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Objective: This study aimed to compare the nasopharynx and oropharynx airway dimensions of Caucasians, Blacks, Japanese, Japanese Brazilians, and Black Caucasians., Methods: A sample of 216 lateral radiographs of untreated young Brazilian subjects (mean age of 12.94 years; SD 0.88) were divided into five groups: Black Caucasian, Black, Caucasian, Japanese, and Japanese Brazilian. Lateral radiographs were used to measure the oropharynx (from the midpoint on the soft palate to the closest point on the anterior pharyngeal wall) and the nasopharynx (from the intersection of the posterior border of the tongue and the inferior border of the mandible to the closest point on the posterior pharyngeal wall). Analyses of variance (ANOVA) and Tukey's test were performed (p< 0.05)., Results: The linear dimension of the oropharynx was similar among the different ethnic groups. Caucasian individuals presented a significantly greater linear dimension of the nasopharynx than Black Caucasian and Black individuals., Conclusions: All the groups had similar buccopharyngeal values. However, Caucasian individuals had significantly higher values when compared to Black Caucasians and Black individuals.

This study aims to examine the relationship between the locations of Fovea Palatinae and the posterior vibrating line in different classes of soft palate angulation (House Classification), accordingly determine its reliability as a landmark and a tool for determining the posterior limit of the maxillary complete denture. 280 completely edentulous patients with normal healthy mucosa from both genders were randomly selected. The House classification of the soft palate angulation was identified and recorded as Class I, II, or III. Phonation was used to determine the position of the vibrating line. The Fovea Palatinae was then marked. Then, the distance between the Fovea Palatinae and the vibrating line was measured and recorded. Finally, the relative position of the Fovea Palatinae to the vibrating line was recorded as being anterior, posterior, or on the vibrating line. The Chi Square test, the effect size measures (Eta and Cramer's V tests), The Spearman's Rho rank correlation test, and multinominal logistic regression analysis were utilized to analyse the data. House classification percentages were measured among people whose Fovea Palatinae was detectable; Class II palate was the most prevalent (47.14%), followed by Class I (43.93%), and then Class III (8.93%). Based on vibrating line position, 129 (58%) had a vibrating line anterior to Fovea Palatinae, 57 (26%) on the Fovea Palatinae, 36 (16%) posterior to Fovea Palatinae, and in 58 (21%) Fovea Palatinae were not detected. The mean distance between the vibrating line and Fovea Palatinae was 3.66 ± 1.6 mm anteriorly and 2.97 ± 1.36 mm posteriorly. No significant differences were found between males and females in regard to House classification and vibrating line position. The odds of having the fovea posterior to the vibrating line would increase by 5% for each year increase in the age (P = 0.035, odds ratio = 1.050). Class II House classification of the soft palate was found to be the most prevalent among the study participants. Also, the vibrating line was anterior to the Fovea Palatinae in the majority of cases. The odds of having the fovea posterior to the vibrating line would increase by age. The Fovea Palatinae could be considered a useful guide for locating the vibrating line., (© 2024. The Author(s).)

The present study was carried out to study the morphology of the goat's soft palate and palatine tonsil by gross anatomy, morphometry, light and scanning electron microscopy (SEM). Twelve heads of normal adult (18-24 months) apparently healthy goats of both sexes were collected from local commercial slaughterhouses in Qena Governorate, Egypt. The oral cavity was dissected, and samples were collected for both light and SEM. The soft palate of the goat formed the caudal continuation of the hard palate. It was relatively short, it extended from the level of the caudal border of the last upper molar tooth to terminate caudally against the base of the epiglottis. The oral mucous membrane of the soft palate was covered by non-keratinized stratified squamous epithelium. The lamina propria and submucosa contained connective tissue fibers, diffuse and nodular lymphatic tissue, striated muscle fibers, and a large number of mucous and serous palatine glands. By SEM, the ventral surface had several rounded openings occupied by flower-like structures. These openings represented the entrances to the palatine glands. The palatine tonsil was large and protruded from a fossa in the lateral wall of the oropharynx. It had 2-3 elongated irregular openings that lead to the underlying crypts. These crypts were well-developed and lined by non-keratinized stratified squamous epithelium. The epithelium of the tonsillar crypts directly covered lymphoid tissue and was infiltrated by lymphocytes. Tonsillar glands of pure mucous type were demonstrated. In conclusion, the study provides the basic morphological features of soft palate, as well as the palatine tonsil of the goat by gross observation, light and SEM. The palatine tonsils of goat were well-developed with extensive crypt system, suggesting their essential role in the immunological response against antigens that enter through the oral cavity. The current findings may be useful to understand the role of the palatine tonsil in immunity and disease pathogenesis. RESEARCH HIGHLIGHTS: The study reported the basic morphological features of soft palate and palatine tonsil of goat. The ventral surface of the soft palate had several rounded openings occupied by flower-like structures. The palatine tonsils of goat were well-developed with extensive crypt system. The findings might help to understand the role of the palatine tonsil in immunity and disease pathogenesis., (© 2023 Wiley Periodicals LLC.)

Objective: There have been few studies on the anatomy of palatine aponeurosis (PA). Herein, we elucidated the relationship between the PA and soft palate muscles and pharyngeal muscles., Design: Two cadaveric specimens were dissected to observe the gross anatomy of the PA. Six cadaveric specimens were processed and scanned by micro-computed tomography to determine the elaborate anatomy. Images were exported to Mimics software to reconstruct a three-dimensional model., Results: The PA covered the anterior (32.1%-38.8%) of the soft palate, extending from the tensor veli palatini (TVP) and connecting to 3 muscles: palatopharyngeus (PP), uvula muscle, and superior pharyngeal constrictor (SC). The SC and PP are attached to the PA on the medial side of the pterygoid hamulus. SC muscle fibers were attached to the hamulus, forming a distinct gap between the hamulus. Some muscle fibers of the PP and uvula originated from the PA. The PA extended from the TVP to the midline and the posterior edge of the hard palate. The PA was not uniformly distributed, which was complementary to the attached muscles in thickness., Conclusions: PA, as a flexible fibrous membrane, maintains the shape of the soft palate. It extends from the TVP and covers anteriorly about one-third of the soft palate. The PA provides a platform for the soft palate muscles and pharyngeal muscles, connecting to the PP, uvula muscle, and SC. These muscles are important for palatopharyngeal closure and middle-ear function. It is necessary to minimize the damage to the PA during surgical interventions.

Background: The soft palate anatomy of individuals can have a range of morphologies. Cephalometric analysis is a low-cost approach to analyze the soft palate in patients with or without developmental abnormalities., Methods: The lateral cephalogram of the patients visiting Tribhuvan University Teaching Hospital, Institute of Medicine for various dental treatment purposes was evaluated. The soft palate was delineated on the radiographs by sketching the soft palate's contour along its radiolucent outline using the curve lines and connectors of Microsoft PowerPoint. The soft palate was then categorized according to the study by You M et al. Results: The different types of soft palate morphology observed in the study were rat tail (42.4%), leaf-like (40.8%), butt-like shape (8.9%), straight-line (4.7%), s-shaped (1.9%), and crooked (0.9%). The males had rat-tail (44.4%), leaf-like (41.1%), butt-like shape (8.4%), straight-line (3.9%), s-shaped (1.3%), and crooked (0.6%), whereas the females had rat-tail like (40.6%), leaf-like (40.6%), butt-like shape (9.5%), straight-line (5.6%), s-shaped (2.5%), and crooked (1.2%) types of soft palate., Conclusions: The rat-tail form of the soft palate was the most prevalent, followed by the leaf-like in both sexes. The least common type was the crooked form. This study found no evidence of sexual dimorphism.

