BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurre...BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.展开更多
Pharyngeal cartilage morphogenesis is crucial for the formation of craniofacial structures.Cranial neural crest cells are specified at the neural plate border,migrate to pharyngeal arches,and differentiate into pharyn...Pharyngeal cartilage morphogenesis is crucial for the formation of craniofacial structures.Cranial neural crest cells are specified at the neural plate border,migrate to pharyngeal arches,and differentiate into pharyngeal chondrocytes,which subsequently flatten,elongate,and stack like coins during maturation.Although the developmental processes prior to chondrocyte maturation have been extensively studied,their subsequent changes in morphology and organization remain largely elusive.Here,we show that wnt2bb is expressed in the pharyngeal ectoderm adjacent to the chondrogenic precursor cells in zebrafish.Inactivation of Wnt2bb leads to a reduction in nuclearβ-catenin,which impairs chondrogenic precursor proliferation and disrupts chondrocyte morphogenesis and organization,eventually causing a severe shrinkage of pharyngeal cartilages.Moreover,the decrease ofβ-catenin in wnt2bb^(-/-)mutants is accompanied by the reduction of Yap expression.Reactivation of Yap can restore the proliferation of chondrocyte progenitors as well as the proper size,shape,and stacking of pharyngeal chondrocytes.Our findings suggest that Wnt/β-catenin signaling promotes Yap expression to regulate pharyngeal cartilage formation in zebrafish.展开更多
BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping symptoms.While proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are unclear.Reflux mo...BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping symptoms.While proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are unclear.Reflux monitoring techno-server reliability.We hypothesized that PAR episodes alone might also predict PPI responsiveness.AIM To investigate whether PAR episodes alone predict a positive response to PPI therapy.METHODS Patients suspected of having LPR were prospectively recruited from otolaryngologic clinics in three Taiwan residents tertiary centers.They underwent a 24-hour esophagopharyngeal pH test using either 3-pH-sensor or hypopha-ryngeal MII-pH catheters while off medication,followed by a 12-week esomeprazole course(40 mg twice daily).Participants were categorized into four groups based on pH results:PAR alone,EAR alone,both pH(+),and both pH(-).The primary outcome was a≥50%reduction in primary laryngeal symptoms,with observers blinded to group assignments.RESULTS A total of 522 patients(mean age 52.3±12.8 years,54%male)were recruited.Of these,190(mean age 51.5±12.4 years,61%male)completed the treatment,and 89(47%)responded to PPI therapy.Response rates were highest in the PAR alone group(73%,n=11),followed by EAR alone(59%,n=68),both pH(+)(56%,n=18),and both pH(-)(33%,n=93).Multivariate analysis adjusting for age,sex,body mass index,and endoscopic esophagitis showed that participants with PAR alone,EAR alone,and both pH(+)were 7.4-fold(P=0.008),4.2-fold(P=0.0002),and 3.4-fold(P=0.03)more likely to respond to PPI therapy,respectively,compared to the both pH(-)group.Secondary analyses using the definition of≥1 PAR episode were less robust.CONCLUSION In the absence of proven hypopharyngeal predictors,this post-hoc analysis found that baseline≥2 PAR episodes alone are linked to PPI responsiveness,suggesting the importance of hypopharyngeal reflux monitoring.展开更多
Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no ...Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, 'fair”, 'slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children.展开更多
Tonsillectomy once was a most common ENT procedure, being referred in past as the “bread and butter of otorhinolaryngologists” though not so commonly performed these days. The usual complications of this procedure h...Tonsillectomy once was a most common ENT procedure, being referred in past as the “bread and butter of otorhinolaryngologists” though not so commonly performed these days. The usual complications of this procedure have been haemorrhage-primary/reactionary/secondary, infection, tonsillar bed structures injury, and even death. With the advent of newer technologies like lasers, microdebriders, coblators, harmonic scalpel, radiofrequency, newer complications also arise. This case report focuses on one such complication of laser assisted tonsillectomy, not much spoken of in books.展开更多
AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwen...AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.展开更多
