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PubMed1980

The role of lateral pharyngeal wall movement in pharyngeal flap surgery.

A total of 202 patients with pharyngeal flaps were assessed with nasopharyngoscopy and multiview fluoroscopy to determine the role of lateral pharyngeal wall movement postoperatively. Variations in the construction of flaps resulted in three categories: namely, a long narrow flap with a high insertion, a short broad flap with a low insertion, and an intermediate-size flap that is inserted in a position somewhere between the first two. It was found that in all cases where there was no evidence of velopharyngeal insufficiency, the sole determiner of velopharyngeal closure was the medical excursion of the lateral pharyngeal walls to the sides of the flap. In flap failures, the causes for velopharyngeal insufficiency were inappropriate degree, level, and symmetry of the lateral pharyngeal wall motion. The success of pharyngeal flap surgery depends largely on the preoperative assessment of the velopharyngeal mechanism and the choice of a type of pharyngeal flap that will best assist closure of the velopharyngeal port during speech.

Evaluation Studies as Topic↗

PubMed1980

The effect of pharyngeal flap surgery on the movements of the lateral pharyngeal walls.

Observations of prepharyngeal and postpharyngeal flap degrees of lateral pharyngeal wall movement seem to indicate that some individuals have the ability to alter patterns of lateral pharyngeal wall motion. However, most of the subjects did not show changes in lateral pharyngeal wall motion, and in those who did show changes, the effects of speech therapy could not be excluded. Therefore, the suggestion that pharyngeal flaps should be "tailored" to the size of the gap in the velopharyngeal sphincter seems valid. Or, to put it differently, it seems likely that in many individuals, if the pharyngeal flap constructed is not as broad as the velopharyngeal gap, velopharyngeal insufficiency and hypernasality are likely to persist because most often the lateral pharyngeal wall movement will not adapt to the presence of a new structure in the pharynx.

Endoscopy↗

PubMed1997

Swallowing and pharyngeal function in postoperative pharyngeal cancer patients.

This study examines the pharyngeal phase of swallowing after the resection of pharyngeal cancer, and focuses on the pharynx as a functional organ. The purpose of the study was to obtain information on both reconstruction and rehabilitation in cases of surgically treated pharyngeal cancer. The records of 21 consecutive patients who underwent surgical treatment of oropharyngeal and hypopharyngeal squamous cell carcinoma between 1990 and 1993 were reviewed. Functional results following surgery were graded on a numerical scale in three categories: pharyngeal swallow, laryngeal and lower airway protection, and oral alimentation. Three treatment groups were observed: group 1 = transoral excision with primary closure (six patients); group 2 = composite resection with primary closure (nine patients); and group 3 = composite resection with deltopectoral or pectoralis major flap closure (six patients). Comparison of pharyngeal swallow and laryngeal protection functions showed no significant difference between the three groups. However, oral alimentation performance in group 1 was significantly better than in group 3, and groups 1 and 2 achieved a similar level. In patients with T3 and T4 tumors postoperative function was poor and no difference in postoperative function was demonstrated between patients undergoing reconstruction with primary closure and patients undergoing reconstruction with deltopectoral or pectoralis major flaps. Patients with T3 and T4 tumors experienced impaired postoperative function regardless of the method of reconstruction used. This is not a condemnation of the surgical treatment of advanced pharyngeal tumors, but rather a suggestion that other reconstruction techniques be considered.

Aged↗

PubMed1998

Pharyngeal cross-sectional area and pharyngeal compliance in normal males and females.

Obstructive sleep apnea syndrome is ascribed to pharyngeal dysfunction, but there are only a few reports about the normal morphological values in this anatomical region. We measured the pharyngeal cross-sectional area and the compliance (collapsibility), using the acoustic reflection technique with air breathing, in 181 healthy subjects (age 21-69 years). We assessed their sex-related differences, and the effects of age, body size and body postures on these parameters. The pharyngeal cross-sectional area, defined as the region from the fauces to the glottis, posturally changed with successive decreases in the sitting, left lateral decubitus and supine positions. The area was significantly greater in male than in female subjects in the sitting position (p < 0.01), but no difference was present in the recumbent positions. The pharyngeal cross-sectional area did not correlate with either age or body size. The specific pharyngeal compliance was greater in the males than in the females (p < 0.01) and increased with age only in the male subjects.

Adult↗

PubMed1993

Asymptomatic pharyngeal carriage of beta-haemolytic streptococci and streptococcal pharyngitis among patients at an urban hospital in Croatia.

