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Background: Adenotonsillar hypertrophy (ATH) is a major cause of pediatric obstructive sleep apnea (OSA), potentially impacting craniofacial growth and development. Currently, whether children with ATH exhibit distinctive hyoid bone position and upper airway morphology remains uncertain. This research aimed to compare the hyoid bone position and upper airway morphology of children with and without ATH. Methods: A total of 199 children aged 6–8 years were recruited for the study, and their pre-treatment lateral cephalograms were obtained. The size of the adenoids and tonsils on the lateral cephalogram was assessed based on Fujioka's and Baroni's methods for classification into groups: adenoid hypertrophy only (AHO) group, tonsillar hypertrophy only (THO) group, adenoid and tonsillar hypertrophy (AH + TH) group, and control group (CG). The position of the hyoid bone and upper airway morphology was analyzed using Dolphin Image Software. Results: The distance between the hyoid bone and mentum was greater in the THO group compared to the AHO group (P = 0.005). Children in the AHO group exhibited a longer soft palate (SPL) compared to the THO group (P = 0.014), whereas the THO group displayed a reduced SPL in comparison to healthy controls (P = 0.008). The THO group showed a more inferior tongue position compared to children in the AHO group (P = 0.004). Subjects in the THO group exhibited significantly wider inferior airway space compared to healthy children (P < 0.001). Conclusions: Adenotonsillar hypertrophy may be associated with hyoid bone position and upper airway morphology in children seeking for orthodontic treatment. In children with enlarged tonsils, the hyoid bone was positioned farther from the mentum than in those with enlarged adenoids. Conversely, children with enlarged adenoids had a longer soft palate compared to those with enlarged tonsils. [ABSTRACT FROM AUTHOR]

An encouraging outcome was described for the use of modified Furlow small double-opposing Z -plasty (sDOZ) using the medial incision (MIsDOZ) approach in repair of Veau type I cleft palate. This retrospective study assessed early results of using extended indication criterion of MIsDOZ for the management of consecutive non-syndromic patients with Veau II cleft palate treated by a single surgeon. Bardach two-flap plus sDOZ (two-flap approach) or medial incision approach with a tension-driven stepwise application of lateral palatal incisions (soft palate only, von Langenbeck type, or two-flap type) were applied. Surgical (age, cleft width, operative time, hospital stay, and complication)- and auditory-perceptual assessment-related data were collected. Two-flap approach (n = 21) demonstrated a significantly (p < 0.001) increased operative time (132.8 ± 12.2 versus 114.8 ± 19.9 min, respectively) and higher use of lateral incisions (100% versus 44.4%) than medial incision approach (n = 27), with no significant (p > 0.05) difference for age at surgery (13.0 ± 6.1 versus 13.6 ± 5.8 months), cleft width (8.5 ± 4.1 versus 8.7 ± 3.8 mm), hospital stay (1.0 ± 0 versus 1.0 ± 0 day), and complication (0% versus 0%) and hypernasality (9.5% versus 7.4%) rates. In conclusion, the medial incision approach for Veau II cleft repair resulted in reduced need for lateral palatal incision with no increase of complication or hypernasality rates. [ABSTRACT FROM AUTHOR]

Agenesis of soft palate is an extremely rare occurrence and is usually seen in conjunction with other congenital anomalies like Nager syndrome, Treacher Collins syndrome, and multiple congenital anomalies. Only a handful of isolated complete agenesis of one half of the soft palate has been reported in literature. Despite extensive literature review, incidence of such a case is practically unheard of. We present to you a case checking all the above boxes. We present this case of agenesis of right half of soft palate that was managed by our technique. [ABSTRACT FROM AUTHOR]

Choristomas are aggregates of microscopically normal tissues in aberrant locations. They can be cartilage, bone, glial tissue, salivary gland, and thyroid tissue. Cartilaginous choristomas of the oral cavity are rare and occur most commonly on the tongue and less often in sites such as the soft palate and gingiva. We report two cases of cartilaginous choristoma in young females presenting with recurrent tonsillitis. Histopathological examination showed the presence of mature island of hyaline cartilage surrounded by lymphoid hyperplasia. Level of Evidence: Level 4 [ABSTRACT FROM AUTHOR]

Tracheal tube introducers are commonly used by anaesthetists for airway management, especially in difficult cases. They are recommended in airway management guidelines and should be readily available in operating theatres, intensive care units, and emergency departments. Tracheal tube introducers are particularly useful with videolaryngoscopy, aiding in directing the tracheal tube tip towards the glottis. A systematic review of airway trauma associated with tracheal tube introducers found that the standard stylet was the most common introducer and had a higher incidence of airway injury compared to other introducers. However, the review had limitations in terms of study heterogeneity and risk of bias. The use of tracheal tube introducers should be considered thoughtfully, and further research is needed to compare different introducer devices and assess the frequency and severity of airway trauma. [Extracted from the article]

To search for the best available scientific evidence in relation to the reported overall and selective complication rates for arthroscopic surgery in patients presenting with internal derangement (ID) of the temporomandibular joint (TMJ). A comprehensive electronic search was conducted without data or language restrictions up to August 2023. Inclusion criteria were the following: study in humans, randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies and series of clinical cases. The proposed PICOS question was: "In clinical trials and retrospective clinical series of patients treated by arthroscopy, which were the overall and selective complication rates?" Exclusion criteria were animal studies, review papers, technical reports, and in vitro studies. The Cochrane Collaboration Tool was used to assess the risk of bias of the included studies in terms of their quality. The Strength of Recommendation Taxonomy (SORT) classification was used to determine the level of evidence of the selected studies. A total of 498 studies were identified. Of these, 16 studies fulfilled the inclusion criteria and were selected for qualitative assessment. Temporary 5th nerve deficit, ranging from 0.15% to 2.38%, was reported to occur in most larger series, comprising 7394 operated joints. Temporary 7th nerve paresis was reported to occur in 0.21%–0.7% in the largest series, comprising 6866 operated joints. Partial hearing loss was reported in 6 studies, ranging from 0.21% to 2.2% in 5845 operated joints. Edema of surrounding soft tissues, including parapharyngeal, soft palate and/or preauricular edema was reported in 8 studies, with complication rates ranging from 2% to 17.9% in 2274 operated joints. Laceration of the EAC was reported in 8 studies involving 2665 operated joints, with complication rates ranging from 0.3% to 6%. A total of 872 complicated events among 11,304 operated joints were reported, accounting for an overall complication rate of 7.71%. Complications from arthroscopic procedures have been inconsistently reported, but there are a small number of retrospective studies with well-reported complications rates. As overall complication rate accounts for less than 8% of the cases, arthroscopy seems to be a highly safe procedure for the treatment of internal derangement (ID) of the TMJ. Due to the absence of studies with high evidence, information for patients about complications should be based on clinical series of cases. [ABSTRACT FROM AUTHOR]

The study was focused on the anatomical characteristics of the Egyptian long-eared hedgehog's oral cavity by using gross and scanning electron microscopic examinations. The upper lip had an elongated T-shaped snout-like structure. The hard palate had a triangular rostral part (which had a semicircular area and a caudal ridged area with the first 3 or 4 ridges) and a caudal part (which contained seven or eight slightly oblique ridges with raphae). The diamond-incisive papilla is flanked on both sides by a groove and a fissure. The hard palate surface had glandular openings and a microplicae system. The uneven, soft palate's surface had multiple grooves and folds with 12–16 Gemmal papillae. The Gemmal papillary surface had three to four taste pores with microplicae and glandular openings. The dorsal lingual surface had six filiform subtypes: pointed (on the tip, rostral border, and median apical region), triangular (on the lateral apical and circumvallate regions), bifurcated (on the median tip only), leaf-like (on the median body region), branched (on the lateral root region), and small pointed papillae (on the median root). There were two fungiform subtypes: ovals (on the rostral border and lateral region) and rounds (on the median apical region and body). The caudal root part had a triangular arrangement of three circumvallate papillae. In conclusion, the finding confirmed its oral cavity adaptation with its insectivorous feeding habits and Egyptian environment. Highlight: The hard palate had a triangular rostral part (which was divided into a semicircular area and a caudal ridged area) and a caudal part (which contained seven or eight slightly oblique ridges). The diamond-incisive papilla is flanked on both sides by a groove and a fissure. The hard palate had glandular openings and a microplicae system. The uneven, soft palate's surface had multiple grooves and folds with 12–16 Gemmal papillae. The Gemmal papillary surface had three to four taste pores with microplicae and glandular openings. The dorsal lingual surface had six filiform subtypes: pointed, triangular, bifurcated, leaf-like, branched, and small pointed papillae. There are two fungiform subtypes: ovals (on the rostral border and lateral region) and rounds (on the median apical region and body). The caudal root part had a triangular arrangement of three circumvallate papillae. [ABSTRACT FROM AUTHOR]