Objective： To evaluate the effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea and hypopnea syndrome （OSAHS）. Methods： We conducted a non-randomized retrospective clinical trial...Objective： To evaluate the effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea and hypopnea syndrome （OSAHS）. Methods： We conducted a non-randomized retrospective clinical trial of 75 patients with OSAHS. Fifty-four patients were managed by exercising of the pharyngeal musculature and genioglossus （exercising group）. Twenty-one patients, who refused to undertake any treatment, were defined as the control group. We took the Epworth Sleepiness Scale （ESS）, checked patients＇ polysomnography, and took 320- detector computed tomography （CT） before treatment. Six and twelve months later, we made records of apnea hypopnea index （AHI）, lowest arterial oxygen saturation （LSaO2）, body mass index （BMI）, the shortest sagittal diameter, and transverse diameter, and the effective rates of exercising were calculated and compared with the 21 patients without any treatment （control group） at the same time. SPSS 10.0 was used to analyze the data. Results： Before treatment, the ESS value was 7.67; 6 and 12 months later, the values were 3.54 and 3.25, respectively in the exercising group. AHI was decreased to 15.36 after 6 months and 13.79 after 12 months from 22.84 at the beginning. LSaO2 values were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. There were significant differences in ESS scores, AHI, and LSaO2 between pre-treatment and post-treatment in the exercising group （P〈0.05）. However, there was no statistical difference in all the parameters between 6 and 12 months of exercising. The effective rates were 70.37% and 74.07% after 6- and 12-month exercising, respectively. There were significant differences between the exercising and control groups （P〈0.0001）. There was no statistical difference in the effective rate of the exercising group between 6 and 12 months of exercising （P〉0.05）. At 12 months of exercising, the compliance of the anteroposterior pharyngeal wall of the retropalatal area was lower （P〈0.01） than that before treatment. There was no significant change of BMI in either group. Conclusions： Exercising pharyngeal musculature and genioglossus is a kind of non-invasive and cost-effective method to treat some OSAHS patients, especially those who are old, without surgical complications, and especially mild and moderate OSAHS patients who do not want to take surgery and continuous positive airway pressure （CPAP） treatment. In addition, exercising pharyngeal musculature and genioglossus can be considered as remedial treatment of OSAHS to surgery and other therapies.展开更多
BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibula...BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0.05).CONCLUSION The mean total airway volume in patients with retrognathic mandible was significantly smaller than that of patients with a normal mandible.展开更多
AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first autho...AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop(IPCL) classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type Ⅳ and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection(ESD) at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72 lesions were located on the posterior oropharyngeal wall.All 93 lesions were flat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39 were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1 to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34 biopsied patients found the rate of complete resection by biopsy to be 79%.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.展开更多
Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy i...Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy in esophageal cancer 2 years ago was admitted to our hospital with primary pharyngeal cancer. The type of upper endoscope used was EG-580NW (FUJI Film, Tokyo, Japan). The endoscope is a trans-nasal endoscope that can provide high quality endoscopic images. The pharyngeal cancer located at right lateral wall which was previously detected could be observed easily. We asked the patient to blow hard and puff his cheeks with his mouth closed. When inspecting the hypopharynx and the orifice of the esophagus, we told the patient that we would start the trumpet maneuver. Results: After the trumpet maneuver, the pharyngeal mucosa was stretched out. Another primary lesion was observed at the posterior wall of the hypopharynx near the pharyngoesophageal junction. This technique provided a much better view of the lesion than had been possible with trans-oral endoscopy,allowing us to remove the biopsy specimen without sedation. Conclusion: In conclusion, the trumpet maneuver using trans-nasal endoscopy is a useful technique for precise inspection before treatments for patients who have already detected the lesions.展开更多
