scholarly journals Preoperative descriptive upper airway assessment in craniomaxillofacial tumor

2021 ◽  
Vol 10 (6) ◽  
pp. e5710615424
Author(s):  
Maísa Pereira da Silva ◽  
Felipe Eduardo Baires Campos ◽  
Guilherme de Souza Silva ◽  
Wagner Henriques de Castro
Keyword(s):  
Surgical Planning ◽  
Computer Software ◽  
Upper Airway ◽  
Preoperative Assessment ◽  
Potential Growth ◽  
Airway Patency ◽  
Jaw Bones ◽  
Lack Of Information ◽  
Functional Complaints

Giant osteoma appears as a benign nonodontogenic tumor of craniofacial and jaw bones with potential growth. This type of tumor affects different maxillofacial regions, thus requiring proper planning to resolve the patient’s esthetic and/or functional complaints. Medial impairment of the mandible can compromise upper airway (UA) dimensions,  leading to respiratory disorders. However, to date, there is a lack of information in the literature about 3D UA imaging protocols for surgical planning. Accurate evaluation, elucidating the involvement of the upper airway patency, may demonstrate the need and urgency for surgical intervention. Therefore, our study aim  report a case of a giant mandibular osteoma, associated with a sudden constriction of the oropharyngeal space that was assessed by a Computer Software. The UA was assessed all dimensions, and determining the surgical procedure. In follow up could observed an improvement of UA and patient complain. This study emphasizes the importance of the detailed preoperative assessment of giant osteoma to determinate the correct approach.

scholarly journals Subcutaneous Emphysema: A Rare Postoperative Complication after Tonsillectomy

2015 ◽  
Vol 3 (1) ◽  
pp. 51-53
Author(s):  
Manilal Aich Litu ◽  
Nurul Karim Chowdhury ◽  
Mohammad Amzad Hossain ◽  
Abdullah Al Mamun ◽  
Mashuque Mahmud ◽  
...  
Keyword(s):  
Subcutaneous Emphysema ◽  
Upper Airway ◽  
Preoperative Assessment ◽  
Safe Procedure ◽  
Parotid Region ◽  
Free Air ◽  
Chest X Ray ◽  
Upper Mediastinum ◽  
Uncommon Complication

Tonsillectomy is considered as a relatively safe procedure. This report aimed at describing an uncommon complication of this surgical procedure - subcutaneous emphysema. A 12 years old girl admitted for tonsillectomy operation. After routine preoperative assessment her operation was performed under general anesthesia. Surgery was uneventful. 7-8 hours after surgery, during follow-up in postoperative room progressing subcutaneous emphysema was noticed which initially involved the neck. But later on, it extended upper chest, upper arms, face & back. Crepitus swelling of neck and bilateral parotid region, typical of subcutaneous emphysema was noted. Chest X ray showed free air in the cervical regions reaching upper mediastinum. There was no airway obstruction and patient’s general condition was stable. Emphysema was no longer clinically evident 3 days after & patient was released. Subcutaneous emphysema is an uncommon complication of tonsillectomy, appearing almost ever after deeper dissections of the pharyngeal mucosa, when a porous surface is created, thus providing a route for the entry of air. Increased upper airway pressure may contribute to this injury.J. Paediatr. Surg. Bangladesh 3(1): 51-53, 2012 (January)

scholarly journals Modular tapered conical revision stem in hip revision surgery: mid- term results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Alberto Fioruzzi ◽  
Eugenio Jannelli ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Preoperative Assessment ◽  
Bone Defects ◽  
Implant Design ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Stem Design ◽  
Additional Surgery ◽  
Prime Concern ◽  
Distal Fixation

Abstract Background The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern. Methods We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1–15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intra-operative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined. Results Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8–90%) for any complication and 92.3% (CI: 91.8–92.7%) according to revision for any causes at 81 months follow-up. Conclusions Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.

scholarly journals Effect of Head Elevation on Passive Upper Airway Collapsibility in Normal Subjects during Propofol Anesthesia

