RESUMO
OBJECTIVE: The aim of this study was to analyze the function of the palatal muscles in vivo by real-time wireless electromyography in rats. The effects of palatal wounding were also analyzed. METHODS: Microelectrodes were implanted six rats; in the masseter muscle (two-rats) for comparison, in the unwounded soft palate (two-rats) and the soft palate that received a surgical wound (two-rats). Two weeks after implantation, a wound was made in the soft palate using a 1â¯mm biopsy-punch. Electromyographic measurements and video-recordings were taken weekly to monitor train-duration and peak-amplitude during eating, grooming and drinking. RESULTS: The train-duration of the masseter muscle during eating was 0.49⯱â¯0.11â¯s (rat-1) and 0.56⯱â¯0.09â¯s (rat-2), which was higher than during grooming. In the unwounded soft palate the train-duration during eating was 0.63⯱â¯0.12â¯s (rat-1) and 0.69⯱â¯0.069â¯s (rat-2), which was higher than during grooming and drinking. The peak-amplitude for eating in the normal soft palate before surgery was 0.31⯱â¯0.001â¯mV (rat-1) and 0.33⯱â¯0.02â¯mV (rat-2). This decreased to 0.23⯱â¯0.03â¯mV and 0.25⯱â¯0.11â¯mV respectively, after surgery. For drinking the peak-amplitude was 0.30⯱â¯0.01â¯mV (rat-1) and 0.39⯱â¯0.01â¯mV (rat-2) before surgery, which decreased to 0.23⯱â¯0.09â¯mV and 0.20⯱â¯0.14â¯mV respectively, after surgery. CONCLUSION: The reduced peak-amplitude suggests impaired soft palate function after wounding. This is the first study into the in vivo function of the soft palate after surgical wounding. This model will contribute to develop strategies to improve soft palate function in patients.
Assuntos
Músculos Palatinos/fisiologia , Palato Mole/fisiologia , Ferimentos e Lesões/fisiopatologia , Animais , Eletromiografia , Músculo Masseter/fisiologia , Palato Mole/lesões , RatosRESUMO
Resumen El presente estudio tuvo como objetivo establecer los patrones morfológicos presentes en las rugosidades palatinas de una población costarricense mediante el método de Trobo y efectuar un análisis estadístico con las variables de sexo, edad y afinidad biológica. Se eligiron al azar 70 pacientes a los que se realizaron impresiones y modelos dentales superiores, se documentó el sexo, edad y afinidad biológica de cada uno, junto con el consentimiento informado. Se analizó estadísticamente la distribución de patrones de género, edad y afinidad biológica. Las técnicas para el análisis de la información fueron las distribuciones de frecuencia, cruce de variables, comparación de medias con base en el análisis de variancia, coeficiente de correlación de Spearman; pruebas de Chi cuadrado, para evaluar la independencia entre las características de edad y sexo. Estas pruebas señalan un predominio de tipos de rugas palatinas rectas y de tipo simples tanto en la población masculina como femenina, sin encontrarse variación en el número de rugas asociadas a sexo o afinidad biológica; pero sí se determinó diferencia por grupo de edad, disminuyen en número conforme se incrementa la edad. Por otra parte no se presentó dimorfismo por sexo, lateralidad ni posición.