Objective: The purpose of this study was to examine the surgical impact of the pedicled buccal fat pad (BFP) flap on the levator veli palatini (LVP) muscle and surrounding velopharyngeal (VP) anatomy following primary palatoplasty using magnetic resonance imaging (MRI)., Design: Observational, prospective., Setting: MRI studies were completed at 3 different facilities. All participants with BFP flap were operated on by the same surgeon., Participants: Five pediatric participants with cleft palate with or without cleft lip (CP±L) who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls., Interventions: All participants underwent nonsedated MRI 2 to 5 years postoperatively., Main Outcomes and Measures: Anatomical measures of the velopharynx and LVP among the 3 participant groups., Results: Median values were significantly different among groups for velar length ( P = .042), effective velar length ( P = .048), effective VP ratio ( P = .046), LVP length ( P = .021), extravelar LVP length ( P = .009), and LVP origin-origin distance ( P = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio ( P = .040), extravelar LVP length ( P = .033), and LVP length ( P = .022)., Conclusions: This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine whether this procedure provides a more favorable mechanism for VP closure.

Purpose: The purpose of this study was to determine the palatal bone and soft tissue thicknesses using a miniscrew-supported maxillary skeletal expander (MSE) in Class III malocclusion., Methods: The thicknesses of the palatal bone and soft tissue were measured in cone-beam computed tomography images obtained from 58 patients. All 20 points were crossing points between five levels, which were defined at 3 mm intervals relative to the line connecting the central fossae of the first molar (Level 0), and 2 mm and 4 mm lateral to the anteroposterior reference line (AP line)., Results: The palatal bone was significantly thicker in males than females in the anterior palate up to Level 0, while there was no significant sex-related difference in the posterior palate. There was a tendency for the thickness to decrease in the posterior direction, except in females at 2 mm lateral to the AP line. The palatal soft tissue was significantly thicker in males than females in all positions. At 2 mm lateral to the AP line, the palatal soft tissue thickness decreased in the posterior direction. A 4 mm lateral to the AP line, it initially decreased in the posterior direction, and then increasing again at Level - 6 (6 mm posterior of Level 0). As the lateral distance from the AP line increased, the palatal bone thickness decreased while the palatal soft tissue thickness increased., Conclusions: These findings provide quantitative data on the palatal bone and soft tissue thicknesses for the miniscrew-supported MSE in the posterior palate.

The Modified Mallampati Classification stratifies predicted difficulty of endotracheal intubation based on anatomic features.

Purpose: This study aims to attain metric data of the velopharyngeal dimensions of healthy subjects as well as patients with velopharyngeal insufficiency using the example of cleft and lip palate (CLP) in order to determine possible differences in the volumes of both groups., Methods: Volumes and distances of velopharyngeal areas were analyzed retrospectively using cone beam computed tomography data sets (n = 60). Group 1 included healthy patients receiving dental implants (n = 31). Group 2 was represented by patients with surgically closed cleft lip and palate (n = 29)., Results: Biggest differences among mean values of both groups were found for: minimum axial area (p = 0.000), airway area caudal (p = 0.000), distance between posterior nasal spine and posterior pharyngeal wall (PPW) (p = 0.014), mean distance between velum and PPW (p = 0.000), length of PPW (p = 0.000) and length of anterior pharyngeal wall (p = 0.000)., Conclusion: Differences in the shape and geometry of the velopharyngeal area in subjects with a regular velopharyngeal structure and function and patients with cleft palate do exist. The significant differences found here can be categorized into two groups: one reflects distances between the anterior and posterior pharynx, presenting longer distances for patients with CLP. The second significant difference regards values of length in cranio-caudal direction, which is longer in healthy subjects. With regards to these values, one could conclude, that even though total volumes of both groups did not differ in size, group 1 shows three-dimensional velopharyngeal shapes that are longer and narrower, whereas shapes of patients of group 2 tend to be wider and shorter in general.

Objective: To compare the dimensions and density of the tongue in brachycephalic and mesaticephalic dog breeds and to document the relative extents of the nasopharyngeal and oropharyngeal airways occupied by the tongue and palatal tissues., Study Design: Case control study., Animals: Sixteen brachycephalic dogs and 12 mesaticephalic dogs., Methods: The volume of the tongue was measured with computed tomography in all dogs. Cross-sectional areas of tongue, oropharynx, nasopharynx, and palatal soft tissue were evaluated at two levels, the caudal aspect of the hard palate and the level of the hamulae of the pterygoid. Density of the tongue and soft palate were measured. All variables were compared between brachycephalic and mesaticephalic dogs (P ≤ .05)., Results: Absolute tongue volumes did not differ between groups, the volume of the tongue was greater in brachycephalic dogs than in mesaticephalic dogs when expressed relative to (a) body weight (median 5650, interquartile range [IQR] 4833-6522 vs median 4454, IQR 4309-4743, respectively), (b) ratio between skull length/width (70 833, IQR 62490-126 209 vs 48 064, IQR 22984-64 279, respectively), and (c) skull length (689.93, IQR 618.55-970.61 vs 460.04, IQR 288.77-561.69, respectively). The proportion of air (oropharyngeal and nasopharyngeal)/soft tissue (tongue and palatal tissue) in brachycephalic dogs was decreased by approximately 60%, and the tongue was approximately 10 times denser in brachycephalic dogs than in mesaticephalic dogs., Conclusion: A relative macroglossia was detected in brachycephalic dogs along with reduced air volume in the upper airway. Tongues of brachycephalic dogs were denser than those of mesaticephalic dogs., Clinical Significance: The relative macroglossia in brachycephalic breeds may contribute to upper airway obstruction., (© 2019 The American College of Veterinary Surgeons.)

Objective: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea., Methods: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed., Results: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2., Conclusion: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.

Objective: The ventral jugular foramen and the infrapetrous region are difficult to access through conventional lateral and posterolateral approaches. Endoscopic endonasal approaches to this region are obstructed by the eustachian tube (ET). This study presents a novel strategy for mobilizing the ET while preserving its integrity. Qualitative and quantitative comparisons with previous ET management paradigms are also presented., Methods: Ten dry skulls were analyzed. Four ET management strategies were sequentially performed on a total of 6 sides of cadaveric head specimens. Four measurement groups were generated: in group A, the ET was intact and not mobilized; in group B, the ET was mobilized inferolaterally; in group C, the ET underwent anterolateral mobilization; and in group D, the ET was resected. ET range of mobilization, surgical exposure area, and surgical freedom were measured and compared among the groups., Results: Wide exposure of the infrapetrous region and jugular foramen was achieved by removing the pterygoid process, unroofing the cartilaginous ET up to the level of the posterior aspect of the foramen ovale, and detaching the ET from the skull base and soft palate. Anterolateral mobilization of the ET facilitated significantly more retraction (a 126% increase) of the ET than inferolateral mobilization (mean ± SD: 20.8 ± 11.2 mm vs 9.2 ± 3.6 mm [p = 0.02]). Compared with group A, groups C and D had enhanced surgical exposure (142.5% [1176.9 ± 935.7 mm2] and 155.9% [1242.0 ± 1096.2 mm2], respectively, vs 485.4 ± 377.6 mm2 for group A [both p = 0.02]). Furthermore, group C had a significantly larger surgical exposure area than group B (p = 0.02). No statistically significant difference was found between the area of exposure obtained by ET removal and anterolateral mobilization. Anterolateral mobilization of the ET resulted in a 39.5% increase in surgical freedom toward the exocranial jugular foramen compared with that obtained through inferolateral mobilization of the ET (67.2° ± 20.5° vs 48.1° ± 6.7° [p = 0.047]) and a 65.4% increase compared with that afforded by an intact ET position (67.2° ± 20.5° vs 40.6° ± 14.3° [p = 0.03])., Conclusions: Anterolateral mobilization of the ET provides excellent access to the ventral jugular foramen and infrapetrous region. The surgical exposure obtained is superior to that achieved with other ET management strategies and is comparable to that obtained by ET resection.

