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Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features of craniofacial morphology and OSA severity in a population of patients with OSA. Material and Methods: A sample of forty-two patients (n = 42, M = 76%, mean age = 57.8 ± 10.8) with a polysomnographically (PSG) confirmed diagnosis of OSA were recruited and underwent cephalometric evaluation of 16 cephalometric variables. In addition, the apnea−hypopnea index (AHI), oxygen desaturation (SatMin), Epworth sleepiness scale (ESS), and body mass index (BMI) were assessed. Then t-tests were performed to compare the values of all cephalometric variables between two AHI severity-based groups (mild-to-moderate = AHI ≤ 30; severe = AHI > 30). Single- and multiple-variable regression analyses were performed to assess the associations between AHI scores and cephalometric features. Results: Mean AHI, SatMin, and BMI were 31.4 ev/h, 78.7%, and 28.1, respectively. The cephalometric variables were not significantly different between the two OSA-severity groups (p > 0.05). Multiple-variable regression analyses showed that gonial angle and nasopharynx space were negatively associated with AHI, explaining 24.6% of the total variance. Conclusion: This investigation reported that severity of AHI scores in patients with OSA showed a negative correlation with gonial angle and nasopharynx space. As a general remark, although maxillofacial anatomy can be a predisposing factor for OSA, disease severity depends mainly upon other variables.

Objectives: To determine the prevalence of olfactory and taste dysfunction (OD; TD) among COVID-19 positive health care workers (HCWs), their associated risk factors and prognosis., Methods: Between May and June 2020, a longitudinal multicenter study was conducted on symptomatic COVID-19 PCR confirmed HCWs (COVID-19 positive) in London and Padua., Results: Hundred and fourteen COVID-19 positive HCWs were surveyed with a response rate of 70.6% over a median follow-up period of 52 days. UK prevalence of OD and TD was 73.1% and 69.2%, respectively. There was a male to female ratio of 1:3 with 81.6% being white, 43.7% being nurses/health care assistants (HCAs), and 39.3% being doctors. In addition, 53.2% of them worked on COVID-19 wards. Complete recovery was reported in 31.8% for OD and 47.1% for TD with a 52 days follow-up. The job role of doctors and nurses negatively influenced smell ( P = .04 and P = .02) and taste recovery ( P = .02 and P = .01). Ethnicity (being white) showed to positively influence only taste recovery ( P = .04). Sex (being female) negatively influenced OD and TD recovery only in Paduan HCWs ( P = .02 and P = .011, respectively). Working on a COVID-19 ward did not influence prognosis., Conclusions: The prevalence of OD and TD was considerably higher in HCWs. The prognosis for OD and TD recovery was worse for nurses/HCAs and doctors but working on a COVID-19 ward did not influence prognosis. Sixty-eight percent of surveyed HCWs at 52 days continued to experience OD or TD requiring additional future medical management capacity., Level of Evidence: 4., Competing Interests: The authors declare that they have no conflict of interest., (© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society.)

Objective : To investigate the association between volumetric measurements of craniofacial morphology and temporomandibular disorders (TMDs). Methods : Computerized tomography (CT) scans of 20 individuals aged 18 to 40 with (TMD group) or without TMJ pain (control group) were gathered based on a case-control design. Three-dimensional reconstructions were performed to evaluate the gonial angle, condylar volume, and the distance between the posterior edge of the condyle and the sigmoid notch. Results : The gonial angle was significantly larger (8% difference) in the TMD group with respect to controls, whereas the condylar volume was significantly higher in the control group (15.2% difference). No significant difference was found in the linear distance. Conclusion : There is an association between the presence of TMJ pain and some features of craniofacial morphology. Individuals with TMJ pain have a lower condylar volume and a tendency towards hyperdivergent growth.