In a one-year study at the University Hospital of Infectious Diseases in Zagreb, Croatia the rate of asymptomatic throat carriage of beta-haemolytic streptococci was investigated. Throat carriage was investigated in 1796 patients, none of whom had a sore throat nor signs and/or symptoms of a respiratory tract infection. The carrier rate of beta-haemolytic streptococci was 8.3%, for group A streptococci 6%, group B 1.3%, group C 0.3% and group F 0.1%. The highest rate was observed in the 6 to 14 year age group: 13.8% for all streptococcal groups, 11.7% for group A alone. The proportion of non-A streptococci was higher in older age groups. Tonsillectomised individuals were less frequently carriers. No sex or season-dependent variations were observed. In a four-month study of 629 patients with pharyngitis the throat cultures yielded: group A streptococci in 44.7%, group B in 1.7%, group C in 0.8%, and group G in 0.6% of the patients. Group A streptococci in 44.7%, group B in 1.7%, group C in 0.8%, and group G in 0.6% of the patients. Group A streptococcal rates in carriers compared to rates in patients with pharyngitis suggest that approximately one fourth of the schoolchildren with culture-positive pharyngitis actually are not truly infected, but only carriers currently having a sore throat of non-streptococcal etiology. Antibiotics were administrated to 605 (96.2%) patients with pharyngitis; in 571 (94.4%) of the cases before culture results became available. After culture-negative results were obtained the therapy was discontinued in only 28.5% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1998

Five-day cefdinir treatment for streptococcal pharyngitis. Cefdinir Pharyngitis Study Group.

A multicenter, randomized, controlled, investigator-blind study was performed to evaluate the safety and efficacy of oral cefdinir versus oral penicillin V for the treatment of pharyngitis due to group A beta-hemolytic streptococci (GABHS). Patients 13 years of age and older were randomized to receive either oral cefdinir (300 mg twice a day) for 5 days followed by placebo for 5 days or oral penicillin V (250 mg four times a day) for 10 days. Throat cultures were obtained, and signs and symptoms of pharyngitis were recorded at study admission and follow-up visits on study days 11 to 15, 16 to 20, and 25 to 31. Patients kept a diary to record medication intake and their assessment of throat pain at admission and at each day of study treatment. Five hundred fifty-eight patients were enrolled, of whom 432 (77.4%) were clinically and microbiologically evaluable. The GABHS eradication rates 5 to 10 days after completion of therapy were 193 of 218 (88.5%) in the cefdinir group and 176 of 214 (82.2%) in the penicillin group (P = 0.053). Clinical cure rates were 89.0 and 84.6%, respectively (P = 0.80). By the time of the long-term follow-up visit, 2 to 3 weeks after completion of treatment, 156 of 191 (81.7%) of the assessable cefdinir patients and 152 of 195 (77.9%) of the penicillin patients remained free of GABHS. Both treatments were well tolerated, with adverse reaction rates of 18.3% in the cefdinir study arm and 15.0% in the penicillin study arm (P = 0.278). Five-day treatment with cefdinir is safe and effective therapy for GABHS pharyngitis. Based on its twice-a-day dosage and shorter course of therapy, leading to potentially greater patient compliance, cefdinir may be considered for use in the treatment of pharyngitis caused by GABHS.

Administration, Oral↗

PubMed2005

Differential expression of Sonic hedgehog along the anterior-posterior axis regulates patterning of pharyngeal pouch endoderm and pharyngeal endoderm-derived organs.

Previous studies have implicated Sonic hedgehog (Shh) as an important regulator of pharyngeal region development. Here we show that Shh is differentially expressed within the pharyngeal endoderm along the anterior-posterior axis. In Shh-/- mutants, the pharyngeal pouches and arches formed by E9.5 and marker expression showed that initial patterning was normal. However, by E10.5-E11.0, the first arch had atrophied and the first pouch was missing. Although small, the second, third, and fourth arches and pouches were present. The expression patterns of Fgf8, Pax1, and Bmp4 suggested that pouch identity was abnormal at E10.5 and that Shh is a negative regulator of these genes in the pouches. Despite the loss of pouch identity and an increase in mesenchymal cell death, arch identity markers were expressed normally. Our data show that a Shh-dependent patterning mechanism is required to maintain pouch patterning, independent or downstream of arch identity. Changes in the distribution of Bmp4 and Gcm2 in the third pouch endoderm and subsequent organ phenotypes in Shh-/- mutants suggested that exclusion of Shh from the third pouch is required for dorsal-ventral patterning and for parathyroid specification and organogenesis. Furthermore, this function for Shh may be opposed by Bmp4. Our data suggest that, as in the posterior gut endoderm, exclusion of Shh expression from developing primordia is required for the proper development of pharyngeal-derived organs.