AbstractEndoscopic nasopharyngectomy represents a significant intervention for recurrent nasopharyngeal carcinoma (NPC). Various surgical techniques, including transnasal and transoral approaches, are employed. However, the impact of these procedures on nasal airflow dynamics is not well understood. This computational fluid dynamics (CFD) study aimed to investigate alterations in nasal airflow and air conditioning following endoscopic nasopharyngectomy. A 55-year-old male patient with recurrent NPC was selected, whose CT data were utilized for image reconstruction. A preoperative model and two postoperative models, including the transnasal and transoral approach models, were established. The airflow patterns and various CFD parameters were analyzed. In the postoperative models, the high-speed airflow went along the soft palate and into the nasopharyngeal outlet, and there was the low-speed turbulence in the expanded nasopharyngeal cavity. Compared to the preoperative model, the postoperative models exhibited reductions in surface-to-volume ratio, nasal resistance, airflow velocity and proportion of high wall shear stress regions in nasopharynx. The changing trends of nasopharyngeal air temperature and humidity in the preoperative and transoral models were consistent. The heating and humidification efficiency decreased in the transnasal model compared to the transoral model. The endoscopic nasopharyngectomy for recurrent NPC affects the nasal airflow and warming and humidification function. The transoral approach has less influence on aerodynamics of the upper airway compared to the transnasal approach. From a CFD perspective, the endoscopic nasopharyngectomy does not increase the risk of postoperative complications, including the empty nose syndrome and the carotid blowout syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Atypical pleomorphic adenoma (PA) is an uncommon tumor, more frequent in submandibular and parotid glands. PA is classified as atypical when it presents hypercellularity, necrosis or hyalinization, dysplasia, capsular violation or distant metastases. Case Report: We described a case of a 39-year-old female presented with a slowly growing mass involving the soft palate. A life-threatening bleeding from PA with hemorrhagic shock occurred and required ligation of the external carotid artery with tracheotomy. A transoral en-bloc excision of the mass (70 x 50 x 40 mm) was performed. Pathological exam demonstrated an atypical PA, with hypercellular fields and myoepithelial and squamous differentiation. Conclusion: An appropriate diagnostic evaluation and a prompt intervention are essential to avoid dangerous complications, even for benign neoplasms. [ABSTRACT FROM AUTHOR]

Background: Metastatic tumors of the oro-facial tissuesare rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5–7th decades but possibly occurring at any age, metastases may represent the first sign of an occult cancer or manifest in patients with an already known history of a primary carcinoma, mostly from the lungs, kidney, prostate, and colon/rectum in males, and the uterus, breast, lung, and ovary in females. In the oro-facial tissues, the most involved sites are the oral mucosa, gingiva/jawbones, tongue, and salivary glands. Methods: A broad and deep literature review with a comprehensive analysis of the existing research on oro-facial metastases from renal-cell carcinoma (RCC) was conducted by searching the most used databases, with attention also paid to the clear-cell histological variant, which is the most frequent one. Results: Among the 156 analyzed studies, 206 cases of oro-facial metastases of renal cancer were found in patients with an average age of 60.9 years (145 males, 70.3%; 61 females, 29.6%). In almost 40% of the cases, metastasis represented the first clinical manifestation of the primary tumor, and 122 were histologically diagnosed as clear-cell renal-cell carcinoma (ccRCC) (59.2%). The tongue was involved in most of the cases (55 cases, 26.7%), followed by the gingiva (39 cases, 18.9%), mandible (35 cases, 16.9%), maxilla (23 cases, 11.1%), parotid gland (22 cases, 10.6%), buccal mucosa (11 cases, 5.3%), lips (7 cases, 3.3%), hard palate (6 cases, 2.8%), soft palate, masticatory space, and submandibular gland (2 cases, 0.9%), and lymph nodes, tonsils, and floor of the mouth (1 case, 0.4%). Among the 122 ccRCCs (84 males, 68.8%; 38 females, 31.1%), with an average age of 60.8 years and representing in 33.6% the first clinical manifestation, the tongue remained the most frequent site (31 cases, 25.4%), followed by the gingiva (21 cases, 17.2%), parotid gland (16 cases, 13.1%), mandibular bone (15 cases, 12.2%), maxillary bone (14 cases, 11.4%), buccal mucosa and lips (6 cases, 4.9%), hard palate (5 cases, 4%), submandibular gland and soft palate (2 cases, 1.6%), and lymph nodes, tonsils, oral floor, and masticatory space (1 case, 0.8%). The clinical presentation in soft tissues was mainly represented by a fast-growing exophytic mass, sometimes accompanied by pain, while in bone, it generally presented as radiolucent lesions with ill-defined borders and cortical erosion. Conclusions: The current comprehensive review collected data from the literature about the incidence, site of occurrence, age, sex, and survival of patients affected by oro-facial metastases from renal-cell carcinoma, with particular attention paid to the cases diagnosed as metastases from clear-cell renal-cell carcinoma, which is the most frequent histological variant. Clinical differential diagnosis is widely discussed to provide clinicians with all the useful information for an early diagnosis despite the effective difficulties in recognizing such rare and easily misdiagnosed lesionsTheir early identification represents a diagnostic challenge, especially when the clinical work-up is limited to the cervico–facial region. Nevertheless, early diagnosis and recently introduced adjuvant therapies may represent the key to better outcomes in such patients. Therefore, general guidelines about the clinical and radiological identification of oro-facial potentially malignant lesions should be part of the cultural background of any dentist. [ABSTRACT FROM AUTHOR]

Background: Palatal dysfunction (PD), which encompasses palatal instability (PI) and intermittent dorsal displacement of the soft palate, is the most common performance‐limiting upper respiratory tract obstruction in young Thoroughbred racehorses. Soft palate thermocautery (SPT) performed under general anaesthesia is a routinely performed procedure for PD in some countries, but the procedure for and outcome of SPT performed under standing sedation has not been published. Objectives: (1) To describe a technique for SPT performed under standing sedation; and (2) to assess post‐operative performance in horses compared to controls using the Racing Post rating (RPR), British Horseracing Authority official rating (OR), Performance Index and Earnings. Study design: Retrospective case series. Methods: Medical records were reviewed for all horses that had SPT performed under standing sedation following topical and local infusion of lidocaine hydrochloride into the rostral soft palate, and that were identified to have PI by overground endoscopy. Two matched controls were identified for each case. The median RPR, OR, Performance Index and Earnings for the three pre‐operative and three post‐operative races were compared. Results: No significant differences were identified between the SPT (n = 23) and Control groups (n = 46) for baseline characteristics or outcomes. Main limitations: Retrospective study design, small sample size. Conclusions: No significant differences in racing performance were identified between horses that had SPT performed under standing sedation and controls. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of anatomical terminology and the controversy surrounding the second edition of the Terminologia anatomica (TA2). The author, who has been involved in the development of anatomical terminology, expresses concerns about the extensive changes made in TA2 and argues for a more cautious approach to modifying terms. They propose combining TA with the Terminologia Neuroanatomica as a basis for future anatomical terminology and making changes only when necessary. The author emphasizes the importance of a consistent and evolving terminology for teaching anatomy and creating learning materials. [Extracted from the article]

