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PubMed1993

A modification of the Sanvenero-Rosselli velopharyngoplasty.

A modification of the cranially-pedicled velopharyngoplasty is described. It consists of the preparation of two mucosal flaps on the dorsal side of the soft palate. They are pedicled on the velar rim and sutured to the free part of the pharyngeal flap between its origin and the recipient bed. Advantages of the method comprise reliable healing, the breadth of the flap and an improved velopharyngeal occlusion with results which favourably influence speech.

Adult↗
PubMed1989

Preserving the pterygoid plates in posterior repositioning of the LeFort I osteotomy.

The pterygoid plates have to be fractured and displaced to allow the maxilla to be repositioned posteriorly in the Le Fort I push-back osteotomy. A technique to reposition the maxilla posteriorly while preserving the pterygoid plates and the greater palatine neurovascular bundle is described. This technique reduces the risk of damaging the internal maxillary artery and the internal jugular vein which can lead to excessive haemorrhage. The disturbance to the Eustachian apparatus is also minimized.

Humans↗
PubMed2001

Comprehensive management of cleft lip and palate deformities.

PURPOSE: The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. The goal of this article is to present a versatile, universal philosophy of management of these deformities involving early repair. PATIENTS AND METHODS: Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty at 3 months, followed by soft and hard functional palatoplasty at 9 months. RESULTS: All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla. When early gingivoperiosteoplasty was performed in 25% of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition. This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal. CONCLUSION: Optimal rehabilitation of the patients was achieved by following the principles and treatment strategies described. If the treatment principles are not incorporated in the functional repair (ie, joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected.

Child↗
PubMed2000

Evolution of methods of uranostaphyloplasty exemplified by the analysis of 1118 primary operations for congenital palatal defects.

Of a total of 1118 uranostaphyloplasties in a maxillofacial hospital in Kiev, 819 have been operated on since 1980 by a new technique; 424 (52%) of these were in children under the age of 3 years. Analysis of the anatomical and the functional results of the operation, anthropometric studies, and data on logopaedic training showed that the proposed method of uranostaphyloplasty (cleft-palate repair) was effective both anatomically and functionally.

Age Factors↗
PubMed1987

[The importance of x-ray cinematography of deglutition for indicating the need for myotomy of the pharyngoesophageal sphincter].

Fourteen patients were examined one to four years after cricopharyngeal myotomy that had been carried out because of dysfunction of the pharyngo-esophageal sphincter. Twelve patients were examined radiologically. Eleven of the 14 patients were clinically improved or cured. In two patients who were not improved, the underlying condition was a polymyositis. The other patients suffered from an idiopathic dysfunction. Because of the small numbers involved, no detailed statistical analysis was carried out. Nevertheless, our results indicate that: Cricopharyngeus myotomy produces marked improvement or cure in patients with idiopathic dysfunction. Weak propulsive peristalsis of the pharyngeal constrictors is a prognostic factor indicating a poor clinical result of surgery. There is little chance of clinical improvement in patients with polymyositis.

Cineradiography↗
PubMed1993

Effects of sedation produced by thiopentone on responses to nasal occlusion in female adults.

To test the hypothesis that full wakefulness is an important factor in the control of the route of breathing in adult humans, we have studied the responses to nasal occlusion before and during sedation with thiopentone in 14 female subjects. A tightly fitting partitioned face mask separated the nasal and oral breathing routes. Nasal and oral breathing were identified from changes in carbon dioxide concentration and airway pressure in the different compartments of the face mask. Arterial oxygen saturation (SpO2) was monitored simultaneously. Eleven of 14 subjects breathed only through the nose (nasal breathers) both before and during sedation. In these subjects, the time required to initiate oral breathing in response to nasal occlusion during sedation was significantly longer than that before sedation (mean 37.7 (SD 15.5) s vs 3.2 (1.3) s (P < 0.01)). Also, there was a significant difference (P < 0.01) in the smallest values of SpO2 attained during nasal occlusion before (98.0 (0.8)%) and after (89.3 (4.3)%) sedation. In adult humans the ability to maintain adequate ventilation by switching from the nasal to the oral route in response to nasal occlusion is greatly impaired during sedation, probably because of the impairment of conscious influence on the control of the palatal muscles.