The great vessels of the heart originate from the pharyngeal arch arteries(PAAs).Anomalies of the PAAs often occur together with pharyngeal pouch malfo rmations,but the reasons for this phenomenon are not fully unders...The great vessels of the heart originate from the pharyngeal arch arteries(PAAs).Anomalies of the PAAs often occur together with pharyngeal pouch malfo rmations,but the reasons for this phenomenon are not fully understood.In the current study,we show that platelet-derived growth factor(PDGF)signaling derived from the pharyngeal pouches plays an important function in PAA vasculogenesis,During PAA development in zebrafish embryos,pdgfaa and pdgfab are expressed in the developing pharyngeal pouches.Results from loss-of-function experiments revealed a critical role of these genes in PAA formation.We found that nitroreductase(NTR)-mediated pouch ablation distinctly decreased PDGF receptor tyrosine phosphorylation,yielding a severe loss of PAAs.Importantly,pouch-specific overexpression of pdgfaa in pdgfaa-/-;pdgfab-/-mutants significantly relieved the PAA defects,which indicated a primary role of pharyngeal pouch-expressed PDGF ligands in signal activation and PAA morphogenesis.Our findings further showed that PDGF signaling was indispensable for the proliferation of PAA angioblasts.Together,these results established a role for PDGFaa-and PDGFab-mediated tissuetissue interaction during PAA development.展开更多
Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyng...Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.展开更多
Adult pharyngeal teeth in Mylopharyngodon piceus are molariform. Based on SEM observations ofthe developing teeth, this paper describes the morphological diversification of pharyngeal teeth in M.piceus. The larval and...Adult pharyngeal teeth in Mylopharyngodon piceus are molariform. Based on SEM observations ofthe developing teeth, this paper describes the morphological diversification of pharyngeal teeth in M.piceus. The larval and juvenile teeth are changed from conical to adult molariform teeth through sevenstages. Comparisons are made between each stage and corresponding types in some species of differentsubfamilies in Cyprinidae. It is considered that the ontogenetic resemblances of the pharyngeal teehbear relationship to the phylogeny of cyprinids.展开更多
Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation...Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation angiography (DSA) findings of 19 patients with tumors infiltrating parapharyngeal space by surgery and pathology were analysed, including four branchial cleft cysts, three jugular glomus tumors, four carotid body tumors, three neurilemomas and five carcinomas of nasopharynx involving parapharyngeal space. Fifteen patients underwent MRI scanning nine patients had CT scanning, three patients MRA and five patients DSA. Results: MRI provided clinically useful informations about the size, shape, extent and site of the parapharyngeal space tumors, and also their effects on adjacent structures. The main MRI features of paraganglioma presented as many low signal tortuous and creeping vessels in the tumor. The main CT features of jugular glomus tumor revealed as jugular foramen enlargement with bone destruction. Tumor vessels were clearly displayed by MRA and DSA. Conclusion: MRI was superior to CT in the diagnosis of tumors invading parapharyngeal space. The location and nature of the lesions could be diagnosed accurately by MRI combined with CT or DSA.展开更多
Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports avail...Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.展开更多
Disrupted morphogenesis and growth of the embryonic maxillary jaw lead to oral facial clefting in humans (OFC) and result in an incompletely formed secondary mouth and face. A requirement for Wnt signaling and Wnt9b i...Disrupted morphogenesis and growth of the embryonic maxillary jaw lead to oral facial clefting in humans (OFC) and result in an incompletely formed secondary mouth and face. A requirement for Wnt signaling and Wnt9b in particular are postulated in the etiology of OFC from association studies in humans and from animal models. Loss of murine Wnt9b leads to reduced upper jaw (maxillary) outgrowth and OFC, though the signaling architecture leading to this phenotype is poorly understood. Previous murine Wnt9b studies largely overlooked cranial neural crest cell (CNCC) patterning