Search

Summary Objective The objective of this observational study was to assess the relationship between established aging biobehavioral measures and voice decline in normally aging adults. Study design Cross-sectional study. Methods Participants 60–85 years of age were divided into two age and sex-matched groups, based on the presence or absence of presbylaryngeus. Both groups underwent a battery of tests measuring anthropometric variables, inflammatory markers, general health measures, and vocal function parameters. Differences from the norm were calculated for all variables. Parametric and nonparametric tests were performed to assess group differences. In addition, variable selection analysis was performed to determine variables that were most influential in predicting the occurrence of presbylaryngeus in our current sample. Results Fifty-three participants were divided into age and sex-matched groups of “presbylaryngeus” (n = 26) and “non-presbylaryngeus” (n = 27). The two groups were statistically different in select measures of inflammatory markers, general health measures, and vocal function parameters. Anthropometric measures were not statistically different. Based on variable selection, the variables most predictive of the presence of presbylaryngeus were measures of the Physical Activity Scale of the Elderly, C-reactive protein, laryngeal airway resistance, and vocal roughness. Conclusions In addition to group differences in vocal function measures, results for the presbylaryngeus group consistently trended sub-optimally on anthropometric measures, two inflammatory markers, and general health measures. These results suggest that this sample of individuals with presbylaryngeus demonstrated greater biobehavioral deficits associated with aging as compared to age and sex-matched non-presbylaryngeus individuals.

Knowledge on brain networks subserving vocalization in vocally healthy individuals under various task conditions is scarce but paramount to understand voice disorders. The aims of our study were to determine (1) the effect of social-evaluative stress on the central neural control of phonation underlying speech production; and (2) the neural signature, personality profile, and aerodynamic vocal function in relation to salivary cortisol responses. Thirteen vocally healthy females underwent an event-related sparse-sampling fMRI protocol consisting of voiced and whispered sentence productions with and without exposure to the social-evaluative stressor public speaking anticipation. Participants completed a personality questionnaire, rating scales of negative emotional state, and provided salivary cortisol samples. In the total sample, the task contrast of voiced productions revealed that stressor exposure resulted in a peak activation in the right caudate with concomitant deactivations in the bilateral pgACC and aMCC, and right IFG, BA 9, BA 10, insula, putamen, and thalamus. There were individual differences in stressor-induced brain activations as a function of stress reactivity with greater cortisol reactivity linked with lower laryngeal motor cortex activity and lower scores on aspects of extraversion. Our data confirm that stress alters the phonatory control for speech production through limbic-motor interactions. The findings support the Trait Theory of Voice Disorders (Roy and Bless 2000) and help provide critical insights to the study of voice disorders such as primary muscle tension dysphonia.

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

Background and objectives: Bisphosphonates represent selective inhibitors of excess osteoblastic bone resorption that characterizes all osteopathies, targeting osteoclasts and their precursors. Their long-term administration in postmenopausal women suffering from osteoporosis has resulted in neural adverse effects. The current study focuses on the research of possible alterations in the femoral nerve, caused by bisphosphonates. We hypothesized that bisphosphonates, taken orally (per os), may produce degenerative changes to the femoral nerve, affecting lower-limb posture and walking neuronal commands. Materials and Methods: In order to support our hypothesis, femoral nerve specimens were extracted from ten female 12-month-old Wistar rats given 0.05 milligrams (mg) per kilogram (kg) of body weight (b.w.) per week alendronate per os for 13 weeks and from ten female 12-month-old Wistar rats given normal saline that were used as a control group. Specimens were studied using immunohistochemistry for selected antibodies NeuN (Neuronal Nuclear Protein), a protein located within mature, postmitotic neural nucleus, and cytosol and Sox10 (Sex-determining Region Y (SRY) - High-Motility Group (HMG) - box 10). The latter marker is fundamental for myelination of peripheral nerves. Obtained slides were examined under a light microscope. Results: Samples extracted from rats given alendronate were more Sox10 positive compared to samples of the control group, where the marker&rsquo, s expression was not so intense. Both groups were equally NeuN positive. Our results are in agreement with previous studies conducted under a transmission electron microscope. Conclusions: The suggested pathophysiological mechanism linked to histological alterations described above is possibly related to toxic drug effects on Schwann and neuronal cells. Our hypothesis enhances the existing scientific evidence of degenerative changes present on femoral nerve following bisphosphonates administration, indicating a possible relationship between alendronate use and neuronal function.