Background: Amyotrophic lateral sclerosis (ALS) patients often require long-term tracheostomy ventilation (LT-TV) because of progressive ventilatory failure. Although widely used for non-invasive ventilation (NIV), passive exhalation port systems have not been gaining popularity for TV because of the possibility of carbon dioxide (CO 2 ) rebreathing. The current study set out to investigate the effect of a Whisper Swivel connector in comparison to an active exhalation valve on gas exchange and symptoms in ALS patients requiring LT-TV., Methods: A prospective randomized controlled trial was carried out to compare the clinical outcome of ten ALS patients receiving LT-TV by means of a Trilogy 100 ventilator with a Whisper Swivel passive exhalation port (group A) and of 10 ALS patients connected to an Airox Legendair ventilator with an active exhalation valve (group B). The study's main outcome measure was CO 2 retention at the 30-day follow-up assessment., Results: One patient in each of the two cohorts showed significant CO 2 retention. At the 30-day assessment, scores on the following measures were not significantly different in the two groups: the Borg dyspnea scale {2 [1-3] vs. 1 [1-3]; P=0.2891}, the visual analogue scale (VAS) dyspnea {20 [10-85] vs. 20 [0-50]; P=0.8571}, the Epworth sleepiness scale (ESS) {8 [4-10] vs. 5.5 [0-12]; P=0.1443}, the EuroQol-VAS (EQ-VAS) {55 [50-80] vs. 50 [30-80]; P=0.4593} and the relative stress scale (RSS) {49 [30-65] vs. 52 [25-64]; P=0.8650}. At the 3-month follow-up assessment, the numbers of hospitalizations and deaths were likewise similar in the two groups., Conclusions: The efficacy of the Whisper Swivel connector is similar to that of an active exhalation valve in ALS patients undergoing LT-TV., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background : Sialorrhoea and drooling are disabling manifestations of different neurological disorders. The aim of this study was to evaluate the effects of botulinum neurotoxin type A (BoNT/A) injection on hypersalivation in 90 patients with neurological diseases of different aetiologies, and to define the minimum number of injected salivary glands to reduce sialorrhoea. Determining the minimum number of glands that need to be engaged in order to have a significant reduction in drooling may be very useful for establishing the minimum total dosage of BoNT/A that may be considered effective in the treatment of hypersalivation. Methods : Twenty-five mouse units (MU) of BoNT/A ( onabotulinumtoxin A, Botox; Allergan, Irvine, CA, USA; 100 MU/2 mL, 0.9% saline; or incobotulinumtoxin A , Xeomin; Merz Pharma, Germany; 100 MU/2 mL, 0.9% saline) were percutaneously injected into the parotid (p) glands and/or submandibular (s) glands under ultrasound control. On this basis, patients were divided into three groups. In group A (30 patients), BoNT/A injections were performed into four glands; in group B (30 patients), into three glands, and in group C (30 patients), into two glands. Patients treated in three glands (group B) were divided into two subgroups based on the treated glands (2 p + 1 s = 15 patients; 2 s + 1 p = 15 patients). Similarly, patients being injected in two glands (group C) were subdivided into three groups (2 p = 10 patients; 1 p + 1 s = 10 patients; 2 s = 10 patients). In patients who were injected in three and two salivary glands, saline solution was injected into the remaining one and two glands, respectively. Assessments were performed at baseline and at 2 weeks after the injections. Results : BoNT/A significantly reduced sialorrhoea in 82 out of 90 patients. The effect was more evident in patients who had four glands injected than when three or two glands were injected. The injections into three glands were more effective than injections into two glands. Conclusions : Our results have shown that BoNT/A injections induced a significant reduction in sialorrhoea in most patients (91%). In addition, we demonstrated that sialorrhoea associated with different neurological diseases was better controlled when the number of treated glands was higher., Competing Interests: The authors declare no conflict of interest. We had no founding sponsor.

Aims: The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identified by cephalometry, for the efficacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA)., Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated., Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate., Conclusions: The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account., (© 2015 American Academy of Sleep Medicine.)

Background: Although respiratory exacerbations are common in patients with quadriplegic cerebral palsy (CP), little is known about the factors that are related to increased exacerbation risk. This study aimed to identify the clinical and pulmonary function variables signaling risk of exacerbation in this type of patient., Methods: Thirty-one children and young adults with quadriplegic CP underwent a comprehensive history, physical examination, and pulmonary function test, including arterial blood gas analysis, airway resistance using the interrupter technique, and home overnight SpO2 monitoring. Subjects were divided into 2 groups depending on the number of respiratory exacerbations reported during the year before study entry: frequent exacerbators (ie, ≥ 2 exacerbations) and infrequent exacerbators (ie, < 2 exacerbations)., Results: The frequent exacerbators were more likely to require hospitalization due to respiratory disorders compared with the infrequent exacerbators (13/14 vs 9/17, P = .02). Respiratory exacerbation was found to be associated with diagnosis of gastroesophageal reflux (adjusted odds ratio of 23.95 for subjects with confirmed diagnosis, P = .02) and higher PaCO2 levels (adjusted odds ratio of 12.60 for every 5-mm Hg increase in PaCO2 , P = .05). Subjects with PaCO2 ≥ 35 mm Hg showed an exacerbation odds ratio of 15.2 (95% CI 1.5-152.5, P = .01)., Conclusions: Gastroesophageal reflux and increased PaCO2 can be considered simple, clinically useful markers of increased exacerbation risk in young subjects with quadriplegic CP., (Copyright © 2015 by Daedalus Enterprises.)

