PURPOSE: This study aimed to assess the impact of positional changes on upper airway obstruction patterns during drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA) and identify the airway regions most responsive to this change. Special focus was placed on the tongue base, a critical area in OSA pathophysiology. METHODS: This prospective study was conducted from June 2021 to June 2024. DISE was performed in patients with obstructive sleep apnea (OSA) in supine and lateral positions to simulate the effect of positional therapy. Findings were evaluated using the VOTE classification. RESULTS: The examination was performed on 186 patients, with a median Apnea-Hypopnea Index (AHI) of 19.3. In the supine position, complete obstructions were noted at the soft palate (88.2%), oropharynx (33.3%), tongue base (53.2%), and epiglottis (15.6%). Lateral positioning significantly reduced obstructions, particularly at the tongue base, where obstruction resolved in 94/99 of cases (94.9%). This improvement was significantly more pronounced at the tongue base than at other sites (p < 0.001). CONCLUSION: These results suggest that DISE can identify airway regions responsive to positional changes, potentially guiding clinical decisions on positional therapy. The findings show a significant reduction in tongue base obstruction during lateral positioning in DISE. Since tongue base obstruction is a key contributor to airway collapse in OSA, this improvement suggests a practical, non-invasive treatment approach. While these findings highlight an acute association between lateral positioning and reduced obstruction, further studies are needed to evaluate its long-term clinical efficacy.
- MeSH
- dospělí MeSH
- endoskopie * metody MeSH
- jazyk patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukce dýchacích cest terapie MeSH
- obstrukční spánková apnoe * terapie patofyziologie MeSH
- orofarynx patofyziologie MeSH
- patro měkké patofyziologie MeSH
- polohování pacienta * metody MeSH
- polysomnografie MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Práca sa zaoberá manažmentom pacienta s rázštepom pery a podnebia od prenatálneho po pooperačné obdobie na pracovisku ORL oddelenia Detskej fakultnej nemocnice Košice. Pojednávame o racionálnom plánovaní jednotlivých chirurgických výkonov s ohľadom na anestéziologické zázemie. Metodika: V práci sú retrospektívne zhodnotené štatistické údaje súboru 70 pacientov operovaných pre rázštep pery a 74 pacientov pre rázštep podnebia v období rokov 2015–2021. Sledovanými parametrami bol počet pacientov v jednotlivých skupinách, vek v čase operácie, pomer pohlaví, výskyt patológie vzhľadom na stranu postihnutia a typ operačného výkonu. Výsledky sú porovnané s údajmi z literatúry. Výsledky: Pre jednostranný rázštep pery bolo operovaných 54 pacientov, pre obojstranný rázštep 16 pacientov. V tomto súbore pacientov sme pozorovali najčastejšie ľavostranný rázštep pery a podnebia – 38 pacientov. Autori preferujú včasnú intervenciu v prípade rázštepu pery, pričom pri jednostrannom rázštepe využívajú techniku podľa Millarda najmä pre jej univerzálnosť. Pri obojstrannom rázštepe uprednostňujú techniku podľa Blacka. Do mesiaca je operovaných 55 % pacientov pre jednostranný aj obojstranný rázštep pery. Pacienti s rázštepom podnebia sú operovaní v 78 % do roka dvojlalokovou plastikou podľa Bardacha, najčastejšie v období 7.–9. mesiaca. Záver: Pacienti s rázštepom pery a podnebia zvyčajne počas života podstúpia viacero chirurgických výkonov, a preto je dôležité racionálne plánovanie a redukovať počet celkových anestézií spájaním výkonov. Pre zabezpečenie komplexnej starostlivosti o pacientov s rázštepom pery a podnebia je nutná medziodborová spolupráca.