events and instead focused on later events during fusion of facial prominences. Using zebrafish and a morpholino-mediated knockdown approach, we demonstrate functional requirements for Wnt9b signaling during two crucial stages of facial development: 1) CNCC patterning into Dorsal-Intermediate-Ventral (D-I-V) domains;and 2) facial outgrowth during the primary to secondary mouth transition (PM to SM). Zebrafish embryos deficient for Wnt9b (Wnt9b morphants) exhibit an open bite with fused jaw joints as well as a flat face. Open bite and jaw joint fusion in Wnt9b morphants phenocopies characteristics of edn1 pathway is mutant zebrafish with disrupted D-I-V patterning of CNCC. Expression studies show Wnt9b morphants exhibit perturbed expression of edn1 signaling targets including dlx2a, jag1b, and msxe, consistent with disrupted CNCC patterning. Wnt9b morphant upper jaws have stunted outgrowth reminiscent of murine Wnt9b mutants and Wnt9b morphant skulls phenocopy the broad class of foreshortened skull zebrafish mutants known as hammerheads. Wnt9b morphants show upregulated expression of pitx2a after the opening of the primary mouth and disrupted expression of Wnt5b which is consistent with disrupted chondrocyte stacking. Strong upregulation of dorsal mesodermal frzb expression in the prechordal plate of Wnt9b morphants suggests a role for Wnt9b in primary mouth induction or maintenance. Collectively these results argue that Wnt9b has a much earlier developmental requirement. This work draws attention to potential vertebrate homologies that pattern CNCC and facial outgrowth and therefore calls for a reexamination of Wnt9b’s role during mammalian craniofacial development.展开更多
Mutations in human TBX22 cause X-linked cleft palate with anklyoglossia syndrome. The two zebrafish tbx22 splice isoforms, tbx22-1 and tbx22-2, encode proteins of 444 and 400 amino acids, respectively. Zebrafish tbx22...Mutations in human TBX22 cause X-linked cleft palate with anklyoglossia syndrome. The two zebrafish tbx22 splice isoforms, tbx22-1 and tbx22-2, encode proteins of 444 and 400 amino acids, respectively. Zebrafish tbx22 mRNA expression mirrors mammalian TBX22 expression and is consistent with early patterning of the vertebrate face. In zebrafish, tbx22 mRNA is strongly expressed during early pharyngeal arch development in the ventral mesenchyme, and a later expression domain is found in ectomesenchymal cells underlying the stomodeum, a bilaminar epithelial structure demarcating the early forming mouth. Therefore, tbx22 is hypothesized to be involved in craniofacial development. The objective of this work is to characterize the role of tbx22 during craniofacial development in zebrafish. Tbx22 knockdown revealed that defects in tbx22 signaling cause mild clefting, joint defects and dorsoventral patterning defects in cartilages. Quantitative PCR and in situ analysis revealed that knockdown of tbx22 also causes a dramatic decrease in expression of osr1 and gdf5. Craniofacial patterning is dependent on proper signals from endoderm, mesoderm and ectoderm. The early influence of tbx22 on signals within the ventral mesenchyme impacts the domains of several key pharynx-geal arch signals, thereby helping to regulate proper patterning of the developing jaw.展开更多
Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbid...Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.展开更多
Tuberculosis is a communicable disease manifesting as pulmonary and extra pulmonary infection. Extra pulmonary tuberculosis involving pharynx is usually secondary to active pulmonary tuberculosis. Primary oropharyngea...Tuberculosis is a communicable disease manifesting as pulmonary and extra pulmonary infection. Extra pulmonary tuberculosis involving pharynx is usually secondary to active pulmonary tuberculosis. Primary oropharyngeal tuberculosis is rare and has been reported in association with immunocompromised states like HIV-AIDS and chronic alcoholism. It has very unusual clinical presentation and sometimes mimics malignancy. We report herewith two cases of primary oropharyngeal tuberculosis, clinically mimicking a malignancy, in immunocompetent adult patients. A high index of suspicion is required to diagnose pharyngeal tuberculosis in patients presenting with ulceroproliferative mass in oropharynx. Histopathological findings of characteristic tuberculous granuloma are confirmatory. Anti-tuberculous therapy gives excellent results within two months of commencing the treatment.展开更多
Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during...Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.展开更多
文摘BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.
