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PubMed2002

The ascending pharyngeal artery: branches, anastomoses, and clinical significance.

Neuroradiologists generally do not fully appreciate the importance of the territory of the ascending pharyngeal artery. The ascending pharyngeal artery is a small but important artery that supplies multiple cranial nerves and anastomotic channels to the anterior and posterior cerebral circulations. Several disease processes in the head and neck involve the ascending pharyngeal artery. To evaluate and treat such diseases, it is necessary for neuroradiologists not only to know selective angiography and embolization techniques, but also the territory of the ascending pharyngeal artery, anastomoses, and vascular supply to the vasa nervorum of lower cranial nerves. Herein, the normal angiographic anatomy of the ascending pharyngeal artery, its relationship with neighboring territories, its importance in clinical situations, and research models are reviewed.

Arteries↗

PubMedDate not supplied

Peroral pharyngeal block for placement of esophageal endoprostheses.

BACKGROUND AND OBJECTIVES: The placement of plastic peroral endoprostheses frequently is done in the United States as a palliation for esophageal cancer. However, the combination of topical local anesthetics and sedatives, the most commonly used means to achieve anesthesia, can cause complications and often does not adequately suppress the gag reflex. The purpose of this study was to compare sedation requirements in patients receiving the standard topical local anesthetic versus patients receiving peroral pharyngeal plexus block. METHODS: From December 1987 through April 1991, 11 patients underwent endoscopic esophageal stent placement. The first six patients received topical 10% lidocaine spray, the other five patients received pharyngeal plexus blocks. Supplemental sedation was given until the patient closed their eyes but were responsive to verbal stimuli. Completeness of block was evaluated by stimulating the posterior oropharynx. Total sedative requirements were recorded for each patient. RESULTS: Patients receiving pharyngeal plexus block had profound anesthesia and suppression of the gag reflex, as determined by examination and the patient's tolerance of the procedure. Patients receiving only topical anesthesia and intravenous sedation tolerated the procedure poorly and required a greater amount of intravenous sedation than those in the blocked group (p less than 0.01). There were no anesthetic complications in patients receiving pharyngeal blocks. CONCLUSIONS: Our experience indicates that the endoscopic placement of esophageal endoprostheses is optimally performed with the aid of pharyngeal plexus block. This block provides profound anesthesia with minimal risk in debilitated, high-risk patients. The neuroanatomy of the oropharynx is also reviewed.

Aged↗

PubMed2004

[Distributing and changes of NO and calcitonin gene-related peptide in pharyngeal tissues and plasma in obstructive sleep apnea and hypopnea syndrome].

OBJECTIVE: To explore the distributing and changes of nitric oxide (NO) and calcitonin gene-related peptide (CGRP) in obstructive sleep apnea and hypopnea syndrome (OSAHS). METHODS: This study investigated the content of NO and CGRP in plasma and in pharyngeal tissues of OSAHS subjects. Moreover, the distribution of NOS and CGRP in pharyngeal tissues was researched using method of immunohistochemistry. RESULTS: (1) Plasma NO level in control group was higher than in mild OSAHS group and in serious OSAHS group, P < 0.001. There was a significant increase in plasma CGRP after UPPP (P < 0.001), and the plasma CGRP level in control group was as high as that in after UPPP group (P > 0.05) NO level in pharyngeal tissue of OSAHS increased significantly, P < 0.001), but CGRP level decreased markedly, P < 0.001. (2) Immunohistochemistry change about NOS: there was a feeble positive expression in mucosa squamous epithelium of OSAHS and powerful positive expression in some salivary glandular epithelium, striated muscle cells, vascular wall/small vascular wall and epithelium of glandular duct of OSAHS. (3) Immunohistochemistry change about CGRP: There were diffusible positive markings in striated muscle cells and most cilium columnar epithelium in OSAHS, and negative expressions in other sites. CONCLUSIONS: (1) Circulating NO and CGRP are suppressed in OSAHS, and reversible promptly after UPPP. Further more, The content of NO in pharyngeal tissues increases significantly and that of CGRP decreases markedly. (2) The distribution of NOS and CGRP in pharyngeal tissue changes apparently according to sites.

