Injection snoreplasty: how to treat snoring without all the pain and expense.

OBJECTIVE: We introduce Injection Snoreplasty: an innovative, safe, and effective palatal snoring procedure with minimal cost and discomfort to the patient. A well-described sclerotherapy agent, Sotradecol, is injected into the soft palate to reduce/eliminate palatal flutter snoring. STUDY DESIGN AND SETTING: Twenty-seven patients with a diagnosis of palatal flutter snoring (respiratory disturbance index less than 10) by sleep study were enrolled in the protocol. Office treatment sessions were performed 6 to 8 weeks apart. Success was judged by subjective improvement in snoring and objective evidence of palatal stiffening/scarring. RESULTS: Twenty-five (92%) of 27 patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than 1 treatment (average, 1.8) in order to receive optimal palatal stiffening. CONCLUSION/SIGNIFICANCE: Injection Snoreplasty is a simple, safe, and effective office treatment for primary snoring. Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal/no convalescence.     

Transpalatal approach with pedicled palatal osteo-muco-periosteal flap

Background: In the conventional technique of transpalatal approach, the palatal mucoperiosteum is incised and widely elevated and hard palate bone is removed in piece meal and discarded. These technique lead to complications, namely, temporary or permanent palatal fistula, palatal scarring leading to palatal disfiguration and velopharyngeal incompetence. In this article we describe a new technique of doing palatotomy to avoid these complications. Methods: A retrospective review of post‐operative complications of 20 patients that underwent transpalatal approach by the conventional technique was performed. To avoid the complications encountered in these cases, a new approach was designed when the palatal mucoperiosteum on the pathological side was elevated partially, greater palatine artery was coagulated and palatal osteotomy was performed from the oral side. On the non‐pathological side, hard palate was sectioned from the nasal side, thus preserving the ipsilateral palatal mucoperiosteum. The entire mucoperiosteum with attached hard palate was reflected orally as a single block which was pedicled on the greater palatine artery and palatal mucoperiosteum of the non‐pathological side, thereby creating palatal osteo‐mucoperiosteal flap. The flap was placed back at the end of the procedure. Eight patients were operated by this new technique. Results: All 20 patients operated by the conventional transpalatal approach developed post‐operative complications. In the eight patients operated by the new technique, no post‐operative complications were encountered after 2 years' follow‐up. Conclusions: We found palatal osteo‐mucoperiosteal flap an easy and safe way of preserving the hard palate mucoperiosteum and bone with its vasculature resulting in quicker healing and minimal functional impairment.     

Cleft lip and palate: retrospective study of 35 years of management

The author having treated more than 2,000 C.L. (P) cases, and recognized his errors, delivers his main conclusions: 1--The Cupid-s bow always complete on the healthy side is to be strictly respected; 2--The nasal floor muscles should be identified and set in due place, especially the oblique part of the orbicularis oris, responsible for the nasal equilibrium; 3--The long muscular loop (orbicularis, buccinator, superior pharyngii constrictor) should be closed within the neo-natal period; 4--The velum should be closed and set back before the ninth month; in order to minimize scarring, only mucosal flaps should be taken from the palatal shelves; 5--If the velum deserves lengthening, tissue transfer by superiorly based pharyngeal flap, to be cut six months later; 6--Leave alone the bone until 7 or 8 years of age, close the gap with a Campbell flap; 7--Consider that no forceful orthopaedics can overwhelm the strength of scars developed over and between the palatal shelves. So, be light and late on the bone; 8--No addiction to any skin design provided some sort of Z-plasty is used; 9--Think muscle. Spare the bone.     

