scholarly journals Lingual and Maxillary Labial Frenuloplasty with Myofunctional Therapy as a Treatment for Mouth Breathing and Snoring

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Chirag Govardhan ◽  
Janine Murdock ◽  
Leyli Norouz-Knutsen ◽  
Sanda Valcu-Pinkerton ◽  
Soroush Zaghi
Keyword(s):  
Upper Airway ◽  
Mouth Breathing ◽  
Therapeutic Interventions ◽  
Surgical Interventions ◽  
Open Mouth ◽  
Myofunctional Therapy ◽  
Craniosacral Therapy ◽  
The Stability ◽  
Tongue Resting Position ◽  
Open Mouth Posture

Chronic mouth breathing may adversely affect craniofacial development in children and may result in anatomical changes that directly impact the stability and collapsibility of the upper airway during sleep. Mouth breathing is a multifactorial problem that can be attributed to structural, functional, and neurological etiologies, which are not all mutually exclusive. While therapeutic interventions (myofunctional, speech and swallowing, occupational, and craniosacral therapy) may address the functional and behavioral factors that contribute to mouth breathing, progress may sometimes be limited by restrictive lingual and labial frenum that interfere with tongue and lip mobility. This case report explores the case of a three-year-old girl with mouth breathing, snoring, noisy breathing, and oral phase dysphagia that was successfully treated with lingual and labial frenuloplasty as an adjunct to myofunctional therapy. Within four days of the procedure, the patient had stopped snoring and demonstrated complete resolution of open mouth breathing. The patient was also observed to have increased compliance with myofunctional therapy exercises. This report highlights the effectiveness of surgical interventions to improve the efficacy of myofunctional therapy in addressing open mouth posture and low tongue resting position.

scholarly journals 0893 Myofunctional Therapy in Children With Mild Obstructive Sleep Apnea: A Meta-Analysis

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A340-A340
Author(s):  
A Bandyopadhyay ◽  
K N Kaneshiro ◽  
M Camacho
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Mouth Breathing ◽  
Apnea Hypopnea Index ◽  
Facial Growth ◽  
Myofunctional Therapy ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea

Abstract Introduction OSA affects 2-4% of children and untreated OSA can have adverse behavior and quality of life outcomes. 40% of children can have residual obstructive sleep apnea (OSA)despite first line treatment (adenotonsillectomy). Alternative modalities of treatment for OSA are limited. Myofunctional therapy comprises of exercises targeting upper airway muscles that can improve facial growth and have been shown to treat OSA in adults. There is paucity of data on the role of myofunctional therapy (MT) in children. The objective of this study was to systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for OSA in children and to perform a meta-analysis on the polysomnographic and mouth breathing data. Methods Medline, Embase, CINAHL, Scopus, Web of Science and Cochrane were searched from inception through October 1st, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results Eight studies (91 patients) reported polysomnography and/or mouth breathing outcomes. The pre- and post-MT apnea hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 3.75± 3.14/h to 2.08 ± 2.48/h, mean difference (MD) -1.6 [95% confidence interval (CI) -2.42, -0.78], P =0.0001. Mean oxygen saturations improved from 96.03 ± 1.1% to 96.67 ± 0.95%, MD 0.42 (95% CI 0.21, 0.63), P <0.0001. Lowest oxygen saturations improved from 86.6 ± 7.3% to 90.94 ± 3.05%, MD 1.01 (95% CI 0.25, 1.77), P = 0.009. Mouth breathing decreased in all three studies reporting subjective outcomes. Conclusion Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 45% in children with mild obstructive sleep apnea. Mean oxygen saturations, lowest oxygen saturations and mouth breathing outcomes improved in children. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments. Support None

The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis

2010 ◽  
Vol 268 (4) ◽  
pp. 533-539 ◽  
Author(s):  
Eun Joong Kim ◽  
Ji Ho Choi ◽  
Kang Woo Kim ◽  
Tae Hoon Kim ◽  
Sang Hag Lee ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Mouth Breathing ◽  
Open Mouth ◽  
Obstructive Sleep

How Does Open-Mouth Breathing Influence Upper Airway Anatomy?