Adult↗
PubMed2004

Progressive ataxia and palatal tremor (PAPT): clinical and MRI assessment with review of palatal tremors.

Palatal tremor has been subdivided into essential (EPT) and symptomatic palatal tremor (SPT). A subgroup of the SPT form has a syndrome of progressive ataxia and palatal tremor (PAPT). Published details of cases of PAPT are sparse and the disorder appears heterogeneous. We present clinical and MRI features of six patients with sporadic PAPT who attended The University Health Network between 1991 and 2002. Eye movements were recorded using a magnetic search coil technique. We review previously reported cases of PAPT from the English language literature and relate this disorder to EPT and SPT. PAPT may be divided into sporadic and familial forms. We identified 22 other prior reported cases of sporadic PAPT. Sporadic PAPT is a subtype of SPT in which progressive cerebellar degeneration is the most symptomatic feature. A combination of vertical nystagmus and palatal tremor was found in one of our cases. Internuclear ophthalmoplegia, a new finding, was present in two of our patients and indicated additional brainstem dysfunction. Inferior olivary high signal abnormalities were present on MRI in all of our cases. The cause of sporadic PAPT remains uncertain. In some previous reports of sporadic PAPT, the combination of brainstem or pontine atrophy, parkinsonism, autonomic dysfunction or corticospinal tract abnormalities suggests a diagnosis of multiple system atrophy, although pathological verification is lacking. Familial PAPT is associated with marked brainstem and cervical cord atrophy with corticospinal tract findings, but the typical olivary MRI abnormalities have not been reported. A substitution in the glial fibrillary acidic protein (GFAP) gene has been described in a family with PAPT, raising the possibility of Alexander's disease. One other familial syndrome of PAPT, termed 'dark dentate disease', has also been reported. PAPT is a subgroup of SPT in which ataxia progresses and is not usually the result of a monophasic illness. Eye movement abnormalities suggest a disorder of both the cerebellum and brainstem. Familial PAPT differs from sporadic PAPT in having marked atrophy of cervical cord and brainstem with corticospinal signs but without hypertrophic olivary appearance on MRI.

Adolescent↗
PubMed2005

The 'essentials' of essential palatal tremor: a reappraisal of the nosology.

Essential palatal tremor (EPT) is an uncommon disorder, distinct from symptomatic palatal tremor (SPT), but characterized by superficially similar rhythmic movements of the soft palate. While the pathophysiology of SPT has been relatively well defined, this is not the case in EPT. Based on an analysis of 103 published cases, we reviewed EPT in the context of other movement disorders with similar features and outline possible pathophysiological mechanisms. Phenomenologically it remains best classified as a tremor. Four major causes, including a central generator, peripheral/mechanical, voluntary/special skill and psychogenic, appear to account for the majority of cases of EPT, although there is considerable overlap in the pathogenic mechanisms underlying these categories. Among the cases reviewed, a large proportion fit into the latter two categories, although there are others where multiple mechanisms are likely at play. Based on our reappraisal, we suggest a change in designation to 'isolated palatal tremor', with primary and secondary subtypes. This retains the distinction from SPT and emphasizes the non-uniform, heterogeneous nature of the disorder.

Adolescent↗
PubMed1983

Effects of levator retrodisplacement on conductive hearing loss in the cleft palate patient.

The effect of a levator retrodisplacement procedure upon conductive hearing loss in cleft palate patients was evaluated. Forty-two children with cleft palates, operated upon between 1970 and 1975, were included in the study. The results suggest that 73.5% of those in the levator retrodisplacement group achieved normal hearing, compared with 37.5% among those whose palatoplasties did not include levator retrodisplacement. The degree of hearing impairment in patients with levator retrodisplacement was mild (20 to 40 db) in contrast to that in patients without levator retrodisplacement, whose impairment was severe (40 to 60 db).

