Bifid Uvula in childern , dono t take lightly, .pptx

compilication of bivid uvula and how to expect it

1. Bifid Uvula: don’t take it lightly! Dr Magdy Shafik Ramadan M.S, Diploma , Ph.D Pediatric

2. Agenda 1 2 3 4 5 Definition Introduction Incidence ,causes and function of uvula Clinical significance Management 2 Presentation title 20XX

3. Definition The uvula), also known as the palatine uvula, The word is derived from the diminutive of  uva , the  Latin  word for "grape ", due to the uvula's grape-like shape . is a conic projection from the back edge of the middle of the  soft palate , composed of  connective tissue   containing a number of  racemose glands , and some muscular fibers . [1] [2]   It also contains many  serous glands , which produce thin saliva. [3 ]   It is only found in  human s . [

4. Summary of differences between uvula and epiglottis 4 Presentation title 20XX Uvula Epiglotis Soft tissue structure Tough cartilaginous structure Wedge shaped Leaf shaped Located at the base of the tongue Located in the throat behind the tongue and at the entrance of the larynx Aids in signal production when food brushes against in order to close the epiglottis Aids in preventing food and liquid from entering the trachea during swallowing

5. Introduction uvula is the fleshy, hanging ball in the back of your throat. A bifid uvula is a uvula that’s forked or split . This condition is usually inherited (passed down), but genetic conditions and environmental factors can also cause it. Treatment usually isn’t necessary unless your bifid uvula causes pain or interferes with proper function . 5

6. It is often considered as a marker for sub mucous cleft palate. Compared to the normal one, it has fewer amounts of muscular tissues. It is commonly noticed in infants and is rarely found in adult. It can cause problems in ear. Sometimes it is unable to reach the posterior pharyngeal wall during swallowing, causing regurgitation and nasal intonation 6

7. 7 Presentation title 20XX Submucosa cleft palate

8.  It may be associated with aneurysm in different vascular bed like coronary and abdominal aortic aneurysm .. Bifid uvula, although looks benign , apparently sometimes may be associated with anomalies leading to catastrophic complications . Cornelia de Lange syndrome is a rare congenital syndrome associated with bifid uvula and sub mucous cleft palate that causes problems in airway due anatomical distortion 8 Presentation title 20XX

9. 9 Presentation title 20XX Bifid uvula may be associated with increased risk of schizophrenia, mild mental retardation, and chromosomal disorder.

10. 10 Presentation title 20XX Incidence Bifid uvula occurs in about 2% of the general population , [7]   although some populations may have a high incidence, such as  Native Americans  who have a 10% rate. [8] Bifid uvula is a common symptom of the rare genetic syndrome  Loeys –Dietz syndrome , [9]  which is associated with an increased risk of aortic aneurysm

11. Society and culture 11 Presentation title 20XX In some parts of Africa, including  Somalia ,  Ethiopia  and  Eritrea , the uvula or a section of it is ritually ) الطقوس removed by a traditional healer. [13]   In this case, the uvula may be noticeably shortened.

12. Function of the uvula 12 Presentation title 20XX During swallowing , the soft palate and the uvula move together to close off the  nasopharynx , and prevent food from entering the  nasal cavity . It has also been proposed that the abundant amount of thin saliva produced by the uvula serves to keep the throat well lubricated The uvula plays an important role in the articulation of the sound of the  human voice   to form the sounds of speech. [1]   It functions in tandem (تعمل جنبا الي جنب ) with the back of the throat, the palate, and  air  coming up from the  lungs  to create a number of  guttural  and other sounds.  

13. 13 Presentation title 20XX Consonants  pronounced ( الحروف الساكنة المنطوقة مع اللهاة with the uvula are not found in  English ; however, languages such as  Arabic ,  French ,  German ,  Hebrew ,  Ubykh , and  Hmong  use  uvular consonants  to varying degrees. Certain  African languages  use the uvula to produce  click consonants  as well. In English (as well as many other languages), it closes to prevent air escaping through the nose when making some sounds.