2007 ◽  
Vol 117 (6) ◽  
pp. 1102-1106 ◽  
Author(s):  
Seung Hoon Lee ◽  
Ji Ho Choi ◽  
Chol Shin ◽  
Heung Man Lee ◽  
Soon Young Kwon ◽  
...  
Keyword(s):  
Upper Airway ◽  
Mouth Breathing ◽  
Open Mouth ◽  
Airway Anatomy

569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A224-A225
Author(s):  
Fayruz Araji ◽  
Cephas Mujuruki ◽  
Brian Ku ◽  
Elisa Basora-Rovira ◽  
Anna Wani
Keyword(s):  
Sleep Apnea ◽  
Primary Care Physicians ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Study ◽  
Surgical Interventions ◽  
Screening Guidelines ◽  
Obstructive Sleep ◽  
Children’S Sleep ◽  
Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

scholarly journals The Numbers Needed to Treat for Neurological Disorders

2005 ◽  
Vol 32 (4) ◽  
pp. 440-449 ◽  
Author(s):  
Miguel Bussière ◽  
Samuel Wiebe
Keyword(s):  
Absolute Risk ◽  
Time Frame ◽  
Therapeutic Interventions ◽  
Cochrane Library ◽  
Number Needed To Treat ◽  
Therapeutic Effects ◽  
Surgical Interventions ◽  
Blood Patch ◽  
Numbers Needed To Treat ◽  
Meta Analyses

ABSTRACT:Background:Numerous therapeutic interventions have been developed in the neurosciences. Clinicians need summary measures about efficacy of therapies that derive from the best available evidence, and that can be readily extrapolated to clinical practice. The number needed to treat (NNT) is intuitive and clinically applicable. We provide clinicians with a single source that summarizes important therapies in the main neurological and neurosurgical areas.Methods:Critically appraised evidence about therapies in the neurosciences was obtained from meta-analyses in all neurosciences groups in the Cochrane library, and from critically appraised topics at the University of Western Ontario. Therapies were included if they were deemed relevant and if outcomes were dichotomous. For each therapy, we obtained absolute risk differences and their 95% confidence intervals (CI), the corresponding NNTs, control and experimental event rates, and the time-frame of the outcome assessment.Results:We assembled a table of NNTs for 87 interventions in ten disease categories, deriving from meta-analyses (70%) or randomized controlled trials (30%), and assessing surgical interventions (7%), procedures (9%) or pharmacological treatments (84%). The NNTs varied widely, ranging from 1 in the use of epidural blood patch for post-dural puncture headache to 4608 for meningococcal vaccination. Preventative interventions had substantially larger NNTs. Time-frames were inappropriately short for many chronic conditions.Conclusions:Large collections of NNTs provide useful, updateable summaries of therapeutic effects in the neurosciences, an increasingly interventional clinical field.

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

2019 ◽  
Vol 133 (03) ◽  
pp. 168-176 ◽  
Author(s):  
S Sharma ◽  
J C R Wormald ◽  
J M Fishman ◽  
P Andrews ◽  
B T Kotecha
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Current Evidence ◽  
Nasal Surgery ◽  
Surgical Interventions ◽  
Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

scholarly journals Residual Neuromuscular Blockade in Critical Care

2012 ◽  
Vol 32 (3) ◽  
pp. e1-e10 ◽  
Author(s):  
Jason Wilson ◽  
Angela S. Collins ◽  
Brea O. Rowan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Upper Airway ◽  
Surgical Interventions ◽  
Residual Neuromuscular Blockade ◽  
Factors Affecting ◽  
Anesthesia Time