维吾尔族恒牙初期正常[牙合]腭部形态研究

目的：对新疆地区维吾尔族恒牙初期正常牙合睁部形态以及发育状况进行测量分析,为维吾尔族提供正常腭部形态参考指标。方法：收集符合纳入标准的新疆地区维吾尔族恒牙初期正常牙牙合膏模型,按照年龄以及性别进行分组,测量9项腭部相关指标,用SPSS17．0统计软件对各组数据进行统计分析。结果：13～15岁组中,第一前磨牙间腭宽度以及第二前磨牙间腭宽度,男女性别之间差异具有统计学意义（P〈0．05）;16～17岁组中,第二前磨牙间腭高以及第一磨牙间腭宽度,男女性别之间差异具有统计学意义;LSD-t检验结果显示维吾尔族恒牙初期腭部形态各项指标男女各年龄组之间差异均不具有统计学意义;维、汉民族之间多项腭部形态指标差异具有统计学意义。结论：维吾尔族恒牙初期腭部形态具有明显性别差异,均为男性大于女性,但未发现增龄性变化,维、汉恒牙初期腭部形态之间种族差异明显。     

A novel route for placing free flap pedicle from a palatal defect

One of the better options available to repair a large palatal defect is by employing a free flap. Almost all the times such free flaps are plumbed to facial vessels. The greatest challenge in such cases is the placement of the pedicle from palatal shelf to recipient vessels because there is no direct route available. As majority of large palatal fistulae are encountered in operated cleft palates there is a possibility of routing the pedicle through a cleft in the maxillary arch or via pyriform aperture. When such a possibility doesn’t exist the pedicle is routed behind the maxillary arch. We describe a novel technique of pedicle placement through a maxillary antrostomy, in this case report, where a large palatal fistula in a 16 year old boy was repaired employing a free radial artery forearm flap. The direct route provided by maxillary antrostomy is considered the most expeditious of all possibilities mentioned above.KEY WORDS: Free radial artery forearm flap, large palatal fistula, maxillary antrostomy, palatal fistula repair     

Evaluation of palatal snoring surgery in an animal model.

OBJECTIVE: We introduce an animal model to reproduce and measure palatal snoring and to assess the effectiveness of cautery-assisted palatal stiffening operation and injection snoreplasty versus a control (no palatal intervention) on treatment of palatal flutter snoring.Study design and setting An anesthetized laboratory canine model uses 2 simultaneous temporary tracheotomies. An inferior tracheotomy is cannulated with an endotracheal tube for ventilation. A superior tracheotomy is cannulated with a tube passed cephalad and seated in the hypopharynx. Negative pressure applied to the upper tube leads to partial collapse of the upper airway with palatal fluttering, and the anesthetized dog snores. Videostroboscopy records palatal flutter frequency before and after surgical intervention. Preoperative and postoperative palatal assessments are made on 15 beagles. RESULTS: Cautery-assisted palatal stiffening operation and injection snoreplasty objectively stiffen the canine soft palate with diminished snoring compared with controls.Conclusion and significance We provide a reproducible animal model to experimentally measure new interventions to treat palatal flutter snoring.     

Cautery-assisted palatal stiffening operation.

Outpatient surgical therapy of habitual snoring and mild obstructive sleep apnea has evolved significantly in recent years. We introduce the cautery-assisted palatal stiffening operation (CAPSO) and detail its important advantages over uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and palatal radiofrequency ablation. CAPSO is critically analyzed with regard to extent of surgery, need for repetition of procedure, results, complications, predictors of success, and cost analysis. CAPSO is a mucosal surgery that induces a midline palatal scar that stiffens the floppy palate. Two hundred six consecutive patients underwent CAPSO over an 18-month period, followed by office examination and telephone evaluation. The success rate was initially 92% and dipped to 77% after 1 year. CAPSO eliminates excessive snoring caused by palatal flutter and has success rates that were comparable with those of traditional palatal surgery. CAPSO is a simple and safe office procedure that avoids the need for multiple-stage operations and does not rely on expensive laser systems or radiofrequency generators and hand pieces.     