Introduction: Allergic stomatitis is an oral inflammatory disorder characterized by a painful, burning sensation, or itchiness in the oral cavity which clinically appears as erythematous plaques, vesiculation, ulceration, and/or hyperkeratosis. The causative agents include drugs, dental materials, and food ingredients. Allergic stomatitis might develop after a person eats, touches, or inhales food allergen which then triggers the hypersensitivity reaction. The most common types of food hypersensitivity generally involve type 1 and type 4 reactions or a combination of both. Purpose: This case report aims to discuss a case of allergic stomatitis caused by one of the staple food ingredients in Indonesia: cassava. Case: A 26-year-old woman came with complaints of burning pain from multiple ulcers on her right inner cheek. The ulcers appeared shortly after the patient ate boiled cassava, extending to the soft palate and causing pain when swallowing food. The patient has a history of asthma. Case Management: The patient was referred for a total IgE examination with a result of 271.41 KIU/L (normal < 150 KIU/L). She was prescribed an antiseptic mouthwash and topical corticosteroids for palliative therapy. Additionally, multivitamins were also prescribed to speed up the healing process. Conclusion: Allergic stomatitis can be caused by food ingredients, even those considered healthy or non-allergenic. A complete anamnesis, including the patient's food history, along with supporting examinations, must be carried out to confirm the diagnosis and select appropriate therapy. [ABSTRACT FROM AUTHOR]

This document discusses the use of fluoroscopy-guided balloon dilation as a treatment for severe nasopharyngeal stenosis resulting from radiotherapy for nasopharyngeal carcinoma. The authors describe a case study of a 57-year-old male patient who underwent this procedure after declining surgical treatment. The balloon dilation treatments were performed under fluoroscopic guidance and resulted in symptom relief and sustained therapeutic effect without re-stenosis. The authors argue that fluoroscopy-guided balloon dilation offers advantages over endoscopic methods, such as precise localization and real-time control of the dilation effect. They suggest that further research should explore the use of steroids and mitomycin-C to reduce scar formation post-dilation treatment. [Extracted from the article]

Objective: To evaluate a method of measuring the change in palatal length and shape following maxillary advancement using synchronous lateral videofluoroscopy and voice recording in order to understand how movement of the maxilla may affect VPI risk in patients with cleft lip and/or palate (CL/P). Design: Retrospective cohort study of children with cleft lip and/or palate. Setting: Single center, tertiary children's hospital. Participants: Patients with cleft lip and/or palate who underwent maxillary advancement between 2016–21 inclusive. Interventions: Maxillary advancement surgery, including those who underwent concurrent mandibular procedures. Main outcome measures: The length of the soft palate and the genu angle were measured throughout palatal dynamic range. Pre- and post-operative measurements were compared using a one sided T-test, with subgroup analysis for patients with clinical VPI. Results: Ten patients were examined. The mean distance of maxillary advancement was 10.5 mm. The average increase in pre-genu soft palate length was 2.8 mm in the resting position and 2.9 mm in the closed position. The genu angle decreased in the closed position by 16.3 degrees. Conclusions: The soft palate showed limited ability to lengthen following maxillary advancement and this may explain the risk of VPI. There was partial compensation by the muscle sling of the palate as demonstrated by a more acute post-operative genu angle and this suggests one reason for the variability of VPI reported. Future research is required to investigate how length and shape changes measured using this method can predict VPI risk. [ABSTRACT FROM AUTHOR]

Objective: The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution. Design: Retrospective cohort study. Setting: Tertiary children's hospital. Patients: Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017. Outcome measures: We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA). Results: 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p = 0.037) and more likely to have cleft palate (63/119 vs 14/41; p = 0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p = 0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p = 0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p = 0.032). PSA scores were found to be lower (less hypernasal) after PFU (p = 0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p = 0.001), while PFT (p = 0.525) did not demonstrate a statistical difference. Conclusion: The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications. [ABSTRACT FROM AUTHOR]

Objective: Identification of at risk patients before surgery could facilitate improved clinical communication, care pathways and postoperative pain management Design: A retrospective cohort study was performed in all infants who had undergone cleft palate repair. Setting: Tertiary Institutional Participants: Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and July 2022 Intervention: Requirement for analgesic intervention in the post operative care unit Main outcome measure: Adverse perioperative event defined as pain or distress. Secondary outcomes were the incidence of airway obstruction, hypoxemia or unplanned intensive care admission. Results: Two hundred and ninety one patients (14.6 months,10.1 kg weight) were included. Cleft distribution included submucous (5.2%), Veau I (23.4%), Veau 2 (38.1%), Veau 3 (24.4%), and Veau 4 (8.9%). Overall 35% of 291 infants undergoing cleft palate repair experienced pain or distress requiring opiate intervention in the first hour after surgery. Infants with a Veau 4 cleft palate had 1.8 times and Veau 2 cleft palate had 1.5 times the risk of postoperative pain compared to infants with Veau 1 cleft palate (relative risk 1.82, 95%CI 1.04−3.18 and 1.49, 95%CI 0.96−2.32 respectively). The use of bilateral above elbow arm splints was significantly associated with postoperative pain or distress (odds ratio 2.23, 95%CI 1.01−5.16). Conclusions: Post operative pain requiring intervention in PACU is common despite adequate intraoperative multimodal analgesia, local anaesthesia infiltration and postoperative opiate infusions. Infants undergoing soft palate alone or submucous palate repair may require less perioperative opiates. [ABSTRACT FROM AUTHOR]

Abstract The study was focused on the anatomical characteristics of the Egyptian long-eared hedgehog's oral cavity by using gross and scanning electron microscopic examinations. The upper lip had an elongated T-shaped snout-like structure. The hard palate had a triangular rostral part (which had a semicircular area and a caudal ridged area with the first 3 or 4 ridges) and a caudal part (which contained seven or eight slightly oblique ridges with raphae). The diamond-incisive papilla is flanked on both sides by a groove and a fissure. The hard palate surface had glandular openings and a microplicae system. The uneven, soft palate's surface had multiple grooves and folds with 12–16 Gemmal papillae. The Gemmal papillary surface had three to four taste pores with microplicae and glandular openings. The dorsal lingual surface had six filiform subtypes: pointed (on the tip, rostral border, and median apical region), triangular (on the lateral apical and circumvallate regions), bifurcated (on the median tip only), leaf-like (on the median body region), branched (on the lateral root region), and small pointed papillae (on the median root). There were two fungiform subtypes: ovals (on the rostral border and lateral region) and rounds (on the median apical region and body). The caudal root part had a triangular arrangement of three circumvallate papillae. In conclusion, the finding confirmed its oral cavity adaptation with its insectivorous feeding habits and Egyptian environment. Graphical Abstract

Objectives: This study aims to analyze trends in utilization and reimbursement of soft palate surgery for OSA using the Medicare national database. Methods: A retrospective analysis of the 2000 to 2021 Part B National Summery datafiles using current Procedural Terminology (CPT) codes 42145 (uvulopalatopharyngoplasty [UPPP]), 42950 (pharyngoplasty [PP]), and 42140 (uvulectomy [UVU]) was performed. Results: Between 2000 and 2021, the number of OSA surgeries fell 65.7% from 4208 to 1443. UPPP fell 87.6% from 3455 in 2000 to 428 in 2021 (P <.001). UVU also fell in popularity, from 568 to 376 (33.8%; P <.001). In contrast, the performance of PP rose 245.4% over time, from 185 to 639 (P <.001). When comparing 2000 to 2009, both PP and UVU rose in relative use (from 4.4% to 12.3% and from 13.5% to 20.4% of all soft palate OSA surgeries, respectively), while UPPP fell (82.1% to 67.3%; P <.001). Total Medicare payments for all 3 procedures fell 57.2% from $1 658 844 to $633 091 (P <.001). Adjusted total UPPP payments fell 88.7% (P <.001). Adjusted total PP payment rose 137.5% to $262 538 in 2021 (P <.001). Conclusion: Soft palate surgery for OSA has declined amongst the Medicare population over 21 years (2000-2021). The more individualized and tissue sparing PP has risen in popularity but did not overcome the large decline of the traditional UPPP. Accordingly, there was a 75.7% fall in inflation-adjusted reimbursements. Overall, our data indicates a decline in soft palate surgery in the management of geriatric OSA, with modest relative increase in pharyngoplasty procedures. [ABSTRACT FROM AUTHOR]