Purpose The aims of the current study were to determine age-related changes to the phonatory and articulatory subsystems and to investigate an exploratory model of intelligibility for healthy aging based on phonatory and articulatory measures. Method Fifteen healthy, older adults (55-81 years) and 15 younger adults (20-35 years) participated in instrumental assessments of the phonatory (aerodynamic, acoustic) and articulatory (kinematic) subsystems. Speech intelligibility was determined by five listeners during multi-talker babble. Results Older adults displayed shorter maximum phonation time, greater airflow during sentence reading, and lower cepstral peak prominence (CPP) and CPP SD. Additionally, older adults had slower tongue movement speed than younger adults. Speech intelligibility was also significantly reduced in the older group. A generalized estimating equations model combining phonatory and articulatory measures showed that CPP SD, low/high (L/H) spectral ratio mean and SD, Cepstral Spectral Index of Dysphonia (CSID), and maximum tongue movement speed were significant contributors to intelligibility changes in older individuals. While L/H mean and SD and CSID displayed an inverse relationship with intelligibility, CPP SD and maximum tongue speed displayed a direct relationship with intelligibility. Discussion Aging affects the phonatory and articulatory subsystems with implications for speech intelligibility. Phonatory cepstral/spectral measures except for mean CPP were associated with speech intelligibility changes, suggesting that changes in voice quality may contribute to reduced intelligibility in older adults. Pertaining to articulation, slower tongue movement speed likely contributed to reduced intelligibility in older individuals.

Background and objectives: Bisphosphonates (BPs) are selective inhibitors of osteoclasts, used for the treatment of bone disorders. The objective of this study is to investigate the possible effects of BPs on the tongue&rsquo, s mucosa. Materials and Methods: Specimens of the tongue of 20 female 12-month old Wistar rats were taken. Ten were used as control group, while in the remaining alendronate (Fosamax, Merck) was administered per os from 13 weeks. Observation of the harvested samples was made by Transmission Electron Microscopy (TEM). Results: In the experimental group, focal alterations were observed to various extent in all specimens. The basement membrane was intact. Furthermore, an increase at the intercellular space was observed, predominantly at the middle layer, and the desmosomes were disorganized. In the lamina propria focal edema was observed. Conclusions: Investigation on the effect of BPs on the tongue&rsquo, s mucosa through TEM hasn&rsquo, t been documented in the past. According to our results, BPs seem to cause mild mucosal lesions on the tongue.

Our previous studies demonstrated that it is possible to perform the classification of both simulated pressed and actual vocally fatigued voice productions versus vocally healthy productions through the pattern recognition of sEMG signals obtained from subjects’ anterior neck. In these studies, the commonly accepted Vocal Fatigue Index factor 1 (VFI-1) was used for the ground-truth labeling of normal versus vocally fatigued voice productions. Through recent experiments, other factors with potential effects on classification were also studied, such as sEMG signal normalization, and data imbalance—i.e., the large difference between the number of vocally healthy subjects and of those with vocal fatigue. Therefore, in this paper, we present a much improved classification method derived from an extensive study of the effects of such extrinsic factors on the classification of vocal fatigue. The study was performed on a large number of sEMG signals from 88 vocally healthy and fatigued subjects including student teachers and teachers and it led to important conclusions on how to optimize a machine learning approach for the early detection of vocal fatigue.

Symptoms of voice disorder may range from slight hoarseness to complete loss of voice; from modest vocal effort to uncomfortable neck pain. But even minor symptoms may still impact personal and especially professional lives. While early detection and diagnosis can ameliorate that effect, to date, we are still largely missing reliable and valid data to help us better screen for voice disorders. In our previous study, we started to address this gap in research by introducing an ambulatory voice monitoring system using surface electromyography (sEMG) and a robust algorithm (HiGUSSS) for pattern recognition of vocal gestures. Here, we expand on that work by further analyzing a larger set of simulated vocal dysfunctions. Our goal is to demonstrate that such a system has the potential to recognize and detect real vocal dysfunctions from multiple individuals with high accuracy under both intra and intersubject conditions. The proposed system relies on four sEMG channels to simultaneously process various patterns of sEMG activation in the search for maladaptive laryngeal activity that may lead to voice disorders. In the results presented here, our pattern recognition algorithm detected from two to ten different classes of sEMG patterns of muscle activation with an accuracy as high as 99%, depending on the subject and the testing conditions.

