Assessment of the effect of head and neck position on upper airway anatomy in sedated paediatric patients using Magnetic Resonance Imaging

OBJECTIVE: To assess the effects of isolated hyoid suspension on subjective and objective parameters of obstructive sleep apnea and to evaluate changes in upper airway anatomy with the help of standardized magnetic resonance imaging. STUDY DESIGN AND SETTING: Fifteen patients received isolated hyoid suspension. Changes in respiratory disturbance index were assessed with polysomnography, and anatomical changes with standardized magnetic resonance imaging. Snoring, daytime sleepiness, and functional parameters were assessed with questionnaires. Lateral x-ray cephalometry was performed preoperatively. RESULTS: Mean respiratory disturbance index was reduced from 35.2 ± 19.1 to 27.4 ± 26.2. Forty percent of the patients were classified as responders. Daytime sleepiness improved significantly. Relevant changes in upper airway anatomy could not be detected. There were no remarkable differences between responders and nonresponders in regard to imaging. CONCLUSIONS: Hyoid suspension is effective only in a subgroup of patients and does not lead to relevant changes in airway diameters in the awake patient. Magnetic resonance imaging and x-ray cephalometry do not add additional information for patient selection. SIGNIFICANCE: The reported clinical effects of hyoid suspension are more likely due to functional changes in airway collapsibility than to an enlargement of the upper airway.

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A Novel Volumetric Magnetic Resonance Imaging Paradigm to Study Upper Airway Anatomy

SLEEP ◽

10.1093/sleep/25.5.530 ◽

2002 ◽

Vol 25 (5) ◽

pp. 530-540 ◽

Cited By ~ 75

Author(s):

Kevin C. Welch ◽

Gary D. Foster ◽

Christen T. Ritter ◽

Thomas A. Wadden ◽

Raanan Arens ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Upper Airway ◽

Resonance Imaging ◽

Airway Anatomy

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Assessment of Upper Airway Anatomy in Awake, Sedated and Anaesthetised Patients Using Magnetic Resonance Imaging

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200208 ◽

1994 ◽

Vol 22 (2) ◽

pp. 165-169 ◽

Cited By ~ 67

Author(s):

G. D. Shorten ◽

N. J. Opie ◽

P. Graziotti ◽

I. Morris ◽

M. Khangure

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

General Anaesthesia ◽

Soft Palate ◽

Upper Airway ◽

Posterior Pharyngeal Wall ◽

Resonance Imaging ◽

Pharyngeal Wall ◽

Airway Anatomy ◽

Clinically Significant

Magnetic Resonance Imaging was used to quantify the effects of 1. sedation and 2. general anaesthesia with a laryngeal mask airway (LMA) in place on the minimum antero-posterior (A-P) diameters of the naso-, oro- and hypopharynx and on the angle of the epiglottis relative to the adjacent posterior pharyngeal wall. Median saggital T1-weighted images of the pharynx were obtained in 46 patients (16 awake, 14 sedated, 16 under general anaesthesia). In sedated patients, the A-P diameters of the pharynx were less than in awake patients, in particular at the levels of the epiglottis and soft palate. General anaesthesia and placement of a LMA was also associated with a reduced A-P diameter at the level of the soft palate, but with increased diameters at the levels of the tongue and epiglottis. Placement of a LMA caused abnormal downfolding of the epiglottis in most cases but this did not cause clinically significant airway obstruction.

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