scholarly journals Tongue and Upper Airway Dimensions: A Comparative Study between Three Popular Brachycephalic Breeds

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 662
Author(s):  
Johannes Sebastian Siedenburg ◽  
Gilles Dupré
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Upper Airway ◽  
Cross Sectional ◽  
Skull Length ◽  
Computed Tomography Scans ◽  
French And English ◽  
Level 3 ◽  
Tongue Volume ◽  
Airway Dimensions

Relative macroglossia has been identified in brachycephalic compared to mesaticephalic dogs. This study assessed the tongue volume comparing three common brachycephalic breeds, including 30 French bulldogs, 30 pugs, and 15 English bulldogs. Computed tomography scans of intubated dogs with the hard palate suspended were examined for total tongue volume and cross-sectional areas (CSAs) of the tongue, oropharynx, soft palate, and nasopharyngeal airways at three levels: 1, caudal tip of the hard palate; 2, caudal tip of the hamulus; 3 cranial to the basihyoid bone. Tongue volume normalized to bodyweight, was significantly higher in English and French bulldogs than in pugs. Normalized to skull length, CSA of the tongue was smaller in pugs than in French and English bulldogs. At level 3, French bulldogs had larger oropharyngeal CSA than English bulldogs and pugs. Soft palate CSA was the largest in English bulldogs at level 3. At levels 1 and 2, soft palate and nasopharyngeal CSA was the smallest in pugs. At level 3, French bulldogs had higher total airway/soft tissue ratios than pugs. The smaller tongue volume in pugs questions the accuracy of the term macroglossia in this breed and these findings should be considered if surgical correction is sought.

Effect of Combined Mouth Closure and Chin Lift on Upper Airway Dimensions during Routine Magnetic Resonance Imaging in Pediatric Patients Sedated with Propofol

1999 ◽  
Vol 90 (6) ◽  
pp. 1617-1623. ◽  
Author(s):  
Adrian Reber ◽  
Stephan G. Wetzel ◽  
Karl Schnabel ◽  
Georg Bongartz ◽  
Franz J. Frei
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Soft Palate ◽  
Pediatric Patients ◽  
Upper Airway ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Propofol Sedation ◽  
Routine Magnetic Resonance Imaging ◽  
Airway Dimensions

Background In pediatric patients, obstruction of the upper airway is a common problem during general anesthesia. Chin lift is a commonly used technique to improve upper airway patency. However, little is known about the mechanism underlying this technique. Methods The authors studied the effect of the chin lift maneuver on airway dimensions in 10 spontaneously breathing children (aged 2-11 yr) sedated with propofol during routine magnetic resonance imaging. The minimal anteroposterior and corresponding transverse diameters of the pharynx were determined at the levels of the soft palate, dorsum of the tongue, and tip of the epiglottis before and during the chin lift maneuver. Additionally, cross-sectional areas were calculated at these sites, including tracheal areas 2 cm below the glottic level. Results Minimal anteroposterior diameter of the pharynx increased significantly during chin lift at all three levels in all patients. The diameters of the soft palate, tongue, and epiglottis increased from 6.7+/-2.8 mm (SD) to 9.9+/-3.6 mm, from 9.6+/-3.6 mm to 16.5+/-3.1 mm, and from 4.6+/-2.5 mm to 13.1+/-2.8 mm, respectively. The corresponding transverse diameter of the pharynx also increased significantly at all three levels in all patients but without significant predominance. The diameters at the levels of the soft palate, tongue, and epiglottis increased from 15.8+/-5.1 mm to 22.8+/-4.5 mm, from 13.5+/-4.9 mm to 18.7+/-5.3 mm, and from 17.2+/-3.9 mm to 21.2+/-3.7 mm, respectively. Cross-sectional pharyngeal areas increased significantly at all levels (soft palate, from 0.88+/-0.58 cm2 to 1.79+/-0.82 cm2; tongue, from 1.15+/-0.45 cm2 to 2.99+/-1.30 cm2; epiglottis, from 1.17+/-0.70 cm2 to 3.04+/-0.99 cm2), including the subglottic level (from 0.44+/-0.15 cm2 to 0.50+/-0.14 cm2). Conclusions This study shows that all children had a preserved upper airway at all measured sites during propofol sedation. Chin lift caused a widening of the entire pharyngeal airway that was most pronounced between the tip of the epiglottis and the posterior pharyngeal wall. In pediatric patients, chin lift may be used as a standard procedure during propofol sedation.

scholarly journals Evaluation of the upper airway dimensions following Herbst appliance treatment in adolescents: A retrospective study

