Thesis (Ph. D.)--University of Chicago, The Dept. of Molecular Genetics and Cell Biology, Jun. 2003. / Includes bibliographical references (p. 180-194). Also available on the Internet.

Pharyngoesophageal (PE) tumours are tumours involving simultaneously the hypopharynx and the cervical oesophagus. The challenge in its surgical management lies in its deep-seated location behind the manubrium bone in the cervicothoracic region, in close proximity to great vessels in the lower neck and superior mediastinum. Classically curative surgery is in the form of total pharyngo-laryngo-oesophagectomy (PLO) and gastric pull-up (GPU) via a three-phase one-stage operation. However PLO and GPU is a major undertaking associated with high operative morbidity and reported in-hospital mortality rates of up to 10%. With a comprehensive preoperative work-up we demonstrated accurate tumour diagnosis and staging, with a 100% negative predictive rate. Together with vigilant postoperative surveillance and compliant follow-up, incidence of synchronous and metachronous tumours were low at 11.9% and 1.7% respectively. Manubrial resection (MR) provided access to PE tumours in the cervicothoracic region enabling resection under direct vision with adequate resection margins - pharyngo-laryngo-cervico-oesophagectomy (PLCO). The trachea was resected and re-sited as a mediastinal tracheostoma in case of posterior tracheal wall invasion. Paratracheal and paraoesophageal lymph node dissection was performed in case of nodal metastasis. MR provided ample space for reconstruction of the resultant defect. Furthermore, it enabled access to vessels in the superior mediastinum to support microvascular tissue transfer. Intra-thoracic volume changes on maximal inspiration and expiration measured using computed tomography scan did not show significant difference pre- and post- MR. With attention to operative details, MR proved to be safe with minimal functional disturbance. Free jejunal (FJ) flap was the preferred reconstructive modality as it offered the lowest pharyngocutaneous fistula and anastomotic stricture rates, and donor site morbidities. All patients resumed unrestricted oral diet postoperation. Videofluoroscopic swallowing studies (VFSS) and high resolution manometry (HRM) demonstrated significantly prolonged transit times for all bolus consistencies compared with normal subjects due to asynchronous contractions between the FJ and the oesophageal remnant, presence of retrograde propulsion and residue accumulation within the FJ. However, patients reported significant improvement in swallowing outcomes and associated quality of life (QOL) compared with preoperation (65.3% vs. 42.7%, p=0.02). Majority of patients were able to speak conveniently with a modality of their choice. MR, PLCO and FJ flap showed significantly lower operative morbidities (58.3% vs. 85.7%, p=0.05), shorter hospital stay (42.5 vs. 50.7 days, p=0.37), and lower in-hospital mortality (8.3% vs. 9.5%, p=0.52) compared with PLO and GPU. None required intensive care unit postoperation. In resecting less, oncological outcomes and survival were not inferior to PLO and GPU. FJ patients were able to resume oral diet sooner than GPU with a higher functional oral intake scale (FOIS) at 6 months (100.0% vs. 92.8%). Shorter transit times for all bolus consistencies were demonstrated in VFSS and HRM of GPU patients due to the lack of contractions within the gastric tube. Swallowing, speech and associated QOL outcomes were comparable between the 2 groups. In conclusion, MR, PLCO and FJ flap should be adopted in the surgical management of patients with isolated PE tumours. / published_or_final_version / Surgery / Master / Master of Surgery

This thesis was concerned with coarticulatory patterns across various speech articulators and whether these can be accounted for by similar movement organization principles. Movements of the tongue dorsum, and the upper and lower pharynx, were recorded separately by a computerized ultrasound system during the production of vowel-consonant-vowel sequences. The movement amplitude, duration, and onset (relative to specific acoustic events) were computed for each articulator for a variety of speech gestures. It was shown that both spatial and temporal aspects of the movements varied in a similar manner for the three articulators as a function of the phonological context. The results indicate that spatiotemporal articulatory adjustments for vowels co-occur with the articulation of a consonant. This pattern can be accounted for by the notions of co-production and the 'spatial proximity' hypothesis.

Thesis (M. Sc. Med.)--University of Sydney, 2008. / Title from title screen (viewed 29 July 2008). Submitted in fulfilment of the requirements for the degree of Master of Science in Medicine to the Discipline of Medicine, Faculty of Medicine. Degree awarded 2008; thesis submitted 2007. Includes bibliographical references. Also available in print form.