Objective: The purpose of this study was to assess the relationship between cephalometric parameters and apnoea-hypopnoea index (AHI) controlling for the effect of gender, age, and body mass index (BMI) on a large sample of patients with obstructive sleep apnoea (OSA)., Methods: This retrospective cohort study was conducted on the lateral cephalograms of 253 Caucasian adult OSA patients. Cephalometric analyses were performed using 14 parameters for skeletal and soft tissue morphology, including antero-posterior and vertical jaw relationships, hyoid bone position, soft palate length and thickness, airway space, and tongue length and height. A hierarchical regression was run to examine the amount of variability in AHI that cephalometric variables explained after controlling for patients' general characteristics (gender, age, and BMI)., Results: After controlling for gender, age, and BMI, the increase in AHI variance accounted for by cephalometric parameters was equal to 0.103. Among the cephalometric variables, only MP-H and PNS-P were statistically significant (P < 0.05)., Limitations: Given the retrospective nature of the study, it is difficult to assess whether other confounding variables not considered in the present study could have influenced the relationship between cephalometric parameters and AHI., Conclusions: This study revealed the existence of a relationship between OSA severity and some cephalometric parameters. Indeed soft palate length and vertical position of the hyoid bone were significant predictors of AHI in adult Caucasian OSA patients., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue., Materials and Methods: The records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and F -test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined., Results: Measurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar)., Conclusions: The measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.

Aim: The primary aim of this study was to assess the differences in the upper airway morphology between responders and non-responders to mandibular advancement splint (MAS) treatment in obstructive sleep apnoea (OSA) management. The secondary aim was to assess the correlation between the minimum cross-sectional area of the upper airway and the anatomical structures (i.e. mandibular external length, maxillary length, soft palate length, area of the tongue, maxillomandibular enclosure size, and anatomical balance ratio) surrounding the upper airway. The third aim was to assess the differences in the overall skeletal configuration between responders and non-responders to MAS treatment., Methods: Data from 64 patients (23 females and 41 males) diagnosed with OSA by polysomnography (PSG) at baseline and provided with an adjustable MAS were analysed. All patients had NewTom3G cone beam computed tomography (CBCT) scans, performed in the supine position, at baseline. After acclimatization to MAS, follow-up PSG tests were performed to assess the apnoea-hypopnea index (AHI) with the MAS in situ. Responders were defined by a post-treatment AHI less than 10/hour and at least 50 per cent reduction in AHI, and non-responders by a post-treatment AHI at least 10/hour or less than 50 per cent reduction in AHI. Several upper airway and anatomical variables surrounding the upper airway based on CBCT images were measured to determine the differences between responders and non-responders to MAS., Results: There were 36 responders (AHI = 24.8 ± 11.9 at baseline) and 28 non-responders (AHI = 31.2 ± 20.3 at baseline) to MAS. There were no significant differences in the upper airway morphology between responders and non-responders (P = 0.17-0.93) or in the anatomical structure surrounding the upper airway (P = 0.24-0.58)., Conclusion: Within the limitations of this study, it can be concluded that there are no significant differences in upper airway morphology and in anatomical structures surrounding the upper airway between responders and non-responders to MAS treatment. These findings suggest that the craniofacial anatomical structures analyzed in this study cannot explain the response to MAS treatment., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose The observed sexual dimorphism of velopharyngeal structures among adult populations has not been observed in the young child (4- to 9-year-old) population. The purpose of this study was to examine the age at which sexual dimorphism of velopharyngeal structures become apparent and to examine how growth trends vary between boys and girls. Method Static 3-dimensional magnetic resonance imaging velopharyngeal data were collected among 202 participants ranging from 4 to 21 years of age. Participants were divided into 3 groups based on age, including Group 1: 4-10 years of age, Group 2: 11-17 years of age, and Group 3: 18-21 years of age. Nine velopharyngeal measures were obtained and compared between groups. Results Significant sex effects were evident for levator length ( p = .011), origin to origin ( p = .018), and velopharyngeal ratio ( p = .036) for those in Group 2 (11-17 years of age). Sex effects became increasingly apparent with age, with 7 of 9 variables becoming significantly different between male and female participants in Group 3. Boys, in general, displayed a delayed growth peak in velopharyngeal growth compared to girls. Conclusion Results from this study demonstrate the growth of velopharyngeal anatomy with sexual dimorphism becoming apparent predominantly after 18 years of age. However, velopharyngeal variables displayed variable growth trends with some variables presenting sexual dimorphism at an earlier age compared to other velopharyngeal variables.

Purpose: This study was performed to investigate the changes of upper airway before and after functional correction in ClassⅡmalocclusion children with high mandibular plane angle at growth and development peak., Methods: Cone-beam CT (CBCT) data of the upper airway were inputted into Minics 17.0 software for measurement of changes in the upper airway before and after functional treatment by high headgear-activator. The changes of upper airway before and after treatment were analyzed with SPSS22.0 software package., Results: The change of the total volume of the upper airway, the volume of the velopharynx, glossopharynx, laryngopharynx; the sectional area of the tip of soft palate, roof of the epiglottis, the minimum sectional area of the oropharynx were significant (P<0.05). The upper airway morphology tended to be circular in the soft palate tip plane(P<0.05), but there was no significant difference in the plane of epiglottis(P>0.05)., Conclusions: High headgear-activator corrected mandibular hypoplasia in children with increased airway volume, increased ventilation, improved respiratory function to prevent occurrence of obstructive sleep apnea hypopnea syndrome after adult.

Introduction: The role of obstructive tonsils in ventilatory disorders and abnormal lip posture is widely discussed in the literature but remains controversial. The data reported on the probable relationship between obstructive tonsils and an existing breathing disorder or lip incompetence were subjective. The purpose of this study was to evaluate the relationship between the obstructive character of the tonsils and the type of ventilation and lip posture., Materials and Methods: This is a cross-sectional study performed in children aged from 6 to 12 years old. The subjects were divided into two groups (A and B) according to the obstructive or non-obstructive character of the palatal tonsils. Type of ventilation and lip posture at rest were recorded for each child. The collected data were analysed using the SPSS 20.0 software (for Windows). A Student's t-test and a Chi 2 test were respectively used to compare quantitative and qualitative variables according to the obstructive character of the tonsils for each group. The level of significance is fixed at P=0.05., Results: The subjects in group B with obstructive palatal tonsils were significantly more likely to oral breathing and lip incompetence than the subjects with non-obstructive tonsils (group A)., Conclusion: The clinical examination of children with ventilatory and postural disorders with lip incompetence must be directed towards the search for associated obstructive palatal tonsils in order to plan an early etiological treatment. This would allow to avoid subsequent problems in the dentofacial structures., (Copyright © 2018. Published by Elsevier Masson SAS.)

Inherited traits of obstructive sleep apnoea (OSA) may have link to the heritability of the airway anatomy. The aim of this study was to investigate heritability of the airway anatomy by comparing skeletal and soft tissue features of Korean monozygotic twins (MZ) and dizygotic twins (DZ). In total, 72 participants (mean age, 41.5 ± 5.9 years; 40 males, 32 females) including 48 MZ (24 pairs) and 24 DZ (12 pairs) with same sex were participated. The craniofacial, craniovertebral, hyoideal and pharyngeal parameters were measured using lateral cephalograms. The genetic analysis was performed using Falconer's method. High heritability was detected in the hyoid position and inclination of the cervical column. The velopharyngeal and hypopharyngeal dimensions showed higher heritability compared to those of the nasopharynx and oropharynx. The body mass index (BMI) had interactions with the nasopharyngeal and hypopharyngeal dimensions and length of the tongue and soft palate. The mandibular growth had correlations with the nasopharyngeal and hypopharyngeal dimensions. The vertical skeletal relationships appeared to have interaction with the nasopharyngeal, velopharyngeal and hypopharyngeal dimensions, as well as length of the tongue and soft palate. A forwarded inclination of the cervical columns was seen in connections with BMI and the nasopharyngeal and hypopharyngeal dimensions. The airway structures and head postures seemed to be under strong genetic controls. The airway dimensions had associations with BMI, head postures and skeletal structures which showed high heritability. Forwarded head postures would be physiological adaptations of compromised airway adequacy by increased BMI and retrognathia., (© 2018 John Wiley & Sons Ltd.)