Calcitonin Gene-Related Peptide↗

PubMed2004

Antigen-presenting cells in the hypertrophic pharyngeal tonsils: a histochemical, immunuhistochemical and ultrastructural study.

The antigen presenting cells (APCs) with special interest to dendritic cells (DC), were investigated in 28 hypertrophic and 10 control pharyngeal tonsils of children by histochemistry, immunohistochemistry and electron microscopy. In this study, we are trying to clarify the function and classification of APC in pharyngeal tonsils using morphologic criteria, Human Leukocyte Antigen Monoclonal Antibody (HLA-DR MoAb), which is specific for APCs, and acid phosphatase (APh) reacting with both phagosomes and lysosomes. The surface epithelium of the patient group examined by light microscopy, heavy infiltration of lymphocytes, degenerated columnar cells and a few HLA-DR MoAb (+) columnar cells was observed. Additionally, a significant number of APCs which were Langerhans cells (LCs), interdigitating dendritic cell (IDC), follicular dendritic cell (FDC) and macrophages were stained with both HLA-DR MoAb and APh in the epithelial, interfollicular-subepithelial and follicular areas. Ultrastructural examinations revealed that lymphocytes, macrophages, LC and M cells were found among the surface columnar epithelial cells of the patient group. The interactions between M cells and LC suggested that M cells probably passed antigens from surface to LC. In the interfollicular-subepithelial areas of the hypertrophic pharyngeal tonsil, IDCs were in close contact with lymphocytes, macrophages and plasma cells. Seven types of FDCs (FDC-1 - FDC-7) were recognised according to their ultrastructural appearances. Differentiated FDCs (FDC-4) were also in close contact with each active subtype of FDCs in follicular areas besides lymphocytes. These findings supported the idea that although the pharyngeal tonsils contained several types of active APCs, only DC were in close contact with immunocompetent cells and the other APC's. Therefore, these morphologic appearances of DC could be a sign of function to initiate the immune response of the pharyngeal tonsil.

Antigen-Presenting Cells↗

PubMed1989

[Localization of the rabbit pharyngeal motoneurons and peripheral courses of their axons: a study by means of the retrograde HRP or fluorescent labeling technique].

The localization of the rabbit pharyngeal montoneurons in the nucleus ambiguus and peripheral courses of their axons were investigated using injection of retrograde labeling tracers, i.e., HRP and nuclear yellow, into the individual pharyngeal muscles or using the injection in conjunction with intracranial severing of either the vagal or glossopharyngeal rootlets. The nucleus ambiguus of the rabbit was divided into four groups of neuron, of which the following two, the compact cell group (CoG) and the medial scattered group (SGm), were pertinent to the pharyngeal montoneurons. The CoG is a group formed by a compact arrangement of the smallest neurons and situated in the rostral half of the nucleus ambiguus. The SGm is a group formed by a scattered arrangement of slightly larger neurons in the rostral one-third of the nucleus and located medial to the CoG. The labeled stylopharyngeal motoneurons occupied the rostral portion of the SGm at a level from about 2800 to 3100 microns rostral to the obex. They were completely abolished by severing the glossopharyngeal rootlets, in contrast to no change of labeled neuron number when severing the vagal rootlets. Thus, all axons of the stylopharyngeal motoneurons were concluded to traverse the glossopharyngeal rootlets. The labeled palatopharyngeal motoneurons were found in the caudal portion of the CoG at a level from 500 to 1900 microns rostral to the obex, with their number being numerous at the caudal one-third of CoG, 500 to 1300 microns. All their axons traversed the vagal rootlets. The labeled pharyngeal constrictor motoneurons were found at almost all rostrocaudal levels of CoG, 500 to 2900 microns rostral to the obex, with their number being numerous in its middle one-third level. Although motoneurons of the superior constrictor, those of the middle constrictor, and those of the thyro and cricopharyngeal muscles composing the inferior constrictor overlapped rostrocaudally in location, their ranges of appearance had a tendency of arranging rostrocaudally in that order. At the middle one-third level of CoG, in which the CoG was subdivided into two subgroups, dorsomedial and ventrolateral, the superior and middle constrictor motoneurons were located in its entire portion. The majority of axons of the pharyngeal constrictor motoneurons traversed the vagal rootlets, though a few axons whose somata lay in the rostral portion of the CoG traversed the glossopharyngeal rootlets.