Animals↗

PubMed1986

Adherence of vaginal and pharyngeal strains of group B streptococci to human vaginal and pharyngeal epithelial cells.

In vitro tests for adherence to human vaginal and pharyngeal epithelial cells were used to study the problem of tissue-specific tropism in group B streptococci (GBS). Twenty-two vaginal or pharyngeal clinical isolates of GBS (serotypes Ia, Ib, II, and III) were used. No significant differences in adherence to vaginal and pharyngeal epithelial cells were found between GBS from both sources: statistical analysis furnished no evidence for tissue-specific tropism. Serotype III vaginal GBS adhered better to vaginal and pharyngeal epithelial cells than did serotype III GBS strains isolated from the pharynx. However, pronounced differences in the level of adherence were found among strains of the same serotypes and from the same sources. Thus, the results obtained suggest that differences in adherence may rather be strain-dependent that type-dependent.

Bacterial Adhesion↗

PubMed1983

Pharyngeal dysfunction after treatment for pharyngeal cancer with surgery and radiotherapy.

Radiologic examinations of the pharynx were performed in 13 patients presenting with dysphagia following treatment of pharyngeal cancer with excision and radiotherapy. The conventional single-film technique or double-contrast examination was unremarkable, although 2 patients had clinical evidence for local recurrence. The patients were also examined with cineradiography using a film speed of 50 and 100 frames/sec. Various functional abnormalities (pharyngeal paresis, epiglottic dysfunction, dysfunction of the laryngeal vestibule, cricopharyngeal incoordination, and cervical esophageal webs) were found in all but 1 patient. The results indicate that functional abnormalities of the pharynx secondary to radiotherapy and surgery are common in patients who have dysphagia after treatment. These functional pharyngeal disorders are accurately diagnosed with cineradiography.

Adult↗

PubMed1997

A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Cefdinir Pediatric Pharyngitis Study Group.

OBJECTIVE: To compare the safety and efficacy of a 5-day regimen of cefdinir with those a conventional 10-day regimen of penicillin V for the treatment of streptococcal pharyngitis in children. DESIGN: Investigator-blind, randomized controlled trial. SETTING: Primary care, ambulatory. PATIENTS: Children aged 1 to 12 years with signs and symptoms of pharyngitis and a positive result on a rapid screening test for Streptococcus pyogenes (ie, a convenience sample). Four hundred eighty-two patients were enrolled in the study, and 440 were clinically and microbiologically evaluable. The most common reasons patients were nonevaluable were failure to return for specified visits and noncompliance with the administration of the medication; 2 patients receiving penicillin V discontinued use of the drug because of adverse events. INTERVENTION: Patients were randomized to receive either 7-mg/kg cefdinir, twice daily, for 5 days or 10-mg/kg penicillin V potassium, 4 times daily, for 10 days. MAIN OUTCOME MEASURES: The eradication of S pyogenes and the clinical cure of the signs and symptoms of pharyngitis, both determined 5 to 10 days after the completion of therapy. RESULTS: Streptococcus pyogenes was eradicated in 201 (90%) of the 224 patients receiving cefdinir and 155 (72%) of the 216 patients receiving penicillin V (95% confidence interval [CI], 10.7%-25.1%; P < .001). The clinical cure rates were 92% and 91% in the groups receiving cefdinir and penicillin V, respectively (95% CI, -4.5% to 6.1%; P = .80). Adverse events, regardless of the opinion of the investigator about their relationship to the study medication, occurred in 12.5% of the patients receiving cefdinir and 13.6% of the patients receiving penicillin V (P = .69). CONCLUSIONS: A 5-day regimen of cefdinir eradicated a higher proportion of S pyogenes than a 10-day regimen of penicillin V. No difference was noted between the regimens for clinical outcomes or adverse event rates.

Adolescent↗

PubMed1995

Randomized evaluation of benzathine penicillin V twice daily versus potassium penicillin V three times daily in the treatment of group A streptococcal pharyngitis. Pharyngitis Study Group.