Koalas are characterised by a highly unusual vocal anatomy, with a descended larynx and velar vocal folds, allowing them to produce calls at disproportionately low frequencies. Here we use advanced imaging techniques, histological data, classical macroscopic dissection and behavioural observations to provide the first detailed description and interpretation of male and female koala vocal anatomy. We show that both males and females have an elongated pharynx and soft palate, resulting in a permanently descended larynx. In addition, the hyoid apparatus has a human-like configuration in which paired dorsal, resilient ligaments suspend the hyoid apparatus from the skull, while the ventral parts tightly connect to the descended larynx. We also show that koalas can retract the larynx down into the thoracic inlet, facilitated by a dramatic evolutionary transformation of the ventral neck muscles. First, the usual retractors of the larynx and the hyoid have their origins deep in the thorax. Secondly, three hyoid muscles have lost their connection to the hyoid skeleton. Thirdly, the genioglossus and geniohyoid muscles are greatly increased in length. Finally, the digastric, omohyoid and sternohyoid muscles, connected by a common tendinous intersection, form a guiding channel for the dynamic down-and-up movements of the ventral hyoid parts and the larynx. We suggest that these features evolved to accommodate the low resting position of the larynx and assist in its retraction during call production. We also confirm that the edges of the intra-pharyngeal ostium have specialised to form the novel, extra-laryngeal velar vocal folds, which are much larger than the true intra-laryngeal vocal folds in both sexes, but more developed and specialised for low frequency sound production in males than in females. Our findings illustrate that strong selection pressures on acoustic signalling not only lead to the specialisation of existing vocal organs but can also result in the evolution of novel vocal structures in both sexes., (© 2018 Anatomical Society.)

To compare the projectional surface anatomy of healthy individuals in an adult population with those with a thyroid mass, using computed tomography (CT). Sixteen slice CT images of 101 individuals were analyzed using a 32-bit Radiant DICOM viewer to establish the relationships among major anatomical landmarks in the neck and their vertebral levels. The structures investigated included: hard palate (HP), hyoid bone (HB) including body and lesser horns, soft palate (SP), thyroid gland (TG) (both superior and inferior poles), thyroid gland anteroposterior (APD) and superoinferior (SID) diameters, thyroid isthmus (TI) superoinferior dimension, epiglottis, vertebral arteries (right and left), and both right and left parotid glands (superior and inferior extents). The vertebral levels noted most frequently were: body of hyoid bone (C4, 42.71%); lesser horns of hyoid bone (C3, 36.46%); thyroid gland superior pole (C6, 31.25%); and thyroid gland inferior pole (T2, 30.2%). TG-ID, TG-APD, and TG-SID were not significantly different between males and females in the healthy group; however, there was a significant gender difference in thyroid gland inferior diameter in the pathology group [males 2.16(±1.16) vs. females 3.37(±1.30), P = 0.01, paired sample t-test]. Further studies are needed to determine whether neck pathology in those with a thyroid mass affects the dimensions of the thyroid gland. Moreover, the surface anatomy of the neck should be revisited using modern imaging techniques to address inconsistencies in anatomy and clinical reference texts. Clin. Anat. 30:781-787, 2017. © 2017Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Aim: To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea., Method: A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test., Results: Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm 3 before treatment to 6.57 ± 2.03 cm 3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05)., Conclusion: Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

Conclusions: Modified Friedman stage can be used to predict glossopharyngeal obstruction better than before in patients with obstructive sleep apnea (OSA)., Objective: To evaluate the diagnostic value of modified Friedman stage in predicting glossopharyngeal obstruction in patients with OSA., Methods: Eighty-five OSA patients with Friedman stage III were divided into IIIa group and IIIb group based on an imaginary line drawn in the horizontal and middle position of the soft palate. Polysomnography (PSG) was performed after nasopharyngeal tube (NPT) insertion (NPT-PSG) to diagnose glossopharyngeal obstruction. Apnea-hypopnea index (AHI) determined by NPT-PSG (NPT-AHI) and glossopharyngeal obstruction result determined by NPT-PSG (NPT-PSG result) were compared between the two groups., Results: There were significant differences in NPT-AHI (p < 0.01) and NPT-PSG result (p < 0.01) between the two groups.

Purpose: Mandibular advancement splints (MAS) are an effective treatment for obstructive sleep apnoea (OSA). However, MAS are not equally efficacious across all patients and the reasons are not well understood. Craniofacial and upper airway structure individually influence MAS response. We aimed to assess anatomical balance, defined as the ratio of upper airway soft tissue (ST) volume to maxillomandibular enclosure volume, between MAS treatment responders and non-responders., Methods: OSA patients (apnoea-hypopnea index (AHI) >10 h(-1)) were recruited for MAS treatment. Magnetic resonance imaging of the upper airway was performed during wakefulness without and with MAS in situ. Images were processed for volumetric analysis of upper airway soft tissues (tongue, soft palate, paraphayrngeal fat pads and lateral pharyngeal walls) and three-dimensional cephalometry to acquire intra-mandibular space area (IMA) and total maxillomandibular (Mm) volume. Anatomical balance ratios were compared between MAS treatment responders (AHI <10 h(-1) + 50 % reduction) and non-responders., Results: Image analysis was completed in 69 patients (68 % male, age 50.5 ± 10.1 years, BMI 29.6 ± 5.0 kgm(2), AHI 27.0 ± 14.7 h(-1)) including 36 responders. Soft tissue volumes did not differ between MAS responders and non-responders. Non-responders had increased ST/IMA compared to responders (4.9 ± 0.6 vs. 4.6 ± 0.6, p = 0.031). In multivariate logistic regression with AHI and BMI, ST/IMA was the only predictive variable (p = 0.036, ROC AUC 0.7). However, changes in ST/Mm did not directly relate to treatment response., Conclusions: Anatomical imbalance assessed by intra-mandibular space area was associated with poor MAS treatment response. However, changes in anatomical balance with mandibular advancement did not reflect treatment outcome as static imaging may not adequately capture improvements in upper airway function.

Some researchers contend that in adults the tensor tympani muscle (TT) connects with the tensor veli palatini muscle (TVP) by an intermediate tendon, in disagreement with the other researchers. To resolve this controversy, we examined serial sections of 50 human embryos and fetuses at 6-17 weeks of development. At 6 weeks, in the first pharyngeal arch, a mesenchymal connection was found first to divide a single anlage into the TT and TVP. At and after 7 weeks, the TT was connected continuously with the TVP by a definite tendinous tissue mediolaterally crossing the pharyngotympanic tube. At 11 weeks another fascia was visible covering the cranial and lateral sides of the tube. This "gonial fascia" had two thickened borders: the superior one corresponded to a part of the connecting tendon between the TT and TVP; the inferior one was a fibrous band ending at the os goniale near the lateral end of the TVP. In association with the gonial fascia, the fetal TT and TVP seemed to provide a functional complex. The TT-TVP complex might first help elevate the palatal shelves in association with the developing tongue. Next, the tubal passage, maintained by contraction of the muscle complex, seems to facilitate the removal of loose mesenchymal tissues from the tympanic cavity. Third, the muscle complex most likely determined the final morphology of the pterygoid process. Consequently, despite the controversial morphologies in adults, the TT and TVP seemed to make a single digastric muscle acting for the morphogenesis of the cranial base., (© 2016 Wiley Periodicals, Inc.)