Animals↗

PubMed1983

Antibody response in bovine pharyngeal fluid following foot-and-mouth disease vaccination and, or, exposure to live virus.

Samples of pharyngeal fluid and serum were collected from cattle after exposure to live foot-and-mouth disease (FMD) virus (with or without prior vaccination) or after subcutaneous vaccination with inactivated virus. The pharyngeal fluid samples were examined for FMD neutralising activity and specific anti-FMD IgG, IgM and IgA antibodies. The neutralising activity of the serum was also monitored. A peak of neutralising activity which occurred in the pharyngeal fluid of unvaccinated cattle seven days after virus exposure corresponded to a rise in specific IgM and IgA antibodies. This peak appeared to be due to serum and tissue fluid escaping from the damaged mucosa during the acute inflammatory phase of infection. At later stages (20 to 60 days after virus exposure) the pharyngeal fluid neutralising activity corresponded to a rise in specific IgA antibodies, suggesting that active local antibody production was taking place. The pharyngeal fluid neutralising activity detected after revaccination with oil emulsion or aqueous vaccines, without exposure to live virus, corresponded to a rise in specific IgG and IgM antibody levels and this may have been due to serum transudation.

Animals↗

PubMed1984

The development of pharyngeal endocrine organs in mouse and chick embryos.

Some interesting differences exist between development of the pharyngeal endocrine organs in mouse and chicken. In both, the thyroid forms as an evagination of the pharyngeal floor in the midline at the level of pharyngeal arch II and moves caudally to the base of the neck. In the chicken, the thyroid divides to form paired organs whereas in the mouse it forms a moustache-shaped bar that later fuses with the parathyroid and ultimobranchial bodies. The thymi, parathyroids and ultimobranchial bodies form as lateral evaginations of the pharyngeal pouches. The chick forms two pairs of thymi and parathyroids from the third and fourth pouches whereas the mouse forms a single pair of each primordium from the third pouch. Ultimobranchial evaginations form from the caudal wall of the sixth pouch in the chick and from the posterior pharynx in the mouse. In the chick all of these evaginations detach from the pharynx and come to lie along the carotid arteries as separate organs that surround the thyroids. In the mouse the parathyroids and ultimobranchial bodies fuse with the lateral thyroid lobes. The thymi move to the ventral midline and fuse to form a single organ. Positioning of these organs appears to be related to three developmental events. Outgrowth of the original evaginations and their ventral movements conform to the curved shape of the pharyngeal arches. Ventral growth of the primordia should result in their convergence near the origin of the ventral aortic roots. The thyroid appears to be attached to the common carotid arteries. Lateral growth of the carotids is consistent with the change in thyroid shape. In the mouse the thymi lie ventral to the other organs. Their movement appears to be related to ventral closure of ventral ectoderm in the neck region.

Animals↗

PubMed1983

Radiographic assessment of epiglottic length and pharyngeal and laryngeal diameters in the Thoroughbred.