Objective: Zombification, a magical and religious process in Haiti, has been scientifically studied and remains relevant. Originating from the convergence of African, Caribbean, and Christian rites, it involves a comatose trance, transforming individuals into living dead through Voodoo practices. Haitian zombies consistently exhibit a preserved expression marked by a nasal voice, a result of nasalization—using nasal cavities as resonators during phonation. The aim of this study was to ascertain the mechanisms through which zombification could impact the voices of the subjects. Methods: A comprehensive investigation was conducted using both primary and secondary sources. Primary sources involved direct or reported testimonies of individuals undergoing zombification, with audio or video recordings available from the collections of the Laboratory of Anthropology, Archaeology, and Biology (UVSQ/Paris-Saclay University), as well as on the internet. Secondary sources encompassed the entirety of existing literature regarding zombification in Haiti on one hand, alterations in the voices of subjects when mentioned on the other hand, and toxicological hypotheses or evidence available on PubMed/Medline and Google Scholar. Results: Few post-zombification observations exist, but 20th-century studies clarified the physio pathological process, confirming its reality. Wade Davis demonstrated in 1983 that zombification results from poisoning, with effects ranging from reversible to fatal, implicating substances like tetrodotoxin and datura. Nasalization can be natural or pathological, affecting various phonemes. No mutilating acts or surgery have been reported related to Haitian zombification. Conclusion: The pharmacological characteristics of tetrodotoxin, coupled with testimonials, present a medical hypothesis elucidating the biological mechanism underlying nasalization in this context. Given that tetrodotoxin induces flaccid paralysis as a neurotropic poison, its neurological impact could account for soft palate paralysis or spasms. Additionally, the severe hypotension induced by tetrodotoxin may elucidate oral and pharyngeal necrosis. [ABSTRACT FROM AUTHOR]

The prenatal diagnosis of epignathus presents a unique challenge for physicians. Differential diagnosis is usually based on the anatomic location of the tumor. Typical prenatal ultrasound characteristics of epignathus include a mixed solid and cystic lesion with vascularity in the solid component, originating from the hard or soft palate, and it is often associated with other anomalies such as craniofacial clefts or trans‐sphenoidal intracranial extension. Herein, we present a case of prenatal diagnosis of epignathus with rare ultrasonographic findings, prenatal management requiring collaborative efforts of a multidisciplinary team, and a well‐planned innovative ex utero intrapartum treatment procedure. In addition, this report highlights the evolving postnatal diagnosis of the rare developmental anomaly, duplication of the pituitary gland‐plus syndrome, which includes various midline craniofacial, central nervous system, spinal, and endocrine abnormalities. Synopsis: We report a case of fetal oral epignathus with uncommon ultrasonographic findings managed collaboratively with an innovative EXIT procedure, revealing an associated DPG‐plus syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Sarcomas of the head and neck region account for less than 10% of soft tissue sarcomas, and comprise less than 1% of head and neck malignancies. Approximately 80% of sarcomas arise from soft tissue, with the remaining originating from bone or cartilage. Head and neck sarcomas typically occur more frequently in men. Case report: Our patient was a 30 year old male who presented with a ulceroproliferative mass over the soft palate increasing in size over past 6 months. Punch biopsy of the lesion was suggestive of carcinosarcoma. MRI PNS was suggestive of 38 × 39 × 33 mm sized lobulated lesion involving soft palate on right side, crossing midline and displaces uvula. The lesion involved right side of hard palate, right retromolar trigone with abutment of right medial pterygoid. It was also suggestive of bilateral sub centimetric nodes involving bilateral level 2 neck nodes. The patient received 3 cycles neoadjuvant chemotherapy Ifosfamide and Doxorubicin and patient had no subjective response to chemotherapy with subjective increase in the size of lesion. MRI PNS post neoadjuvant chemotherapy was suggestive of 46 × 46 × 41 mm lobulated lesion involving right side of the soft palate crossing midline over to the left, involving right posterior hard palate and right retromolar trigone, tonsillar fossa and TL sulcus. CECT thorax was negative for lung metastasis. Our patient was a 30 year old male who presented with a ulceroproliferative mass over the soft palate increasing in size over past 6 months. Punch biopsy of the lesion was suggestive of carcinosarcoma. MRI PNS was suggestive of 38x39x33mm sized lobulated lesion involving soft palate on right side, crossing midline and displaces uvula. The lesion involved right side of hard palate, right retromolar trigone with abutment of right medial pterygoid. It was also suggestive of bilateral sub centimetric nodes involving bilateral level 2 neck nodes. The patient received 3 cycles neoadjuvant chemotherapy Ifosfamide and Doxorubicin and patient had no subjective response to chemotherapy with subjective increase in the size of lesion. MRI PNS post neoadjuvant chemotherapy was suggestive of 46 × 46 × 41 mm lobulated lesion involving right side of the soft palate crossing midline over to the left, involving right posterior hard palate and right retromolar trigone, tonsillar fossa and TL sulcus. CECT thorax was negative for lung metastasis. Discussion: The patient underwent wide local excision with medial maxillectomy via a bilateral Weber-Ferguson incision with Diffenbach extension and sent for frozen. The margins were negative and free of tumor. Bilateral modified neck dissection type 3 was done for lymph node clearance. A bilateral temporalis flap was done for reconstruction of the defect with a temporary obturator placement. Sarcomas of the sinonasal region may present a diagnostic challenge, as their location in the sinuses or nasal cavity may lead to presenting symptoms such as epistaxis, nasal congestion, or sinus pain and pressure that may be attributed to more benign causes such as chronic sinusitis, sinonasal polyposis, or allergic rhinitis. The less common sinonasal sarcoma subtypes may present a diagnostic challenge as their histopathological characteristics may overlap, especially with variations in tumor grade or with dedifferentiation. Additionally, the ideal treatment modality may present a therapeutic challenge, as the response to radiation and/or chemotherapy may vary according to the sarcoma subtype. Surgery is considered to be the mainstay in the management of carcinosarcomas of head and neck. Based on the evidence presented herein, elective neck dissection should be considered to treat squamous cell carcinomas of the maxillary palate, ginigiva, and alveolus. [ABSTRACT FROM AUTHOR]

Background: In Saudi Arabia, a traditional therapy for a folk labeled problem known as “Autheem – ” is often offered to infants. The procedure involves manipulating an infant’s soft palate to alleviate pain associated with infant colic and poor feeding. However, concerns remain about this procedure’s impact on infant health and its potential to transmit infections. This study focused on perceptions that Saudi mothers hold about Autheem therapy. Methods: A descriptive, cross-sectional, community-based study was conducted via an online platform to reach Saudi mothers in the Riyadh region of Saudi Arabia. Results: Five hundred and thirty-six Saudi mothers participated; half were older than 30 years of age. Despite a high rate of college degree attainment, the majority of mothers relied on their elders as a source of information (88.4%). Autheem was viewed to be a stand-alone disease by 86.5% of respondents; 71.4% believed it could not be treated with modern medicine. Most infants were under six months of age when they received Autheem therapy (72%). Roughly 13% of mothers found that their infant had a fever after the therapy; we found an association between Autheem therapy and viral illnesses. About 13% of mothers altered their child’s vaccination schedule after Autheem therapy. Conclusion: Older mothers have more positive attitudes towards and stronger beliefs in Autheem therapy than younger mothers. The therapy’s strong association with viral illnesses and its negative impact on vaccination schedules are major public health concerns.

Foot and mouth disease (FMD) is a highly contagious viral disease affecting cloven-hoofed animals. This disease is one of the most important in animal health due to its significant socio-economic impact, especially in case of an outbreak. One important challenge associated with this disease is the ability of the FMD virus (FMDV) to persist in its hosts through still unresolved underlying mechanisms. The absence of relevant in vitro models is one factor preventing advancement in our understanding of FMDV persistence. While a primary bovine cell model has been established using cells from FMDV primary and persistence site in cattle, it appeared interesting to develop a similar model based on ovine anatomical sites of interest to compare host-pathogen interactions. Thus, epithelial cells derived from the palatine tonsils and the dorsal soft palate were isolated and cultured. Their epithelial nature was confirmed using immunofluorescence. Following monolayer infection with FMDV O/FRA/1/2001 Clone 2.2, the FMDV-sensitivity of these cells was evaluated. Dorsal soft palate (DSP) cells were also expanded in multilayers at the air-liquid interface to mimic a stratified epithelium sensitive to FMDV infection. Our investigation revealed the presence of infectious virus, as well as viral antigens and viral RNA, up to 35 days after infection of the cell multilayers. Further experiment with DSP cells from different individuals needs to be reproduced to confirm the robustness of the new model of persistence in multilayer DSP. The establishment of such primary cells creates new opportunities for FMDV research and analysis in sheep cells. [ABSTRACT FROM AUTHOR]