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

scholarly journals Hereditary Angio-Oedema for Dermatologists

Dermatology ◽  
2019 ◽  
Vol 235 (4) ◽  
pp. 263-275 ◽  
Author(s):  
Anette Bygum
Keyword(s):  
Molecular Genetic ◽  
Upper Airway ◽  
Orphan Drugs ◽  
Prophylactic Therapy ◽  
Molecular Genetic Testing ◽  
C1 Inhibitor ◽  
Surgical Interventions ◽  
Increased Risk ◽  
Life Threatening

Among angio-oedema patients, hereditary angio-oedema (HAE) should not be overlooked. Besides skin swellings, these patients might have very painful abdominal attacks and potentially life-threatening angio-oedema of the upper airway. They will not respond to traditional anti-allergic therapy with antihistamines, corticosteroids, and adrenaline, and instead need specific drugs targeting the kallikrein-kinin pathway. Classically, patients with HAE have a quantitative or qualitative deficiency of the C1 inhibitor (C1INH) due to different mutations in SERPING1, although a new subtype with normal C1INH has been recognised more recently. This latter variant is diagnosed based on clinical features, family history, or molecular genetic testing for mutations in F12, ANGPT1,or PLG.The diagnosis of HAE is often delayed due to a general unfamiliarity with this orphan disease. However, undiagnosed patients are at an increased risk of unnecessary surgical interventions or life-threatening laryngeal swellings. Within the last decade, new and effective therapies have been developed and launched for acute and prophylactic therapy. Even more drugs are under evaluation in clinical trials. It is therefore of utmost importance that patients with HAE are diagnosed as soon as possible and offered relevant therapy with orphan drugs to reduce morbidity, prevent mortality, and improve quality of life.

Proliferation of primary human hepatocytes and prevention of hepatitis B virus reinfection efficiently deplete nuclear cccDNA in vivo

Gut ◽  
2017 ◽  
Vol 67 (3) ◽  
pp. 542-552 ◽  
Author(s):  
Lena Allweiss ◽  
Tassilo Volz ◽  
Katja Giersch ◽  
Janine Kah ◽  
Giuseppina Raffa ◽  
...  
Keyword(s):  
Acute Infection ◽  
In Situ Hybridisation ◽  
Human Hepatocytes ◽  
Human Hepatocyte ◽  
Therapeutic Interventions ◽  
Viral Spread ◽  
Primary Human Hepatocytes ◽  
The Stability ◽  
The Impact

ObjectiveThe stability of the covalently closed circular DNA (cccDNA) in nuclei of non-dividing hepatocytes represents a key determinant of HBV persistence. Contrarily, studies with animal hepadnaviruses indicated that hepatocyte turnover can reduce cccDNA loads but knowledge on the proliferative capacity of HBV-infected primary human hepatocytes (PHHs) in vivo and the fate of cccDNA in dividing PHHs is still lacking. This study aimed to determine the impact of human hepatocyte division on cccDNA stability in vivo.MethodsPHH proliferation was triggered by serially transplanting hepatocytes from HBV-infected humanised mice into naïve recipients. Cell proliferation and virological changes were assessed by quantitative PCR, immunofluorescence and RNA in situ hybridisation. Viral integrations were analysed by gel separation and deep sequencing.ResultsPHH proliferation strongly reduced all infection markers, including cccDNA (median 2.4 log/PHH). Remarkably, cell division appeared to cause cccDNA dilution among daughter cells and intrahepatic cccDNA loss. Nevertheless, HBV survived in sporadic non-proliferating human hepatocytes, so that virological markers rebounded as hepatocyte expansion relented. This was due to reinfection of quiescent PHHs since treatment with the entry inhibitor myrcludex-B or nucleoside analogues blocked viral spread and intrahepatic cccDNA accumulation. Viral integrations were detected both in donors and recipient mice but did not appear to contribute to antigen production.ConclusionsWe demonstrate that human hepatocyte division even without involvement of cytolytic mechanisms triggers substantial cccDNA loss. This process may be fundamental to resolve self-limiting acute infection and should be considered in future therapeutic interventions along with entry inhibition strategies.

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