In a randomized, prospective, multicenter study the clinical and bacteriological efficacies of three dosage schedules with two different salts of oral penicillin V suspensions (regimen 1: potassium salt of penicillin V, 50,000 U/kg of body weight per day in three divided doses; regimen 2: benzathine salt of penicillin V, 50,000 U/kg of body weight per day in two divided doses; and regimen 3: benzathine salt of penicillin V, 100,000 U/kg of body weight in two divided doses) for the treatment of streptococcal pharyngitis were evaluated. Children with clinical signs of acute pharyngitis and a positive throat culture for group A beta-hemolytic streptococci (GABHS) were eligible. There was no difference between the treatment groups with respect to the overall clinical success rate. Eradication of the original serotype of GABHS from throat cultures was achieved in 87.1% (regimen 1), 85.5% (regimen 2) and 87.7% (regimen 3) of patients. The incidence of potential drug-related adverse events was significantly higher in patients treated with regimen 3. The results of this and earlier studies strongly suggest that oral penicillin given twice daily should be the recommended treatment for the initial treatment of pharyngitis due to GABHS. Doubling the total daily dose is not beneficial in the usual clinical setting. Because of its favorable pharmacokinetics, the benzathine salt of penicillin V appears to be well suited for a twice-a-day dosage schedule.

Adolescent↗

PubMed1999

Comparison of cefdinir and penicillin for the treatment of streptococcal pharyngitis. Cefdinir Pharyngitis Study Group.

Cefdinir, an oral cephalosporin active against Streptococcus pyogenes (group A beta-hemolytic streptococci [GABHS]), is also resistant to degradation by most oropharyngeal beta-lactamases. This multicenter, randomized, controlled, double-masked study assessed the tolerability and efficacy of 2 dosing regimens of cefdinir in the treatment of pharyngitis due to GABHS. Adults and adolescents with pharyngitis due to GABHS received cefdinir 600 mg QD, cefdinir 300 mg BID, or penicillin V 250 mg QID each for 10 days. A throat culture and clinical assessment were obtained 4 to 9 days after completion of therapy. Of 919 patients enrolled, 644 (70.1%) were microbiologically assessable. The eradication rates 4 to 9 days after completion of therapy were 91.4% in the cefdinir QD group, 91.7% in the cefdinir BID group, and 83.4% in the penicillin group (P = 0.02 for cefdinir QD vs penicillin, P = 0.01 for cefdinir BID vs penicillin, P = 0.95 for cefdinir QD vs cefdinir BID). Clinical cure rates were also superior with cefdinir QD (94.8%, P = 0.02) and cefdinir BID (96.3%, P < 0.01) compared with penicillin (88.9%). Diarrhea was more common in the cefdinir groups (P < 0.001). Seventeen cefdinir patients and 4 penicillin patients discontinued therapy because of adverse reaction (P = 0.13). Ten days of treatment for streptococcal pharyngitis with cefdinir QD or BID is superior to treatment with penicillin V for the eradication of GABHS from the pharynx, although it is associated with a higher rate of adverse reactions.

Administration, Oral↗

PubMedDate not supplied

Examination of pharyngeal secretions to determine the etiology of pharyngitis.

Wright-stained throat smears from 174 outpatients with a chief complaint of sore throat were examined. In the presence of tonsillar and/or pharyngeal exudate, cervical lymphadenitis, temperature greater than or equal to 24 less than or equal to 72h, examination of the throat smears would have doubled the accuracy of differentiating streptococcal pharyngitis (SP) from nonstreptococcal pharyngitis (NSP). In the presence of one, two, three, or all four of the preceding presenting characteristics, examination of throat smears would have increased the diagnostic accuracy by 46, 50, 13, and 14 per cent, respectively. Examination of a Wright-stained throat smear may help distinguish SP from NSP among patients in an outpatient setting where follow-up and, therefore, treatment based on culture results may not be optimal.

Adolescent↗

PubMedDate not supplied

Prevalence of Legionella in pharyngeal secretions of patients with pharyngitis.

A serological investigation has suggested that Legionella pneumophila may be associated with sore throat in adults. In a study of 177 adults and children with acute pharyngitis, Legionella species were not isolated from pharyngeal cultures, which utilized selective and nonselective buffered charcoal-yeast extract media. Group A beta-hemolytic streptococci were isolated from 14 percent of the 177 symptomatic patients. Throat cultures from 88 asymptomatic control subjects were negative for Legionella and beta-hemolytic streptococci. Further studies are needed to determine if Legionella species are associated with acute pharyngitis.

Adult↗

PubMed1989

Pharyngeal pumping continues after laser killing of the pharyngeal nervous system of C. elegans.