Abstract The present study aimed to establish the morphological patterns present in the palatal rugae in a Costa Rican population by means of the Trobo method and to carry out a statistical analysis with the variables of sex, age and biological affinity. Seventy patients were randomly chosen to whom impressions and superior dental models were made, the sex, age and biological affinity of each one was documented, together with the informed consent. The distribution of gender, age and biological affinity patterns was statistically analyzed. The techniques for the analysis of the information were the frequency distributions, crossing of variables, comparison of means based on the analysis of variance, Spearman's correlation coefficient; Chi square tests, to evaluate the independence between the characteristics of age and sex. These tests indicate a predominance of straight and simple types of palatal rugae in both the male and female population, with no variation in the number of rugae associated with sex or biological affinity; but a difference was determined by age group, they decrease in number as age increases. On the other hand, there was no dimorphism due to sex, laterality or position.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Antropologia Forense , Achados Morfológicos e Microscópicos , Boca , Músculos PalatinosRESUMO
BACKGROUND: Bone reconstruction in congenital craniofacial differences, which affect about 2-3% of newborns, has long been the focus of intensive research in the field of bone tissue engineering. The possibility of using mesenchymal stromal cells in regenerative medicine protocols has opened a new field of investigation aimed at finding optimal sources of multipotent cells that can be isolated via non-invasive procedures. In this study, we analyzed whether levator veli palatini muscle fragments, which can be readily obtained in non-invasive manner during palatoplasty in cleft palate patients, represent a novel source of MSCs with osteogenic potential. METHODS: We obtained levator veli palatini muscle fragments (3-5 mm3), during surgical repair of cleft palate in 5 unrelated patients. Mesenchymal stromal cells were isolated from the muscle using a pre-plating technique and other standard practices. The multipotent nature of the isolated stromal cells was demonstrated via flow cytometry analysis and by induction along osteogenic, adipogenic, and chondrogenic differentiation pathways. To demonstrate the osteogenic potential of these cells in vivo, they were used to reconstruct a critical-sized full-thickness calvarial defect model in immunocompetent rats. RESULTS: Flow cytometry analysis showed that the isolated stromal cells were positive for mesenchymal stem cell antigens (CD29, CD44, CD73, CD90, and CD105) and negative for hematopoietic (CD34 and CD45) or endothelial cell markers (CD31). The cells successfully underwent osteogenic, chondrogenic, and adipogenic cell differentiation under appropriate cell culture conditions. Calvarial defects treated with CellCeram™ scaffolds seeded with the isolated levator veli palatini muscle cells showed greater bone healing compared to defects treated with acellular scaffolds. CONCLUSION: Cells derived from levator veli palatini muscle have phenotypic characteristics similar to other mesenchymal stromal cells, both in vitro and in vivo. Our findings suggest that these cells may have clinical relevance in the surgical rehabilitation of patients with cleft palate and other craniofacial anomalies characterized by significant bone deficit.
Assuntos
Fissura Palatina , Células-Tronco Mesenquimais , Músculos Palatinos , Animais , Fissura Palatina/terapia , Humanos , Recém-Nascido , Músculo Esquelético , Osteogênese , RatosRESUMO
Introdução: A fissura labiopalatina é a deformidade craniofacial mais frequente e sua incidência é estimada em 1:600 nascidos vivos no Brasil. O objetivo desse estudo é avaliar a incidência de fístulas para os pacientes submetidos à palatoplastia com veloplastia intravelar estendida. Métodos: Trata-se de estudo descritivo retrospectivo com 25 pacientes que foram operados pelo mesmo cirurgião no período de setembro de 2011 a setembro de 2012. A técnica de Von Langenbeck, juntamente com a veloplastia intravelar estendida, foi realizada em todos os pacientes. Foram excluídos do estudo os pacientes com fístulas palatinas, portadores de síndromes ou outras malformações. A idade média da realização da palatoplastia foi de 30,6 meses, variando de 12 meses a 159 meses. Foram selecionados 19 pacientes: onze (58%) do gênero masculino e oito (42%) do gênero feminino. A fissura palatal isolada foi a mais comum, encontrada em nove (47%) pacientes. A fissura transforame esquerda estava presente em sete (37%) pacientes e três (16%) pacientes eram portadores de fissura transforame bilateral. Resultados: Somente dois (11%) pacientes evoluíram com fístula palatina até o acompanhamento pós-operatório de 6 meses. Conclusão: A técnica de Von Langenbeck associada à veloplastia estendida mostrou-se com baixa incidência de fístulas palatinas (11%) quando comparada ao índice encontrado na literatura mundial (7% a 42%).