14. Causes of Bifid Uvula 14 Presentation title 20XX Genetic , environmental, and toxic factors may be  possible causes  for a child being born with a bifid uvula. However, the definitive cause is unknown . If it is genetic, then the likelihood of a child having it will depend upon the number of people affected in a family, and how closely they are related to the child. Bifid uvula occurs between the  7th and 12th  week of pregnancy because of an error in the fusion of the uvula. For environmental and toxic causes, some risk factors have been identified as increasing the chance of having a baby with a cleft palate.

15. 15 Presentation title 20XX The following examples might contribute to the likelihood, though this is unclear: smoking during pregnancy diabetes substance abuse certain medications, such as those for  epilepsy poor prenatal healthcare

16. Clinical significance 16 Presentation title 20XX 1-Bobbing of the Uvula ( ( اللهاة المتمايلة Bobbing of the uvula can be seen in patients with severe  aortic insufficiency . 2-Velopharyngeal insufficiency In a small number of people, the uvula does not close properly against the back of the throat, causing a condition known as  velopharyngeal insufficiency  or VPI. This causes "nasal" (or more properly "hyper-nasal") speech , where a lot of extra air comes down the nose, and the speaker is unable to say certain consonants, for example producing the sound /b/ like /m/.

17. 17 Presentation title 20XX 3-Snoring and sleep apnea The uvula can also contribute to  snoring  or heavy breathing during sleep; having an elongated uvula can cause vibrations which lead to the snoring. This can lead to  sleep apnea , which may be treated by removal of the uvula or part of the uvula if necessary, an operation known as  uvulopalatopharyngoplasty  (commonly referred to as  UPPP , or U3P). It should be noted, however, that this operation can also cause sleep apnea if scar tissue forms and the airspace in the velopharnyx is decreased.

18. 18 Presentation title 20XX The success of UPPP as a treatment for sleep apnea is unknown, but some research has shown 40-60% effectiveness in reducing symptoms. [2]   Typically apnea subsides for the short term , but returns over the medium to long term, and sometimes is worse than it was before the UPPP.

19. 19 Presentation title 20XX 4-Nasal regurgitation During swallowing, the soft palate and the uvula move superiorly to close off the  nasopharynx , preventing food from entering the nasal cavity. When this process fails, the result is called  nasal regurgitation.  It is common in people with VPI. 4-

20. 5-Swollen uvula - uvulitis causes 1)  dehydration   (from arid weather); 2) excessive  smoking   or other inhaled irritants; 3)  snoring ; 4)  allergic reaction ; or 5) a viral or  bacterial infection . If the swelling is caused by dehydration, drink plenty of fluids. If the cause is a bacterial infection,  gargling  salt water may help.

21. 21 Presentation title 20XX A swollen uvula is normally not life-threatening and subsides in a short time, typically within a day. However, it can also be a sign of other problems. Some patients with a history or recurring uvulitis have to carry an  EpiPen  containing  Adrenaline  ( Epinephrine ) to inject themselves whenever the uvulitis begins.

22. Incidence among newborns (roughly 2% of infants have this  bifid  or split uvula).. . This occurs in about 1% of caucasians and 10% of Native Americans. Newborns with  cleft palate  also have a split uvula Bifid uvulas have less muscle in them than a normal uvula, this may cause recurring problems with middle ear infections . 6-Bifid uvula

23. Is it normal to have a split uvula? 23 Presentation title 20XX A bifid uvula doesn’t necessarily mean there’s something wrong. Some people are just born with a naturally split uvula. However, a bifid uvula can indicate a submucosal cleft palate. That means that your palate didn’t fully develop in the uterus. But unlike a typical cleft palate, you often can’t see a submucosal cleft palate because it’s under the tissue

24. When should I see my healthcare provider? 24 Presentation title 20XX Schedule an appointment with your healthcare provider if you or your baby develop: Difficulty swallowing . Trouble sleeping. Snoring . Fatigue  or daytime sleepiness. Throat irritation.

25. complications 25 Presentation title 20XX There are no medical complications with a bifid uvula if it is an isolated condition. However, it is important to eliminate the association with a submucous cleft , as that can have clinical repercussions. To further diagnose this, a doctor may conduct nasopharyngoscopy . This procedure is when a small tube is placed in the nose to look at the palate.

