near-global distribution during the Palaeozoic and Mesozoic. Members of this group occupied a range of different habitats (aquatic, amphibious, terrestrial), reflected by large morphological disparity of the cranium throughout their evolutionary history. A diagnostic feature of temnospondyls is the presence of an open palate with large interpterygoid vacuities, in contrast to the closed palate of most other early tetrapods and their fish-like relatives. Although the function of the interpterygoid vacuities has been discussed in the past, no quantitative studies have been performed to assess their biomechanical significance. Here, we applied finite element analysis, to test the possibility that the interpterygoid vacuities served for stress distribution during contraction of the jaw closing musculature. Different original and theoretical skull models, in which the vacuities differed in size or were completely absent, were compared for their mechanical performance. Our results demonstrate that palatal morphology played a considerable role in cranial biomechanics of temnospondyls. The presence of large cranial vacuities were found to offer the dual benefit of providing additional muscle attachment areas and allowing for more effective force transmission and thus an increase in bite force without compromising cranial stability.
We present the case of unanticipated airway ignition during hard palate biopsy. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and monopolar diathermy were utilised for the procedure, during which an arc arose from the diathermy tip to a titanium implant, causing a brief ignition on the monopolar diathermy grip. This case highlights the need for maintained awareness of fire risk when using diathermy in the presence of THRIVE during airway surgery.
A 45-year-old woman presented to a clinic in rural Uganda with a 1-year history of a progressively enlarging ulcerated mass on the hard palate. The mass had initially been painless but recently had become painful and was causing difficulty in speaking and swallowing.
The most common benign tumour of the major salivary glands is the pleomorphic adenoma. They are seen rarely in the minor salivary glands, usually in hard palate, soft palate and nasopharynx. Pleomorphic adenomas in nasal cavity are unusual and may be misdiagnosed because they have predominant myoepithelial cellularity and fewer myxoid stromata compared with those elsewhere. We present a case of 38-year-old male with a 2-year history of left nasal obstruction and epistaxis since 6 months. Diagnostic nasal endoscopic examination showed a soft lobulated mass in left nasal cavity attached to anterior part of the septum. Radiological examination demonstrated soft tissue mass filling left nasal cavity with an eroded septum. The biopsy from the mass was suggestive of pleomorphic adenoma and was resected endoscopically. Histopathological examination was consistent with pleomorphic adenoma. These are rare tumours of the nasal cavity and can be managed effectively with the endoscopic approach.