A clinical study and the diagnosis in magnetic resonance imaging of renal scarring

Twenty-nine kidneys of seventeen patients (nine boys and eight girls) with vesicoureteral reflux and repeated urinary tract infection were studied by magnetic resonance imaging for diagnosis of renal scarring and correlation between clinical data and the degree renal scarring. Renal scarring is classified into three types according to findings in magnetic resonance imaging. The degree of renal scarring are classified into five grades according to traditional grading of intravenous pyelogram. If a fine deformity of calyx is shown on intravenous pyelogram, magnetic resonance imaging demonstrates renal scarring. Magnetic resonance imaging without irradiation is exceedingly valuable for the diagnosis of renal scarring. The appearances of magnetic resonance imaging were supported by X-ray computed tomography. There is a substantial correlation between serum creatinine and the grades of renal scarring by magnetic resonance imaging. There is a substantial correlation between fever attacks and the grade of renal scarring, and there is a significant reverse correlation between the age of the onset of upper urinary tract infection and the grade of renal scarring. It is suggested that upper urinary tract infection is the most significant factor in scar formation.     

Is permanent maxillary tooth removal without palatal injection possible?

OBJECTIVE: The aim of the present study was to demonstrate if articaine HCl could provide palatal anesthesia in maxillary tooth removal without the need for a second palatal injection. STUDY DESIGN: Of 53 patients, 23 had bilateral and 30 had unilateral extractions. In the study group 2 mL of 4% articaine/HCl with 1:100,000 epinephrine was injected into the buccal vestibule of the tooth. After 5 min the extraction was performed. 27 subjects were controls and subjected to the same protocol with palatal injection. All patients completed a Faces Pain Scale (FPS) and a 100-mm Visual Analogue Scale (VAS) after extraction. RESULTS: According to VAS and FPS scores, when permanent maxillary tooth removal with palatal injection (97.5%) and without palatal injection (96.8%) were compared the difference was not statistically significant (P > .05) [corrected]. CONCLUSION: Permanent removal of maxillary teeth without palatal injection is possible by depositing 2 mL articaine/HCl to the buccal vestibule of the tooth.     

硬腭黏骨膜瓣翻转衬里修复腭瘘的疗效评价

目的:探讨硬腭黏骨膜瓣翻转衬里修复腭瘘的临床效果。方法:应用瘘口两侧的邻近瓣,将一侧硬腭黏骨膜瓣翻转作衬里褥式缝合修复18例腭瘘患者。结果:18例腭部瘘孔均获得关闭,无感染、复裂等并发症。结论:硬腭黏骨膜瓣翻转衬里修复腭瘘临床效果良好,为腭瘘的修补提供了一种有效安全的方法。     

Tomographic diagnosis of palatal defects

We present the results of a pilot study conducted to evaluate the effectiveness of palatal tomography in patients suspected of having palatal defects not detectable by other methods. Twelve patients were involved in the projects, ranging in age from 3 to 11 years. There were 8 boys and 4 girls. Each patient was evaluated with voice recordings, lateral cineradiographic x-rays, and palatal tomograms. Nine of the 12 patients were found by tomography to have palatal defects that had not been detected either by cineradiography or by clinical investigation, including physical examination of the palate. The results of this study are presented with clinical findings.     

Congenital palatal fistula: an isolated entity

Traumatic and postoperative palatal fistulae are common, but congenital palatal fistula is the rarest of all deformities. A case of isolated congenital palatal fistula is reported with an attempt to correlate the presented malformation with embryologic development of the palate.     