A lateral radiograph of the pharyngeal region provides a technique for identifying pharyngeal disorders, including entrapment of the epiglottic cartilage and dorsal displacement of the soft palate. Epiglottic cartilage length, predicted from radiographs by measurement from the body of the thyroid cartilage to the tip of the epiglottis (thyroepiglottic length), was well correlated to actual length at postmortem examination (r2 = 0.98). Thyroepiglottic length, corrected for magnification, was 8.76 +/- 0.44 cm in 24 healthy Thoroughbreds. Nine Thoroughbreds with entrapment of the epiglottic cartilage and 6 with dorsal displacement of the soft palate had significantly short thyroepiglottic lengths--6.59 +/- 0.33 cm and 6.43 +/- 0.40 cm, respectively. The nasopharyngeal diameter of the Thoroughbreds with dorsal displacement of the soft palate was significantly less than the nasopharyngeal diameter of healthy Thoroughbreds. There was no significant difference between healthy and abnormal Thoroughbreds for pharyngoepiglottic, laryngeal, or tracheal measurements as determined from the lateral radiographs. The head should be placed in a normal resting position to obtain the pharyngeal radiograph. Maximum dorsiflexion of the head significantly increased the pharyngoepiglottic distance, whereas maximum ventriflexion significantly decreased this distance. The nasopharyngeal diameter during dorsiflexion was significantly greater than during ventriflexion. This investigation documented that a lateral pharyngeal radiograph provides important diagnostic information for evaluating suspected pharyngeal disorders in Thoroughbreds with airway obstruction of the cranial part of the respiratory tract.

Animals↗

PubMed1980

A comparison of transverse and vertical pharyngeal flaps using electromyography and judgments of nasality.

Previous studies have reported less than adequate speech results for vertical types of pharyngeal flaps with some patients. However, no controlled judgments of nasality have been reported for transverse pharyngeal flaps, and no comparative studies have been done. In this investigation, 21 listeners evaluated nasality in two groups of seven cleft palate patients. One group had had vertical pharyngeal flaps, while the other group had had transverse pharyngeal flaps. The possible relationship of observable electromyographic activity to nasality was also studied. The results indicated that perceptual ratings of postoperative speech in the two groups did not differ significantly. Also, because similar muscle action potentials were observed in both types of pharyngeal flaps, it was concluded that this activity was not a contributing factor in the judgments of nasality.

Child↗

PubMed1978

Aspects of the human pharyngeal hypophysis in normal and anencephalic fetuses and neonates and their possible significance in the mechanism of its control.

Aspects of the pharyngeal hypophysis in normal and anencephalic human fetuses and neonates have been described. Volumetric and histological changes in the normal gland similar to those observed previously in the adult are noted. The sellar and pharyngeal hypophyses develop in parallel during intrauterine life, but the latter has reached its maximum development by the time of birth. It is suggested that the control of the pharyngeal hypophysis is mediated through factors in the blood, and that the nature of the control and the vascular route vary at particular periods in both fetal and adult life. From a study of the anencephalic material it appears that the individual cells of the pharyngeal hypophysis are capable of marked response to a specific endocrine imbalance, but the capacity of the pharyngeal hypophysis as a whole to compensate significantly for deficiencies of the sellar adenohypophysis is strictly limited by its inability to hypertrophy to any marked degree.

Anencephaly↗

PubMed1998

Effect of bilateral blockade of the pharyngeal branch of the vagus nerve on soft palate function in horses.

OBJECTIVE: To determine the effect of bilateral blockade of the pharyngeal branch of the vagus nerve on soft palate function in horses. ANIMALS: 5 Standardbreds. PROCEDURE: Peak tracheal inspiratory and expiratory pressures and airflow were measured while horses exercised at the speeds corresponding to 75 and 100% of the speed that resulted in maximal heart rate, with and without pharyngeal branch of the vagus nerve blockade. Respiratory frequency-to-stride frequency coupling ratio was measured by correlating foot fall measurements with respiratory frequency. The pharyngeal branch of the vagus nerve was blocked bilaterally as the nerve coursed through the auditory tube diverticulum (guttural pouch) across the longus capitus muscle. RESULTS: Persistent, reversible dorsal displacement of the soft palate (DDSP) occurred in all horses after nerve blockade, and lasted from 1 to 3 hours; normal nasopharyngeal function returned within 3 hours. Compared with control values, peak expiratory tracheal pressure increased (P = 0.001), expiratory impedance increased (P = 0.007), and minute ventilation decreased (P = 0.04). Respiratory frequency-to-stride frequency coupling ratio decreased (P = 0.009) so that horses took 1 breath/stride without the nerve block and, approximately, 1 breath/2 strides with the block. CONCLUSION: DDSP creates flow-limiting expiratory obstruction and may be caused by neuromuscular dysfunction involving the pharyngeal branch of the vagus nerve. It may alter performance by causing expiratory obstruction and by altering breathing strategy in horses. CLINICAL RELEVANCE: A repeatable, reversible model of DDSP exists that allows further study of the disease. Dysfunction of the neuromuscular group, pharyngeal branch of the vagus nerve and palatinus and palatopharyngeus muscles, may be implicated in the pathogenesis of clinical DDSP.