Introduction Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option. Material and methods In this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction. Results The use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases. Conclusion The negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.

Summary Primary muscle tension dysphonia (pMTD) is a voice disorder that occurs in the absence of laryngeal pathology. Dysregulated activity of the paralaryngeal muscles is considered the proximal cause; however, the central origin of this aberrant laryngeal muscle activation is unclear. The Trait Theory (Roy and Bless, 2000a,b) proposed that specific personality traits can predispose one to laryngeal motor inhibition and pMTD, and this inhibition is mediated by a hyperactive “behavioral inhibition system (BIS)” composed of limbic system structures (and associated prefrontal connections). This case study used functional magnetic resonance imaging to detect brain activation changes associated with successful management of pMTD, thereby evaluating possible neural correlates of this poorly understood disorder. Method A 61-year-old woman with moderate-to-severe pMTD underwent functional magnetic resonance imaging scans before and immediately after successful treatment using manual circumlaryngeal techniques. Experimental stimuli were blocks of repeated vowel production and overt sentence reading. Results Significantly greater activation was observed pre- versus posttreatment in all regions of interest during sentence production, that is, periaqueductal gray, amygdala, hypothalamus, anterior cingulate cortex, hippocampus, dorsolateral prefrontal cortex, Brodmann area 10, and premotor and inferior sensorimotor cortex. Conclusions Our findings are compatible with overactivation of neural regions associated with the BIS (cingulate cortex, amygdala, hypothalamus, periaqueductal gray) and motor inhibition networks (eg, [pre-]supplementary motor area) along with the dorsolateral prefrontal cortex and medial prefrontal cortex. Heightened input from limbic regions combined with dysfunctional prefrontal regulation may interfere with laryngeal motor preparation, initiation, and execution thereby contributing to disordered voice in pMTD.

Objectives This systematic review examined the evidence linking vocal nodule development in children to personality traits, psychological factors, and associated behavioral tendencies. Methods Four electronic databases—PubMed, Scopus, ScienceDirect, EBSCO Host—as well as the reference lists from articles (including online sources) were searched. After screening for relevance, eight comparative, case-control studies were identified that met inclusion criteria. The quality of each study was evaluated by two raters using a modified, standardized checklist. Results Four studies were rated as “good quality” and four were “fair”. The questionnaires used to measure personality or psychological factors varied widely among the studies, and the results linking personality dispositions (and associated behavioral inclinations) to vocal nodule development in children were mixed. Conclusions Fair to good quality evidence exists to suggest that psychological factors or personality traits related to extraversion and impulsivity (and their related behavioral inclinations) might predispose children to vocal nodules and deserve further attention. Clinical implications, limitations of the current systematic review, and recommendations for future research are also discussed.

Angiogenesis and the acquisition of an angiogenic phenotype is important for cancer cell proliferation. Copper in an essential trace element that participates in many enzymatic complexes like the cytochrome c, superoxide dismutase and lysyl oxidase and it is involved in processes, like embryogenesis, growth, angiogenesis and carcinogenesis. In particular, its involvement in carcinogenesis was described for the first time in oral submucous fibrosis, where fibroblasts produce large amounts of collagen in the presence of copper. Copper's action in carcinogenesis is two-fold: (1) it participates in reactions with an increased redox potential that result in the production of oxidative products and oxidative stress. Through this mechanism, copper may cause DNA mutations in the nucleus and mitochondria or alterations to membrane phospholipids, (2) it participates in angiogenesis even in the absence of angiogenic molecules, as it was reported for the first time in rabbit cornea models with copolymer pellets charged with PGE1. Copper chelation regimens like penicillamine and tetrathiomolybdate are being described in the literature as having anti-angiogenic, anti-fibrotic and anti-inflammatory actions. Animal models of brain cancer that evaluated the anti-angiogenic properties of copper, have proven evidence of the reduction of tumor's microvascular supply, tumor volume and vascular permeability after plasma copper levels reduction. Interestingly, plasma copper levels reduction was shown to suppress micrometastases generation in mice models of breast cancer. We hypothesize that copper chelation therapy: increases oxidative stress in cancer cells to a level that does not allow survival because of the reduction of anti-oxidative enzymes production. It may also result in inhibition of angiogenesis and of the initiation of the angiogenic switch, because copper normally enhances endothelial cell migration and proliferation, improves binding of growth factors to endothelial cells and enhances the expression of angiogenic molecules. Copper chelation may also reduce extracellular matrix degradation and cancer spread, through reduction of MMP-9 production and probably of other collagenases and may inhibit propagation of micrometastases. However, copper chelation therapy may enhance angiogenesis through reduction of thrombospondin-1, that results into an increase in VEGF-VEGFR2 complexes and a high level of active MMP-9. These hypotheses help in understanding of the anti-angiogenic action of copper chelation therapies and of the complex network of interactions between copper and other molecules involved in angiogenesis. It may also stimulate further research regarding differences in copper metabolism, the effects of anti-copper regimens on organs, the development of resistance, and their possible angiogenic action through thrombospondin expression reduction.