Cleft Palate↗
PubMed2004

Influence of the Furlow palatoplasty for patients with submucous cleft palate on facial growth.

The purpose of this study was to investigate the facial growth in patients with submucous cleft palate operated on using the Furlow palatoplasty. A total of 30 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 4 years and 3 months. Twenty-five of 30 patients were followed up. Mid-facial growth was measured using lateral cephalograms in 18 patients whose age was greater than 8 years. The parameters obtained in the lateral cephalogram were compared with those of a healthy population in Korea. Eleven (61.1%) of 18 patients observed were within the clinical normal range for the age group for the parameter of the span between the anterior nasal spine and posterior nasal spine, 6 patients (33.3%) were over the range, and 1 patient (5.6%) was below the range. For the sella-nasion-subspinale angle, 55.6% of patients were within the clinical normal range, 27.8% were over the range, and 16.6% were below the range. For the sella-nasion-supramentale angle, 55.6% of patients were within the clinical normal range, 22.2% were over the range, and 22.2% were below the range. For the sella-nasion-subspinale-sella-nasion-supramentale angle, 72.2% of patients were within the clinical normal range, 27.8% were over the range, and none were below the range. For the span between the basion and posterior nasal spine, 50.0% of patients were within the clinical normal range, 27.8% were over the range, and 22.2% were below the range. In conclusion, our results suggest that the Furlow palatoplasty is a useful procedure as an initial treatment of submucous cleft palate and that this technique has a less harmful effect on facial growth because there is no excessive surgical intervention on the hard palate and alveolar process.

Adolescent↗
PubMed1985

Comparison of electromyographic signals from different electrode placements in the palatoglossus muscle.

It is a general practice to insert a single electrode pair per muscle for electromyographic recording. The location of electrode insertion influences the character of the signal obtained. The objective of the experiment was to study the relationships between electromyographic signals recorded simultaneously from different locations in an anatomically simple muscle involved in speech production. Signals from three pairs of fine wire electrodes placed high, middle, and low in the palatoglossus muscle of five speakers of American English were amplified, rectified, and integrated. The data were analyzed statistically to determine the patterns of similarity and degree of independence among simultaneous signals from different sites in the muscle for a given speaker. The middle signal was most often the best, and the low signal was most often the poorest representative of the group of signals. The greatest similarity was found between the high and middle signals; next most similar were the middle and low signals. Similarity between signals varied with utterance. In some cases, the relationship between two signals varied over time. This variation may be due to change in interelectrode distance during anisometric contraction or to different motor unit firing patterns.

Biometry↗
PubMed2003

Awake negative pressure reflex response of the genioglossus in OSA patients and normal subjects.

We hypothesized that the response of the genioglossus to negative pressure during wakefulness should be intact in obstructive sleep apnea (OSA) patients despite published evidence showing impairment of the response of palatal muscles (Mortimore IL and Douglas NJ. Am J Respir Crit Care Med 156: 867-873, 1997). Thus the response of the genioglossus to brief nasal negative pressure applications (NPAs) in early inspiration was compared between OSA patients and an age-matched group of normal subjects at two study sites (n = 11 per group in Long Beach, n = 14 per group in Boston). Subjects were studied in the sitting (Long Beach) or supine (Boston) posture, and the genioglossus electromyogram (EMGgg) was measured with an intraoral surface electrode (Long Beach) or intramuscular electrode (Boston). The response of the EMGgg was expressed as the percent change from baseline where the baseline EMGgg was the value at the onset of the NPA. In Long Beach, the EMGgg response was significantly higher in the OSA patients at a lower suction pressure of approximately 10 cmH(2)O (75.2 +/- 8.4 vs. 37.4 +/- 4.0% increase; P < 0.001) but not at a higher suction pressure of approximately 20 cmH(2)O. In Boston, the response in the OSA patients was also greater (107.2 +/- 25.9 vs. 46.3 +/- 8.3%; P < 0.05) at a suction pressure of approximately 13 cmH(2)O. We conclude that the response of the genioglossus to NPA during wakefulness is not impaired in OSA patients compared with normal subjects and is greater at low suction pressures.

Adult↗