2020 ◽  
Vol 10 ◽  
pp. 153-163
Author(s):  
Min Gu ◽  
Yifan Lin ◽  
Colman Patrick Joseph McGrath ◽  
Urban Hägg ◽  
Ricky Wing Kit Wong ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Soft Palate ◽  
Upper Airway ◽  
Class Ii Malocclusion ◽  
Growth Data ◽  
Herbst Appliance ◽  
Downward Movement ◽  
Dimensional Changes ◽  
Lateral Cephalograms ◽  
Airway Dimensions

Objectives: This retrospective study investigated dimensional changes in the upper airway following Herbst appliance therapy in adolescents with Class II malocclusion and compared those changes with growth data. Materials and Methods: Lateral cephalograms from 44 Herbst-treated adolescents (23 boys, mean age = 13.3 ± 1.1 years, and 21 girls, mean age = 12.6 ± 1.1 years) were analyzed for the changes in the upper airway and craniofacial variables. Longitudinal cephalometric data of 34 untreated adolescents (15 boys, mean age = 12.6 ± 0.3 years, and 19 girls, mean age = 12.9 ± 0.4 years) were used as growth data for comparison. Results: Following treatment, significant changes were noted in most of the variables. Boys displayed greater downward movement of the hyoid bone than girls did (P = 0.021). Compared with the growth data, a greater increase in retroglossal oropharyngeal depth and hypopharyngeal depth was observed in boys and girls, respectively. Both displayed a decrease in the inclination of the soft palate and a smaller change in nasopharyngeal depth. Conclusion: Herbst appliance therapy enlarges the upper airway dimensions at two dissimilar sites in girls (oropharynx) and boys (hypopharynx). Boys display a greater increase in anterior and posterior facial heights than girls do, potentially accounting for the site dissimilarities. Moreover, a Herbst appliance improves the inclination of the soft palate and restricts the growth of the nasopharynx in both boys and girls.

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.

Morphologic Changes in the Upper Airway of Children during Awakening from Propofol Administration

2002 ◽  
Vol 96 (3) ◽  
pp. 607-611 ◽  
Author(s):  
Ronald S. Litman ◽  
Eric E. Weissend ◽  
David A. Shrier ◽  
Denham S. Ward
Keyword(s):  
Soft Palate ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Transverse Diameter ◽  
Sectional Area ◽  
Upper Airways ◽  
Cross Sectional ◽  
Propofol Sedation ◽  
The Cross ◽  
Morphologic Changes

Background The purpose of this study was to determine the morphologic changes that occur in the upper airway of children during awakening from propofol sedation. Methods Children undergoing magnetic resonance imaging of the head underwent additional scans of the upper airway during deep sedation with propofol; this was repeated on awakening. Axial views were obtained at the most posterior sites of the pharynx at the levels of the soft palate and tongue. Measurements were then obtained of the anterior-posterior (A-P) diameter, transverse diameter, and cross-sectional areas at these levels. Results Data were obtained on 16 children, aged 10 months to 7 yr. In both sedated and awakening states, most children had the smallest cross-sectional area of the pharynx at the level of the soft palate. During the sedated state, at the soft palate level, the transverse diameter was most narrow in 11 children, the A-P diameter was most narrow in 1 child, and they were equal in 2 children. During the sedated state, at the level of the tongue, the transverse diameter was most narrow in 9 children, the A-P diameter was most narrow in 5 children, and they were equal in 2 children. During awakening, at the soft palate level, the transverse diameter was most narrow in none of the children, the A-P diameter was most narrow in 13 children, and they were equal in 1 child. At the level of the tongue, the transverse diameter was most narrow in 4 children, and the A-P diameter was most narrow in 12 children. During awakening, the A-P diameter of the pharynx at the level of the soft palate decreased in 12 children, increased in 1 child, and remained the same in 1 child. (P < 0.001). The transverse diameter increased in 11 children, decreased in 1 child, and remained the same in 2 children (P = 0.001). The cross-sectional area at the level of the soft palate increased in 4 children, decreased in 8 children, and stayed the same in 2 children (P = 0.5). During awakening, the A-P diameter of the pharynx at the level of the tongue decreased in 11 children, increased in 4 children, and remained the same in 1 child. (P = 0.01). The transverse diameter increased in 11 children and decreased in 5 children (P = 0.07). The cross-sectional area at the level of the tongue increased in 7 children, decreased in 7 children, and stayed the same in 2 children (P = 0.9). Conclusions The dimensions of the upper airways of children change shape significantly on awakening from propofol sedation. When sedated, the upper airway is oblong shaped, with the A-P diameter larger than the transverse diameter. On awakening, the shape of the upper airway in most children changed such that the transverse diameter was larger. Cross-sectional areas between sedated and awakening states were unchanged. These changes may reflect the differential effects of propofol on upper airway musculature during awakening.

Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations

2002 ◽  
Vol 39 (4) ◽  
pp. 397-408 ◽  
Author(s):  
Christina Persson ◽  
Anna Elander ◽  
Anette Lohmander-Agerskov ◽  
Ewa Söderpalm
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Reference Group ◽  
University Hospital ◽  
Perceptual Judgment ◽  
Cross Sectional ◽  
Velopharyngeal Function ◽  
Isolated Cleft Palate ◽  
The Impact

Objective The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. Design A cross-sectional retrospective study. Setting A university hospital serving a population of 1.5 million inhabitants. Subjects Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. Interventions A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. Main outcome Measures Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. Results The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. Conclusion Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Effect of Increasing Depth of Propofol Anesthesia on Upper Airway Configuration in Children

2003 ◽  
Vol 99 (3) ◽  
pp. 596-602 ◽  
Author(s):  
Russell G. Evans ◽  
Mark W. Crawford ◽  
Michael D. Noseworthy ◽  
Shi-Joon Yoo
Keyword(s):  
Confidence Interval ◽  
Soft Palate ◽  
Upper Airway ◽  
Magnetic Resonance Images ◽  
Cross Sectional Area ◽  
Depth Of Anesthesia ◽  
Sectional Area ◽  
Cross Sectional ◽  
Airway Narrowing ◽  
Pharyngeal Airway

Background The upper airway tends to be obstructed during anesthesia in spontaneously breathing patients. The purpose of the current study was to determine the effect of increasing depth of propofol anesthesia on airway size and configuration in children. Methods Magnetic resonance images of the upper airway were obtained in 15 children, aged 2-6 yr. Cross-sectional area, anteroposterior dimension, and transverse dimension were measured at the level of the soft palate, dorsum of the tongue, and tip of the epiglottis. Images were obtained during infusion of propofol at a rate of 50-80 microg.kg-1.min-1 and after increasing the depth of anesthesia by administering a bolus dose of propofol and increasing the infusion rate to 240 microg.kg-1.min-1. Results Overall, the cross-sectional area of the entire pharyngeal airway decreased with increasing depth of anesthesia. The reduction in cross-sectional area was greatest at the level of the epiglottis (24.5 mm2, 95% confidence interval = 16.9-32.2 mm2; P < 0.0001), intermediate at the level of the tongue (19.3 mm2, 95% confidence interval = 9.2-29.3 mm2; P < 0.0001), and least at the level of the soft palate (12.6 mm2, 95% confidence interval = 2.7-22.6 mm2; P < 0.005) in expiration and resulted predominantly from a reduction in anteroposterior dimension. The airway cross-sectional area decreased further in inspiration at the level of the epiglottis. The narrowest portion of the airway resided at the level of the soft palate or epiglottis in the majority of children. Conclusion Increasing depth of propofol anesthesia in children is associated with upper airway narrowing that occurs throughout the entire upper airway and is most pronounced in the hypopharynx at the level of the epiglottis.

scholarly journals Usefulness of Hard Palate Measurements in Predicting Airway Dimensions in Patients Referred for Cone Beam CT

2021 ◽  
Vol 15 (1) ◽  
pp. 505-511
Author(s):  
Mustafa Alkhader ◽  
Mohammad S. Alrashdan ◽  
Nour Abdo ◽  
Rashed Abbas
Keyword(s):  
Hard Palate ◽  
3D Imaging ◽  
Cone Beam Ct ◽  
Correlation Coefficients ◽  
Cone Beam ◽  
Additive Effects ◽  
Sectional Area ◽  
Cross Sectional ◽  
Pearson Coefficient ◽  
Airway Dimensions

Purpose: The aim of the study was to evaluate the usefulness of hard palate measurements in predicting airway dimensions in patients referred for cone-beam CT (CBCT). Materials and Methods: Six hundred forty-three patients (239 males and 404 females) were examined by CBCT. Using dedicated CBCT software (Kodak CS 3D imaging version 3.8.6, Carestream, Rochester, NY, USA); different hard palate (palatal interalveolar length, palatal arch depth, maxillo-palatal arch angle, and alveolar width) and airway measurements (airway volume, minimum cross-sectional area, minimum anteroposterior distance, minimum right to left distance and airway length) were obtained and correlated using Pearson’s correlation coefficients and regression analysis. Results: Although the correlation between hard palate and airway measurements was weak (Pearson coefficient (r) < 0.40), there were significant (P < 0.05) additive effects for hard palate measurements in predicting airway dimensions. Maxillo-palatal arch angle was the only hard palate measurement that had no effect in predicting airway dimensions. Conclusion: Hard palate measurements are considered useful in predicting airway dimensions in patients referred for CBCT.