Introduction: Cleft lip and palate is the most common craniofacial deformity, with an estimated incidence of 1 case per 600 live births in Brazil. The aim of this study was to determine the incidence of fistula among patients undergoing palatoplasty with extended intravelar veloplasty. Methods: This retrospective descriptive study evaluated 25 patients operated between September 2011 and September 2012 by the same surgeon. The von Langenbeck technique combined with extended intravelar veloplasty was performed in all patients. The study excluded patients with palatal fistulas, syndromes, or other malformations. The age at palatoplasty varied between 12 and 159 months, and the average age was 30.6 months. Nineteen patients were selected, comprising 11 (58%) male patients and 8 (42%) female patients. Isolated cleft palate was the most common deformity, found in 9 (47%) patients. Unilateral (left) trans-foramen cleft was present in 7 (37%) patients, and bilateral trans-foramen cleft was seen in 3 (16%) patients. Results: Only 2 (11%) patients had palatal fistula in a postoperative follow-up period of 6 months. Conclusion: The von Langenbeck technique associated with extended veloplasty resulted in a low incidence of cleft palate fistulas (11%) compared with the rate found in previous studies (7%-42%).
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , História do Século XXI , Músculos Palatinos , Palato Mole , Prontuários Médicos , Epidemiologia Descritiva , Estudos Retrospectivos , Fissura Palatina , Anormalidades Craniofaciais , Procedimentos de Cirurgia Plástica , Estudo de Avaliação , Ossos Faciais , Fístula , Doenças do Recém-Nascido , Lábio , Azul de Metileno , Músculos Palatinos/anormalidades , Músculos Palatinos/cirurgia , Palato Mole/anormalidades , Palato Mole/cirurgia , Palato Mole/patologia , Prontuários Médicos/normas , Fissura Palatina/cirurgia , Fissura Palatina/terapia , Anormalidades Craniofaciais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ossos Faciais/cirurgia , Fístula/cirurgia , Fístula/patologia , Doenças do Recém-Nascido/cirurgia , Doenças do Recém-Nascido/patologia , Lábio/cirurgia , Azul de Metileno/uso terapêuticoRESUMO
The palatoglossus muscle is classically described as an extrinsic muscle of the tongue. However, this descriptionis not consensus among the researchers, is one that sometimes it is not considered a muscle of the tongue.Thus, the objective of this study is to discuss some neuroanatomical aspects of palatoglossus muscle that mayhelp explain this aspect. Furthermore, this study shall be useful for clinicians, surgeons and academics thatmanipulate and keep particular interest for this anatomical site.
Assuntos
Língua/anatomia & histologia , Músculos Palatinos/inervação , Palato/anatomia & histologia , NeuroanatomiaRESUMO
Introducción y Objetivo: El manejo del anclaje es fundamental para el éxito del tratamiento en ortodoncia fi ja, sin embargo no hay consenso acerca de la efectividad del anclaje esquelético para la retracción de los dientes anteriores. El objetivo fue evaluar la efectividad del anclaje esquelético para el cierre de espacios en el arco maxilar.Materiales y Métodos: Se realizó una revisión sistemática de literatura a partir de las bases de datos PubMed, Lilacs, Cochrane, Scielo. Se incluyeron ensayos clínicos controlados, donde el anclaje esquelético fuera utilizado para el cierre de espacios; tresrevisores analizaron los resúmenes y textos completos para considerar el cumplimiento de los criterios de inclusión y exclusión de manera independiente, en un formato de extracción de datos.Resultados: Se identifi caron 324 artículos, de los cuales 316 fueron rechazados después de la evaluación, de los ocho estudios inicialmente seleccionados, cinco fueron excluidos. Sólo tres estudios cumplieron con los criterios de inclusión. Se realizó un metanálisis con el método de efectos aleatorios para el movimiento mesial del molar superior, en el cual los dispositivos de anclaje esquelético temporal mostraron ser más efectivos en el control del anclaje en -2,72 mm (-4,10,- 1,33 IC95%) al compararlos con los métodos de anclaje ortodóntico convencional, esta diferencia fue estadísticamente signifi cativa. Conclusiones: El anclaje esquelético temporal parece ser más efectivo para controlar el movimiento mesial del molar durante el cierre de espacios, comparado con el anclaje ortodóntico convencional, sin embargo la evidencia científi ca en la literatura es escasa.