2011 ◽  
Vol 115 (2) ◽  
pp. 273-281 ◽  
Author(s):  
Masato Kobayashi ◽  
Takao Ayuse ◽  
Yuko Hoshino ◽  
Shinji Kurata ◽  
Shunji Moromugi ◽  
...  
Keyword(s):  
Upper Airway ◽  
Normal Subjects ◽  
Target Concentration ◽  
Airway Patency ◽  
Head Elevation ◽  
Jaw Opening ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility ◽  
Head Flexion ◽  
Male Subjects

Background Head elevation can restore airway patency during anesthesia, although its effect may be offset by concomitant bite opening or accidental neck flexion. The aim of this study is to examine the effect of head elevation on the passive upper airway collapsibility during propofol anesthesia. Method Twenty male subjects were studied, randomized to one of two experimental groups: fixed-jaw or free-jaw. Propofol infusion was used for induction and to maintain blood at a constant target concentration between 1.5 and 2.0 μg/ml. Nasal mask pressure (PN) was intermittently reduced to evaluate the upper airway collapsibility (passive PCRIT) and upstream resistance (RUS) at each level of head elevation (0, 3, 6, and 9 cm). The authors measured the Frankfort plane (head flexion) and the mandible plane (jaw opening) angles at each level of head elevation. Analysis of variance was used to determine the effect of head elevation on PCRIT, head flexion, and jaw opening within each group. Results In both groups the Frankfort plane and mandible plane angles increased with head elevation (P < 0.05), although the mandible plane angle was smaller in the free-jaw group (i.e., increased jaw opening). In the fixed-jaw group, head elevation decreased upper airway collapsibility (PCRIT ~ -7 cm H₂O at greater than 6 cm elevation) compared with the baseline position (PCRIT ~ -3 cm H₂O at 0 cm elevation; P < 0.05). Conclusion : Elevating the head position by 6 cm while ensuring mouth closure (centric occlusion) produces substantial decreases in upper airway collapsibility and maintains upper airway patency during anesthesia.

scholarly journals NIMG-53. GLUTAMATE/GABA RATIO ON MRS IS ELEVATED IN PATIENTS WITH LOWER GRADE GLIOMAS AND SEIZURES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii159-ii160
Author(s):  
Roberta Rudà ◽  
Riccardo Pascuzzo ◽  
Francesca Mo ◽  
Alessia Pellerino ◽  
Peter B Barker ◽  
...  
Keyword(s):  
Tumor Location ◽  
Resonance Spectroscopy ◽  
Lower Grade ◽  
Lack Of Information ◽  
Baseline Evaluation ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND There is lack of information on the role of excitatory and inhibitory neurotransmitters in the development of seizures in patients with lower grade gliomas. Increase of glutamate and downregulation of GABA have been suggested in preclinical models and human surgical samples to be associated with brain tumor-related epilepsy. MATERIAL AND METHODS We prospectively investigated with the use of magnetic resonance spectroscopy (MRS) the differences in the ratio of metabolites (glutamate/GABA, glutamate/creatine and GABA/creatine) in the peritumoral areas between patients with or without seizures in a series of lower grade gliomas. Tumors were classified according to WHO Classification of 2016 as follows:11 grade II IDH mutated and 1p/19q codeleted; 3 grade III IDH mutated and 1p/19q codeleted; 6 grade II IDH mutated and 1p/19q intact; 1 grade III IDH mutated and 1p/19q intact; 1 grade II IDH wild-type. Patients received surgery alone or followed by temozolomide chemotherapy according to the presence of risk factors. RESULTS At baseline evaluation, maximum glutamate/GABA values were significantly higher (p=0.023) in the peritumoral area of patients with seizures (1.008 ± 0.368) with respect to those without seizures (0.691 ± 0.170). No other metabolites ratio showed significant differences between the two groups. Similar results were obtained when analyzing the metabolites ratio in the examinations during the follow-up. In the cohort of patients with seizures (n.14) variations of metabolite ratios were not associated with tumor location, 1p/19q codeletion, use of AEDs, concomitant chemotherapy or seizure characteristics (type, duration, frequency). CONCLUSIONS The study is ongoing with the aim of analyzing further the correlations between ratio of metabolites and status of the tumor (stable vs progressive).

