Hybrid nasopharyngeal and oropharyngeal airway for improving upper airway and capnography in sedated patients

CJEM ◽  
2021 ◽  
Author(s):  
Vionarica Gusti ◽  
Himat Vaghadia
Keyword(s):  
Upper Airway ◽  
Oropharyngeal Airway

scholarly journals The influence of craniofacial morphology on the upper airway dimensions

2014 ◽  
Vol 85 (5) ◽  
pp. 874-880 ◽  
Author(s):  
Iveta Indriksone ◽  
Gundega Jakobsone
Keyword(s):  
Linear Regression Analysis ◽  
Upper Airway ◽  
Correlation Coefficients ◽  
Craniofacial Morphology ◽  
Multivariate Linear Regression Analysis ◽  
Cross Sectional ◽  
Old Patients ◽  
Oropharyngeal Airway ◽  
Semiautomatic Segmentation ◽  
Airway Dimensions

ABSTRACT Objective:  To evaluate the influence of craniofacial morphology on the upper airway dimensions in healthy adult subjects. Materials and Methods:  The records of 276 healthy 17- to 27-year-old patients were extracted from the cone-beam computed tomography image database of the Institute of Stomatology, Riga Stradins University. Dolphin 11.7 software was used to evaluate craniofacial anatomy and semiautomatic segmentation of the upper airway. Measurements of oropharyngeal airway volume (OPV), minimal cross-sectional area (CSAmin), and nasopharyngeal airway volume (NPV) were obtained. The presence of adenoid tissues was recorded. Associations between variables were analyzed by Spearman's correlation coefficients, and multivariate linear regression analysis was used to identify factors that had a possible influence on upper airway dimensions. Results:  The following factors were identified as influencing the variability of NPV (23%): SNA angle, gender, and presence of adenoids. Statistically significant, although weak, correlations were found between SNB angle and OPV (r  =  0.144, P < .05) and CSAmin (r  =  0.182, P < .01). Conclusion:  The results suggest that craniofacial morphology alone does not have a significant influence on upper airway dimensions.

Upper airway obstruction in the unconscious patient

1959 ◽  
Vol 14 (5) ◽  
pp. 760-764 ◽  
Author(s):  
Peter Safar ◽  
Lourdes A. Escarraga ◽  
Francis Chang
Keyword(s):  
Upper Airway ◽  
Posterior Pharyngeal Wall ◽  
Muscle Relaxants ◽  
The Unconscious ◽  
Pharyngeal Wall ◽  
Airway Patency ◽  
Forward Displacement ◽  
Oropharyngeal Airway ◽  
Spontaneously Breathing ◽  
Head Neck

Airway patency was studied in 80 anesthetized, spontaneously breathing patients, who received no muscle relaxants. With the neck flexed (chin towards chest) the airway was obstructed in all patients, both in the supine and prone positions, with and without an artificial oropharyngeal airway in place. With extension at the atlanto-occipital joint (chin up) in the supine position approximately 50% of the patients had an open airway. The other 50% required, in addition to extension of the neck, forward displacement of the mandible or the insertion of an oropharyngeal airway or both. Roentgenograms demonstrated that the tongue is pushed against the posterior pharyngeal wall when the neck is flexed and the mandible is not held forward. The incidence and degree of obstruction was similar in the prone and supine positions, with comparable positions of the head, neck and mandible. Submitted on December 19, 1958

scholarly journals Three-dimensional evaluation of upper airway following rapid maxillary expansion: A CBCT study

2013 ◽  
Vol 84 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Hakan El ◽  
Juan Martin Palomo
Keyword(s):  
Three Dimensional ◽  
Upper Airway ◽  
Rapid Maxillary Expansion ◽  
Control Group ◽  
Nasal Passage ◽  
Maxillary Expansion ◽  
Oropharyngeal Airway ◽  
Significant Difference ◽  
Group A ◽  
Maxillary Constriction

ABSTRACT Objectives: To evaluate, by using cone beam computed tomography, the skeletal, dental, oropharyngeal (OP) airway volume, and nasal passage (NP) volume changes that occur after rapid maxillary expansion (RME). Materials and Methods: Two groups were selected, each with 35 patients (15 males, 20 females), an RME group (mean age, 14.02 ± 1.46 years) and a control group (mean age, 14.10 ± 1.44 years). The RME group consisted of patients with maxillary constriction who were treated with Hyrax palatal expanders, and the control group comprised age- and sex-matched patients who underwent comprehensive orthodontic treatment without the use of a rapid maxillary expander. Results: All of the transverse skeletal (medial orbital width, lateral nasal width, maxillary width, and mandibular width) and interdental (intermolar, interpremolar, and intercanine) parameters were significantly enlarged in the RME group. A statistically significant increase in airway variables was seen in both groups between pretreatment (T0) and final records (T1). The mean increase of NP airway volume for the RME group (1719.9 ± 1510.7 mm3) was twofold compared with the control group (813.6 ± 1006.7 mm3), and no intergroup significant difference was found for the OP volume. Conclusions: Rapid maxillary expansion creates a significant increase in nasal passage airway volume but no significant change in the oropharyngeal airway volume.