Objective: To investigate the difference of lateral cephalogram, PSG, BMI in Uygur and Han OSAHS male patients. Method: OSAHS male patients with 33 Uygur cases and 42 Han cases,30 normal Uygur cases and 36 normal Han cases were taken as control.Lateral cephalogram of upright position in waking state, then comparecraniofacial strcture parameters and PSG dates, etc. Result: Patients in OSAHS group and normal group had significant differences in the MP-H, PAS, PNS-P, BMI ( P <0.05), the Uygur healthy men and Uygur male OSAHS patients had significant difference in the ANB° ( P <0.05). The difference was statistically significant in PNS-P, MP-H and BMI in Uygur and Han OSAHS male patients ( P <0.05). Conclusion: The differences in airway plane, hyoid position and length of soft palate and weight were significantly different between healthy men and OSAHS men. Han OSAHS male patients and Uygur male patients had significant differences in Hyoid position, length of the soft palate and weight. Lateral cephalogram can judge blocking site of upper airway and provide opration plan., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Prevalence of subclinical middle ear lesions in dogs that undergo computed tomography (CT) and magnetic resonance imaging of the head has been reported up to 41%. A predisposition in brachycephalics has been suggested, however evidence-based studies are lacking. Aims of this retrospective cross-sectional study were to compare CT characteristics of the middle ear in groups of nonbrachycephalic and brachycephalic dogs that underwent CT of the head for conditions unrelated to ear disease, and test associations between thickness of the soft palate and presence of subclinical middle ear lesions. One observer recorded CT findings for each dog without knowledge of group status. A total of 65 dogs met inclusion criteria (25 brachycephalic, 40 nonbrachycephalic). Brachycephalic dogs had a significantly thicker bulla wall (P = 2.38 × 10(-26)) and smaller luminal volume (P = 5.74 × 10(-20)), when compared to nonbrachycephalic dogs. Soft palate thickness was significantly greater in the brachycephalic group (P = 2.76 × 10(-9)). Nine of 25 brachycephalic dogs had material in the lumen of the tympanic cavity, compared to zero of 45 of nonbrachycephalics. Within the brachycephalic group, a significant difference in mean soft palate thickness was identified for dogs with material in the middle ear (12.2 mm) vs. air-filled bullae (9 mm; P = 0.016). Findings from the current study supported previous theories that brachycephalic dogs have a greater prevalence of subclinical middle ear effusion and smaller bulla luminal size than nonbrachycephalic dogs. Authors recommend that the bulla lumen volume formula previously developed for mesaticephalic dogs, (-0.612 + 0.757 [lnBW]) be adjusted to 1/3(-0.612 + 0.757 [lnBW]) for brachycephalic breeds., (© 2016 American College of Veterinary Radiology.)

The primary focus of this study was to assess age-related changes in the vertical distance of the estimated level of velopharyngeal closure in relation to a prominent landmark of the cervical spine: the anterior tubercle of cervical vertebra 1 (C1). Midsagittal anatomic magnetic resonance images were examined across 51 participants with normal head and neck anatomy between 4 and 17 years of age. Results indicate that age is a strong predictor (P = 0.002) of the vertical distance between the level of velopharyngeal closure relative to C1. Specifically, as age increases, the vertical distance between the palatal plane and C1 becomes greater resulting in the level of velopharyngeal closure being located higher above C1 (range 4.88-10.55 mm). Results of this study provide insights into the clinical usefulness of using C1 as a surgical landmark for placement of pharyngoplasties in children with repaired cleft palate and persistent hypernasal speech. Clinical implications and future directions are discussed.

The convexity of the dorsal surface of the velum is critical for normal velopharyngeal (VP) function and is largely attributed to the levator veli palatini (LVP) and musculus uvulae (MU). Studies have correlated a concave or flat nasal velar surface to symptoms of VP dysfunction including hypernasality and nasal air emission. In the context of surgical repair of cleft palates, the MU has been given relatively little attention in the literature compared with the larger LVP. A greater understanding of the mechanics of the MU will provide insight into understanding the influence of a dysmorphic MU, as seen in cleft palate, as it relates to VP function. The purpose of this study was to quantify the contributions of the MU to VP closure in a computational model. We created a novel 3-dimensional (3D) finite element model of the VP mechanism from magnetic resonance imaging data collected from an individual with healthy noncleft VP anatomy. The model components included the velum, posterior pharyngeal wall (PPW), LVP, and MU. Simulations were based on the muscle and soft tissue mechanical properties from the literature. We found that, similar to previous hypotheses, the MU acts as (i) a space-occupying structure and (ii) a velar extensor. As a space-occupying structure, the MU helps to nearly triple the midline VP contact length. As a velar extensor, the MU acting alone without the LVP decreases the VP distance 62%. Furthermore, activation of the MU decreases the LVP activation required for closure almost 3-fold, from 20% (without MU) to 8% (with MU). Our study suggests that any possible salvaging and anatomical reconstruction of viable MU tissue in a cleft patient may improve VP closure due to its mechanical function. In the absence or dysfunction of MU tissue, implantation of autologous or engineered tissues at the velar midline, as a possible substitute for the MU, may produce a geometric convexity more favorable to VP closure. In the future, more complex models will provide further insight into optimal surgical reconstruction of the VP musculature in normal and cleft palate populations.

Objectives: To examine muscle tissue distribution along the length of the velum in living individuals using magnetic resonance imaging (MRI)., Design: Using the three-dimensional MRI data acquired from 10 normal white adults, two area measures including the muscular area and the total velar area were obtained from 10 oblique slices running perpendicular to velar length. A polynomial regression analysis was performed where the proportion of the muscular to the total velar area was regressed on the slice numbers running along the length of the velum., Results: The proportion of the muscular to total velar area increased from the anterior section of the velum, reaching a maximum (33.24%) in the midsection, and decreasing in the posterior section of the velum. A third-order (cubic) polynomial function that best illustrated the proportional data (R(2) = .47) was derived., Conclusions: The present study demonstrated that MRI is a viable tool to examine the muscle tissue distribution of the velum in living individuals. Although the overall pattern in the muscle tissue distribution of the healthy velum was similar to that reported in previous literature based on cadaver specimens, the participants in the present study appeared to have greater muscular proportion of the velum. The muscular proportion measure derived from the healthy living individuals can be used as an additional parameter accounting for sufficient intravelar muscle mass for future studies.

Objective: To histologically evaluate and compare features of myofibers within the elongated soft palate (ESP) of brachycephalic and mesocephalic dogs with those in the soft palate of healthy dogs and to assess whether denervation or muscular dystrophy is associated with soft palate elongation., Sample: Soft palate specimens from 24 dogs with ESPs (obtained during surgical intervention) and from 14 healthy Beagles (control group)., Procedures: All the soft palate specimens underwent histologic examination to assess myofiber atrophy, hypertrophy, hyalinization, and regeneration. The degrees of atrophy and hypertrophy were quantified on the basis of the coefficient of variation and the number of myofibers with hyalinization and regeneration. The specimens also underwent immunohistochemical analysis with anti-neurofilament or anti-dystrophin antibody to confirm the distribution of peripheral nerve branches innervating the palatine myofibers and myofiber dystrophin expression, respectively., Results: Myofiber atrophy, hypertrophy, hyalinization, and regeneration were identified in almost all the ESP specimens. Degrees of atrophy and hypertrophy were significantly greater in the ESP specimens, compared with the control specimens. There were fewer palatine peripheral nerve branches in the ESP specimens than in the control specimens. Almost all the myofibers in the ESP and control specimens were dystrophin positive., Conclusions and Clinical Relevance: These results suggested that palatine myopathy in dogs may be caused, at least in part, by denervation of the palatine muscles and not by Duchenne- or Becker-type muscular dystrophy. These soft palate changes may contribute to upper airway collapse and the progression of brachycephalic airway obstructive syndrome.

Objective: To describe the nasopharyngeal airway dimensions of two brachycephalic breeds and to localize the area of smallest airway dimensions., Study Design: Prospective, descriptive, computed tomographic imaging study., Animals: Thirty pugs and 30 French bulldogs with brachycephalic upper airway syndrome., Methods: The thickness and length of the soft palate, cross-sectional area of the airway passage dorsal to the soft and hard palates, and cross-sectional area of the frontal sinus were measured and normalized to each dog's skull index and body weight before statistical comparison between breeds. Nasopharyngeal turbinates and surrounding airway space, and a possible relationship between the canine tooth angulation and the severity of airway obstruction were assessed., Results: Pugs had significantly smaller cross-sectional areas of the airway dorsal to the soft and hard palates than French bulldogs. In both breeds, the smallest nasopharyngeal cross-sectional areas were located dorsal to the caudal end of the soft palate. The soft palate of pugs was significantly shorter than that of French bulldogs and also significantly thinner when normalized to each dog's skull index. Pugs more commonly exhibited nasopharyngeal turbinates. Pugs had significantly smaller air-filled cavities at the location of the frontal sinus. No correlation between the nasopharyngeal dimensions and canine tooth angulation was observed., Conclusion: Computed tomographic assessment of the upper airway morphology showed the smallest nasopharyngeal cross-sectional areas were located dorsal to the caudal end of the soft palate in both breeds. Pugs had a smaller nasopharyngeal cross-sectional area despite smaller soft palate dimensions than French bulldogs., (© Copyright 2015 by The American College of Veterinary Surgeons.)