Objectives: To assess the effectiveness of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea syndrome (OSAS) over a long-term follow-up in patients non-compliant with continuous positive airway pressure (CPAP) and to identify potential predictive factors of response to MADs., Methods: Fifteen OSAS patients were enrolled. Apnea-hypopnea index (AHI) and daytime sleepiness were assessed at baseline and at the end of follow-up. Potential baseline predictors of treatment effectiveness were assessed., Results: AHI and Epworth Sleepiness Scale (ESS) scores improved significantly with MADs. Sixty per cent of patients were 'responders', of whom 33% were 'full responders'. Sixty-seven per cent of patients showed total compliance. No correlations between the potential predictors and the response to MAD therapy were found., Discussion: Effectiveness of MAD therapy was shown over a long-term follow-up in OSAS patients with low compliance to CPAP. Efforts to identify predictive success factors fell short.

Aims: The present study was designed to test the hypothesis that dental occlusion may have a role in mediating the effects of bruxism in temporomandibular disorders (TMD) patients. It aimed to answer the clinical research question: in a population of TMD patients with clinically diagnosed clenching-type bruxism, are the different TMD diagnoses associated with different occlusal features?, Materials and Methods: A total of 294 TMD patients (73% females, mean age 38·3±9·2 years) who were positive for a clinical diagnosis of clenching-type bruxism underwent an assessment in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I, as well as a recording of nine occlusal features. Statistical analyses were performed to test the null hypotheses that: (1) no differences existed between the patients with or without the various occlusal features as for the prevalence of the various single and combined RDC/TMD group diagnoses (single variable analysis), and (2) having any specific occlusal feature makes no difference in distinguishing within the RDC/TMD diagnoses (multiple variable analysis)., Results: The distribution of the different combination of RDC/TMD axis I diagnoses was significantly different in patients with laterotrusive interferences with respect to those without such interferences (chi-square = 15·209; P = 0·033) as well as in patients with a slide from retruded contact position (RCP) to maximum intercuspation (MI) >2 mm with respect to those without such slide (chi-square = 4·029; P = 0·012) and in those with or without molar class asymmetry (chi-square = 17·438; P = 0·015). Multinomial regression analysis showed that the model including the various occlusal features account for 20·4% of the variance for RDC/TMD diagnoses (Nagelkerke R(2) = 0·204) and allowed the rejection of the null hypothesis that having such specific occlusal features makes no difference in distinguishing within the RDC/TMD diagnoses., Conclusions: Within the limitations of this study, it can be suggested that in a population of patients with TMD and clinically-diagnosed clenching-type bruxism, the patterns of TMD diagnoses may be influenced, at least in part, by the presence of some features of dental occlusion, namely, slide RCP-MI, laterotrusive interferences, and molar asymmetry.

It is well known that head trauma may cause hearing loss, which can be either conductive or sensorineural. Benign paroxysmal positional vertigo and olfactory dysfunction due to head trauma are also well known. The association between sensorineural hearing loss and anosmia, following head trauma, is extremely rare. Two rare cases of post-traumatic occurrence of hearing loss, olfactory dysfunction and benign positional vertigo are reported and the pathophysiology of the association between sensorineural hearing loss, anosmia and benign paroxysmal positional vertigo, after head injury, are briefly discussed. ENT specialists should, in the authors' opinion, be aware of the possible association between anosmia, sensorineural hearing loss and benign paroxysmal positional vertigo after head injury, even in the absence of skull fracture.

Laryngeal muscles in mammals are involved in highly specialized functions such as control of air passage, sphincter for airway protection and phonation. In this study, we aimed to assess whether such specialized functions are accompanied by specific distributions of fibre types. To this end, we studied the expression of the isoforms of the heavy subunit of myosin, myosin heavy chain (MyHC), which are considered the molecular markers of fibre types. The pattern of MyHC isoform expression was determined in 5 intrinsic laryngeal muscles: tensors as thyroarytenoid (TA), vocal (Vo), cricothyroid (CT), adductors as transverse arytenoid or interaytenoid (IA), and abductors as posterior cricoarytenoid (PCA), and 2 extrinsic muscles such as thyropharingeal (TPh) and cricopharingeal (CrPh). Muscles were sampled in 14 patients (11 males and 3 females, age 55-75 years) subjected to laryngectomy. MyHC isoforms were separated by SDS-PAGE and quantified by computer assisted densitometry. The comparison between the proportions of MyHC isoforms showed that: i) the three isoforms expressed in trunk and limb muscles (I, IIA and IIX) were present in all muscles examined, ii) the fast or type II MyHC isoforms were predominant in all muscles, representing 60-70% of the total, with no significant differences with respect to muscle types, iii) an additional isoform (indicated as MyHC L) was present in the muscles of the majority of the subjects and was more abundant in Vo and IA. MyHC L was, however, not found in any muscle of the three female patients and was never found in TA and TPh, iv) a great interindividual variability in MyHC distribution was present in all muscles.