Failure of manual respiration

1959 ◽  
Vol 14 (1) ◽  
pp. 84-88 ◽  
Author(s):  
Peter Safar
Keyword(s):  
Airway Obstruction ◽  
Tidal Volume ◽  
Tracheal Tube ◽  
Dead Space ◽  
Upper Airway ◽  
Obese Patients ◽  
Tidal Exchange ◽  
Artificial Airway ◽  
Oropharyngeal Airway ◽  
Oronasal Mask

The tidal volumes moved during performance of the BPAL and CPAL methods in 29 curarized, anesthetized, apneic adults were measured with a spirometer through an oronasal mask (with and without an artificial oropharyngeal airway in place) and through a tracheal tube. With the conventional BPAL method without an artificial airway the average tidal volume was zero, or less than dead space air in 12 of 15 subjects studied. The failure was mainly due to pharyngeal obstruction by the relaxed tongue, occurring when the neck was flexed and the mandible was not supported. An artificial oropharyngeal airway only slightly improved the tidal exchange. A modified BPAL method, which consisted of the head being tilted backward, increased the tidal volume and decreased the incidence of obstruction. With the conventional CPAL method the tidal volumes likewise depended mainly on the position of the head and neck. A modified CPAL method, which consisted of maintaining the head tilted backward by elevating the shoulders, was compared in 10 subjects with the modified BPAL method. The tidal volumes were greater and the incidence of upper airway obstruction was lower with the modified CPAL method. With a tracheal tube in place, tidal volumes of 260–840 ml were moved without signs of airway obstruction. The low values occurred in short and obese patients with reduced lung-thorax compliance. Submitted on August 28, 1958

Oropharyngeal airway appliance for infant with upper airway obstruction: report of a case

2003 ◽  
Vol 27 (1) ◽  
pp. 25-28 ◽  
Author(s):  
T. Shimoyama ◽  
T. Kato ◽  
Norio Horie ◽  
D. Nasu ◽  
T. Kaneko
Keyword(s):  
Cerebral Palsy ◽  
Side Effects ◽  
Respiratory Distress ◽  
Upper Airway ◽  
Base Plate ◽  
Male Infant ◽  
Suction Catheter ◽  
Guide Tube ◽  
Oropharyngeal Airway ◽  
Airway Obstructions

A palatal appliance with oropharyngeal tube that reduces the upper airway obstructions of an elevenmonth-old male infant with severe cerebral palsy is presented. The palatal appliance was composed of the base plate, the outer guide tube that held the oropharyngeal tube inside it, and the extra outer guide tube for the suction catheter. After the setting of the appliance, respiratory distress was improved without side effects.

scholarly journals Elevated Hyoid Bone Position in Response to Mandibular Advancing Appliance Predicts Effectiveness of the Appliance for Obstructive Sleep Apnea

2021 ◽  
Vol 2 ◽  
Author(s):  
Eung-Kwon Pae ◽  
Ronald M. Harper
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Hyoid Bone ◽  
Upper Airway ◽  
Correlation Coefficients ◽  
Oropharyngeal Airway ◽  
Obstructive Sleep ◽  
Lateral Cephalograms ◽  
Before And After ◽  
Airway Morphology

The objective was to determine whether hyoid bone elevation induced by an anterior mandibular positioning appliance (AMP) predicts the effectiveness of the AMP in patients with obstructive sleep apnea (OSA). Fifteen patients (12 males and 3 females) underwent polysomnographic recordings and lateral cephalograms before and after AMP use of at least 6 months. Measurements of sleep variables and upper airway morphology were compared between pre-AMP and with-AMP states. The AMP appliance reduced apnea-hypopnea indices (AHI) ~53% (33.77 ± 3.29 vs. 15.85 ± 3.78, P = 0.0013). Cephalograms of the oropharyngeal airway showed that the hyoid bone moved superiorly toward the inferior mandibular border (Δ H-MP) ~5 mm (23.4 ± 1.44 vs. 18.27 ± 1.86, P = 0.0377), with the AMP inserted in the oral cavity; no airway measurement other than hyoid bone position changed. No significant correlations emerged between AHI improvement (Δ AHI) and amounts of hyoid elevation (Δ H-MP) when all patients were pooled. However, when the samples were subcategorized, the correlation coefficients increased significantly (P < 0.01) in both subgroups. This outcome suggests the presence of two distinct types among the “Good-Responders” to AMP appliance use. Overall use of the AMP appliance is effective; however, the effectiveness of the appliance appears to depend on the mode of hyoid elevations, likely resulting from muscle responsiveness in patients with AMP use. The results suggest that Δ H-MP measurements may be a useful marker to segregate patients with tongue and hyoid muscles responsive to AMP from those not-so-responsive.