Background: Orofacial clefts are one of the most common congenital malformations of the fetal face and ultrasound is mainly responsible for its diagnosis. It is difficult to view the fetal palate, so there is currently no unified standard for fetal palate screening, and the diagnosis of cleft palate is not included in the relevant prenatal ultrasound screening guidelines. Many prenatal diagnoses for cleft palate are missed due to the lack of effective screening methods. Therefore, it is imperative to increase the display rate of the fetal palate, which would improve the detection rate and diagnostic accuracy for cleft palate. We aim to introduce a fetal palate screening software based on the "sequential sector scan though the oral fissure", an effective method for fetal palate screening which was verified by our follow up results and three-dimensional ultrasound and to evaluate its feasibility and clinical practicability. Methods: A software was designed and programmed based on "sequential sector scan through the oral fissure" and three-dimensional ultrasound. The three-dimensional ultrasound volume data of the fetal face were imported into the software. Then, the median sagittal plane was taken as the reference interface, the anterior upper margin of the mandibular alveolar bone was selected as the fulcrum, the interval angles, and the number of layers of the sector scan were set, after which the automatic scan was performed. Thus, the sector scan sequential planes of the mandibular alveolar bone, pharynx, soft palate, hard palate, and maxillary alveolar bone were obtained in sequence to display and evaluate the palate. In addition, the feasibility and accuracy of the software in fetal palate displaying and screening was evaluated by actual clinical cases. Results: Full views of the normal fetal palates and the defective parts of the cleft palates were displayed, and relatively clear sequential tomographic images and continuous dynamic videos were formed after the three-dimensional volume data of 10 normal fetal palates and 10 cleft palates were imported into the software. Conclusions: The software can display fetal palates more directly which might allow for a new method of fetal palate screening and cleft palate diagnosis. [ABSTRACT FROM AUTHOR]

Pleomorphic adenoma is a benign tumor that can occur in the salivary glands, most commonly in the parotid gland. While it primarily occurs in the major salivary glands, it can sometimes be found in the minor salivary glands. Within the minor salivary glands, it most often originates in the hard palate and soft palate, and less frequently in the upper lips. Due to its location in the minor salivary glands, most pleomorphic adenoma involve and protrude on the mucosa. A 61-year-old man presented with 1.5 cm exophytic mass on the skin of his upper lip. This mass was exophytic on the skin and did not involve or protrude into the inner lip mucosa. The mass was entirely excised, and a subsequent permanent biopsy diagnosed it as a pleomorphic adenoma. In such situations, it can be challenging to suspect pleomorphic adenoma during a physical examination, leading to potential diagnostic confusion. It might also be mistaken for an inclusion cyst or another type of mass, making it tempting to treat without verifying the pathological results. [ABSTRACT FROM AUTHOR]

Herpailurus yagouaroundi, popularly known as the jaguarundi cat, is a small cat with a wide territorial distribution. Understanding its morphological characteristics is of great importance for the evolution of scientific knowledge of the species and its eating habits. With that in mind, the objective was to describe the morphology of its oral cavity to contribute to future studies on its diet in captivity. Three specimens of H. yagouaroundi were used, and underwent the process of fixation in 10% formaldehyde, photodocumentation, preparation of histological slides for evaluation of lips, cheeks, hard palate, soft palate and tongue, for subsequent photomicrography. Macroscopically, the animal presented tactile hairs in the region of the cheek and close to the lips, the latter with a blackish color and smooth appearance, hard palate with wrinkles and palatine grooves full of palatine papillae, and soft palate with folds of the mucosa. The tongue had an elongated shape with different thicknesses in each region, at the apex of the tongue, filiform papillae were observed, including fungiform ones. At the base of the organ, vallate papillae, conical papillae, more delicate than the filiform ones, foliate papillae and marginal papillae were observed on the side of the tongue. Analyzing the literature, it was possible to prove that the jaguarundi cat has characteristics very similar to those of large cats. Evaluating the presence of a greater variety of lingual papillae, it is suggested that the eating habits of jaguarundi cats are more restricted and that they are more selective in their food. [ABSTRACT FROM AUTHOR]

Formants, or resonance frequencies of the upper vocal tract, are an essential part of acoustic communication. Articulatory gestures—such as jaw, tongue, lip, and soft palate movements—shape formant structure in human vocalizations, but little is known about how nonhuman mammals use those gestures to modify formant frequencies. Here, we report a case study with an adult male harbor seal trained to produce an arbitrary vocalization composed of multiple repetitions of the sound wa. We analyzed jaw movements frame‐by‐frame and matched them to the tracked formant modulation in the corresponding vocalizations. We found that the jaw opening angle was strongly correlated with the first (F1) and, to a lesser degree, with the second formant (F2). F2 variation was better explained by the jaw angle opening when the seal was lying on his back rather than on the belly, which might derive from soft tissue displacement due to gravity. These results show that harbor seals share some common articulatory traits with humans, where the F1 depends more on the jaw position than F2. We propose further in vivo investigations of seals to further test the role of the tongue on formant modulation in mammalian sound production. [ABSTRACT FROM AUTHOR]

Background: The buccinator myomucosal island flaps are an excellent option for "like with like" oropharyngeal reconstruction in selected cases. We report a series of 15 patients and discuss the functional outcomes. Methods: From January 1, 2020 to February 31, 2023, 15 patients underwent oropharyngeal tumor resection and reconstruction with myomucosal island flaps. Buccal artery myomucosal island flap and tunnelized facial artery myomucosal island flap were used in 10 and 5 patients, respectively. In four cases, a total soft palate reconstruction was performed. Before removing the nasogastric tube, a videoendoscopy was performed in all cases to assess postoperative swallowing. Functional assessment was evaluated after a follow‐up of at least 12 months. Speech intelligibility and patient speech perception were assessed using the Hirose's 10‐point scoring system and the Voice Handicap Index. Dysphagia was assessed using the Dysphagia Outcome and Severity Scale and the Dysphagia Handicap Index. Finally, donor site morbidity was analyzed, and quality of life was assessed using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ‐C30). Results: The median length of hospital stay was 10.5 days. Nasal feeding tube was removed on average in 8.6 days after surgery, and all patients were able to tolerate an oral soft diet. Intelligibility was very good in all cases. No major complications were detected, and donor site morbidity was low. Global quality of life was acceptable in all cases. Conclusions: Buccinator myomucosal island flaps represent a very interesting and versatile option for the functional reconstruction of oropharyngeal defects up to 7–8 cm. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

The oropharynx represents one of the most challenging areas to reconstruct for the head and neck surgeon. The buccinator myomucosal island flaps pedicled on the facial artery [tunnelized facial artery myomucosal island flap (t-FAMMIF)] or the buccal artery [buccal artery myomucosal island flap (BAMMIF)] are an ideal reconstructive option for moderate size defects measuring up to 8–9 cm. Two fresh specimens have been used to show the step-by-step surgical technique of both island flaps. Design and flap extension, dissection plane, identification of the vascular pedicle, flap rotation and insetting are described. Reconstructive indications and the pros and cons of each one are discussed in this article. Myomucosal island flaps represent a very useful and versatile option for the functional reconstruction of the oropharynx. A detailed knowledge of the vascular anatomy of the cheek is key to obtain a large flap while minimizing the risk of complications. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the postoperative clinical and functional outcomes of palatoplasty with three soft palate cleft repairs and analyse the factors potentially impacting these outcomes. A retrospective analysis was conducted on a consecutive series of 337 patients who underwent primary cleft palate repair by palatoplasty modified with either Furlow Z-plasty (P-FZP, n = 77), intravelar veloplasty (P-IVV, n = 110), or combined intravelar veloplasty–Furlow Z-plasty (P-IVV-FZP, n = 150). The postoperative outcomes evaluated included wound healing (complete closure/fistula) and velopharyngeal function. Demographic and surgical data were analysed using both univariate and multivariate analysis. There was no significant difference between the groups with regard to the sex distribution, age at repair, cleft width, cleft type, or follow-up duration. However, relaxing incisions were significantly more common with P-FZP (26.0%) and P-IVV (29.1%) compared to P-IVV-FZP (10%) (P = 0.002 and <0.001, respectively). The complete wound closure rate was significantly higher with P-IVV-FZP (97.3%) compared to P-FZP (88.3%) (P = 0.012) and P-IVV (90%) (P = 0.015). The normal velopharyngeal function rate was comparable for P-IVV-FZP (86.7%) and P-FZP (83.1%), and both rates were significantly better than the rate with P-IVV (73.6%) (P = 0.039 and 0.029, respectively). The cleft type and width were identified as factors influencing postoperative outcomes. In conclusion, it may be appropriate to prioritize the palatoplasty with combined intravelar veloplasty–Furlow Z-plasty whenever feasible. [ABSTRACT FROM AUTHOR]