Aims: The aim of this work was to investigate the effects of commonly used orthodontic appliances on the magnetic resonance (MR) image quality of the craniofacial region, with special interest in the soft palate and velopharyngeal wall using real-time speech imaging sequences and anatomical imaging of the temporomandibular joints (TMJ) and pituitaries., Methods: Common orthodontic appliances were studied on 1.5 T scanner using standard spin and gradient echo sequences (based on the American Society for Testing and Materials standard test method) and sequences previously applied for high-resolution anatomical and dynamic real-time imaging during speech. Images were evaluated for the presence and size of artefacts., Results: Metallic orthodontic appliances had different effects on image quality. The most extensive individual effects were associated with the presence of stainless steel archwire, particularly if combined with stainless steel brackets and stainless steel molar bands. With those appliances, diagnostic quality of magnetic resonance imaging speech and palate images will be most likely severely degraded, or speech imaging and imaging of pituitaries and TMJ will be not possible. All non-metallic, non-metallic with Ni/Cr reinforcement or Ni/Ti alloys appliances were of little concern., Limitations: The results in the study are only valid at 1.5 T and for the sequences and devices used and cannot necessarily be extrapolated to all sequences and devices. Furthermore, both geometry and size of some appliances are subject dependent, and consequently, the effects on the image quality can vary between subjects. Therefore, the results presented in this article should be treated as a guide when assessing the risks of image quality degradation rather than an absolute evaluation of possible artefacts., Conclusions: Appliances manufactured from stainless steel cause extensive artefacts, which may render image non-diagnostic. The presence and type of orthodontic appliances should be always included in the patient's screening, so the risks of artefacts can be assessed prior to imaging. Although the risks to patients with fixed orthodontic appliances at 1.5 T MR scanners are low, their secure attachment should be confirmed prior to the examination., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aims: To histologically examine tissue obtained from the thick rostral portion of the soft palate in severely affected brachycephalic dogs, and to quantitatively compare the histological findings with a similar region in control dogs., Methods: Nine dogs examined for treatment of brachycephalic obstructive airway syndrome (BOAS) were prospectively recruited into the study. Four mesaticephalic dogs were also recruited following euthanasia for reasons unrelated to respiratory or gastrointestinal disease. Palatine tissue was harvested using an elliptical incision extending from the junction with the hard palate to the free caudal edge, and passing axial to the tonsilar crypts. The resected portion was fixed in formalin and stained using H&E. Tissues were examined in transverse section and assessments of the palatinus muscles, interstitium, lamina propria and salivary tissue were recorded. Quantitative analysis of the proportions of palatinus muscle, salivary tissue and stroma was performed using ImageJ image analysis software., Results: When compared to the control dogs, the histological findings of the clinically affected dogs showed a marked increase in acute and chronic muscle degeneration and necrosis. This was typified by swollen, hypereosinophilic fibres with centralised nuclei, myofibre atrophy, loss of cross striations and fragmented sarcoplasm. There was reduced proportions of palatinus muscle (p<0.001) and increased proportions of collagenous stroma (p=0.004) and salivary gland tissue (p=0.046) in the clinical samples, compared to control dogs., Conclusions: Increased thickness of the palate in dogs with BOAS was not due to muscle hypertrophy but was due to increased stroma within the lamina propria, and increased proportions of salivary tissue. There was also a reduction of muscle mass, especially within the paired palatinus muscles, that may have consequences for palate function., Clincal Relevance: The results of this study enable us to start investigating the aetiology of the changes seen in brachycephalic compared to mesaticephalic dogs, which will impact timing and extent of treatment of clinical cases.

Objective: To discuss the soft palate, hard palate and mandibule for the pathogenesis and clinical treatment of patients who have obstructive sleep apnea hypopnea syndrome., Method: There were 52 patients with OSAHS diagnosed by the PSG and 32 cases of normal healthy volunteers in our hospital. All objects were given 128 slice spiral CT scan of the upper airway. We measured the related indexes of the soft palate, hard palate and mandible, then analysed statistical differences between them and did Pearson correlation analysis with apnea hypoventilation index (AHI), average blood oxygen saturation (MSaO2) in PSG., Result: Compared with the control group, the soft palate length [(37.93 ± 5.20)mm VS (33.52 ± 4.25)mm] and the distance between mandible with cervical vertebra [(75.00 ± 7.10)mm VS (69.93 ± 5.58)mm] increased significantly, but the distance of trailing edge of hard palate to inferior margin of slope significantly reduced [(42.57 ± 4.52)mm VS (45.80 ± 2.94)mm, P < 0.01] in patients with OSAHS. Each measurement associated with AHI and MSaO2 had no significant correlation (P > 0.05)., Conclusion: The soft palate, hard palate and mandibular are some of the important risk factors of OSAHS, and they also have reference value for the choice of clinical treatment operation. Preoperative CT examination can offer help in the treatment of OSAHS.

Purpose: This study predicted the effects of velopharyngeal (VP) anatomical parameters on VP function to provide a greater understanding of speech mechanics and aid in the treatment of speech disorders., Method: We created a computational model of the VP mechanism using dimensions obtained from magnetic resonance imaging measurements of 10 healthy adults. The model components included the levator veli palatini (LVP), the velum, and the posterior pharyngeal wall, and the simulations were based on material parameters from the literature. The outcome metrics were the VP closure force and LVP muscle activation required to achieve VP closure., Results: Our average model compared favorably with experimental data from the literature. Simulations of 1,000 random anatomies reflected the large variability in closure forces observed experimentally. VP distance had the greatest effect on both outcome metrics when considering the observed anatomic variability. Other anatomical parameters were ranked by their predicted influences on the outcome metrics., Conclusions: Our results support the implication that interventions for VP dysfunction that decrease anterior to posterior VP portal distance, increase velar length, and/or increase LVP cross-sectional area may be very effective. Future modeling studies will help to further our understanding of speech mechanics and optimize treatment of speech disorders.

Objective: To evaluate the changes in retropalatal airway and velopharyngeal dimensions after posterior impaction (PI) only or PI and setback (PI/SB) of the maxilla in patients with skeletal Class III undergoing two-jaw surgery., Materials and Methods: Subjects consisted of 60 Class III patients treated with two-jaw surgery. They were divided into two groups: group 1 (n  = 30; PI of the maxilla; mean  =  2.6 mm) and group 2 (n = 30; PI/SB of the maxilla; mean  =  2.8 mm and 1.8 mm, respectively). Using three dimensional computed tomography images taken 1month before surgery (T0) and at least 6 months after surgery (T1), retropalatal airway volume, minimum cross-sectional area, and lateral and anteroposterior (AP) dimensions of minimum cross-sectional area, soft palate angle, soft palate length, and pharyngeal depth were measured. A paired t-test and independent t-test were used for statistical analysis., Results: Group 1 showed increase in retropalatal airway volume and minimum cross-sectional area (P < .01 and P < .05, respectively). Group 2 exhibited decrease in retropalatal airway volume, minimum cross-sectional area, and lateral and AP dimensions of minimum cross-sectional area (all P < .01). Although groups 1 and 2 showed an increase in soft palate length (P < .01 and P < .001, respectively), pharyngeal depth significantly increased only in group 1 (P < .01). Groups 1 and 2 were significantly different in retropalatal airway volume, minimum cross-sectional area, and AP dimension (P < .05, P < .001, and P < .05, respectively)., Conclusion: Because the direction of surgical movement in the maxilla can determine the changes in the retropalatal airway and velopharyngeal dimensions, it is recommended that clinicians investigate whether patients suffer from sleep-related breathing disorders before performing PI/SB of the maxilla.