Introduction: The paper deals with the management of patients with cleft lip and patients with cleft lip and palate since prenatal to postoperative period at ENT department of the Children‘s University Hospital in Košice. We discuss reasonable planning of surgical procedures with respect to anaesthetic care. Methods: We retrospectively analysed the clinical data of 144 patients. We performed a primary lip suture in a group of 70 patients and 74 patients underwent palatoplasty since 2015 to 2021. We evaluated a number of patients in different groups, age of patients in a time of surgery, gender ratio, occurrence of pathology and a type of surgery method. We compare our results with literature. Results: A group of 54 patients had primary lip suture for unilateral cleft lip and 16 patients for bilateral cleft lip. We noticed left cleft lip and palate as the most often pathology – 38 patients. The authors prefer early intervention in the case of cleft lip, while in the case of unilateral cleft lip they use the technique according to Millard mainly because of its universality. In the case of a bilateral cleft, they prefer the technique according to Black. Within a month, 55% of patients are operated on for unilateral and bilateral cleft lip. 78% of patients with cleft palate are operated on within a year with two-lobe plastic surgery according to Bardach, most often in the period 7–9 month. Conclusion: Patients with cleft lip and cleft lip and palate usually undergo multiple surgeries during their lifetime. Reasonable planning and reduction the number of general anaesthesia by combining procedures is important. Multidisciplinary collaboration is necessary to ensure comprehensive care.
- MeSH
- kojenec MeSH
- lidé MeSH
- management nemoci MeSH
- novorozenec MeSH
- patro abnormality chirurgie patologie MeSH
- ret abnormality chirurgie patologie MeSH
- retrospektivní studie MeSH
- rozštěp patra chirurgie patologie MeSH
- rozštěp rtu * chirurgie patologie MeSH
- vrozené vady chirurgie klasifikace MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
A case report on a 70-year-old male patient with atypical candidal infection on the palate that was misdiagnosed for a tumour based on clinical examination. The lesion was an accidental finding when the patient was at a registered dentist for a preventive check-up.
- MeSH
- chybná diagnóza MeSH
- lidé MeSH
- nádory * MeSH
- orální kandidóza * diagnóza MeSH
- patro MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
A case report on a 70-year-old male patient with atypical candidal infection on the palate that was misdiagnosed for a tumour based on clinical examination. The lesion was an accidental finding when the patient was at a registered dentist for a preventive check-up.
- MeSH
- chybná diagnóza MeSH
- lidé MeSH
- nádory * MeSH
- orální kandidóza * diagnóza MeSH
- patro MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVES: The study followed the modelling of postnatal growth of a healthy palate of the Central European (Czech) population sample based on transverse data on sex and age from 6 to 19 years. MATERIALS AND METHODS: Digitised 3D models of 212 healthy palatal surfaces were evaluated using 3D geometric morphometrics and superimpositions. The individuals were grouped based on age (preschool, younger and older school age, younger and older adolescents, young adults) and sex (♂ n = 101, ♀ n = 111). RESULTS: Female palatal development was non-linear and was interrupted between the 10-12 years and then proceeded intensively until the age of 15 when it ceased. In contrast, male-modelled growth was consistent throughout the follow-up and continued linearly until at least 19 years of age. The palate did not widen further with increasing age, and primarily palatal vaulting and heightening were found. The characteristics and distribution of areas with extensive modelled growth changes were comparable in females and males, as confirmed by the location of principal components (PC1 and PC2) within modal space and growth trajectories. The extent of sexual dimorphism increased from 15 years of age due to pubertal spurt combined with earlier completion of palatal development in females. CONCLUSIONS: The study showed modelled healthy palatal development from 6 years of age to early adulthood, which might be utilised as reference standards for the Central European population sample. CLINICAL RELEVANCE: The comparison of normal reference subjects with patients with cranio-maxillo-facial dysmorphologies represents the first step in diagnosing and establishing effective therapy.