Introduction and Objetive: Anchorage management is essential for successful fi xed orthodontic treatment; however there is no consensus about the effectiveness of skeletal anchorage for anterior teeth retraction. The aim of this review was to evaluate the effectiveness of skeletal anchorage forspace closure in the maxillary arch. Materials and Methods: A systematic review of the literature was performed in PubMed, Cochrane, Lilacs, Scielo databases. Controlled clinical trials were included, where skeletal anchorage was used for space closure. Three reviewers examined the abstracts and full texts to determine fulfi llment of the inclusion and exclusion criteria independently in a data extraction form. Results: 324 papers, out of which 316 were excluded after the evaluation of title and abstract of the eight initially selected trials. Only three trials met the inclusion criteria.A meta-analysis was performed with a random effects method for the mesial movement of upper molars in which the temporary skeletal anchorage devices showed to be more signifi cantly moreeffective in controlling anchorage -2,7 mm (-4,10,-1,33 CI 95%) when compared to the conventionalanchorage control methods.Conclusions: Temporary skeletal anchorage seems to be more effective in controlling the movement of molars during mesial space closure, when compared to the conventional orthodontic anchorage although evidence in the literature is limited.
Assuntos
Humanos , Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Aparelhos Ortodônticos , Fechamento de Espaço Ortodôntico , Músculos PalatinosRESUMO
OBJECTIVE: Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods. DESIGN: The design used was a systematic review of randomized controlled trials. DATA SOURCES: Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved. REVIEW METHODS: This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments. DATA SYNTHESIS: Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant. CONCLUSIONS: There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.
Assuntos
Músculos Laríngeos/fisiopatologia , Tono Muscular/fisiologia , Músculos Palatinos/fisiopatologia , Músculos Faríngeos/fisiopatologia , Apneia Obstrutiva do Sono/reabilitação , Língua/fisiopatologia , Resistência das Vias Respiratórias/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Terapia por Estimulação Elétrica , Medicina Baseada em Evidências , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Apneia Obstrutiva do Sono/fisiopatologiaRESUMO
OBJECTIVE: Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. DESIGN: Transversal study. SETTING: Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. PATIENTS: Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. INTERVENTIONS: Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. MAIN OUTCOME MEASURES: Severity scale for videonasoendoscopic and videotoscopic findings. RESULTS: There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. DISCUSSION AND CONCLUSIONS: Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.
Assuntos
Fissura Palatina/fisiopatologia , Fissura Palatina/cirurgia , Otite Média/fisiopatologia , Músculos Palatinos/fisiopatologia , Músculos Palatinos/cirurgia , Insuficiência Velofaríngea/fisiopatologia , Brasil , Cartilagem/anormalidades , Criança , Endoscópios , Tuba Auditiva/anormalidades , Feminino , Humanos , Masculino , Otite Média/etiologia , Otoscopia , Insuficiência Velofaríngea/etiologia , Gravação em Vídeo/instrumentaçãoRESUMO
Objetivo: Demonstrar a eficácia do reposicionamento do músculo elevador do véu palatinoem pacientes portadores de fissura lábio-palatina anteriormente submetidos a palatoplastiapor outras técnicas. Método: Foram realizadas, 16 cirurgias de repalatoplastia posterior comdissecção radical da musculatura do véu palatino. A nasofibroscopia foi o instrumento demensuração da voz no período pré e pós-operatório, 3, 9 e 15 meses após a cirurgia. Duasfonoaudiólogas com experiência no tratamento do fissurado participaram na avaliação davoz nos períodos pré e pós-operatórios, sendo a hipernasalidade classificada em equilíbriooronasal, hipernasalidade leve, moderada e importante. O índice de Kappa foi utilizado paraavaliar o grau de concordância entre os observadores. O teste de igualdade proporcional foiutilizado com o objetivo de comparar as diferenças de voz no pré e pós-operatórios de 3,9 e 15 meses. O valor de p < 0,05 foi adotado para a significância estatística. Resultados:Seis pacientes eram do sexo masculino, com idade média de 17,93 anos. Houve uma boaconcordância entre as avaliadoras, sendo a menor de 76,6% (índice de Kappa). Com o retroposicionamentoda musculatura houve melhora no índice da hipernasalidade (p < 0,05),principalmente na hipernasalidade leve e moderada. Conclusão: Houve grande melhorado quadro da insuficiência velofaríngea após a dissecção radical, o que evidencia que talprocedimento é necessário e deve ser incluído no algoritmo dos protocolos em casos secundáriose preconiza-se que seja usado, também, em casos primários.