Rationale: Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children., Objectives: To investigate the anatomic risk factors in adolescents with OSAS compared with obese and lean control subjects using magnetic resonance imaging (MRI)., Methods: Three groups of adolescents (age range: 12-16 yr) underwent MRI: obese individuals with OSAS (n = 49), obese control subjects (n = 38), and lean control subjects (n = 50)., Measurements and Main Results: We studied 137 subjects and found that (1) obese adolescents with OSAS had increased adenotonsillar tissue compared with obese and lean control subjects; (2) obese OSAS adolescents had a smaller nasopharyngeal airway than control subjects; (3) the size of other upper airway soft tissue structures (volume of the tongue, parapharyngeal fat pads, lateral walls, and soft palate) was similar between subjects with OSAS and obese control subjects; (4) although there were no major craniofacial abnormalities in most of the adolescents with OSAS, the ratio of soft tissue to craniofacial space surrounding the airway was increased; and (5) there were sex differences in the pattern of lymphoid proliferation., Conclusions: Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.

Objectives/hypothesis: To describe and to assess reproducibility of a method to model the lumen of the pharyngeal airway using anatomic structures., Study Design: Single-center, institutional review board-approved retrospective case series., Methods: Multiple structural landmarks (hard palate, palatal aponeurosis, genu, velum, and lateral wall; pharyngeal and vallecular tongue base; and epiglottis) were used as reference points to score the associated airway. These characteristics were then combined to create a luminal model of the pharyngeal airway. Retrospective assessment by two independent observers of 117 sedated endoscopies from a convenience sample (81% male, aged 51.4 years; apnea hypopnea index 38.5 events/hr) was performed., Results: Scoring of individual landmarks demonstrated a good or better agreement (kappa of 0.42-0.79). Agreement on whether the airway was constricted/obstructed was very high (kappa > 0.77). Based on differences in airway measures at different levels, multiple patterns of luminal shape and narrowing were observed. The upper pharyngeal lumen was classified into different shapes based on findings at different levels of the soft palate (oblique, 52%; intermediate, 23%; vertical, 25%). Similarly, the lower pharynx was classified into three shapes based on the structure of the tongue., Conclusion: Multiple pharyngeal luminal configurations describing airway phenotypes can be described using landmarks identifiable on endoscopy., Level of Evidence: 4., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Propofol and midazolam are widely used for pediatric magnetic resonance imaging (MRI) sedation. Increasing depth of sedation may be associated with airway obstruction. A neck collar supporting the mandible and maintaining the head in slight extension may be beneficial in maintaining airway patency., Aim of the Study: Primary aim: To assess upper airway size with and without a neck collar during pediatric MRI sedation with propofol-midazolam. Secondary aim: To evaluate complications encountered during the procedure., Materials and Methods: Sixty patients aged 2-4 years scheduled for MRI of the brain were selected. They were sedated with intramuscular midazolam 0.1 mg·kg(-1) 30 min before the procedure. Patients were sedated with i.v. propofol 1 mg·kg(-1) and continued with 50-100 μg·kg(-1) ·min(-1) . T1 3D fast-field echo axial sequence from the nasopharyngeal roof to subglottic region was taken with and without application of a neck collar. Airway dimensions were measured and analyzed at the base of the tongue, soft palate, and at the epiglottis., Results: At the base of the tongue and soft palate, the cross-sectional area (CSA) and the anteroposterior diameter of the airway were respectively statistically significantly higher when the neck collar was applied. The CSA at the epiglottis was significantly less with application of the neck collar. Complications were not significantly different between the two sequences., Conclusion: Application of a soft neck collar in children aged 2-4 years may enhance the retropalatal and retroglossal airway dimensions during pediatric sedation in the supine position., (© 2015 John Wiley & Sons Ltd.)

A thickened and abnormally long soft palate is mostly involved in the pathogenesis of both nasopharyngeal and oropharyngeal narrowing, affecting the respiratory activity in virtually all of the brachycephalic dogs suffering from Brachycephalic Airway Obstructive Syndrome (BAOS). The morphology of the soft palate in adult mesaticephalic and brachycephalic dogs has been previously described. In this article specimens from brachycephalic dog neonates (N=10) dead from one to 3 hr after birth of unrelated conditions were collected and histologically evaluated at three transverse levels to describe the microscopic aspect of the caudal part of the soft palate. The soft palate of neonate brachycephalic dogs was histologically characterized by a musculo-connective axis containing salivary glands and coated by a mucosal layer on both the nasopharyngeal and the oral side. Quali-quantitative features, such as thickened superficial epithelium, broad oedema of the lamina propria, mucous gland hyperplasia and diverse muscular modifications described in adult brachycephalic dogs, were not observed in the soft palate of brachycephalic neonate dogs. The lack of tissue lesions in the soft palate of newborn brachycephalic dogs further supports the hypothesis that inspiratory depression during the inspiratory phase causes chronic vibration and microtrauma, which lead to soft palate alterations in adult brachycephalic dogs starting from the earliest grade of the respiratory syndrome. Overall, this study provides baseline information for the comprehension of the pathogenesis of BAOS., (© 2014 Wiley Periodicals, Inc.)

Background: Insertion of the intraoral prosthesis causes deflection of the tongue, soft palate affecting the patency of the airway., Aims: To evaluate the cephalometric soft tissue variation in tongue, soft palate, and its effect on posterior airway space in edentulous patients with the insertion of the denture., Settings and Design: Randomized controlled trial., Materials and Methods: Complete denture (CD) prosthesis was fabricated for first time denture wearers comprising 22 males and 18 females within the age range of 50-65 years. Lateral skull radiographs were taken for each of the subjects in their resting position without CDs (T0), with CDs (T1) at least 1-week postinsertion and after 6 months of usage (T2), respectively. The reference points, lines, and angles on the cephalometric films were used to evaluate the position or inclination of the head, variations in tongue position and length, the changes in the anteroposterior dimension of the soft palate, and posterior airway space variations. Intra-investigator error variance was not found to be statistically significant (P < 0.05)., Statistical Analysis Used: Using Statistical Package for the Social Sciences (SPSS) v16.0 the significant difference in the paired samples (without CD and with CD) was found using the paired t-test. The probability value P = 0.05 is considered as a significant level., Results: On comparison of T1 and T0, the heads were more extended with the downward position of the tongue with an increase in its length and the posterior airway space was decreased in T1. Significant differences in values were not observed between T1 and T2., Conclusions: With CDs, the change in airway space was related to alteration in soft palate and tongue dimension. There were no changes in dimension at 6 months follow-up.

The velopharynx is a complex structure that is responsible for separation of the oral and nasal cavities during speech production and swallowing. Incompetence of this mechanism can lead to hypernasality, with nasal air emission and incomprehensible speech, as well as nasopharyngeal regurgitation. There can be a significant social stigma associated with velopharyngeal dysfunction, and surgical treatment can be curative in many cases. Knowledge of the normal anatomy and physiology of the velopharyngeal complex is essential when planning for surgical repair., (© 2015 S. Karger AG, Basel.)

The posterior palatal seal area is defined as the soft tissue area at or beyond the junction of the hard and soft palates on which pressure within physiologic limits can be applied by a removable complete denture to aid in its retention. The retention of the maxillary denture is affected by the extent and the design of the posterior palatal seal. This article discusses a method of defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using microabrasion and a nonfluid wax addition technique., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

In our ongoing series of anatomical studies to determine the three-dimensional architecture of the human velar muscles, we have previously reported on the palatopharyngeus. The present study deals with the musculus uvulae (MU), in which the positional relationships of its origin to the posterior nasal spine and the palatine aponeurosis, as well as the interrelation between its anatomical status and functions, have yet to be clarified. Macroscopic and microscopic examinations were performed on 25 and 2 cadavers, respectively. In the former, bilateral MUs and their adjacent structures were exposed mainly from the nasal aspect. In the latter, the soft palates embedded in paraffin were cut into frontal and sagittal sections and alternately processed with HE and Azan stains. The left and right MUs adjacent to each other were found to run longitudinally along the midline beneath the nasal aspect of velum. It was overlaid by glandular tissue that increased in amount as it coursed distally. After originating from the oral surface of palatine aponeurosis, it ran backward to cross above the sling formed by the levator veli palatini muscles of both sides and reached the tip of uvula with its muscle fibers intermingled with glandular tissue. Past studies have proposed three functions of MU to enhance the efficiency of velopharyngeal closure: space occupier, stiffness modifier, and velar extensor. All of the above-described anatomical characteristics of MU could be explained as being adapted for these functions. This implies that MU is actively responsible for maintaining the velopharyngeal closure efficiency., (© 2014 Wiley Periodicals, Inc.)

