Upper airway changes following high oblique sagittal split osteotomy (HSSO)

Orthognathic surgery describes the surgical movement of the mandible and maxilla to correct dentofacial deformities that result from congenital or traumatic etiologies. Patients with dentofacial deformity often have malocclusion and functional problems related to breathing, chewing, or speech articulation. Furthermore, facial asymmetries or disproportions resulting from dentofacial deformities can adversely affect the psychosocial health of the patient. The goal of orthognathic surgery is to improve both function and form beyond what can be achieved with orthodontic or medical treatments. Some of the most commonly performed orthognathic surgery procedures include Le Fort I osteotomy of the maxilla, bilateral sagittal split osteotomy of the mandible, and genioplasty. Successful outcome after orthognathic surgery should be judged by achieving an improved dental occlusion, enhanced facial aesthetics, and open upper airway. A number of studies have shown that orthognathic surgery leads to significant improvements in the quality of life of patients with dentofacial deformities. Orthognathic surgery also has a significant impact on the upper airway. In patients with severe obstructive sleep apnea, maxillomandibular advancement has the potential to lead to dramatic improvements in the apnea-hypopnea index and lowest oxygen saturation value. With careful surgical planning and execution, consistent outcomes can be expected. This review contains 17 figures, 4 tables, and 32 references. Key Words: aesthetic surgery, dentofacial deformity, genioplasty, Le Fort I, malocclusion, orthognathic surgery, sagittal split osteotomy of the mandible, sleep apnea, virtual surgical planning

Download Full-text

Laryngeal Manifestations of Autoimmune Diseases

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00168 ◽

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.

Download Full-text

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

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00055 ◽

2020 ◽

Vol 5 (6) ◽

pp. 1469-1481 ◽

Cited By ~ 1

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.

Download Full-text

Swallow Pattern Generator Reconfiguration of the Respiratory Neural Network

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd18.1.3 ◽

2009 ◽

Vol 18 (1) ◽

pp. 3-12

Author(s):

Andrea Vovka ◽

Paul W. Davenport ◽

Karen Wheeler-Hegland ◽

Kendall F. Morris ◽

Christine M. Sapienza ◽

...

Keyword(s):

Behavioral Control ◽

Upper Airway ◽

Pattern Generator ◽

Breathing Patterns ◽

Motor Patterns ◽

Control Assembly ◽

Pharyngeal Swallow ◽

Laryngeal Vestibule ◽

Lower Airways ◽

Swallow Apnea

Abstract When the nasal and oral passages converge and a bolus enters the pharynx, it is critical that breathing and swallow motor patterns become integrated to allow safe passage of the bolus through the pharynx. Breathing patterns must be reconfigured to inhibit inspiration, and upper airway muscle activity must be recruited and reconfigured to close the glottis and laryngeal vestibule, invert the epiglottis, and ultimately protect the lower airways. Failure to close and protect the glottal opening to the lower airways, or loss of the integration and coordination of swallow and breathing, increases the risk of penetration or aspiration. A neural swallow central pattern generator (CPG) controls the pharyngeal swallow phase and is located in the medulla. We propose that this swallow CPG is functionally organized in a holarchical behavioral control assembly (BCA) and is recruited with pharyngeal swallow. The swallow BCA holon reconfigures the respiratory CPG to produce the stereotypical swallow breathing pattern, consisting of swallow apnea during swallowing followed by prolongation of expiration following swallow. The timing of swallow apnea and the duration of expiration is a function of the presence of the bolus in the pharynx, size of the bolus, bolus consistency, breath cycle, ventilatory state and disease.

Download Full-text