Thesis (M.Med.Sc.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 29-35). Also available in print.

Th.--Méd.--Caen, 1985. N°: 1443.

Orientador: Frederico Andrade e Silva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-10T06:32:26Z (GMT). No. of bitstreams: 1 Alves_MarcelaRodrigues_M.pdf: 9082983 bytes, checksum: 3af9f0699c0895b821635a2cbe1ee5ba (MD5) Previous issue date: 2008 / Resumo: O objetivo desta pesquisa foi avaliar a relação entre a morfologia crânio-facial, o espaço aéreo faríngeo, a posição do hióide e a postura crânio-cervical, por meio de cefalometria. Para isso, foram selecionados 52 voluntários, entre 18 e 28 anos, sem distinção por gênero ou cor da pele, escolhidos aleatoriamente, sendo excluídos voluntários com história de tratamento ortodôntico, ausências de dentes (exceto os terceiros molares), presença de anomalias de crescimento ou desenvolvimento do esqueleto crânio-facial, histórico de uso de qualquer tipo de aparelho oclusal e aqueles com deficiências visuais ou fonoaudiológicas. Para cada voluntário, foi realizada uma radiografia cefalométrica em norma lateral, com a cabeça em posição natural, e, em seguida, traçados os cefalogramas. Sobre estes, foram marcados pontos de referência cefalométricos, a partir dos quais foram obtidas medidas lineares e angulares referentes à morfologia crânio-facial, ao espaço aéreo faríngeo, à posição do osso hióide e à postura crânio-cervical. Os dados coletados foram agrupados e as variáveis do perfil crânio-facial relacionadas com as variáveis mensuradas para o espaço aéreo faríngeo, posição do osso hióide e postura crânio-cervical, pela análise estatística de Correlação Linear de Pearson, considerando o nível de significância de 5%. A posição ântero-posterior do osso hióide em relação à coluna cervical (H-TVC) apresentou maior relação com o comprimento do corpo mandibular (Go-Gn; r = 0,501; p<0,01) e comprimento e área intermaxilar (r = 0,625 e r = 0,567, respectivamente; p<0,01). Já sua posição súpero-inferior foi mais fortemente relacionada com a altura facial anterior total (N-Me; r = 0,796; p<0,01) e a altura do terço inferior da face (ENA-Me; r = 0,628; p<0,01). A inclinação do osso hióide apresentou relação significativa apenas com variáveis referentes à inclinação mandibular (SN/Eixo Y; r = 0,394; p<0,01). As variáveis empregadas para a análise do triângulo hióide se relacionaram com a morfologia facial de modo similar. A mensuração da postura crânio-vertical (SN/VERT) apresentou maior relação com o prognatismo mandibular (SNB; r = -0,641; p<0,01). O espaço aéreo faríngeo posterior à língua (VIA-BaS) se relacionou mais fortemente com o comprimento intermaxilar (r = 0,676; p<0,01) e com o eixo de crescimento (SN/Eixo Y; r = -0,505; p<0,01). Dessa forma, pode-se concluir que a posição ântero-posterior do osso hióide apresentou maior relação com o comprimento do corpo mandibular, sua posição súperoinferior com a altura facial anterior e sua inclinação com a inclinação mandibular. A variável postural que mais se relacionou com a morfologia facial foi o ângulo crâniovertical, que apresentou maior relação com o prognatismo mandibular. Por fim, a mensuração do espaço aéreo faríngeo que apresentou maior relação com o esqueleto facial foi o diâmetro posterior à língua, que se relacionou mais fortemente com o comprimento intermaxilar e com o eixo de crescimento / Abstract: The aim of this research was to evaluate the relation between the craniofacial morphology, pharyngeal airway space, the hyoid bone position and the craniocervical posture, by means of cephalometry. In this way, 52 volunteers, between 18 and 28 years old, without gender or skin color distinction, had been randomly selected. Volunteers with orthodontic treatment history, tooth absences (except the third molar ones), presence of growth or development anomalies of the craniofacial skeleton, use of any type of occlusal appliance and those with visual or phonoaudiological deficiencies had been excluded. For each volunteer, a lateral cephalometric radiograph was taken, in natural head posture, and the cephalograms were traced. On these, cephalometric landmarks had been marked, from which linear and angular measurements referring to the craniofacial morphology, pharyngeal airway space, hyoid bone position and craniocervical posture had been taken. The collected data were grouped and the craniofacial profile variables had been related with the airway space, hyoid bone position and craniocervical posture variables, by means of Pearson Linear Correlation statistical analysis, with significance level of 5%. The hyoid bone anteroposterior position in relation to cervical spinal column (H-CVT) showed greater relation with the mandibular body length (GoGn; r = 0,501; p<0,01), intermaxilary length and area (r = 0,625 and r = 0,567, respectively; p<0,01) variables. Its superoinferior position was more strongly related with the total anterior facial height (N-Me; r = 0,796; p<0,01) and facial lower third height (ANS-Me; r = 0,628; p<0,01) variables. The hyoid bone inclination presented significant relation only with mandibular inclination variable (SN/Y axis; r = 0,394; p<0,01). The variables used on the hyoid triangle analysis had related to the facial morphology on the same way. The craniovertical variable (SN/VERT) presented greater relation with mandibular prognathism (SNB; r = -0,641; p<0,01). The pharyngeal airway space behind the tongue (VIA-BaS) presented the strongest relation with the intermaxilary length (r = 0,676; p<0,01) and with the growth axis (SN/Y axis; r = -0,505; p<0,01). On this way, it can be concluded that the hyoid bone anteroposterior position presented greater relation with the mandibular length, its superoinferior position with anterior facial height and its inclination with the mandibular inclination. The postural variable that was more related with the facial morphology was the craniovertical variable, which presented greater relation with the mandibular prognathism. Finally, the pharyngeal airway space that presented greater relation with the facial skeleton was the diameter behind the tongue, which presented strongest relation with the intermaxilary length and the growth axis / Mestrado / Protese Dental / Mestre em Clínica Odontológica