- MeSH
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- obličej * MeSH
- patro * MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
GLI1 fusions involving ACTB, MALAT1, PTCH1 and FOXO4 genes have been reported in a subset of malignant mesenchymal tumors with a characteristic nested epithelioid morphology and frequent S100 positivity. Typically, these multilobulated tumors consist of uniform epithelioid cells with bland nuclei and are organized into distinct nests and cords with conspicuously rich vasculature. We herein expand earlier findings by reporting a case of a 34-year-old female with an epithelioid mesenchymal tumor of the palate. The neoplastic cells stained positive for S100 protein and D2-40, whereas multiple other markers were negative. Genetic alterations were investigated by targeted RNA sequencing, and a PTCH1-GLI1 fusion was detected. Epithelioid mesenchymal tumors harboring a PTCH1-GLI1 fusion are vanishingly rare with only three cases reported so far. Due to the unique location in the mucosa of the soft palate adjacent to minor salivary glands, multilobulated growth, nested epithelioid morphology, focal clearing of the cytoplasm, and immunopositivity for S100 protein and D2-40, the differential diagnoses include primary salivary gland epithelial tumors, in particular myoepithelioma and myoepithelial carcinoma. Another differential diagnostic possibility is the ectomesenchymal chondromyxoid tumor. Useful diagnostic clues for tumors with a GLI1 rearrangement include a rich vascular network between the nests of neoplastic cells, tumor tissue bulging into vascular spaces, and absence of SOX10, GFAP and cytokeratin immunopositivity. Identifying areas with features of GLI1-rearranged tumors should trigger subsequent molecular confirmation. This is important for appropriate treatment measures as PTCH1-GLI1 positive mesenchymal epithelioid neoplasms have a propensity for locoregional lymph node and distant lung metastases.
- MeSH
- dospělí MeSH
- lidé MeSH
- myoepiteliální nádor * patologie MeSH
- nádorové biomarkery genetika metabolismus MeSH
- nádory měkkých tkání * patologie MeSH
- nádory slinných žláz * MeSH
- patro měkké patologie MeSH
- protein Gli1 genetika metabolismus MeSH
- proteiny S100 MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Cíl: Cílem studie bylo zhodnocení efektivity chirurgické léčby u pacientů s obstrukční spánkovou apnoí (OSA). Naší prací jsme chtěli zjistit, zda jsme schopni cílenou a individualizovanou chirurgickou léčbou dosáhnout srovnatelné efektivity s chirurgickou léčbou OSA pro všechny stupně OSA. Metodika: Do retrospektivní studie bylo zařazeno 65 dospělých pacientů, kteří podstoupili základní otorinolaryngologické vyšetření, vícekanálovou polygrafii prokazující OSA a následně chirurgickou léčbu: uvulopalatofaryngoplastikou či radiofrekvenčně asistovanou uvulopalatoplastikou, uvulaflapem, v kombinaci s radiofrekvenčně indukovanou termoterapií kořene jazyka či bez ní. Efektivita chirurgické léčby OSA byla hodnocena dle kontrolní vícekanálové polygrafie s odstupem 3–12 měsíců od operace. Výsledky: V celém souboru pacientů došlo pooperačně ke statisticky signifikantnímu poklesu apnoe/ hypopnoe indexu o 59 % (p = 6,7x10–12) a desaturací o 57 % (p = 3,2x10–5). Nejúspěšnějším výkonem byla uvulopalatofaryngoplastika v kombinaci s radiofrekvenčně indukovanou termoterapií kořene jazyka s redukcí apnoe/ hypopnoe indexu o 59 % (p = 1,8x10–12) a redukcí desaturací o 51 % (p = 0,001), druhý nejúspěšnější výkon byla uvulopalatofaryngoplastika s redukcí apnoe/ hypopnoe indexu o 57 % (p = 0,006) a redukcí desaturací o 85 % (p = 0,07108). Závěr: Chirurgická léčba OSA má při standardizované diagnostice místa obstrukce horních cest dýchacích a při odpovídajícím výběru chirurgického výkonu velmi dobrou efektivitu, a to pro všechny stupně OSA.