Roles of palatine bone denudation repairing with free buccal or palatal mucosal graft on maxillary growth: an experimental study in rabbits

Most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. The present study was designed to investigate growth patterns of the maxilla following palatal bone denudation covering with free buccal or palatal mucosal graft in rabbits with surgically created defects simulating palatal bone denudation. Forty-five purebred New Zealand rabbits were used in this experiment. The animals were divided into 3 groups: 1 control group (left palatal bone denudation was not repaired and the right side was unoperated as a control) and 2 experimental groups (the right side of palatal bone denudation was covered with free buccal or palatal mucosal graft, respectively, and the left side was not repaired). Nineteen metric cranial variables were measured directly from the cleaned skulls. Direct cephalometric measurements were taken in the following dimensions: maxillary length, width and height, posterior facial width, and nasal deflection. Significant differences were noted between 2 sides of maxilla in all animals for the 19 cephalometric measurements. The cephalometric measurements of the right side in maxillary length, height, and width were significantly greater than those in the left side. There was no statistically significant difference between free buccal mucosal graft repaired group and free palatal mucosal graft repaired group for the cephalometric measurements. There was also no statistically significant difference for the cephalometric measurements between the 3 groups. The results of this study demonstrate that palatal bone denudation repaired by free buccal or palatal mucosal graft might prevent maxillary deformity following cleft palate surgery.     

Differential excretion of urinary proteins in children with vesicoureteric reflux and reflux nephropathy

We studied 40 children with a history of vesicoureteric reflux (VUR) without evidence of renal scarring, 93 children with a history of VUR and renal scarring and 10 children with previous urinary tract infections in whom the urinary tract was radiologically normal. Urine retinol-binding protein (RBP), albumin andN-acetyl--d-glucosaminidase (NAG) were measured in each child. All were free from infection at the time of the analysis. Urinary RBP and NAG levels were significantly elevated (P<0.001) in the group of children with renal scarring. Elevated RBP levels were detected in 51% of children with bilateral renal scarring compared with 7% of children with unilateral scarring. Urine RBP excretion increased progressively according to the type of scarring, best determined by the type of scarring of the less affected kidney. In children with renal scarring, elevated NAG levels were seen mostly in the 65 children with bilateral scarring and severe reflux. Urine albumin excretion was elevated in 10 children, 9 with bilateral scarring, all of whom had elevated RBP excretion. Urine protein excretion was unaffected by the presence or absence of persisting VUR. There was a strong negative correlation between glomerular filtration rate and RBP excretion (r=–0.69). We conclude that evidence of tubular dysfunction is common in children with bilateral renal scarring and usually precedes any glomerular protein leak. Tubular dysfunction may be the consequence of relative nephron hyperperfusion in the presence of bilateral scarring.     

Neonatal palatal cysts and their morphology in cleft lip and palate.

Palatal cysts (Epstein pearls) are occasionally noticed as white papules on the palatal mucosa of a neonate whilst having its 6-week postnatal check. We describe five cleft patients and the distribution characteristics of their palatal cysts, including the previously unrecorded observation of a submucous cleft palate with a double row of palatal cysts, one row on each side of the zona pellucida. The role of spatial morphology of palatal cysts in interpreting cleft pathogenesis is discussed.     

改良瓦合瓣修复上颌骨骨折后腭部穿孔的效果评价

目的评价改良瓦合瓣修复上颌骨骨折后腭部穿孔的效果。方法 2015年至2017年,采用改良瓦合瓣修复10例上颌骨骨折后腭部穿孔患者。结果所有患者愈合良好,术后随访1～6个月,患者腭部形态良好,功能未见明显异常。结论通过合适病例的选择,改良瓦合瓣修复上颌骨骨折后腭部缺损可取得良好的术后效果,简单实用,手术创伤小。     