Animals↗

PubMed1998

Pharyngeal airway obstruction in obstructive sleep apnea: pathophysiology and clinical implications.

In obstructive sleep apnea, airflow obstruction is caused by pharyngeal collapse. Current evidence suggests that anatomic alterations predispose to pharyngeal collapse. This article examines the role of structures that elongate and dilate the pharynx in maintaining pharyngeal patency. Their influence on pharyngeal collapsibility is considered. Insights gained are then presented within a conceptual framework that can be used for treating patients.

Airway Obstruction↗

PubMed2002

Azithromycin versus penicillin V for treatment of acute group A streptococcal pharyngitis.

OBJECTIVE: To compare a 3-day azithromycin vs. a 10-day penicillin V regimen for treatment of acute group A streptococcal (GAS) pharyngitis in children and to determine whether viral infection and/or pharyngeal GAS carriage in patients and adult contacts affect clinical and bacteriologic efficacy. METHODS: This multicenter, randomized, comparative, open label study compared 3-day, once daily 10 mg/kg azithromycin oral suspension with a 10-day regimen of 100,000 IU/kg/day penicillin V oral suspension in three divided doses in children with acute GAS pharyngitis. Clinical and bacteriologic efficacy and tolerability of the antibiotics were evaluated. Recurrence of symptoms and infection was monitored for 6 months. RESULTS: In total, 292 children (age range, 2 to 12 years) received at least one dose of study medication. Clinical success (cure/improvement) with either antibiotic was similar at the end of therapy (Day 14; azithromycin, 95%; penicillin V, 97%) and at Day 28 (azithromycin, 94%; penicillin V, 95%). Bacteriologic eradication was significantly less with azithromycin than with penicillin V at Day 14 (azithromycin, 38%; penicillin V, 81%; P < 0.001) and at Day 28 (azithromycin, 31%; penicillin V, 68%; P < 0.001). There was no associated increase in GAS-related sequelae. The lower incidence of bacteriologic eradication with azithromycin was not the result of possible concomitant viral infections in the patients, GAS carriage in one parent/guardian or any reduced susceptibility in pretreatment GAS isolates. Both antibiotics were equally well-tolerated. CONCLUSIONS: Treatment with 3-day, once daily 10 mg/kg azithromycin for GAS pharyngitis is associated with similar high levels of clinical efficacy, but lower levels of bacteriologic eradication, than with 10-day 100,000 IU/kg/day penicillin V.

Administration, Oral↗

PubMedDate not supplied

Thickness and histologic and histochemical properties of the superior pharyngeal constrictor muscle in velocardiofacial syndrome.