基金support of the National Natural Science Foundation of China(32025014 and 32330029 to Q.W.)the National Key Research and Development Program of China(2020YFA0804000 to Q.W.)+2 种基金Guangdong Excellent Youth Team Project(2024B1515040019 to Q.W.)Guangzhou Science and Technology Plan Project(202201010323 to X.H.)the Fundamental Research Funds for the Central Universities(to Q.W.).
文摘Pharyngeal cartilage morphogenesis is crucial for the formation of craniofacial structures.Cranial neural crest cells are specified at the neural plate border,migrate to pharyngeal arches,and differentiate into pharyngeal chondrocytes,which subsequently flatten,elongate,and stack like coins during maturation.Although the developmental processes prior to chondrocyte maturation have been extensively studied,their subsequent changes in morphology and organization remain largely elusive.Here,we show that wnt2bb is expressed in the pharyngeal ectoderm adjacent to the chondrogenic precursor cells in zebrafish.Inactivation of Wnt2bb leads to a reduction in nuclearβ-catenin,which impairs chondrogenic precursor proliferation and disrupts chondrocyte morphogenesis and organization,eventually causing a severe shrinkage of pharyngeal cartilages.Moreover,the decrease ofβ-catenin in wnt2bb^(-/-)mutants is accompanied by the reduction of Yap expression.Reactivation of Yap can restore the proliferation of chondrocyte progenitors as well as the proper size,shape,and stacking of pharyngeal chondrocytes.Our findings suggest that Wnt/β-catenin signaling promotes Yap expression to regulate pharyngeal cartilage formation in zebrafish.
文摘BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping symptoms.While proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are unclear.Reflux monitoring techno-server reliability.We hypothesized that PAR episodes alone might also predict PPI responsiveness.AIM To investigate whether PAR episodes alone predict a positive response to PPI therapy.METHODS Patients suspected of having LPR were prospectively recruited from otolaryngologic clinics in three Taiwan residents tertiary centers.They underwent a 24-hour esophagopharyngeal pH test using either 3-pH-sensor or hypopha-ryngeal MII-pH catheters while off medication,followed by a 12-week esomeprazole course(40 mg twice daily).Participants were categorized into four groups based on pH results:PAR alone,EAR alone,both pH(+),and both pH(-).The primary outcome was a≥50%reduction in primary laryngeal symptoms,with observers blinded to group assignments.RESULTS A total of 522 patients(mean age 52.3±12.8 years,54%male)were recruited.Of these,190(mean age 51.5±12.4 years,61%male)completed the treatment,and 89(47%)responded to PPI therapy.Response rates were highest in the PAR alone group(73%,n=11),followed by EAR alone(59%,n=68),both pH(+)(56%,n=18),and both pH(-)(33%,n=93).Multivariate analysis adjusting for age,sex,body mass index,and endoscopic esophagitis showed that participants with PAR alone,EAR alone,and both pH(+)were 7.4-fold(P=0.008),4.2-fold(P=0.0002),and 3.4-fold(P=0.03)more likely to respond to PPI therapy,respectively,compared to the both pH(-)group.Secondary analyses using the definition of≥1 PAR episode were less robust.CONCLUSION In the absence of proven hypopharyngeal predictors,this post-hoc analysis found that baseline≥2 PAR episodes alone are linked to PPI responsiveness,suggesting the importance of hypopharyngeal reflux monitoring.
文摘Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, 'fair”, 'slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children.