Peccaries are characterized by a prominent skin gland, known as scent gland, which is located in the middle of the rump. These animals are able to survive in a great variety of habitats, from humid tropical forests to semi-arid areas. They are omnivorous animals, and their diet includes fibrous material, vegetables, fruits, small vertebrates and insects. Collared peccary hard palate and soft palate tonsils were studied, macroscopic morphometric data were collected and tissue samples were paraffin-embedded. Sections were stained with HE, Gomori's trichrome and von Kossa; the first two were used to study general organization and the latter to detect calcium deposits. The hard palate showed one incisive papilla followed by several rugae united by a distinct raphe. The hard palate is lined by a keratinised squamous epithelium resting on a dense connective, whereas in the soft palate, the epithelium is parakeratinised and showed lymphocyte infiltration. The palate showed several pacinian corpuscles in the propria-submucosa. Two ovoid-shaped tonsils were found in the soft palate, and several crypts were observed on its surface. The epithelium was highly infiltrated by lymphocytes, and within the crypts, tonsilloliths were frequently observed. The study showed that the general organization of collared peccary palate is similar to other species, but in its oropharynx, only the soft palate tonsil was present and the pacinian corpuscles formed small aggregates., (© 2013 Blackwell Verlag GmbH.)

Transoral robotic surgery (TORS) offers new possibilities that have not been experimented in the field of minimally invasive skull base neurosurgery. We propose to evaluate the feasibility of transoral approach to the sella turcica with the da Vinci system on cadavers. We performed four robot-assisted dissections on human fresh cadavers in order to reach the pituitary fossa by the oral cavity. Cavum mucosa dissection was performed by the head and neck surgeon at the console and then the sphenoid was drilled by the neurosurgeon at the bedside, with intraoperative fluoroscopy and a "double surgeon" control. Mucosa closure was attempted with robotic arms. We succeeded in performing a sellar opening in all cadavers with a minimally invasive approach, as the hard palate was never drilled. The video endoscope offered a large view inside the sphenoidal sinus, as observed in transnasal endoscopy, but with 3D visualization. The camera arm could be inserted into the sphenoidal sinus, and instrument arms in the pituitary fossa. Operative time to reach the pituitary fossa was approximately 60 min in all procedures: 20 min of initial setup, 10 min of mucosal dissection, and 30 min of sphenoid surgery. New anatomical landmarks were defined. Advantages and pitfalls of such an unpublished technique were discussed. This is the first cadaveric study reported da Vinci robotic transoral approach to the sella turcica with a minimally invasive procedure. This innovative technique may modify the usual pituitary adenoma removal as the sella is approached infero-superiorly.

Statement of Problem: The spatial relationship between the foveae palatinae and vibrating lines varies among individuals; such variability could be related to the contour of the palate., Purpose: The purpose of this study was to investigate the relative location of the foveae palatinae and vibrating lines and to determine the correlation between the seal area of the posterior palate and the palatal contour with lateral cephalogram radiography., Material and Methods: Fifty participants were examined. The Valsalva maneuver was used to determine the anterior vibrating line, and the phonation ('ah') method was used to detect the posterior vibrating line. The distance from the anterior to the posterior vibrating line and the distances between the foveae palatinae and the anterior and posterior vibrating lines were measured. A lateral cephalogram was made to trace the hard and soft palate contour, and the angle of the palatal contour was measured with the V-ceph program. Correlation analysis was conducted with statistical software to examine the relation between the distance from the anterior to the posterior vibrating line and the angle of the palatal contour at the junction of the hard and soft palate., Results: The anterior vibrating line was located approximately 2.58 ±1.19 mm anterior to the foveae palatinae, and the posterior vibrating line was located 0.71 ±0.68 mm posterior. A positive correlation was found between the distance from the anterior to the posterior vibrating line in the lateral sagittal plane and the angle of the palatal contour at the junction of the hard and soft palate. Correlation coefficients were 0.495 in the left sagittal plane and 0.560 in the right sagittal plane (P<.05)., Conclusions: Considering their proximity to the posterior vibrating line, the foveae palatinae could be reliable reference points for locating the posterior border of the maxillary denture. The results of this study also suggest that a wider posterior palatal seal area could be obtained if the patient has a gentle palatal contour at the junction of the hard and soft palate., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Study Objectives: The objective of this study was to explore the mechanism of action of the oral pressure therapy (OPT) device, a new treatment for sleep apnea., Design: Case series., Setting: Academic medical center., Patients: Fifteen subjects with sleep apnea who had been successfully treated (responders) with the OPT device and 4 subjects who were not successfully treated (non-responders) with the OPT device., Interventions: All subjects underwent a MRI (without the device, with the device in place without vacuum and with the device in place with vacuum) to examine the biomechanical changes associated with the OPT device., Measurements and Results: Oral pressure therapy significantly (P = 0.002) increased the size of the retropalatal airway in both the lateral and anterior-posterior dimensions by moving the soft palate anteriorly and superiorly and the anterior-superior segment of the tongue forward, toward the teeth. The percentage and absolute increase in the cross-sectional area of the retropalatal region, the superior movement of the soft palate, and the anterior displacement of the tongue were significantly greater in the responders than in the non-responders. In responders, there were significant increases in the mean (P = 0.002), maximum (P = 0.0002), and minimum (P = 0.04) cross-sectional areas of the retropalatal region with the OPT device. However, in the retroglossal region, airway caliber decreased with the OPT device., Conclusions: In those who responded to oral pressure therapy, it increased airway caliber in the retropalatal region by moving the soft palate anteriorly and superiorly and the anterior-superior segment of the tongue forward., Citation: Schwab RJ, Kim C, Siegel L, Keenan BT, Black J, Farid-Moayer M, Podmore J, Vaska M. Examining the mechanism of action of a new device using oral pressure therapy for the treatment of obstructive sleep apnea.

The anatomy of the palate has been extensively described, with a predominant focus on palatal musculature. There are no biomechanical studies investigating the effects of surgical maneuvers on the palate to aid cleft closure. This study aims to describe the soft tissue attachments at different zones and quantify the movement following their release. Fourteen adult cadaver heads were dissected. The palates were split in the midline and five maneuvers described: Step 1, over the hard palate; Step 2, around the greater palatine pedicle; Step 3, over the palatine aponeurosis; Step 4, over the hamulus; and Step 5, resulting in a hamulus fracture. The movements across the midline at the posterior nasal spine following each maneuver were measured. The age range of the 14 heads was between 60 -75 years. Completion of steps 1 and 2 over the hard palate obtained a mean release of 2.6 and 2.0 mm, respectively. The largest movements occurred at Step 3 (5.7 mm) and Step 4 (3.5 mm), after releasing attachments at the posterior hard palate and palatine aponeurosis. Steps 3 and 4 dissections exhibited cumulative release, with a maximum movement with Step 3 (p < 0.05). Isolated fracture of the hamulus (Step 5) yielded a mean movement of 1.4 mm. Individual steps of dissection are described with respect to releasing soft tissue attachments. Medial movement of the oral mucosa is quantified with each step of dissection. The greatest release occurred with dissection overlying the palatine aponeurosis posterior to the hard/soft palate junction. Additional dissection along the hamulus (without fracture) added significantly to this release., (Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)