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11 pages, 963 KiB

Open AccessArticle

Aerodynamic Study of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome

by Salvatore Allosso, Massimo Mesolella, Giovanni Motta, Giuseppe Quaremba, Rosaria Parrella, Martina Ricciardiello and Sergio Motta

J. Pers. Med. 2024, 14(6), 620; https://doi.org/10.3390/jpm14060620 - 10 Jun 2024

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Abstract

Objectives: We aim to verify velopharyngeal sphincter function in 22q11.2 deletion syndrome patients (22q11.2DS) to establish correlations between aerodynamic and perceptual measures of nasality, and to identify aerodynamic measures differentiating typical from atypical velopharyngeal behavior. Methods: Eleven subjects with 22q11.2DS and twenty similar-age control subjects were recruited. The aerodynamic measures were mean Sound Pressure Level, air pressure peak, pressure wave duration, airflow pattern and nasal airflow during the sequence /pi/. The nasality perceptual measures were rhinolalia, rhinophony and nasal air escape. Results: Airflow patterns and perceptual measures were statistically different in the two groups. Pressure wave duration and air pressure peak were lower in study subjects than in controls. Air pressure peak and nasal airflow were negatively correlated with rhinolalia; pressure wave duration was negatively correlated with nasal air escape and rhinolalia in 22q11.2DS patients. Conclusions: This aerodynamic study identified velopharyngeal qualitative and quantitative dysfunctions, suggesting heterogeneous models of velopharyngeal function in syndromic subjects as compared to controls. Full article

(This article belongs to the Section Clinical Medicine, Cell, and Organism Physiology)

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10 pages, 1549 KiB

Open AccessArticle

Surgical Management of Chiari 1.5 in Children: A Truly Different Disease?

by Ignazio G. Vetrano, Arianna Barbotti, Tommaso Francesco Galbiati, Sabrina Mariani, Alessandra Erbetta, Luisa Chiapparini, Veronica Saletti and Laura G. Valentini

J. Clin. Med. 2024, 13(6), 1708; https://doi.org/10.3390/jcm13061708 - 15 Mar 2024

Cited by 2 | Viewed by 2012

Abstract

Background: In patients with Chiari 1.5 malformation (CM1.5), a more aggressive disease course and an increased association with craniovertebral junction (CVJ) anomalies has been suggested. The best management of this subgroup of patients is not clearly defined, also due to the lack of specific series elucidating this anomaly’s peculiar characteristics. Methods: We evaluated a series of 33 patients (25 females, 8 males; mean age at surgery: 13 years) fulfilling the criteria for Chiari 1.5 diagnosis who underwent posterior fossa decompression and duraplasty (PFDD) between 2006 and 2021. Results: Headache was present in all children, five presented central apnea, five had dysphagia, and three had rhinolalia. Syringomyelia was present in 19 (58%) children. Twenty patients (61%) showed various CVJ anomalies, but only one child presented instability requiring arthrodesis. The mean tonsil displacement below the foramen magnum was 19.9 mm (range: 12–30), without significant correlation with the severity of symptoms. Syringomyelia recurred or was unchanged in three patients, and one needed C1–C2 fixation. The headache disappeared in 28 children (84%). Arachnoid opening and tonsil coagulation or resection was necessary for 19 children (58%). Conclusions: In our pediatric CM series, the need for tonsil resection or coagulation was higher in CM1.5 children due to a more severe crowding. Full article

(This article belongs to the Special Issue Chiari 1 Malformation, Syringomyelia and Related Disorders: Advances in Diagnosis and Treatment for Adults and Children)

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11 pages, 871 KiB

Open AccessArticle

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

by Giannicola Iannella, Bianca Vallicelli, Giuseppe Magliulo, Giovanni Cammaroto, Giuseppe Meccariello, Andrea De Vito, Antonio Greco, Stefano Pelucchi, Rossella Sgarzani, Ruggero Massimo Corso, Gloria Napoli, Giulia Bianchi, Salvatore Cocuzza, Antonino Maniaci and Claudio Vicini

Int. J. Environ. Res. Public Health 2020, 17(5), 1542; https://doi.org/10.3390/ijerph17051542 - 27 Feb 2020

Cited by 40 | Viewed by 5120

Abstract

Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea–hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment)

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5 pages, 199 KiB

Open AccessCase Report

Acute Hyponasality (Closed Rhinolalia) and Craniomaxillofacial Fracture Suggest the Coexistence of Retropharyngeal Emphysema and Pneumomediastinum

by Ioannis Papadiochos, Stavros-Evangelos Sarivalasis and Nickolaos Papadogeorgakis

Craniomaxillofac. Trauma Reconstr. 2019, 12(1), 70-74; https://doi.org/10.1055/s-0038-1667017 - 26 Jul 2018

Cited by 1 | Viewed by 92

Abstract

Pneumomediastinum (PM) implies an abnormal condition where a collection of free air or gas is entrapped within the fascial planes of mediastinal cavity. It is considered as benign entity, but an uncommonly seen complication of craniofacial injuries. We report a case of a 63-year-old male patient with the presenting sign of closed rhinolalia who was diagnosed with retropharyngeal emphysema and PM due to a linear and nondisplaced fracture of midface. The patient cited multiple efforts of intense nasal blowing shortly after a facial injury by virtue of a motorcycle accident. He was admitted in our clinic for closer observation and further treatment. The use of a face mask for continuous positive airway pressure was temporarily interrupted, and high concentrations of oxygen were delivered via non-rebreather mask. Patient’s course was uncomplicated and he was discharged few days later, with almost complete resolution of cervicofacial emphysema and absence of residual PM in follow-up imaging tests. Closed rhinolalia (or any acute alteration of voice) in maxillofacial trauma patients should be recognized, assessed, and considered within the algorithm for PM and retropharyngeal emphysema diagnosis and management. For every single case of cervicofacial emphysema secondary to facial injury, clinicians should maintain suspicion for retropharyngeal emphysema or PM development. Full article

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