Purpose Postoperative pain management is important for improved patient care. Our primary objective was to investigate the effect of analgesic treatment adaptation by the pain clinic on postoperative pain relief at an oral and maxillofacial surgery department. Additionally, we aimed to present patients' pain characteristics and the administered analgesic treatment. Materials and methods A total of 128 patients treated at our clinic in the period 2012–2015 who required analgesic treatment adaptation by our pain clinic were included. They were further divided into 10 groups: tumor, temporomandibular joint disorder, tooth extraction, osteomyelitis, bisphosphonate-related osteonecrosis of the jaw, submandibular abscess, orthognathic surgery, cyst, sinusitis, and fracture. Pain characteristics evaluated were intensity on a numerical rating scale (NRS) before and after intervention of the pain clinic, quality, genesis, and type. Results Post treatment pain intensity values at rest 1.8 (SD: 1.4) and on exercise (walking and physical therapy) 4 (SD: 2) were statistically significant better compared to pretreatment values (4.2, SD: 2.5, and 6.8 SD: 2, respectively). The highest pain intensities were reported after tooth extractions, orthognathic surgery, cystectomies, and fracture reposition. Pain was mainly continuous and related to a combination of a somatic and a neuropathic pathophysiological mechanism. Conclusions Intervention by a specialized pain clinic leads to reduction of postoperative pain.

Vascular malformations are benign tumors that are characterized by the presence of blood vessels lined by cells with a normal cell turnover. They constitute less than 1 % of all osseous tumors. A central location within the jaws is rare, but the body of the mandible is most often affected. Reports of intraosseous vascular malformations of the mandibular condyle are extremely rare; only eight previous cases have been reported. The purpose of this study is to present a case of a vascular malformation of the condyle with diagnostic images and to discuss the differential diagnosis.

Purpose Therapies for certain voice disorders purport principles of skeletal muscle rehabilitation to increase muscle mass, strength, and endurance. However, applicability of limb muscle rehabilitation to the laryngeal muscles has not been tested. In this study, the authors examined the feasibility of the rat thyroarytenoid muscle to remodel as a consequence of increased activity instantiated through chronic electrical stimulation. Method Twenty adult Sprague-Dawley rats ( Rattus norvegicus), assigned to a 1-week or 2-week stimulation group, were implanted with a nerve cuff electrode placed around the right recurrent laryngeal nerve and were fitted with a head connector. All animals were placed under anesthesia twice a day for 1 hr each time. Following the training, rats were killed, and thyroarytenoid muscles were isolated for histology and immunohistochemistry. Results Mean muscle fiber area decreased, neuromuscular junction density increased, mitochondrial content increased qualitatively, and glycogen-positive fibers increased, demonstrating exercise-induced changes similar to those seen in limb muscles after endurance training. Conclusion Rat thyroarytenoid muscles are capable of remodeling in response to chronic electrical stimulation.

Objective: Laryngeal muscle dysfunction in the aged contributes to dysphagia and increases the risk of aspiration, factors that lead to higher rates of mortality and morbidity.These changes also co...