Pressure-diameter relationships of the upper airway in awake supine subjects

1991 ◽  
Vol 70 (5) ◽  
pp. 2242-2251 ◽  
Author(s):  
J. R. Wheatley ◽  
W. T. Kelly ◽  
A. Tully ◽  
L. A. Engel
Keyword(s):  
Cervical Vertebra ◽  
Upper Airway ◽  
Normal Subjects ◽  
Inspiratory Effort ◽  
Complex Interaction ◽  
Airway Wall ◽  
X Ray ◽  
Dimensional Changes ◽  
Oropharyngeal Airway ◽  
Wall Apposition

In awake supine normal subjects, dimensional changes of the oropharyngeal airway were measured during exposure to negative intraluminal pressures. The pressure was generated 1) "actively" by subjects inspiring against an externally occluded airway or 2) "passively" by external suction at the mouth during voluntary glottic closure with no inspiratory effort. Airway dimensions were imaged with X-ray fluoroscopy and anteroposterior diameters measured at levels corresponding to cervical vertebra 3 and 4 (C3 and C4). Cephalad axial displacement of the hyoid bone (CDHY) was also measured. During the "active" maneuver, airway diameters and position were maintained at resting levels despite airway pressure up to -15 cmH2O. In contrast, during the passive maneuver at -15 cmH2O, C3 was only 15 +/- 9% and C4 only 47 +/- 8% of control; CDHY was 5.6 +/- 1.8 mm. In three subjects airway wall apposition occurred and persisted until an active inspiratory effort. We conclude that, in the absence of inspiratory effort, negative oropharyngeal airway pressures result in marked narrowing and cephalad displacement of the upper airway, even during wakefulness. Therefore, our data suggest that the complex interaction of upper airway and thoracic muscle activity is critical in determining the effective compliance and patency of the upper airway, which is readily collapsible even in normal subjects.

Laryngeal Manifestations of Autoimmune Diseases

2020 ◽  
Vol 5 (2) ◽  
pp. 439-456
Author(s):  
Jenny L. Pierce
Keyword(s):  
Autoimmune Disease ◽  
Autoimmune Diseases ◽  
Patient Outcomes ◽  
Correct Diagnosis ◽  
Upper Airway ◽  
Clinical Implications ◽  
Laryngeal Function ◽  
The Past ◽  
Referral Practices ◽  
Timely Referral

Purpose This review article provides an overview of autoimmune diseases and their effects on voice and laryngeal function. Method A literature review was conducted in PubMed. Combinations of the following keywords were used: “autoimmune disease and upper airway,” “larynx,” “cough,” “voice,” “dysphonia,” and “dyspnea.” Precedence was given to articles published in the past 10 years due to recent advances in this area and to review articles. Ultimately, 115 articles were included for review. Results Approximately 81 autoimmune diseases exist, with 18 of those highlighted in the literature as having laryngeal involvement. The general and laryngeal manifestations of these 18 are discussed in detail, in addition to the clinical implications for a laryngeal expert. Conclusions Voice, breathing, and cough symptoms may be an indication of underlying autoimmune disease. However, these symptoms are often similar to those in the general population. Appropriate differential diagnosis and timely referral practices maximize patient outcomes. Guidelines are provided to facilitate correct diagnosis when an autoimmune disease is suspected.

Distraction Osteogenesis in the Treatment of Craniofacial Anomalies: Applications and Outcomes

2020 ◽  
Vol 5 (6) ◽  
pp. 1469-1481 ◽  
Author(s):  
Joseph A. Napoli ◽  
Carrie E. Zimmerman ◽  
Linda D. Vallino
Keyword(s):  
Distraction Osteogenesis ◽  
Bone Growth ◽  
Upper Airway ◽  
Craniofacial Anomalies ◽  
Craniofacial Skeleton ◽  
Facial Skeleton ◽  
Psychosocial Impairment ◽  
And Function ◽  
Correct Structure

Purpose Craniofacial anomalies (CFA) often result in growth abnormalities of the facial skeleton adversely affecting function and appearance. The functional problems caused by the structural anomalies include upper airway obstruction, speech abnormalities, feeding difficulty, hearing deficits, dental/occlusal defects, and cognitive and psychosocial impairment. Managing disorders of the craniofacial skeleton has been improved by the technique known as distraction osteogenesis (DO). In DO, new bone growth is stimulated allowing bones to be lengthened without need for bone graft. The purpose of this clinical focus article is to describe the technique and clinical applications and outcomes of DO in CFA. Conclusion Distraction can be applied to various regions of the craniofacial skeleton to correct structure and function. The benefits of this procedure include improved airway, feeding, occlusion, speech, and appearance, resulting in a better quality of life for patients with CFA.

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