Objective: To demonstrate the efficacy of the muscular set back in secondary cases. Method:16 soft palate re-repair were performed with muscular set back. To evaluate the results of thesurgeries through the voice, nasal endoscopies were done pre and post operative (3, 9 and15 months). The results were evaluated by two speech pathologists specialized in cleft lipand palate patients. And the hypernasality was graded as equilibrium, mild, moderate andsevere. The Kappa index was used to evaluate the agreement between the two observers andthe equality of two proportion test gave the statistics significance, as p < 0.05. Results: Sixpatients were males. The mean age was 17.93 years. There was a good concordance betweenthe two evaluators. The least was 76.6% according to the Kappa index. With the retropositioningof the muscles` bundle there was an improvement in the velopharingeal insufficiency (p< 0.05) mainly in the mild and moderate cases. Conclusion: There was a great improvementin velopharingeal incompetence after radical muscle dissection, showing that this procedureis necessary and must be part of secondary palatoplasty protocols. And also must be usedduring primary soft palate repair.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Fissura Palatina/cirurgia , Músculos Palatinos/cirurgia , Palato Mole/cirurgia , Insuficiência Velofaríngea , Relatos de Casos , Pessoas com Deficiência , Métodos , Procedimentos Cirúrgicos OperatóriosRESUMO
Introdução: O processo estilóide do osso temporal é uma projeção óssea que corresponde à origem dos músculos estilo-faríngeo, estilo-hiódeo e estiloglosso. A síndrome de Eagle se caracteriza pela presença de sintomas, como otalgia, disfagia, odinofagia e dor facial, associados ao aumento do processo estilóide maior que 30 mm. Objetivo: Apresentar três casos clínicos de pacientes com diagnóstico de síndrome de Eagle e discutir a apresentação clínica e o tratamento desta doença. Conclusão: O tratamento cirúrgico com ressecção de parte do processo estilóide está relacionado à remissão dos sintomas nos pacientes com diagnóstico de síndrome de Eagle. A abordagem a partir de cervicotomia alta determina boas condições de exposição do processo estilóide, com ressecção mais ampla e preservação de estruturas vasculonervosas.
Assuntos
Humanos , Músculos Faciais/anormalidades , Músculos Faciais/cirurgia , Músculos Laríngeos/anormalidades , Músculos Laríngeos/cirurgia , Músculos da Mastigação/anormalidades , Músculos da Mastigação/cirurgia , Músculos Palatinos/anormalidades , Músculos Palatinos/cirurgia , Transtornos de Deglutição , Dor de Orelha , Dor FacialRESUMO
BACKGROUND: The palatoglossus pillars were admitted as the main receptive responsible area by the pharyngeal swallowing reflex produced by food and tongue posterior progression. This concept sustain the mechanical-thermal maneuver used to recovery the committed pharyngeal function. A pharyngeal motor answer by pillar stimulation is common accepted but not unanimously. AIM: To verify the possible pharyngeal motor answers by palatoglossus pillars mechanical thermal stimulation. METHODS: Healthy volunteers are more able to provide effective reflex answers by pillars stimuli than patients. In this way we evaluated 51 healthy adult volunteers from both sexes reproducing the pillars stimuli using metallic probe. The cold condition was obtained by probe immersion in water maintained to 10 degrees C. RESULTS AND CONSIDERATIONS: The study showed that the mechanical thermal stimuli over pillars was not able to produce any active answer linked to the swallowing pharyngeal phase. It is possible that literature observed answers were due to the gag reflex inadequately interpreted or unconscious voluntary contractions effort produced by the opening mouth and tongue externalization during the pillars exposition to execution of the mechanical thermal stimulation maneuvers.