Objective: No specific treatment for oropharyngeal dysphagia related to diabetic neuropathy has been described to date. Chemical myotomy of the cricopharyngeus (CP) muscle by botulinum neurotoxin type A (BoNT/A) has been effective in reducing or abolishing dysphagia associated with upper esophageal sphincter (UES) hyperactivity of different etiologies. In the present study, we evaluated the efficacy of BoNT/A injections into the CP muscle in diabetic patients with severe oropharyngeal dysphagia associated with diabetic autonomic and/or somatic peripheral neuropathy., Research Design and Methods: Twelve type 2 diabetic patients with severe dysphagia for both solid and liquid foods associated with autonomic and/or peripheral somatic neuropathy were investigated. Swallowing function was evaluated by clinical examination, videofluoroscopy, and simultaneous needle electromyography (EMG) of the CP and pharyngeal inferior constrictor (IC) muscles. Clinical evaluation using a four-level dysphagia severity score was performed every other day for the 1st week and thereafter every other week until week 24. Videofluoroscopy and EMG follow-up were carried out at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. BoNT/A was injected percutaneously into the CP muscle under EMG control., Results: BoNT/A induced the complete recovery of dysphagia in 10 patients and had a significant (P = 0.0001, ANOVA) improvement in 2 patients within 4 +/- 1.1 days (range 3-7). Clinical improvement was confirmed by videofluoroscopy and EMG., Conclusions: Our findings suggest a potential benefit from BoNT/A treatment in dysphagia associated with diabetic neuropathy. Randomized controlled trials are needed to confirm this observation.

Background: Survivin is the smallest mammalian member of the inhibitor of apoptosis (IAP) proteins family. The aim of the present study was to determine survivin expression in laryngeal squamous cell carcinoma (SCC) and in neck lymph node metastases. The survivin value in predicting prognosis in laryngeal SCC was also investigated., Patients and Methods: Survivin expression was investigated in 37 laryngeal SCCs and in 12 cervical lymph node metastases., Results: A nuclear reaction predominated in laryngeal SCCs. Survivin expression was significantly higher in pN+ laryngeal SCCs than in pN0 (p = 0.017). Survivin expression was higher in cervical lymph node metastases than in correspondent primary laryngeal SCCs (p = 0.002). Survivin expression in laryngeal SCCs that developed loco-regional recurrence was significantly higher than in laryngeal SCCs without recurrence of disease (p = 0.039)., Conclusion: Nuclear expression of survivin should be studied as a hallmark of higher risk laryngeal SCCs to develop loco-regional recurrences. Higher survivin expression in pN+ laryngeal SCC may suggest elective neck dissection in clinically N0 patients with high survivin expression in primary SCC. The extremely high survivin expression in lymph node metastases may support the use of survivin in the diagnosis of lymph node micro-metastases.

We report a case of aspiration admitted to our rehabilitation unit in a patient with dysphagia due to diffuse idiopathic skeletal hyperostosis or Forestier's disease of the cervical spine, in whom an episode of pneumonia had occurred. Clinical and instrumental findings, including radiography of the spine, (CT Scan) and videofluoroscopy, confirmed the diagnosis. The dysphagia was hypothesized to be due to mechanical compression and inflammatory changes, accompanied by fibrosis in the esophagus wall. The aspiration pneumonia probably had multifactorial etiology: dysphagia, abnormal cough reflex, colonization of the oropharynx by virulent bacteria, etc. No aspiration pneumonia occurred after medical treatment and rehabilitation had been started. We review the medical literature on this unusual cause of aspiration pneumonia.

Although several reports in the literature have documented the surgical technique, and the oncological outcome achieved with parotidectomy, only a few articles have described the complications of parotid gland surgery and their management. Several complications have been reported in parotid surgery. We re-classified the complications of parotidectomy in intra-operative and post-operative (early and late). The commonest complications after parotidectomy are temporary or permanent facial palsy and Frey's syndrome.