Aim: The aim of this study was to evaluate the effectiveness of surgical treatment in patients with obstructive sleep apnea (OSA). We would like to ascertain in our study whether the targeted and personalized surgical treatment of OSA can achieve similar effectiveness of surgical treatment in all degrees of severity of OSA. Methods: The retrospective study included 65 adult patients who had undergone the basic ear, nose and throat examination, multi-channel polygraphy confirming the diagnosis of OSA and subsequent surgical treatment: uvulopalatopharyngoplasty or radiofrequency-assisted uvulopalatoplasty, uvulaflap, in combination with or without radiofrequency induced thermotherapy at the base of the tongue, and subsequent control multichannel polygraphy at 3–12 months after surgery. Results: It was confirmed that postoperatively all groups of patients reported a statistically significant reduction in apnea/ hypopnea index by 59% (P = 6.7x10–12) and reduction in desaturation by 57% (P = 3.2x10–5). The most effective surgical procedures were uvulopalatopharyngoplasty in combination with radiofrequency induced thermotherapy at the base of the tongue with the reduction of the apnea/ hypopnea index by 59% (P = 1.8x10–12) and reduction of desaturation by 51% (P = 0.001), and uvulopalatopharyngoplasty with the reduction of the apnea/ hypopnea index by 57% (P = 0.006) and reduction of desaturation by 85% (P = 0.07108). Conclusion: The surgical treatment of OSA shows very good effectiveness in all degrees of severity of OSA provided by the standardized diagnosis of the site of obstruction and when the surgical procedure is selected accordingly.
Facial clefts are among the most common congenital defects. Ultrasound (US) imaging of secondary fetal palate, especially the detection of isolated defects, remains challenging. Currently described two-dimensional (2D) and three-dimensional methods are technically demanding and impractical for application during routine fetal anatomy evaluation. As an adjunct method, magnetic resonance imaging can provide additional information but has its limitations. We present a novel 2D US approach using axial and sagittal planes to evaluate the fetal palate and demonstrate the main differences between an intact palate, isolated cleft palate, and a cleft lip with cleft palate.
- MeSH
- lidé MeSH
- patro měkké diagnostické zobrazování embryologie MeSH
- plod MeSH
- rozštěp patra diagnóza MeSH
- rozštěp rtu diagnóza MeSH
- těhotenství MeSH
- tvrdé patro diagnostické zobrazování embryologie MeSH
- ultrasonografie prenatální metody MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Kazuistika se věnuje mezioborové diagnostice a terapii chlapce se submukózním rozštěpem patra v kombinaci s vývojovou dysfázií, poruchou příjmu potravy a hypersenzitivitou orofaciální oblasti. Cílem kazuistické práce bylo poukázat na problematiku submukózních rozštěpů patra, které se často diagnostikují u dětí až v pozdějším věku. Přitom včasná diagnostika a včasné zahájení terapie má pro vývoj dítěte zásadní význam. V kazuistice je popsáno vyšetření, počátek logopedické terapie a následná doporučení u chlapce, kterému byl submukózní rozštěp patra diagnostikovaný až ve 4 letech a 9 měsících. U chlapce se jednalo o kombinaci submukózního rozštěpu patra s vývojovou dysfázií a poruchou přijmu potravy.
The case study examines the therapy, utilising interdisciplinary diagnostics, of a boy with submucosal cleft palate, combined with developmental dysphasia, an eating disorder and hypersensitivity of the orofacial area. The aim of the case study was to highlight the issue of submucosal clefts of the palate, which are often diagnosed in children at a later age. Importantly, early diagnosis and early initiation of therapy are essential for the child's development. The case study describes the examination, the beginning of speech therapy and subsequent recommendations for a boy who was diagnosed with a submucosal cleft palate at the age of 4 years 9 months. The boy had a combination of submucosal cleft palate with developmental dysphasia and an eating disorder.
- MeSH
- afázie MeSH
- dítě MeSH
- klinická logopedie MeSH
- kojenec MeSH
- komunikace MeSH
- lidé MeSH
- patro měkké MeSH
- přijímání potravy MeSH
- velofaryngální nedostatečnost MeSH
- velofaryngeální uzávěr * MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