BACKGROUND: Velocardiofacial syndrome (VCFS) is one of the most common multiple anomaly syndromes in humans. Pharyngeal hypotonia, one of the most common findings in VCFS, contributes to hypernasal speech, which occurs in approximately 75% of individuals with VCFS. OBJECTIVE: To evaluate the thickness and histologic and histochemical properties of the superior pharyngeal constrictor (SPC) muscle in patients with VCFS to determine whether a muscle abnormality exists that might contribute to the hypotonia seen in these patients. Subjects The SPC muscle thickness in 26 VCFS patients (18 male and 8 female; age range, 3-29 years) was compared with SPC muscle thickness in age- and sex-matched controls using magnetic resonance images. The histologic and histochemical properties of the SPC muscle in 9 VCFS patients (6 male and 3 female; age range, 4-12 years) were compared with SPC muscle in 3 adult cadavers without VCFS (all male; age range, 80-86 years) using specimens obtained during pharyngeal flap surgery. RESULTS: The thickness of the SPC muscle was significantly less in patients with VCFS (2.03 mm) than in patients without VCFS (2.85 mm). The SPC muscle contained a significantly greater proportion of type 1 fibers in patients with VCFS (27.7%) than in adults without VCFS (17.9%), and the diameter of the type 1 fibers was significantly smaller in patients with VCFS (21.6 micro m) than in adults without VCFS (26.6 micro m). CONCLUSIONS: Differences in the thickness and histologic and histochemical properties of the SPC muscle found in patients with VCFS compared with individuals without VCFS may offer insight into the cause of pharyngeal hypotonia and hypernasal speech seen in these patients.

Aged↗

PubMed2001

Performance of a predictive model for streptococcal pharyngitis in children.

CONTEXT: Group A beta-hemolytic streptococcus (GABHS) pharyngitis is a common childhood illness. The clinical diagnosis is difficult to determine and laboratory tests have limitations; hence, the condition is generally overdiagnosed and overtreated. Several clinical pediatric-specific predictive models have been published but none have been prospectively studied. OBJECTIVE: To test the performance of a previously published predictive model for GABHS pharyngitis in children in different clinical settings and during different seasons. DESIGN: Prospective cohort study. SETTINGS: Pediatric emergency department and 2 pediatric outpatient clinics. PATIENTS: Children aged between 1 and 18 years with pharyngitis on initial examination at study sites between April 1, 1999, and March 31, 2000. INTERVENTIONS: Recording of clinical features during initial evaluation using a standardized form and recovery of GABHS from patients' throats using reference standard methods. MAIN OUTCOME MEASURES: Posttest probability for GABHS positive throat culture associated with the model's positive predictors (moderate to severe tonsillar swelling, cervical lymphadenopathy [moderate to severe tenderness and enlargement of cervical lymph nodes], scarletiniform rash, and the absence of coryza) and the models' negative predictors (absence of the above signs and the presence of coryza). RESULTS: Of 587 patients analyzed, 218 (37%) had a positive throat culture for GABHS. Forty-nine percent were boys. Mean +/- SD age was 6.7 +/- 3.9 years. There was no difference between the subsets within the sample. The posttest probability values for a positive throat culture associated with positive and negative predictors of the model were 79% and 12%, respectively. CONCLUSIONS: A pediatric predictive model for GABHS pharyngitis performed better than physicians' subjective estimates for a positive throat culture and was comparable with a rapid antigen detection test. The model performed consistently well in different populations and across seasons. It can be useful if reliable microbiological testing and/or follow-up are not attainable.

Adolescent↗

PubMed2004

Empirical validation of guidelines for the management of pharyngitis in children and adults.