26. 26 Presentation title 20XX 1-Swallowing difficulties . It may be apparent shortly after birth that a child has a submucous cleft if they have a weak suck, are taking a long time to feed, or milk comes out of their nose as they feed. 2-Speech problems child often having abnormal nasal speech . In these cases, a submucous cleft palate may not be diagnosed until the child starts talking.

27. Prevention 27 Presentation title 20XX Bifid uvula can be hereditary, . You can’t always prevent it. However, research shows that you can reduce the risk of having a baby with bifid uvula by avoiding specific environmental factors, like smoking and taking certain medications, and taking prenatal vitamins .

28. Management and Treatment 28 Presentation title 20XX Most people with bifid uvula lead normal lives with no treatment. However, if a bifid uvula causes speech or feeding difficulties , your healthcare provider may recommend therapy. Severe cases that interfere with speech, feeding or quality of life may require surgery .

29. Case report 29 Presentation title 20XX Saudi J Anaesth .  2013 Oct-Dec; 7(4): 482–484 A 16-year-old boy, weighing 52 kg, was presented in preanesthetic clinic for fitness for retinal surgery. with all other blood reports and chest X-ray within normal limits . Airway examination was normal, except for bifid uvula [ Figure 1 ] and mild hypertelorism . No other clinical features were suggestive of any syndrome. Anesthetist cleared him for surgery. In view of aspiration, he was premedicated with ranitidine 150 mg and metoclopramide 10 mg at night and early morning respectively.  He was induced with morphine 6 mg, propofol 120 mg, and vecuronium 6 mg( muscle relaxant ) During intubation, 4 min after induction , his non-invasive systolic blood pressure increased to 210 mmHg due to laryngoscopic response,   He developed T-wave inversion in Lead II case1

30. 30 Presentation title 20XX Immediate 20 mg propofol bolus was given in addition to induction dose Intra-operative hemodynamics remained within acceptable range. Surgery took 180 min The patient was not responding to command (even after full muscle relaxant reversal  He was then shifted to intensive care unit (ICU), and computed tomography (CT ) was performed after consulting the neurologist and neurosurgeon. CT showed ruptured aneurysm in the middle cerebral artery  Then, the patient was shifted in neurosurgical theatre for clipping. Craniotomy and clipping surgery was done He was successfully extubated and discharged to home.

31. 31 Presentation title 20XX A 16-year-old boy with bifid uvula Ruptured aneurysm in the right middle cerebral artery of the patient

32. Case 2 32 Presentation title 20XX Emergency Medicine News  34(4B):, April 19, 2012. A 37-year-old man presents with eight days of bilateral ear pain and productive cough with green sputum . His past medical history is significant only for recurrent upper respiratory infections . He takes no prescribed medications. On examination, he is afebrile with stable vital signs . After noting coarse breath sounds and mild fullness in the middle ear bilaterally, you instruct the patient to open his mouth and say ah. You unexpectedly find a healthy appearing uvula that is bifurcated

33. 33 Presentation title 20XX Conclusion Although bifid uvula is in itself a benign finding and should not be treated, its association with recurrent infections and arterial aneurysms may be significant in an emergency department . This patient was eventually diagnosed with viral URI, and did well with symptomatic treatment. The emergency physician discussed the risks of recurrent URI and potential future aneurismal complications with him and his primary care physician .

34. Take A home Message 1 - Uvula is a conic projection from the back edge of the middle of the  soft palate 2- Bivid uvula has fewer amounts of muscular tissues. 3 -It is often considered as a marker for sub mucous cleft palate. 34

35. 4 -  It may be associated with aneurysm in different vascular bed like coronary and abdominal aortic aneurysm 5- The uvula can also contribute to  snoring  or heavy breathing during sleep; having an elongated uvula can cause vibrations which lead to the snoring. 6- If a bifid uvula causes speech or feeding difficulties, your healthcare provider may recommend therapy 35

36. اخيرا Bifid Uvula: don’t take it lightly! 36

37. وبس كده يامؤمن 37

38. Thank you