Assuntos
Temperatura Baixa , Deglutição/fisiologia , Músculos Palatinos/fisiologia , Estimulação Física/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , ReflexoRESUMO
RACIONAL: Os pilares palatoglosso foram admitidos como a principal sede dos receptores responsáveis por iniciar a fase faríngea da deglutição. Essa fase reflexa iniciar-se-ia em resposta ao estímulo produzido pelo progresso do bolo e da língua em sentido posterior. Esses conceitos deram base à manobra mecânico-térmica que visa estimular os receptores desses pilares, produzindo respostas motoras capazes de potencializar a recuperação da função faríngea comprometida. O conceito de possível resposta motora ao estímulo desses pilares, embora comum, não é unanimemente aceito. OBJETIVO: Verificar as possíveis respostas motoras produzidas pelo estímulo mecânico- térmico sobre os pilares palatoglosso. MÉTODOS: Por entender que indivíduos sadios são capazes de prover respostas reflexas mais efetivas do que as que seriam obtidas em pacientes, avaliaram-se 51 voluntários adultos sadios de ambos os sexos reproduzindo o estímulo sobre os pilares, usando sonda metálica de ponta romba resfriada em água mantida a 10°C. RESULTADOS E CONSIDERAÇÕES: O estudo mostrou que o estímulo mecânico-térmico sobre os pilares não foi capaz de produzir qualquer resposta motora envolvida na dinâmica da fase faríngea da deglutição. É possível que as respostas contráteis observadas em alguns estudos devam-se ao reflexo de gag inadequadamente interpretado ou a contrações voluntárias inconscientes por esforço de manutenção da abertura da boca e externalização da língua durante a exposição dos pilares para execução da manobra de estimulação mecânico-térmica.
BACKGROUND: The palatoglossus pillars were admitted as the main receptive responsible area by the pharyngeal swallowing reflex produced by food and tongue posterior progression. This concept sustain the mechanical-thermal maneuver used to recovery the committed pharyngeal function. A pharyngeal motor answer by pillar stimulation is common accepted but not unanimously. AIM: To verify the possible pharyngeal motor answers by palatoglossus pillars mechanical thermal stimulation. METHODS: Healthy volunteers are more able to provide effective reflex answers by pillars stimuli than patients. In this way we evaluated 51 healthy adult volunteers from both sexes reproducing the pillars stimuli using metallic probe. The cold condition was obtained by probe immersion in water maintained to 10°C. RESULTS AND CONSIDERATIONS: The study showed that the mechanical thermal stimuli over pillars was not able to produce any active answer linked to the swallowing pharyngeal phase. It is possible that literature observed answers were due to the gag reflex inadequately interpreted or unconscious voluntary contractions effort produced by the opening mouth and tongue externalization during the pillars exposition to execution of the mechanical thermal stimulation maneuvers.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Temperatura Baixa , Deglutição/fisiologia , Músculos Palatinos/fisiologia , Estimulação Física/métodos , ReflexoRESUMO
Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.