Orientador: Paulo Henrique Ferreira Caria / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T17:13:00Z (GMT). No. of bitstreams: 1 Almeida_ValerioLandimde_M.pdf: 879968 bytes, checksum: c3b0a49773d53169b265d18bb451dcf0 (MD5) Previous issue date: 2013 / Resumo: A morfologia de tecidos moles pode interferir no crescimento e no desenvolvimento das estruturas craniofaciais causando maloclusões. As avaliações dessas alterações durante o crescimento são importantes para a restauração do padrão do crescimento. O objetivo deste estudo foi correlacionar o padrão esquelético com o espaço aéreo faríngeo, a altura do palato e as áreas dos seios maxilar e frontal de crianças e adolescentes. Para isso, foram selecionadas 116 telerradiografias laterais, 55 do gênero feminino, com idade média de 12,04 (DP ±3,04) anos e 61 do gênero masculino com média de idade de 11,91 (DP ±2,92) anos. As telerradiografias foram digitalizadas e as aferições realizadas por um mesmo pesquisador com o software Image J. Para avaliação do padrão esquelético utilizou-se a análise de Wits. Em seguida, a altura do palato, o espaço aéreo faríngeo, as áreas do seio maxilar esquerdo e do seio frontal foram aferidas. Os grupos se distribuíram conforme o gênero e as classes esqueléticas I, II ou III. O coeficiente de correlação intraclasse para todas as medidas foi > 0,99. Adotaram-se modelos de análise de variância apropriados para cada uma das variáveis e houve comparação das médias pelo teste de Tukey a 5% de probabilidade. O espaço aéreo faríngeo foi significativamente maior para o grupo masculino III quando comparado com o feminino de mesma classe. O gênero masculino classe III apresentou maior altura do palato, havendo diferença significativa entre masculino III e masculino I. Não houve diferença entre as médias do seio maxilar. Para o seio frontal houve diferença estatística para as classes II e III e entre os gêneros, exceto para classe I. A análise de correlação de Pearson não comprovou associação entre o padrão esquelético e as demais variáveis, entretanto, sugeriu associação positiva entre seio frontal e seio maxilar (p<0,0001); seio frontal e espaço aéreo faríngeo (p=0,025); seio frontal e altura do palato (p<0,0001); seio maxilar e altura do palato (p<0,0001). Os resultados indicam que o crescimento da face sofre influência da tensão mastigatória e que o padrão esquelético não é o principal determinante das dimensões das variáveis estudadas nesse estágio de crescimento. As correlações positivas encontradas entre as outras variáveis indicam uma relação de dependência e sugere interação biomecânica entre essas estruturas / Abstract: Morphology of the soft tissues interferes with growth and development of craniofacial structures causing malocclusions. Evaluation and diagnostic of musculoskeletal discrepancies in growing patients are especially important for the re-establishment of craniofacial growth pattern. The aim of this study was to correlate the skeletal patterns with the pharyngeal airway space, height of the palate, and areas of the maxillary and frontal sinuses of children and teenagers. Sample included 116 lateral cephalometric radiographs of 55 females with a mean age of 12.04 (SD ±3.04) and 61 males with a mean age of 11.91 (SD ±2.92). Cephalometric radiographs were digitized and all measurements performed by the same examiner using the software Image J. In each radiograph were measured the height of palate, pharyngeal airway space, area of the left maxillary sinus and area of the frontal sinus. Sample was divided in groups (I, II and III) according to gender and skeletal patterns defined by Wits appraisal. Intra-examiner reliability test showed ICC>0.99. Variables were summarized using basic statistics and subsequently by appropriated models of analysis of variance (ANOVA) for each variable. The means were compared by Tukey test at 5%. Pharyngeal airway space revealed a significant difference between the genders for class III group (p<0.001). The height of the palate showed a significant difference between the genders for classes I and III (p<0.001). To maxillary sinus there was no significant difference between the groups. The area of the frontal sinus showed a significant difference between genders for classes II and III (p<0.001). Data indicates that skeletal patterns was not related to the other variables, however a positive correlation was found between the area of the frontal sinus and the area of the maxillary sinus (p<0.0001); area of the frontal sinus and pharyngeal airway space (p=0.025); area of the frontal sinus and the height of the palate (p<0.0001); area of the maxillary sinus and the height of the palate (p<0.0001). The skeletal pattern is not the main factor to determine the pharyngeal airway space size, height of the palate and area of the maxillary and frontal sinuses in those stages of growth. However, the positive interactions found among other variables indicate a correlation of dependence and suggests biomechanical interaction between these structures / Mestrado / Anatomia / Mestre em Biologia Buco-Dental