Does Presurgical Nasoalveolar Molding Have a Long-Term Effect on Nasal and Upper Airway Dimensions?

2020 ◽  
pp. 105566562098023
Author(s):  
Ashwina S. Banari ◽  
Sanjeev Datana ◽  
Shiv Shankar Agarwal ◽  
Sujit Kumar Bhandari
Keyword(s):  
Upper Airway ◽  
P Value ◽  
Airway Patency ◽  
The Mean ◽  
Group 2 ◽  
Acoustic Pharyngometry ◽  
Nasoalveolar Molding ◽  
Area And Volume ◽  
Group 1

Objectives: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. Materials and Methods: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). Results: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft ( P value <.001) and noncleft side ( P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 ( P value <.05). Conclusions: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

scholarly journals Experience of taking care of children exposed to HIV: a trajectory of expectations

2014 ◽  
Vol 22 (5) ◽  
pp. 848-856 ◽  
Author(s):  
Willyane de Andrade Alvarenga ◽  
Giselle Dupas
Keyword(s):  
Antiretroviral Therapy ◽  
Qualitative Study ◽  
Incomplete Information ◽  
Vertical Transmission ◽  
Healthcare Workers ◽  
Child Interaction ◽  
Lack Of Information ◽  
Mother And Child ◽  
Specialized Service

OBJECTIVE: to learn about the experience of caregivers/mothers providing care to infants exposed to HIV through vertical transmission.METHODS: this qualitative study used Symbolic Interactionism as the theoretical framework. A total of 39 caregivers of children exposed to HIV in follow-up at a specialized service were interviewed. Data were analyzed through inductive content analysis.RESULTS: four categories were identified that report on the lonely experience of handling the child's antiretroviral therapy, mainly due to a lack of information or incomplete information; being attentive to required care, such as the use of prophylaxis for pneumonia, vaccines, and other practices restricted to the mother-child interaction; the desire to omit the HIV out of fear of prejudice and fear of the disease, considering future prospects.CONCLUSION: the HIV and the threat this infection may affect the child cause apprehension and feelings such as fear, guilt and anxiety in the caregivers. Healthcare workers need to work together with mothers so they are able to cope with demands and distress. Only then will the treatment to avoid vertical transmission be efficient and will mother and child be supported during the process, despite apprehension with the outcome.

scholarly journals Acute upper airway obstruction as a life-threatening complication of ventral bulla osteotomy: report of two consecutive cases

2021 ◽  
Vol 7 (1) ◽  
pp. 205511692110059
Author(s):  
Michal Vlasin ◽  
Richard Artingstall ◽  
Barbora Mala
Keyword(s):  
Airway Obstruction ◽  
Clinical Signs ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Single Session ◽  
Inflammatory Polyp ◽  
Case Summary ◽  
First Case ◽  
Life Threatening

Case summary This paper presents two cases of acute postoperative upper airway obstruction following ventral bulla osteotomy (VBO) in cats. The first cat underwent a unilateral left-sided VBO for a suspected inflammatory polyp. The second cat underwent a single-session bilateral VBO procedure for bilateral otitis media. In the first case, immediate re-intubation and a gradual lightening of the anaesthetic plane resolved the clinical signs; in the second case, the patient deteriorated and went into acute cardiorespiratory arrest and received cardiopulmonary resuscitation. Both patients recovered well and were discharged home 3 days after surgery. Both cases were reported to show no further clinical signs on postoperative follow-up 3 weeks and 4 months after surgery, respectively. Relevance and novel information Upper airway obstruction should be regarded as a potential complication of VBO in cats.