Thousands of rescued harbor seals (Phoca vitulina) require rehabilitation worldwide. Many require resource intensive gavage feeding due to abandonment soon after birth. Little is known about seal swallowing, therefore, our primary objective was to determine the feasibility of conducting videofluoroscopic swallowing studies (VFS) on seal pups prior to their release. Secondarily, we propose swallowing phase descriptions. We adapted a VFS approach used in humans and our feasibility parameters included: bolus detection and consumption, and number of analyzable swallowing events. Unrestrained seals were imaged in a dry environment using a Siemens mobile c-arm fluoroscopy unit. Oral boluses were thawed herring injected with liquid barium suspension (105% w/v). Two independent raters described swallows using a standardized approach with results summarized descriptively. We successfully completed freely-behaving VFS with two infant seals (1 male: 8 wks, 3 d; 1 female: 5 wks, 3 d). Both consumed five boluses with six fully analyzable swallowing events. We describe four swallow phases: preparatory, prehension, oropharyngeal and esophageal. Airway protection likely occurs in two ways: (1) during the preparatory phase through modified corniculate cartilage contact with the glottis and (2) with soft palate contact to the base of tongue prior to swallow initiation. We have conducted a unique VFS approach on rehabilitated seals, prior to their release. We have described airway protection and suggest that swallowing is initiated earlier in the feeding process than described previously. This protocol success will afford: (1) collection of normative swallowing data, and (2) future knowledge translation from humans to seals. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigated using a high-quality computed tomography (CT) scanner to aid the diagnosis of upper airway disease in dogs without the need for sedation or anaesthesia. Data from seventeen dogs with breathing problems were included, and were classified into three groups based on their condition and whether they had previously undergone airway surgery. Commonly reported clinical signs included noisy breathing and difficulty exercising. Results showed this imaging technique may provide an efficient and safe technique to evaluate the anatomical structures of the upper airway. Understanding upper airway diseases better can improve treatment outcomes, especially for breeds prone to airway disease, laying a foundation for further advancements in veterinary care. This study investigated using a 160-slice multidetector computed tomography (CT) scanner for conscious image acquisition in dogs with upper airway disease, and describes findings in dogs that had previously undergone soft palate surgery. Seventeen client-owned dogs with upper airway disease were retrospectively reviewed, and classified into three groups: group I, "untreated brachycephalic obstructive airway syndrome (BOAS) patients"; group II, "previously treated BOAS patients"; and group III, "patients with respiratory disease other than BOAS". Data included signalment, clinical history, direct laryngoscopy and endoscopy findings, previous surgeries and CT findings. CT scans in group I revealed overlong and thickened soft palates in all dogs, and signs of laryngeal collapse in four dogs. Patients in group II exhibited normal soft palate lengths, while patients in group III displayed various findings such as nasopharyngeal narrowing and tracheal collapse. Upper airway examinations under general anaesthesia confirmed most CT findings. This study demonstrates the feasibility and value of conscious CT scanning for assessing upper airway diseases in dogs, providing valuable diagnostic information while eliminating the need for chemical immobilisation, thus reducing patient stress and cost. These findings offer new insight into upper airway anatomy in awake patients, especially in brachycephalic breeds, and lay a foundation for future research. [ABSTRACT FROM AUTHOR]

A 39-year-old healthy patient accidentally stepped barefoot on an adder and was then bitten into the foot. After initially only local complaints, severe systemic symptoms developed within 10-15 minutes with swelling of the lips and soft palate, recurrent vomiting, bradycardia, weakly palpable peripheral pulse, hypotension, dyspnea and intermittent somnolence. The potentially life-threatening consequences of this severe poisoning could be avoided by using adequate emergency measures and immediate intravenous administration of antivenin. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that may affect the oral mucosa. The variable spectrum of oral lesions observed in SLE can pose challenges in diagnosis, particularly when the lesions occur in isolation. The aim of this study was to describe the oral lesions occurring in patients with SLE from Latin America. Methods: This collaborative record-based study involving 11 oral and maxillofacial pathology and medicine services across Venezuela, Argentina, Chile, Brazil, and Mexico describes the clinicopathological profile of SLE-related oral lesions. Results: Seventy patients with SLE and oral lesions were included in the study. The majority were females (75.7%; female/male ratio: 3.1:1) and white (62.1%), with a mean age of 38.4 years (range: 11–77 years). The most common site of oral lesions was the hard/soft palate (32.0%). Clinically, oral lesions predominantly presented as ulcers (26.6%), erosions (26.6%), and white lesions (23.4%). Isolated oral lesions occurred in 65.2% of individuals, while cutaneous manifestations occurred in 80.3%. The main clinical diagnostic hypothesis in 71.4% of cases was an immune-mediated disease. Oral biopsies followed by histopathological analysis were performed in 50 cases. Conclusion: Oral lesions of SLE exhibit a variety of clinical and histopathological features. A key point in diagnosis is that unusual oral changes without an obvious local cause may indicate a possible systemic condition presenting with oral lesions. A multidisciplinary approach, which includes regular oral examination, is warranted to identify oral lesions and provide treatment. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous sedation (IVS) with propofol (PPF) is commonly performed in dental treatment, particular in patients with dentophobia, with gag reflex, or undergoing implant surgeries, as PPF has the advantages of rapid induction and recovery. However, PPF and other intravenous sedatives may cause respiratory depression. Thus, IVS with PPF requires oxygen administration. But airway burn may occur when high-concentration oxygen is stored in the oral cavity and catches fire. For these reasons, the present study aimed to elucidate the changes in oxygen concentration (OC) under IVS with PPF and oxygen administration. Patients and methods: Nineteen healthy male volunteers participated in the study. None of them had missing teeth, nasal congestion, or temporomandibular joint dysfunction. They were sedated with a continuous PPF infusion dose of 6 mg/kg/hr for 25 min, followed by administration of 3 L/min oxygen via a nasal cannula. The OC was measured at two sites, namely, the median maxillary anterior teeth (MMAT) and median maxillary soft palate (MMSP), before PPF infusion (baseline) and 14, 15– 18 (Term 1), 19, and 20– 23 (Term 2) min after the start of infusion. Results: Compared with the values at baseline, the OC in the MMSP significantly increased at each time point, whereas the OC in the MMAT significantly increased at Term 2. Furthermore, in the comparison of the OC before and after the use of a mouth prop, the OC exhibited an upward trend, but no statistically significant differences were observed between the two time points in the MMAT and MMSP. In IVS with PPF and oxygen administration, the OC in the pharynx increases as the sedative level deepens. Conclusion: Oxygen administration should be temporarily discontinued, and suction should be performed to decrease the OC in the oral cavity when sparking procedures during IVS with PPF and oxygen administration are performed. [ABSTRACT FROM AUTHOR]

Background: Inherited glycosylphosphatidylinositol (GPI) deficiency is an autosomal recessive disease and a set of syndromes caused by different genes involved in the biosynthesis of phosphatidylinositol characterized by severe cognitive disability, elevated serum alkaline phosphatase (ALP) levels, and distinct facial features. This report presents a patient with inherited GPI deficiency caused by a homozygous frameshift variant of PGAP3 due to uniparental isodisomy (UPiD) on chromosome 17. Method: Clinical characteristics of the patient were collected. Microarray analysis followed by adaptive sampling sequencing targeting chromosome 17 was used for the identification of variants. Sanger sequencing was used to confirm the variant in the target region. Results: The patient was born at 38 weeks of gestation with a birthweight of 3893 g. He had a distinctive facial appearance with hypertelorism, wide nasal bridge, and cleft soft palate. Postnatal head magnetic resonance imaging revealed a Blake's pouch cyst. The serum ALP level was 940 IU/L at birth and increased to 1781 IU/L at 28 days of age. Microarray analysis revealed region of homozygosity in nearly the entire region of chromosome 17, leading to the diagnosis of UPiD. Adaptive sampling sequencing targeting chromosome 17 confirmed the homozygous variant NM_033419:c.778dupG (p.Val260Glyfs*14) in the PGAP3 gene, resulting in a diagnosis of inherited GPI deficiency. Conclusion: This is the first report of inherited GPI deficiency caused by UPiD. Inherited GPI deficiency must be considered in patients with unexplained hyperphosphatasemia. [ABSTRACT FROM AUTHOR]