Starting from early stages of craniofacial development, the leading role of vasculature, in particular endothelial progenitor cells, becomes apparent. They are probably the cells that synthesize the appropriate bone morphogenetic protein (BMP), that precedes neural crest cell migration and determines their final destination and skeletal development. During postnatal osteosynthesis in the mandible, angiogenesis similarly goes before osteosynthesis, regulates this process with the production of BMP-2 and serves as a scaffold for osteoblasts. This growth factor is involved in bone metabolism and bone injury repair. The dependence of bone from vasculature, is better understood when looking to osseous changes that result from vasculopathies and arteritides, like in diabetes mellitus and polyarteritis nodosa respectively, that affect the mandible more frequently than previously suspected. These changes are not only the result of a dysregulation of osteoblasts and osteoclasts, but of a complex network of factors that affect the vasculature, like VEGF and hypoxia. Abnormal vasculature results in qualitatively degradated bone, with an atypical architecture or even in bone necrosis. The dynamic interplay between vasculature and bone of the mandible, with the vasculature endothelium playing an initiating and regulatory role in osteosynthesis, supports the hypothesis of an angiogenic origin of bone. This hypothesis, helps in understanding of bone pathology, like avascular necrosis and of the impact of interventions and medications that affect vasculature, on bone metabolism.

Ranulas are rare cystic lesions resulting from damage or rupture of one or more of the ducts of the sublingual gland, that lead to mucus extravasation or dilatation of the gland's duct. Extravasation cysts are more common than retention cysts. We present a case of a 45-year-old male with a squamous cell carcinoma of the ventral surface of the tongue that was treated with excision of the oral lesion and bilateral supraomohyoid neck dissection without supplementary radiotherapy. A left myocutaneous platysma flap was raised for defect closure. Ten months postoperatively he presented complaining of swelling of the right submandibular region. The diagnosis, based on his medical anamnesis and the CT imaging, was a sublingual-plunging ranula. It is postulated that the ranula resulted from damage to the ducts of the sublingual gland during selective neck dissection. One year postoperatively there are no signs of recurrence either of the ranula or of the cancer. We suggest that sublingual gland excision and intraoral cyst marsupialization is a logical treatment for sublingual-plunging ranulas.

Voice disorders are non-trivial when it comes to their early detection. Symptoms range from slight hoarseness to complete loss of voice, and may seriously impact personal and professional life. To date, we are still largely missing reliable data to help us better understand and screen voice pathologies. In this paper, we present an ambulatory voice monitoring system using surface electromyography (sEMG) and a robust algorithm for pattern recognition of vocal gestures. The system, which can process up to four sEMG channels simultaneously, also can store large amounts of data (up to 13 hours of continuous use) and in the future will be used to analyze on-the-fly various patterns of sEMG activation in the search for maladaptive laryngeal activity that may lead to voice disorders. In the preliminary results presented here, our pattern recognition algorithm (Hierarchical GUSSS) detected six different sEMG patterns of activation, and it achieved 90% accuracy.

Clinical evidence suggests that laryngeal muscle dysfunction is associated with human aging. Studies in animal models have reported morphological changes consistent with denervation in laryngeal muscles with age. Life‐long laryngeal muscle activity relies on cytoskeletal integrity and nerve–muscle communication at the neuromuscular junction (NMJ). It is thought that neurotrophins enhance neuromuscular transmission by increasing neurotransmitter release. We hypothesized that treatment with neurotrophin 4 (NTF4) would modify the morphology and functional innervation of aging rat laryngeal muscles. Fifty‐six Fischer 344xBrown Norway rats (6‐ and 30‐mo age groups) were used to evaluate to determine if NTF4, given systemically ( n = 32) or directly ( n = 24), would improve the morphology and functional innervation of aging rat thyroarytenoid muscles. Results demonstrate the ability of rat laryngeal muscles to remodel in response to neurotrophin application. Changes were demonstrated in fiber size, glycolytic capacity, mitochondrial, tyrosine kinase receptors (Trk), NMJ content, and denervation in aging rat thyroarytenoid muscles. This study suggests that growth factors may have therapeutic potential to ameliorate aging‐related laryngeal muscle dysfunction.