Jaw thrust can deteriorate upper airway patency

2005 ◽  
Vol 49 (4) ◽  
pp. 583-585 ◽  
Author(s):  
B. S. Von Ungern-Sternberg ◽  
T. O. Erb ◽  
F. J. Frei
Keyword(s):  
Upper Airway ◽  
Airway Patency

Surgical management of giant sacral schwannomas

1986 ◽  
Vol 65 (3) ◽  
pp. 286-295 ◽  
Author(s):  
Chad D. Abernathey ◽  
Burton M. Onofrio ◽  
Bernd Scheithauer ◽  
Peter C. Pairolero ◽  
Thomas C. Shives
Keyword(s):  
Preoperative Assessment ◽  
Daily Activities ◽  
Joint Involvement ◽  
Complete Relief ◽  
Minimal Risk ◽  
Low Back ◽  
Content Type ◽  
Benign Schwannoma ◽  
Anterior Aspect

✓ Thirteen cases of giant sacral schwannomas with erosion of the anterior aspect of the sacrum and associated intrapelvic extension are reviewed. These tumors showed no sex predilection; the patients' mean age was 38.6 years at the time of diagnosis, and their symptoms predated the diagnosis by an average of 5.2 years. The most common symptoms were low-back pain and lower-extremity dysesthesiae. Plain roentgenograms, myelography, and computerized tomography constituted essential and complementary studies in the preoperative assessment. Choice of surgical approach (anterior transabdominal vs. posterior transsacral) was dependent upon the amount of sacral destruction, intrapelvic extension, and sacroiliac joint involvement. Microscopic examination revealed classic features of benign schwannoma in all but three cases, which were classified as cellular schwannomas. Patients who presented with pain and dysesthesiae reported immediate and complete relief of symptoms following surgery. In addition, all 13 patients were ambulatory and able to resume their routine daily activities postoperatively. At the last reported follow-up examination, which ranged from 5 months to 33 years and 3 months (mean 9 years) after surgery, two patients had died of unrelated causes, two reported return of preoperative symptoms, and the remainder were asymptomatic. This experience suggests that these histologically benign but neurologically devastating tumors should be aggressively resected with the intent of complete extirpation, and that this goal may be accomplished with minimal risk and an excellent prognosis.

Mechanical effects of pharyngeal constrictor activation on pharyngeal airway function

1999 ◽  
Vol 86 (1) ◽  
pp. 411-417 ◽  
Author(s):  
Samuel T. Kuna ◽  
Christi R. Vanoye
Keyword(s):  
Axial Force ◽  
Airway Pressure ◽  
Muscle Activation ◽  
Upper Airway ◽  
Stimulation Frequency ◽  
Airway Patency ◽  
Pharyngeal Airway ◽  
Mechanical Effects ◽  
Airway Function ◽  
Pharyngeal Branch

The mechanical effects of pharyngeal constrictor (PC) muscle activation on pharyngeal airway function were determined in 20 decerebrate, tracheotomized cats. In 10 cats, a high-compliance balloon attached to a pressure transducer was partially inflated to just occlude the pharyngeal airway. During progressive hyperoxic hypercapnia, changes in pharyngeal balloon pressure were directly related to phasic expiratory hyopharyngeus (middle PC) activity. In two separate protocols in 10 additional cats, the following measurements were obtained with and without bilateral electrical stimulation (0.2-ms duration, threshold voltage) of the distal cut end of the vagus nerve’s pharyngeal branch supplying PC motor output: 1) pressure-volume relationships in an isolated, sealed upper airway at a stimulation frequency of 30 Hz and 2) rostrally directed axial force over a stimulation frequency range of 0–40 Hz. Airway compliance determined from the pressure-volume relationships decreased with PC stimulation at and below resting airway volume. Compared with the unstimulated condition, PC stimulation increased airway pressure at airway volumes at and above resting volume. This constrictor effect progressively diminished as airway volume was brought below resting volume. At relatively low airway volumes below resting volume, PC stimulation decreased airway pressure compared with that without stimulation. PC stimulation generated a rostrally directed axial force that was directly related to stimulation frequency. The results indicate that PC activation stiffens the pharyngeal airway, exerting both radial and axial effects. The radial effects are dependent on airway volume: constriction of the airway at relatively high airway volumes, and dilation of the airway at relatively low airway volumes. The results imply that, under certain conditions, PC muscle activation may promote pharyngeal airway patency.

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