Foot-and-mouth disease (FMD) is a severe and extremely contagious viral disease. Cows, sheep, goats, deer, pigs, and other animals with divided hooves are among the animals infected by the FMD viruu, which is a member of the Picornaviridae family and genus Aphtho virus. There are seven different serotypes of this virus: Asia-1, SAT1, SAT2, SAT3, A, O, and C. Heat, ultraviolet light, pH values of 6.5 or higher, gamma radiation, chemicals, and disinfecting agents all inactivate the virus; however, it remains virtually stable at below- freezing temperatures for a prolonged amount of time. Animals affected by this disease develop vesicular lesions on their tongue, dental pad, gums, cheeks, hard and soft palates, lips, nostrils, muzzle, interdigital region (between the hoof), and a coronary band. Viral infections can spread through the respiratory tract or via the oral cavity. Clinical manifestations of FMD are used to diagnose the disease, along with laboratory and epidemiological investigations. Due to the high morbidity linked to outbreaks, difficulties in the local adoption of more advanced production techniques, limitations on trade between countries, and expenses related to the implementation of control measures, FMD results in significant economic losses. FMD can be controlled and prevented through immunization, restrictions on animal migration, physical segregation from wildlife, and clinical therapy. However, FMD demonstrated challenges to control because of its complicated epidemiological nature, poor diagnostic capacity, and lack of cross-immunity between strains. Investigation is consequently essential to progressing the creation of a multivalent and effective vaccination. [ABSTRACT FROM AUTHOR]

Background/Objectives: The public perception relating to the welfare of horses involved with equestrian sports is associated with training methods used and the presentation of horses at events. In this context, very tight nosebands, which are intended to prevent the horse from opening its mouth, also attract a lot of attention. Various studies have evaluated the impact of tight nosebands on stress parameters, whereas the effect of tight nosebands on upper airway function is unknown. Therefore, the aim of the study was to use overground endoscopy to evaluate changes in pharyngeal and laryngeal function when a tight noseband is fitted. Moreover, the ridden horse pain ethogram (RHpE) was applied to investigate signs of discomfort (Dyson et al., 2018). Study design: A randomized, blinded, and prospective study was performed. Methods: Sixteen warmblood horses consisting of twelve mares and four geldings with a mean age of 11.63 ± 3.53 years were ridden on 2 consecutive days with either loose or tight nosebands (two fingers or no space between bridge of the nose and noseband, respectively) and inserted endoscope in a random order. Videos were taken in a riding arena during a standardized exercise protocol involving beginner level tasks for 30 min in all gaits. For video analysis, freeze frames were prepared and analyzed at the beginning of the expiration phase. Pharyngeal diameter was measured using the pharynx‐epiglottis ratio. Other findings (swallowing, pharyngeal collapse, soft palate movements, and secretion) were also evaluated. Moreover, the RHpE was applied. Descriptive statistics and generalized linear mixed effects models were used. Results with a p‐value < 0.05 were considered statistically significant. Results: While the pharynx‐epiglottis ratio did not change significantly in horses ridden with loose versus tight nosebands, there was an increase in mean grade and total counts of parameters assessed in the pharyngeal region, for example, grade of secretion (1.5 [±SD 0.89] vs. 3.13 [±SD 0.96]; p = 0.0001), axial deviation of the aryepiglottic folds (0.29 [±SD 0.73] vs. 1.33 [±SD 1.44]; p = 0.01), and pharyngeal collapse (0.69 [±SD 0.87] vs. 1.88 [±SD 1.54]; p = 0.005) in horses ridden with tight nosebands. There was no RHpE score above 8 indicating musculoskeletal pain, but the RHpE scores were significantly higher in horses ridden with tight nosebands (p < 0.001). Main limitations: Video quality was limited when horses showed large amounts of secretion. Another limitation was the small number of horses. Conclusions: Results add to the evidence obtained in other studies that tight nosebands do not only cause adverse reactions based on the RHpE score such as head behind the vertical or intense staring but also contribute to changes in the pharyngeal region, such as increased secretion and collapse of pharyngeal structures. This may provide further support for future decisions regarding regulations on nosebands. [ABSTRACT FROM AUTHOR]

Evaluate the influence of obesity on the polysomnographic and cephalometric parameters in obstructive sleep apnea (OSA). Fifty records of male patients with OSA, containing information on dental, medical, polysomnographic, and cephalometric exams were selected. The degree of obesity was based on Body Mass Index (BMI). Group I comprised normal or overweight individuals (BMI ≤ 29.9 kg/m2), whereas Group II consisted of obese individuals (BMI ≥ 29.9 kg/m2). BMI significantly correlated with apnea and hypopnea index (p < 0.0005), minimal oxyhemoglobin saturation (p < 0.0005), and two cephalometric variables (soft palate length, p = 0.01 and width, p = 0.01). Group II showed a significant correlation with the position of the hyoid bone (p = 0.02). Soft palate length and width significantly differed between groups (p = 0.014; 0.016). Obese males present wider and longer soft palate dimensions, and patients with a greater BMI present a more inferiorly positioned hyoid bone. [ABSTRACT FROM AUTHOR]

Background: The pharyngeal flap (PF) is useful for reconstruction of soft palate defects, but effective arrangements of PF for various types of soft palate defects are controversial. Here, we classify three types of soft palate defects and discuss the arrangements of PF and their functional prognosis. Methods: Reconstruction was performed based on the classification of the defects. Clinical details were collected, and postoperative function was analyzed. Results: Eight patients were included in the study. The defect sizes ranged from 25 (width) × 40 (depth) to 40 × 60 mm. Six patients underwent pharyngeal flap reconstruction with free‐flap reconstruction, and two underwent pharyngeal flap reconstruction. The pharyngeal flap was harvested at the maximum width of the posterior pharyngeal wall, ranging from 25 to 40 mm in length. Eating and speaking functions were maintained in all patients. Conclusions: Good postoperative function can be maintained by narrowing the velopharyngeal space with a pharyngeal flap. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we compared the outcomes of surgery for nasopharyngeal tumors in dogs using a conventional scalpel blade and a CO2 surgical laser system. We aimed to evaluate surgical time, bleeding level, patient pain, healing time, scar tissue formation, tumor relapse, and complications. We conducted a clinical prospective study involving 12 inpatient dogs, with 6 undergoing surgeries with a scalpel blade and 6 with a CO2 laser. We found that surgery using the CO2 laser resulted in shorter surgical and healing times, lower pain levels, less scar tissue formation, and a lower rate of tumor relapse compared to scalpel blade surgery. Our findings suggest that using the CO2 laser for nasopharyngeal tumor surgery may offer advantages in terms of precision, reduced discomfort, and fewer complications. We aimed to compare surgical time, bleeding level, patient pain level, healing period, scar tissue, relapse of the initial process and complications in patients with nasopharyngeal oncological masses undergoing surgery using a scalpel blade versus a CO2 surgical laser. This is a clinical prospective study comprising surgical work in the nasopharynx area. A sample of 12 inpatients dogs (N = 12) of both genders underwent a surgical excision of nasopharyngeal masses with a scalpel blade (GS n = 6) and CO2 surgical laser (GL n = 6). An Aesculigth CO2 surgical laser-Vetscalpel® model with a superpulse mode, 12 W of power, and a multi-focus pen was used. Statistically significant differences were registered for a p-value of < 0.05. Variations were noted between both groups (GS and GL) concerning surgery time (p = 0.038), first meal time (p = 0.013), pain level (p = 0.003), and healing time (p = 0.014), with the GL group presenting lower values. GL exhibited only one relapse case, with the elapsed time being more than double that of the GS group. Surgical and healing times were shorter in the GL group, and pain levels were lower, with the GL group also demonstrating less scar tissue than the GS group, along with a lower relapse rate. Nasopharynx surgical exposure with precision via the soft palate using the CO2 laser has facilitated successful treatment of regional masses without discomfort and complications, compared to conventional blade scalpel procedures. [ABSTRACT FROM AUTHOR]