Using a laser microbeam to kill specific subsets of the pharyngeal nervous system of C. elegans, we found that feeding was accomplished by two separately controlled muscle motions, isthmus peristalsis and pumping. The single neuron M4 was necessary and sufficient for isthmus peristalsis. The MC neurons were necessary for normal stimulation of pumping in response to food, but pumping continued and was functional in MC- worms. The remaining 12 neuron types were also unnecessary for functional pumping. No operation we did, including destruction of the entire pharyngeal nervous system, abolished pumping altogether. When we killed all pharyngeal neurons except M4, the worms were viable and fertile, although retarded and starved. Since feeding is one of the few known essential actions controlled by the nervous system, we suggest that most of the C. elegans nervous system is dispensable in hermaphrodites under laboratory conditions. This may explain the ease with which nervous system mutants are isolated and handled in C. elegans.

Animals↗

PubMed2005

Tbx1 expression in pharyngeal epithelia is necessary for pharyngeal arch artery development.

During embryonic life, the initially paired pharyngeal arch arteries (PAAs) follow a precisely orchestrated program of persistence and regression that leads to the formation of the mature aortic arch and great vessels. When this program fails, specific cardiovascular defects arise that may be life threatening or mild, according to the identity of the affected artery. Fourth PAA-derived cardiovascular defects occur commonly in DiGeorge syndrome and velocardiofacial syndrome (22q11DS), and in Tbx1(+/-) mice that model the 22q11DS cardiovascular phenotype. Tbx1 is expressed in pharyngeal mesoderm, endoderm and ectoderm, and, in addition, we show that it is expressed in precursors of the endothelial cells that line the PAAs, thus expanding the number of tissues in which Tbx1 is potentially required for fourth PAA development. In this study, we have used cell fate mapping and tissue-specific gene deletion, driven by six different Cre lines, to explore Tbx1 gene-dosage requirements in the embryonic pharynx for fourth PAA development. Through this approach, we have resolved the spatial requirements for Tbx1 in this process, and we show pharyngeal epithelia to be a critical tissue. We also thereby demonstrate conclusively that the role of Tbx1 in fourth PAA development is cell non-autonomous.

Animals↗

PubMed1994

[Occupational risk factors for pharyngeal cancer. Results of the Heidelberg Pharyngeal Cancer Study].

We carried out a case-control study on the role of occupational factors on the risk of pharyngeal cancer. The study was performed at the Department of Otorhinolaryngology/Head and Neck Surgery of the University of Heidelberg and comprised 105 male patients with squamous cell carcinoma of the oropharynx and/or hypopharynx and 420 randomly selected control subjects who were matched for age, sex and residential area (1:4 matching design). The study showed that 34.3% of the cancer patients and 10.1% of the control subjects worked in the construction industry. As construction workers were 26.7% of the cancer patients and 7.1% of the control subjects employed, the relative risk of pharyngeal cancer in construction workers was estimated to be 2.5 (C.I. 1.1-5.5, adjusted for alcohol and tobacco consumption). After further adjustment for alcohol and tobacco consumption, an increased risk of pharyngeal cancer was found for workers exposed to cutting oils (RR = 3.7; C.I. 1.2-11.8), iron dust (RR = 2.7; C.I. 1.0-7.0) asbestos cement (RR = 2.5; C.I. 1.0-6.1), cement (RR = 2.2; C.I. 0.9-5.2) and coal/tar products (RR = 3.6; C.I. 0.8-17.3).

Adult↗

PubMed1995

Ceftibuten vs. penicillin V in group A beta-hemolytic streptococcal pharyngitis. Members of the Ceftibuten Pharyngitis International Study Group.

The efficacy and safety of a 10-day course of ceftibuten oral suspension (9 mg/kg once daily) were compared with those of penicillin V (25 mg/kg/day in 3 divided doses) in children 3 to 18 years old treated for symptomatic pharyngitis and scarlet fever caused by group A beta-hemolytic streptococci (Streptococcus pyogenes). The study was prospective, randomized, multicenter and investigator-blinded; patients were randomized in a 2:1 ratio (ceftibuten:penicillin V). Overall clinical success (cure/improvement) at the primary end point of treatment (5 to 7 days posttherapy) was achieved in 97% (285 of 294) of ceftibuten-treated patients vs. 89% (117 of 132) of penicillin V-treated patients (P < 0.01). Elimination of infecting streptococci 5 to 7 days posttherapy was achieved in 91% (267 of 294) of ceftibuten-treated patients vs 80% (105 of 132) of penicillin V-treated patients (P < 0.01). A significant rise in anti-streptolysin O or anti-DNase B was observed in approximately 30% of patients in both treatment groups. No patient developed rheumatic fever or nephritis. Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported. These data suggest that once daily ceftibuten is as safe as and more effective than three times daily penicillin V for the treatment of group A beta-hemolytic streptococcal pharyngitis.

Adolescent↗