The objectives of this study were to examine whether the personality trait of stress reaction (SR), as assessed with the Multidimensional Personality Questionnaire-Brief Form (MPQ-BF), (1) influences prefrontal and limbic area activity during overt sentence reading and if (2) SR and associated individual differences in prefrontal and limbic activations correlate with sensorimotor cortical activity during overt sentence reading. Ten vocally healthy adults (22-57 years) participated in a functional MRI study using an event-related sparse sampling design to acquire brain activation data during sentence production tasks (covert, whispered, overt). The outcome measure was the blood oxygenation level-dependent signal change in prefrontal, limbic, and primary somatosensory (S1) and motor cortices (M1). Significant positive correlations were found between SR scores and S1, dorsolateral prefrontal cortex (both r =.73, p.05), and periaqueductal gray (r =.88, p.01) activity. M1 activity was positively correlated with SR (r =.64, p.05) and negatively with social potency (r = -.70, p.05). Our findings suggest that motor cortical control subserving voice and speech production varies with expression of selected personality traits. Future studies should investigate the functional significance of personality differences in the central neural control of vocalization.

Purpose To examine the proposal that introversion predictably influences extralaryngeal and vocal behavior in vocally healthy individuals compared with individuals with extraversion and whether differences are of a nature that may support a risk hypothesis for primary muscle tension dysphonia. Method Fifty-four vocally healthy female adults between the ages of 18 and 35 years were divided into 2 groups: introversion ( n = 27) and extraversion ( n = 27). All participants completed a psychological stress reactivity experiment. Before, during, and after the stressor (public speaking), participants were assessed on extralaryngeal muscle activity (surface electromyography: submental, infrahyoid; control site: tibialis anterior), perceived vocal effort, and vocal acoustics (fundamental frequency and intensity). Results Participants in the introversion group exhibited significantly greater infrahyoid muscle activity throughout the protocol and during perceived stress than participants in the extraversion group. For both groups, perceived vocal effort significantly increased during stress, and acoustic measures significantly decreased. Infrahyoid muscle activity during the stress phase was significantly correlated with introversion and Voice Handicap Index scores but not with vocal effort scores. Conclusions The data provided evidence of distinct differences in extralaryngeal behavior between introverts and extraverts. The findings are consistent with the trait theory of voice disorders (Roy & Bless, 2000).

Fibromyxoma represents a rare benign neoplasm that mostly affects the posterior region of the mandible. Here, we report the case of a 46-year-old male with a swelling of the right maxilla. After proper diagnosis, he was treated with enucleation and curettage of the tumor. The defect was filled with a pedicled buccal fat pad flap. The mesenchymal origin from the dental follicle of the fibromyxoma is the most plausible explanation. Radiological examination with MRI, CT, and conventional radiography contributes to the differential diagnosis from other benign tumors, such as the ameloblastoma. Its management is surgical and comprises enucleation and curettage or en bloc resection. Patients must be monitored for at least two years postoperatively in order to diagnose possible recurrence. According to the literature, the maxilla is a rare location of a fibromyxoma and, to our knowledge, our case is the 30th presented case of a fibromyxoma of the maxilla.

Summary The study's objectives were to investigate (1) the frequency of perceived stress, anxiety, and depression for patients with common voice disorders, (2) the distribution of these variables by diagnosis, and (3) the distribution of the variables by gender. Retrospective data were derived from self-report questionnaires assessing recent stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) in a cohort of new patients presenting to a voice clinic. Data are presented on 160 patients with muscle tension dysphonia (MTD), benign vocal fold lesions, paradoxical vocal fold movement disorder (PVFMD), or glottal insufficiency. Pooled data indicated that average stress, anxiety, and depression scores were similar to those found for the healthy population. However, 25.0%, 36.9%, and 31.2% of patients showed elevated stress, anxiety, and depression scores, respectively, compared to norms. Patients with PVFMD had the most frequent occurrence—and patients with glottal insufficiency had the least frequent occurrence of elevated stress, anxiety, and depression. Stress and depression were more common with MTD than with lesions, whereas reverse results were obtained for anxiety. More females than males had elevated stress, anxiety, and depression scores. The data are consistent with suggestions that stress, anxiety, and depression may be common among some patients with PVFMD, MTD, and vocal fold lesions and more common for women than men. However, individual variability in the data set was large. Further studies should evaluate the specific role of these conditions for selected categories of voice disorders in susceptible individuals.