文摘Tonsillectomy once was a most common ENT procedure, being referred in past as the “bread and butter of otorhinolaryngologists” though not so commonly performed these days. The usual complications of this procedure have been haemorrhage-primary/reactionary/secondary, infection, tonsillar bed structures injury, and even death. With the advent of newer technologies like lasers, microdebriders, coblators, harmonic scalpel, radiofrequency, newer complications also arise. This case report focuses on one such complication of laser assisted tonsillectomy, not much spoken of in books.
基金Supported by A Grant-in-Aid for Cancer Research (18-8) from the Ministry of Health, Labour and Welfare of Japan
文摘AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.
基金supported by the Social Development of Science and Technology Program of Ningbo City(No.2010C50031)the Ningbo Natural Science Foundation(No.2013A610261),China
文摘Objective： To evaluate the effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea and hypopnea syndrome （OSAHS）. Methods： We conducted a non-randomized retrospective clinical trial of 75 patients with OSAHS. Fifty-four patients were managed by exercising of the pharyngeal musculature and genioglossus （exercising group）. Twenty-one patients, who refused to undertake any treatment, were defined as the control group. We took the Epworth Sleepiness Scale （ESS）, checked patients＇ polysomnography, and took 320- detector computed tomography （CT） before treatment. Six and twelve months later, we made records of apnea hypopnea index （AHI）, lowest arterial oxygen saturation （LSaO2）, body mass index （BMI）, the shortest sagittal diameter, and transverse diameter, and the effective rates of exercising were calculated and compared with the 21 patients without any treatment （control group） at the same time. SPSS 10.0 was used to analyze the data. Results： Before treatment, the ESS value was 7.67; 6 and 12 months later, the values were 3.54 and 3.25, respectively in the exercising group. AHI was decreased to 15.36 after 6 months and 13.79 after 12 months from 22.84 at the beginning. LSaO2 values were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. There were significant differences in ESS scores, AHI, and LSaO2 between pre-treatment and post-treatment in the exercising group （P〈0.05）. However, there was no statistical difference in all the parameters between 6 and 12 months of exercising. The effective rates were 70.37% and 74.07% after 6- and 12-month exercising, respectively. There were significant differences between the exercising and control groups （P〈0.0001）. There was no statistical difference in the effective rate of the exercising group between 6 and 12 months of exercising （P〉0.05）. At 12 months of exercising, the compliance of the anteroposterior pharyngeal wall of the retropalatal area was lower （P〈0.01） than that before treatment. There was no significant change of BMI in either group. Conclusions： Exercising pharyngeal musculature and genioglossus is a kind of non-invasive and cost-effective method to treat some OSAHS patients, especially those who are old, without surgical complications, and especially mild and moderate OSAHS patients who do not want to take surgery and continuous positive airway pressure （CPAP） treatment. In addition, exercising pharyngeal musculature and genioglossus can be considered as remedial treatment of OSAHS to surgery and other therapies.
文摘BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0.05).CONCLUSION The mean total airway volume in patients with retrognathic mandible was significantly smaller than that of patients with a normal mandible.
文摘AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop(IPCL) classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type Ⅳ and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection(ESD) at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72 lesions were located on the posterior oropharyngeal wall.All 93 lesions were flat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39 were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1 to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34 biopsied patients found the rate of complete resection by biopsy to be 79%.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.
文摘Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy in esophageal cancer 2 years ago was admitted to our hospital with primary pharyngeal cancer. The type of upper endoscope used was EG-580NW (FUJI Film, Tokyo, Japan). The endoscope is a trans-nasal endoscope that can provide high quality endoscopic images. The pharyngeal cancer located at right lateral wall which was previously detected could be observed easily. We asked the patient to blow hard and puff his cheeks with his mouth closed. When inspecting the hypopharynx and the orifice of the esophagus, we told the patient that we would start the trumpet maneuver. Results: After the trumpet maneuver, the pharyngeal mucosa was stretched out. Another primary lesion was observed at the posterior wall of the hypopharynx near the pharyngoesophageal junction. This technique provided a much better view of the lesion than had been possible with trans-oral endoscopy,allowing us to remove the biopsy specimen without sedation. Conclusion: In conclusion, the trumpet maneuver using trans-nasal endoscopy is a useful technique for precise inspection before treatments for patients who have already detected the lesions.