No description available.

This dissertation investigated measures of pharyngeal residue as seen on flexible endoscopic evaluation of swallowing (FEES). Research in this area of deglutology has been stalled due to measurement problems. The particular aims of this project were to compare visual analog scale ratings to categorical ratings of residue on FEES, and to investigate various measurement aspects. METHODS: Speech language pathologists were asked to rate residue from 81 swallows on FEES that demonstrated a wide range of residue severity for thin liquid, applesauce, and cracker boluses. A total of 33 clinicians rated the amount of residue at the time point after the first swallow, twice in a randomized fashion: the first time on a visual analog scale (VAS) and the second time categorically on a five point Likert scale. The results were analyzed for (1) inter/intra-rater agreement, (2) correlations between ratings and residue severity for each rating method, and (3) clusters of ratings to better define the scales and their clinical significance. A total of 2,673 VAS ratings and 2,673 categorical ratings were collected. RESULTS: (1) Both inter- and intra-rater reliability met acceptable levels of agreement, although intra-rater reliability on VAS ratings were slightly higher (r=0.8–0.9) than categorical ratings (k=0.7–0.8). Expert ratings were not significantly different from other clinicians’ ratings for any severity of any of the 3 boluses. (2) Residue ratings fit best on a curvilinear model; a quadratic fit of the data significantly improved the r2 values for each bolus type. (3) An increased residue amount, rated on either the VAS or categorical scale, was significantly associated with worse penetration-aspiration scale scores, but no significant relationship was found between the two methods of residue ratings and measures of quality of life or diet. Novel computerized methods are proposed for future measurement pursuits. CONCLUSION: The results of this dissertation suggest that residue is best measured on a scale with unequal intervals, and clinicians can be reliable in rating overall amount of residue on FEES after the first swallow. Novel computerized measurement approaches are useful building blocks for future research. It is hoped that with better measurement will come better understanding of residue, its risks, and consequences.