CONTEXT: Recent guidelines for management of pharyngitis vary in their recommendations concerning empirical antibiotic treatment and the need for laboratory confirmation of group A streptococcus (GAS). OBJECTIVE: To assess the impact of guideline recommendations and alternative approaches on identification and treatment of GAS pharyngitis in children and adults. DESIGN, SETTING, AND PARTICIPANTS: Throat cultures and rapid antigen tests were performed on 787 children and adults aged 3 to 69 years with acute sore throat attending a family medicine clinic in Calgary, Alberta, from September 1999 to August 2002. Recommendations from 2 guidelines (those of the Infectious Diseases Society of America and of the American College of Physicians-American Society of Internal Medicine/American Academy of Family Physicians/US Centers for Disease Control and Prevention) were compared with rapid testing alone, a clinical prediction rule (ie, the modified Centor score), and a criterion standard of treatment for positive throat culture results only. MAIN OUTCOME MEASURES: Sensitivity and specificity of each strategy for identifying GAS pharyngitis, total antibiotics recommended, and unnecessary antibiotic prescriptions. RESULTS: In children, sensitivity for streptococcal infection ranged from 85.8% (133/155; 95% confidence interval [CI], 79.3%-90.0%) for rapid testing to 100% for culturing all. In adults, sensitivity ranged from 76.7% (56/73; 95% CI, 65.4%-85.8%) for rapid testing without culture confirmation of negative results to 100% for culturing all. In children, specificity ranged from 90.3% (270/299; 95% CI, 86.4%-93.4%) for use of modified Centor score and throat culture to 100% for culturing all. In adults, specificity ranged from 43.8% (114/260; 95% CI, 37.7%-50.1%) for empirical treatment based on a modified Centor score of 3 or 4 to 100% for culturing all. Total antibiotic prescriptions were lowest with rapid testing (24.7% [194/787]; 95% CI, 21.7%-27.8%) and highest with empirical treatment of high-risk adults (45.7% [360/787]; 95% CI, 42.2%-49.3%), due to a high rate of unnecessary prescriptions in adults (43.8% [146/333]; 95% CI, 38.4%-49.4%). CONCLUSIONS: Guideline recommendations for the selective use of throat cultures but antibiotic treatment based only on positive rapid test or throat culture results can reduce unnecessary use of antibiotics for treatment of pharyngitis. However, empirical treatment of adults having a Centor score of 3 or 4 is associated with a high rate of unnecessary antibiotic use. In children, strategies incorporating throat culture or throat culture confirmation of negative rapid antigen test results are highly sensitive and specific. Throat culture of all adults or those selected on the basis of a clinical prediction rule had the highest sensitivity and specificity.

Adolescent↗

PubMed1997

Functional outcome in soft palate reconstruction using a radial forearm free flap in conjunction with a superiorly based pharyngeal flap.

BACKGROUND: Speech and swallowing problems due to velopharyngeal incompetence may follow soft palate resection and reconstruction. Over the past 3 years, we have developed the use of a superiorly based pharyngeal flap in conjunction with a radial forearm flap for soft palate reconstruction. METHODS: This paper describes the technique in detail and compares the functional results in a study with patients undergoing soft palate resection for squamous cell carcinoma treated with or without a pharyngeal flap as an adjunct to a radial forearm free flap for soft palate reconstruction. Seven patients had one quarter or one half soft palate defects reconstructed with a radial forearm flap alone. Of the 11 patients undergoing three quarter or total soft palate resections, all were reconstructed with a radial forearm flap, but 5 were treated with an additional superiorly based pharyngeal flap. The functional outcome for all the patients was analyzed and compared. RESULTS: Our results show that the addition of the superiorly based pharyngeal to the radical forearm flap in soft palate reconstruction results in improved speech and swallowing. We recommend the use of the additional flap in resections in which more than one quarter of the soft palate is included.

Adult↗

PubMed2006

DiGeorge syndrome and pharyngeal apparatus development.

DiGeorge syndrome is the most frequent microdeletion syndrome in humans, and is characterized by cardiovascular, thymic and parathyroid, and craniofacial anomalies. The underlying cause is disturbed formation of the pharyngeal apparatus, a transient structure present during vertebrate development that gives rise to endocrine glands, craniofacial tissue, and the cardiac outflow tract. The pharyngeal apparatus is composed of derivatives of ectoderm, endoderm, mesoderm and the neural crest. Thus, complex interactions between cell types from different origins have to be orchestrated in the correct spatiotemporal manner to establish proper formation of the pharyngeal system. The analysis of engineered mouse mutants developing a phenotype resembling DiGeorge syndrome has revealed genes and signalling pathways crucial for this process. Intriguingly, these mouse models reveal that interference with either of two distinct phases of pharyngeal apparatus development can contribute to the aetiology of DiGeorge syndrome.

Animals↗