基金supported by grants from the National Natural Science Foundation of China(91739101 and 81921006)the National Key Research and Development Program of China(2016YFA0100503 and 2018YFA0800200)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDA16000000).
文摘The great vessels of the heart originate from the pharyngeal arch arteries(PAAs).Anomalies of the PAAs often occur together with pharyngeal pouch malfo rmations,but the reasons for this phenomenon are not fully understood.In the current study,we show that platelet-derived growth factor(PDGF)signaling derived from the pharyngeal pouches plays an important function in PAA vasculogenesis,During PAA development in zebrafish embryos,pdgfaa and pdgfab are expressed in the developing pharyngeal pouches.Results from loss-of-function experiments revealed a critical role of these genes in PAA formation.We found that nitroreductase(NTR)-mediated pouch ablation distinctly decreased PDGF receptor tyrosine phosphorylation,yielding a severe loss of PAAs.Importantly,pouch-specific overexpression of pdgfaa in pdgfaa-/-;pdgfab-/-mutants significantly relieved the PAA defects,which indicated a primary role of pharyngeal pouch-expressed PDGF ligands in signal activation and PAA morphogenesis.Our findings further showed that PDGF signaling was indispensable for the proliferation of PAA angioblasts.Together,these results established a role for PDGFaa-and PDGFab-mediated tissuetissue interaction during PAA development.
基金This research was supported by the National Key Research and Development Project of China(No.2017YFC1309204)the Medical Nutrition Clinical Research Project of China International Medical Foundation(No.Z-2017-24-2110).
文摘Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.
基金This project was funded by the interstional Cooperation of Japan-China and the National Natural Science foundation of China.
文摘Adult pharyngeal teeth in Mylopharyngodon piceus are molariform. Based on SEM observations ofthe developing teeth, this paper describes the morphological diversification of pharyngeal teeth in M.piceus. The larval and juvenile teeth are changed from conical to adult molariform teeth through sevenstages. Comparisons are made between each stage and corresponding types in some species of differentsubfamilies in Cyprinidae. It is considered that the ontogenetic resemblances of the pharyngeal teehbear relationship to the phylogeny of cyprinids.
文摘Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation angiography (DSA) findings of 19 patients with tumors infiltrating parapharyngeal space by surgery and pathology were analysed, including four branchial cleft cysts, three jugular glomus tumors, four carotid body tumors, three neurilemomas and five carcinomas of nasopharynx involving parapharyngeal space. Fifteen patients underwent MRI scanning nine patients had CT scanning, three patients MRA and five patients DSA. Results: MRI provided clinically useful informations about the size, shape, extent and site of the parapharyngeal space tumors, and also their effects on adjacent structures. The main MRI features of paraganglioma presented as many low signal tortuous and creeping vessels in the tumor. The main CT features of jugular glomus tumor revealed as jugular foramen enlargement with bone destruction. Tumor vessels were clearly displayed by MRA and DSA. Conclusion: MRI was superior to CT in the diagnosis of tumors invading parapharyngeal space. The location and nature of the lesions could be diagnosed accurately by MRI combined with CT or DSA.
文摘Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.
