title: Cephalometric oropharynx and oral cavity analysis in Chiari malformation Type I: a retrospective case-control study.
abstract: OBJECTIVE Traditionally, Chiari malformation Type I has been related to downward herniation of the cerebellar tonsils as a consequence of an underdeveloped posterior cranial fossa. Although the common symptoms of Chiari malformation Type I are occipital headaches, cervical pain, dizziness, paresthesia, and sensory loss, patients often report symptoms related to pharyngeal dysfunction such as choking, regurgitation, dysphagia, aspiration, chronic cough, and sleep disorders. In addition, tracheal intubation is often difficult in these patients. The purpose of this study was to analyze the morphological features of the oropharynx and oral cavity in patients with Chiari malformation Type I to help identify underlying anatomical anomalies leading to these debilitating symptoms. METHODS Seventy-six adult patients with symptomatic Chiari malformation Type I with cerebellar tonsillar descent greater than 5 mm below the foramen magnum and a small posterior cranial fossa and 49 sex-matched controls were selected to perform a retrospective case-control MRI-based morphometric study in a tertiary hospital. Eleven linear and areal parameters of the oropharyngeal cavity on midsagittal T1-weighted MRI were measured and the average values between patients and control cohorts were compared. Correlations between variables showing or approaching statistical significance in these structures and posterior cranial fossa measurements related with the occipital bone were sought. RESULTS Significant differences were detected for several oropharynx and oral cavity measures in the patient cohort, primarily involving the length and thickness of the soft palate (p = 9.5E-05 and p = 3.0E-03, respectively). A statistically significant (p < 0.01) moderate correlation between some of these variables and posterior cranial fossa parameters was observed. CONCLUSIONS The existence of structural oropharyngeal and oral cavity anomalies in patients with Chiari malformation Type I was confirmed, which may contribute to the frequent occurrence of respiratory and deglutitory complications and sleep disorders in this syndrome.
authors.affiliation: Pediatric Neurology Research Group, Vall d'Hebron Research Institute.|Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio.
authors.forename: Aintzane
authors.initials: A
authors.lastname: Urbizu
authors.affiliation: Sleep Unit, Department of Clinical Neurophysiology.
authors.forename: Alex
authors.initials: A
authors.lastname: Ferré
authors.affiliation: Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, and.
authors.forename: Maria-Antonia
authors.initials: MA
authors.lastname: Poca
authors.affiliation: Magnetic Resonance Unit (IDI), Department of Radiology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; and.
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
authors.affiliation: Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, and.
authors.forename: Juan
authors.initials: J
authors.lastname: Sahuquillo
authors.affiliation: Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio.
authors.forename: Bryn A
authors.initials: BA
authors.lastname: Martin
authors.affiliation: Pediatric Neurology Research Group, Vall d'Hebron Research Institute.
authors.forename: Alfons
authors.initials: A
authors.lastname: Macaya
mesh_terms: D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging* / Q000473:pathology*; D016022:Case-Control Studies; D002508:Cephalometry; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009960:Oropharynx; D055815:Young Adult
keywords: CMI = Chiari malformation Type I; Chiari malformation Type I; FM = foramen magnum; MRI; PCF = posterior cranial fossa; magnetic resonance imaging; oropharynx and oral cavity; soft palate