Assuntos
Transtornos da Audição/etiologia , Cavidade Nasal , Músculos Palatinos/fisiopatologia , Tremor/patologia , Adulto , Toxinas Botulínicas Tipo A/uso terapêutico , Vias de Administração de Medicamentos , Feminino , Transtornos da Audição/tratamento farmacológico , Transtornos da Audição/patologia , Humanos , Fármacos Neuromusculares/uso terapêutico , Músculos Palatinos/efeitos dos fármacos , Tremor/complicações , Tremor/tratamento farmacológicoRESUMO
Obstructive sleep apnea syndrome (OSAS) is an upper airway obstruction that occurs during the sleep. One of the suggested mechanisms involved in this process is a neuromuscular abnormality of the palatal muscles. Whether children with OSAS develop into OSAS adults, or children and adult OSAS are two distinct disorders occurring at different ages are questions to be answered. Here, we made the histological analysis of palatophryngeal muscle in 34 oral-breathing children of both genders, aged 5-12 years old, with hypertrophic tonsils and adenoids. According to the polysomnographic study the participants were divided into children without sleeping disorders (group I) and children with primary snoring (group II) or apnea (group III). The main histological findings were fiber size variability in 70% cases from groups II and III and in 71% from group I; perimysial connective tissue infiltration in 48% children from groups II and III and in 71% from group I; intracytoplasmatic mitochondrial proliferation in 63% cases from groups II and III and in 57% cases from group I. Muscle necrosis was only observed in one case, in association with subglandular inflammation. Others findings observed in all groups included fibers with internal architecture alteration, such as moth-eaten and lobulated fibers, type 2 fiber predominance, and small areas of fiber type grouping. The presence of similar histological findings in the palatopharyngeal muscle in children with primary snoring or apnea but also in children without sleeping disorders indicate that such changes could be a normal histological feature of this muscle rather than a neurogenic or myopathic pathology.
Assuntos
Músculos Palatinos/patologia , Músculos Faríngeos/patologia , Apneia Obstrutiva do Sono/patologia , Ronco/patologia , Biópsia , Criança , Pré-Escolar , Tecido Conjuntivo/patologia , Feminino , Humanos , Masculino , Respiração Bucal , Músculos Palatinos/crescimento & desenvolvimento , Tonsila Palatina/crescimento & desenvolvimento , Músculos Faríngeos/crescimento & desenvolvimentoRESUMO
A eletromiografia, como método de estudo, tem sido bastante utilizada e vem contribuindo para elucidar o desempenho da musculatura peribucal em vários processos fisiológicos como a mastigação, deglutição e fala, e é um instrumento importante na análise das bases fisiopatológicas das mudanças que ocorrem nesta musculatura. Muitos trabalhos têm sido conduzidos em pacientes com deficiência auditiva e de fala, mas nenhum deles avaliou a musculatura responsável pela fala. Este estudo comparou medidas eletromiográficas dos fascículos superior e inferior do músculo orbicular da boca em indivíduos portadores de deficiência auditiva neurossensorial profunda (surdos) com indivíduos clinicamente normais (ouvintes). A análise eletromiográfica foi realizada em 20 indivíduos, de ambos os sexos, com idade média de 18,5 anos, divididos em dois grupos: o primeiro grupo constituído por 10 indivíduos portadores de deficiência auditiva neurossensorial profunda bilateral e o segundo por indivíduos clinicamente normais. Cinco condições clínicas foram avaliadas: sucção, sopro, projeção e compressão labial e emissão da sílaba "Pa". Verificou-se que os pacientes surdos apresentaram hiperatividade muscular em todas as condições clínicas analisadas, e que o fascículo inferior do músculo orbicular da boca apresentou os níveis mais altos de atividade eletromiográfica, sugerindo a necessidade de um tratamento fonoaudiológico, com enfoque em motricidade oral.
Assuntos
Humanos , Masculino , Feminino , Adulto , Músculos da Mastigação , Músculos Palatinos , Músculos Pterigoides , Eletromiografia , Boca , Pessoas com Deficiência AuditivaRESUMO
O tremor palatal é caracterizado clinicamente por contraçöes rítmicas e involuntárias dos músculos do palato mole. Existem dois tipos de tremor palatal: o sintomático, com o acometimento do músculo levantador do véu palatino por lesäo na via denteado-rubro-olivar e o tremor palatal essencial , em que há o envolvimento do músculo tensor do véu palatino, mas sem lesäo orgânica. Vários tratamentos säo propostos como o emprego de benzodiazepínicos, anticonvulsivantes, anticolinérgicos, precursores de neurotransmissores e toxina botulínica. Os autores apresentam uma breve revisäo a respeito desta desordem e discutem dois pacientes com tremor palatal.