IBUPROFEN COMBINED WITH ANTIBIOTICS SUPPRESSES RENAL SCARRING DUE TO ASCENDING PYELONEPHRITIS IN RATS

PURPOSE: In acute pyelonephritis renal scarring may be decreased by immediate antibiotic therapy. Unfortunately in children there is often a delay in starting treatment, which increases the likelihood of renal scarring. In rodents immediate antibiotic therapy is effective for preventing renal scar formation resulting from experimentally induced pyelonephritis. However, the same treatment beginning 72 hours after infection does not prevent renal scarring in this paradigm. We examined whether delayed administration of the nonsteroidal anti-inflammatory agent ibuprofen only or combined with antibiotics suppresses renal scarring in a model of ascending pyelonephritis in rats. MATERIALS AND METHODS: An inoculum of 5x10(9) organisms per ml. of Escherichia coli strain BH-5 was instilled into the bladder of rats and the urethra was occluded for 4 hours. Groups of animals were and were not treated with 15 mg./kg. cefadroxil or 10 mg./kg. ibuprofen given twice daily for 5 days, or the 2 drugs combined. Treatment began 72 hours after inoculation. In an additional group of rats sterile phosphate buffered saline was instilled into the bladder. In each rat the kidneys were examined grossly and microscopically 6 weeks later. RESULTS: Combined antibiotics and ibuprofen significantly inhibited gross renal scarring compared with no treatment or antibiotics only (p<0.05). No difference in renal scarring was detected in animals that received no treatment versus those that received antibiotics or ibuprofen only (p>0.05). CONCLUSIONS: Renal scarring resulting from acute pyelonephritis in this rat model is not decreased by delayed treatment with antibiotics only. The addition of ibuprofen to antibiotic therapy is effective for decreasing renal scarring due to acute pyelonephritis even when treatment is delayed for 72 hours.     

Acquired renal scars in children

To determine the important factors involved in the etiology of renal scarring we studied 37 children with renal scars seen at our hospital since 1965. This is the second largest series reported to date. Children who had neurogenic bladders or any structural abnormalities of the urinary tract other than vesicoureteral reflex were excluded. The study group included 36 girls and 1 boy. The average age at first detection of renal scars was 5.7 years. Acute pyelonephritic episodes, which were treated early and aggressively, infrequently led to renal scarring. However, the initial prolonged or poorly treated episode of acute pyelonephritis was followed invariably by the development of renal scarring. The severity of renal scarring was related to the grade of vesicoureteral reflux (p less than 0.05), although some scars did develop in the absence of reflux. Neither the shape and position of the ureteral orifice nor the ureteral tunnel length correlated with the severity of renal scarring. Treatment with prophylactic antibiotics may have lessened the severity of renal scarring (0.1 less than p less than 0.2) but treatment with reimplantation surgery did not appear to alter the course of renal scarring. This study suggests that the key to the prevention of renal scarring is the early and aggressive treatment of acute pyelonephritis.     

Acoustical analysis of snoring: can the probability of success be predicted?

PURPOSE: Palatal flutter snoring is the most common form of snoring. However, other types of snoring do exist. Does identifying palatal snoring beforehand translate into improved subjective treatment success with palatal stiffening procedures? METHODS: Fifty-three patients presenting with snoring were evaluated with a commercially available device. The proportion (%) and magnitude of palatal flutter (dB) were quantified. Patients then underwent a palatal stiffening procedure and subjective success/failure was assessed. RESULTS: Overall subjective treatment success was 85% (45 of 53). The percent palatal flutter was the most predictive of success (area under ROC = 0.8556, 95% CI = .7428-.9683). Patients exceeding 68% palatal flutter had a 95% (39 of 41) success rate (P = 0.001, Fisher's exact) and an adjusted odds ratio of treatment success of 25.2 (95% CI = 3.22-196, P = 0.002). CONCLUSION: Palatal stiffening treatments are successful in the majority of patients. However, identifying patients with predominant palatal flutter snoring significantly increases the probability of subjective treatment success. EBM rating: B-2b.     

Mucormycosis causing palatal necrosis and orbital apex syndrome

A case of mucormycosis causing palatal necrosis and orbital apex syndrome is reported successfully treated with systemic antifungal therapy, surgical debridement and control of underlying disease process. After one year of follow-up patient is blind with anatomically preserved right eye and ptosis as well as having palatal obturator. Mucormycosis should be considered in differential diagnosis of palatal necrosis and orbital apex syndrome.