The Hedgehog (HH) pathway regulates embryonic development of anterior tongue taste fungiform papilla (FP) and the posterior circumvallate (CVP) and foliate (FOP) taste papillae. HH signaling also mediates taste organ maintenance and regeneration in adults. However, there are knowledge gaps in HH pathway component expression during postnatal taste organ differentiation and maturation. Importantly, the HH transcriptional effectors GLI1, GLI2 and GLI3 have not been investigated in early postnatal stages; the HH receptors PTCH1, GAS1, CDON and HHIP, required to either drive HH pathway activation or antagonism, also remain unexplored. Using lacZ reporter mouse models, we mapped expression of the HH ligand SHH, HH receptors, and GLI transcription factors in FP, CVP and FOP in early and late postnatal and adult stages. In adults we also studied the soft palate, and the geniculate and trigeminal ganglia, which extend afferent fibers to the anterior tongue. Shh and Gas1 are the only components that were consistently expressed within taste buds of all three papillae and the soft palate. In the first postnatal week, we observed broad expression of HH signaling components in FP and adjacent, non-taste filiform (FILIF) papillae in epithelium or stroma and tongue muscles. Notably, we observed elimination of Gli1 in FILIF and Gas1 in muscles, and downregulation of Ptch1 in lingual epithelium and of Cdon, Gas1 and Hhip in stroma from late postnatal stages. Further, HH receptor expression patterns in CVP and FOP epithelium differed from anterior FP. Among all the components, only known positive regulators of HH signaling, SHH, Ptch1, Gli1 and Gli2, were expressed in the ganglia. Our studies emphasize differential regulation of HH signaling in distinct postnatal developmental periods and in anterior versus posterior taste organs, and lay the foundation for functional studies to understand the roles of numerous HH signaling components in postnatal tongue development. [ABSTRACT FROM AUTHOR]

The present investigation was carried out on 20 recently died, apparently healthy adult buffalo which were free from any pathological condition of tongue from Municipal Slaughter House, Bikaner. The tongue of buffalo was long and muscular organ. It was consisted of three parts- Apex, body and root. The apex was free and flattened with blunt pointed tip. The body was the longest and largest portion between the apex and root of tongue. It had four surfaces- dorsal, ventral and two laterals. Caudal-dorsal part of the body of the tongue formed an elliptical dorsal prominence known as torus linguae. Rostrally, the torus linguae were limited by a shallow transverse depression called as fossa linguae. The average weight was 0.873 Kg, volume 0.758 litre and length 40.24 cm. The tongue of buffalo occupied between two horizontal rami of mandible, on the floor of oral cavity. Dorsally, the fixed part was attached with the glosso-epiglottic fold and anterior pillars of the soft palate while ventrally; the free part of the tongue was connected to the floor of the mouth cavity by a median mucosal fold called as frenulum linguae. Five types of lingual papillae were observed on the tongue of buffalo. They were filiform, conical, lenticular, fungiform and circumvallate. Their distribution varied in different region of the tongue. The taste buds were present in fungiform and circumvallate. [ABSTRACT FROM AUTHOR]

Striated muscle insertions into the skin and mucosa are present in the head, neck, and pelvic floor. We reexamined the histology of these tissues to elucidate their role in transmission of the force. We examined histological sections of 25 human fetuses (gestational ages of ~11–19 weeks and ~26–40 weeks) and 6 cadavers of elderly individuals. Facial muscle insertion or terminal almost always formed as an interdigitation with another muscle or as a circular arrangement in which muscle fiber insertions were sandwiched and mechanically supported by other muscle fibers (like an in-series muscle). Our examination of the face revealed some limited exceptions in which muscle fibers that approached the dermis were always in the nasalis and mentalis muscles, and often in the levator labii superioris alaeque nasi muscle. The buccinator muscle was consistently inserted into the basement membrane of the oral mucosa. Parts of the uvulae muscle in the soft palate and of the intrinsic vertical muscle of the tongue were likely to direct toward the mucosa. In contrast, the pelvic floor did not contain striated muscle fibers that were directed toward the skin or mucosa. Although ‘cutaneous muscle’ is a common term, the actual insertion of a muscle into the skin or mucosa seemed to be very rare. Instead, superficial muscle insertion often consisted of interdigitated muscle bundles that had different functional vectors. In this case, the terminal of one muscle bundle was sandwiched and fixed mechanically by other bundles. [ABSTRACT FROM AUTHOR]

Monocular torsional eye oscillations are a rare form of disconjugate nystagmus and the underlying pathophysiology is not well understood. Here, we present and discuss a case with disabling torsional oscillopsia in one eye only. The patient exhibited (i) spontaneous pendular torsional nystagmus of the left eye and (ii) rhythmic involuntary movements of the soft palate and uvula, consistent with the syndrome of oculopalatal tremor with monocular nystagmus. Brain MRI revealed an infarct of the left dentate nucleus in the cerebellum and, more caudally, a secondary hypertrophic degeneration of the right inferior olivary nucleus. To account for the presence of torsional nystagmus on the eye contralateral to the side of inferior olivary hypertrophy and ipsilateral to the lesioned dentate nucleus, we discuss the hypothesis of a (inferior olivary nucleus-mediated) malfunctioning adaptation of the anterior canal vestibulo-ocular reflex. [ABSTRACT FROM AUTHOR]

Coxsackievirus B1 (CVB1), an enterovirus with multiple clinical presentations, has been associated with potential long‐term consequences, including hand, foot, and mouth disease (HFMD), in some patients. However, the related animal models, transmission dynamics, and long‐term tissue tropism of CVB1 have not been systematically characterized. In this study, we established a model of CVB1 respiratory infection in rhesus macaques and evaluated the clinical symptoms, viral load, and immune levels during the acute phase (0–14 days) and long‐term recovery phase (15–30 days). We also investigated the distribution, viral clearance, and pathology during the long‐term recovery period using 35 postmortem rhesus macaque tissue samples collected at 30 days postinfection (d.p.i.). The results showed that the infected rhesus macaques were susceptible to CVB1 and exhibited HFMD symptoms, viral clearance, altered cytokine levels, and the presence of neutralizing antibodies. Autopsy revealed positive viral loads in the heart, spleen, pancreas, soft palate, and olfactory bulb tissues. HE staining demonstrated pathological damage to the liver, spleen, lung, soft palate, and tracheal epithelium. At 30 d.p.i., viral antigens were detected in visceral, immune, respiratory, and muscle tissues but not in intestinal or neural tissues. Brain tissue examination revealed viral meningitis‐like changes, and CVB1 antigen expression was detected in occipital, pontine, cerebellar, and spinal cord tissues at 30 d.p.i. This study provides the first insights into CVB1 pathogenesis in a nonhuman primate model of HFMD and confirms that CVB1 exhibits tissue tropism following long‐term infection. [ABSTRACT FROM AUTHOR]

Introduction: Obesity and craniofacial structures are aetiologies of obstructive sleep apnoea (OSA). The effect of obesity onset on the craniofacial development and growth of obese OSA subjects has been suggested, but supporting data were lacking. This study aimed to assess the craniofacial features of adult obese OSA patients in relation to their obesity onset. Materials and Methods: A total of 62 adult OSA patients were included in the study, consisting of 12 early‐onset (i.e. before puberty), 21 late‐onset (i.e. after puberty) and 29 non‐obese. All participants underwent a sleep study and cephalometric radiograph. Cephalometric analysis was conducted to measure the craniofacial features among the groups. Results: The early obesity onset group (n = 12) showed a more prognathic mandible, longer lower facial height, protrusive incisors, a more caudal position of the hyoid bone and a wider lower airway. The late‐onset group (n = 21) had more proclined and protrusive upper incisors, a shallower overbite, a more inferiorly positioned hyoid bone and an obtuse craniocervical angle. The overall obese group showed a combination of the findings above, plus a shorter soft palate and shorter airway length. There was no significant difference between early and late obesity onset groups. However, the early group showed a tendency for a shallower or decreased mandibular plane angle and deeper overbite. Conclusions: The current pilot study had many limitations but holds important information as a hypothesis generator. Craniofacial features of OSA patients with different obesity onset showed discrepancies and were distinguished from non‐obese controls. Adult OSA patients with an early obesity onset showed a tendency for a more hypodivergent growth pattern than those with a late obesity onset. [ABSTRACT FROM AUTHOR]