文摘Disrupted morphogenesis and growth of the embryonic maxillary jaw lead to oral facial clefting in humans (OFC) and result in an incompletely formed secondary mouth and face. A requirement for Wnt signaling and Wnt9b in particular are postulated in the etiology of OFC from association studies in humans and from animal models. Loss of murine Wnt9b leads to reduced upper jaw (maxillary) outgrowth and OFC, though the signaling architecture leading to this phenotype is poorly understood. Previous murine Wnt9b studies largely overlooked cranial neural crest cell (CNCC) patterning events and instead focused on later events during fusion of facial prominences. Using zebrafish and a morpholino-mediated knockdown approach, we demonstrate functional requirements for Wnt9b signaling during two crucial stages of facial development: 1) CNCC patterning into Dorsal-Intermediate-Ventral (D-I-V) domains;and 2) facial outgrowth during the primary to secondary mouth transition (PM to SM). Zebrafish embryos deficient for Wnt9b (Wnt9b morphants) exhibit an open bite with fused jaw joints as well as a flat face. Open bite and jaw joint fusion in Wnt9b morphants phenocopies characteristics of edn1 pathway is mutant zebrafish with disrupted D-I-V patterning of CNCC. Expression studies show Wnt9b morphants exhibit perturbed expression of edn1 signaling targets including dlx2a, jag1b, and msxe, consistent with disrupted CNCC patterning. Wnt9b morphant upper jaws have stunted outgrowth reminiscent of murine Wnt9b mutants and Wnt9b morphant skulls phenocopy the broad class of foreshortened skull zebrafish mutants known as hammerheads. Wnt9b morphants show upregulated expression of pitx2a after the opening of the primary mouth and disrupted expression of Wnt5b which is consistent with disrupted chondrocyte stacking. Strong upregulation of dorsal mesodermal frzb expression in the prechordal plate of Wnt9b morphants suggests a role for Wnt9b in primary mouth induction or maintenance. Collectively these results argue that Wnt9b has a much earlier developmental requirement. This work draws attention to potential vertebrate homologies that pattern CNCC and facial outgrowth and therefore calls for a reexamination of Wnt9b’s role during mammalian craniofacial development.
文摘Mutations in human TBX22 cause X-linked cleft palate with anklyoglossia syndrome. The two zebrafish tbx22 splice isoforms, tbx22-1 and tbx22-2, encode proteins of 444 and 400 amino acids, respectively. Zebrafish tbx22 mRNA expression mirrors mammalian TBX22 expression and is consistent with early patterning of the vertebrate face. In zebrafish, tbx22 mRNA is strongly expressed during early pharyngeal arch development in the ventral mesenchyme, and a later expression domain is found in ectomesenchymal cells underlying the stomodeum, a bilaminar epithelial structure demarcating the early forming mouth. Therefore, tbx22 is hypothesized to be involved in craniofacial development. The objective of this work is to characterize the role of tbx22 during craniofacial development in zebrafish. Tbx22 knockdown revealed that defects in tbx22 signaling cause mild clefting, joint defects and dorsoventral patterning defects in cartilages. Quantitative PCR and in situ analysis revealed that knockdown of tbx22 also causes a dramatic decrease in expression of osr1 and gdf5. Craniofacial patterning is dependent on proper signals from endoderm, mesoderm and ectoderm. The early influence of tbx22 on signals within the ventral mesenchyme impacts the domains of several key pharynx-geal arch signals, thereby helping to regulate proper patterning of the developing jaw.
文摘Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.
文摘Tuberculosis is a communicable disease manifesting as pulmonary and extra pulmonary infection. Extra pulmonary tuberculosis involving pharynx is usually secondary to active pulmonary tuberculosis. Primary oropharyngeal tuberculosis is rare and has been reported in association with immunocompromised states like HIV-AIDS and chronic alcoholism. It has very unusual clinical presentation and sometimes mimics malignancy. We report herewith two cases of primary oropharyngeal tuberculosis, clinically mimicking a malignancy, in immunocompetent adult patients. A high index of suspicion is required to diagnose pharyngeal tuberculosis in patients presenting with ulceroproliferative mass in oropharynx. Histopathological findings of characteristic tuberculous granuloma are confirmatory. Anti-tuberculous therapy gives excellent results within two months of commencing the treatment.
文摘Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.