scholarly journals Factors Influencing Upper Airway Dimensions in Skeletal Class Ⅱ Children and Adolescents: A CBCT Study

2021 ◽  
Vol 48 (1) ◽  
pp. 1-11
Author(s):  
Byounghwa Kim ◽  
Jewoo Lee ◽  
Jiyoung Ra
Keyword(s):  
Skeletal Maturity ◽  
Upper Airway ◽  
Craniofacial Morphology ◽  
Cross Sectional ◽  
Skeletal Class ◽  
Factors Influencing ◽  
Facial Height ◽  
One Way Anova ◽  
Relevant Factors ◽  
Airway Dimensions

The purpose of this study is to investigate factors influencing the upper airway dimensions in skeletal Class Ⅱ children and adolescents.In total, 67 patients were selected. Airway volume and minimal cross-sectional area were three-dimensionally assessed. Craniofacial morphology and skeletal maturity were assessed on generated two-dimensional cephalograms. The measurements were analyzed using Mann-Whitney test, one-way ANOVA, Pearson’s correlation, and multiple regression analysis.Upper airway dimensions were significantly smaller in pre-peak stage group, and positively associated with age. Anterior facial height and age were the most relevant factors for airway volume. Mandibular width and age were the most relevant factors for minimal cross-sectional area.Upper airway dimensions were significantly associated with age, skeletal maturity and craniofacial morphology in all three planes.

scholarly journals Effects on the Upper Airway Morphology with Intravenous Addition of Ketamine after Dexmedetomidine Administration in Normal Children

2020 ◽  
Vol 9 (11) ◽  
pp. 3723
Author(s):  
Goutham Mylavarapu ◽  
Robert J. Fleck ◽  
Michale S. Ok ◽  
Lili Ding ◽  
Ali Kandil ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Upper Airway ◽  
Region Growing ◽  
Final Analysis ◽  
Normal Children ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
Airway Morphology ◽  
Dexmedetomidine Infusion ◽  
Airway Dimensions

General anesthesia decreases the tone of upper airway muscles in a dose-dependent fashion, potentially narrowing the pharyngeal airway. We examined the effects of adding ketamine on the airway configuration after dexmedetomidine administration in spontaneously breathing children with normal airways. 25 children presenting for Magnetic Resonance Imaging (MRI) of the brain/spine under general anesthesia were prospectively recruited in the study. Patients were anesthetized with dexmedetomidine bolus (2 mcg over 10 min) followed by dexmedetomidine infusion (2 mcg·kg−1·h) and ketamine and permitted to breathe spontaneously via the native airway. MR-CINE images of the upper airway were obtained with dexmedetomidine infusion alone (baseline) and 5, 10, and 15 min after administering ketamine bolus (2 mg·kg−1) in two anatomical axial planes at the nasopharynx and the retroglossal upper airway. Airway lumen is segmented with a semi-automatic image processing approach using a region-growing algorithm. Outcome measures of cross-sectional area, transverse and anterior-posterior diameters of the airway in axial planes at the level of the epiglottis in the retroglossal airway, and in the superior nasopharynx were evaluated for changes in airway size with sedation. Airway dimensions corresponding to the maximum, mean, and minimum sizes during a respiratory cycle were obtained to compare the temporal changes in the airway size. The dose-response of adding ketamine to dexmedetomidine alone condition on airway dimensions were examined using mixed-effects of covariance models. 22/25 patients based on inclusion/exclusion criteria were included in the final analysis. The changes in airway measures with the addition of ketamine, when compared to the baseline of dexmedetomidine alone, were statistically insignificant. The modest changes in airway dimensions are clinically less impactful and within the accuracy of the semi-automatic airway segmentation approach. The effect sizes were small for most airway measures. The duration of ketamine seems to not affect the airway size. In conclusion, adding ketamine to dexmedetomidine did not significantly reduce upper airway configuration when compared to dexmedetomidine alone.

Applications of Acoustic Rhinometry in the Modeling of Living Human Nasal Cavity Based on CT Scan

2005 ◽  
Author(s):  
Yingxi Liu ◽  
Jun Zhang ◽  
Xiuzhen Sun
Keyword(s):  
Nasal Cavity ◽  
Fluid Dynamic ◽  
Upper Airway ◽  
Acoustic Rhinometry ◽  
Cavity Model ◽  
Cfd Model ◽  
Cross Sectional ◽  
Significant Information ◽  
3 Dimensional ◽  
Computed Tomography Scans

Acoustic rhinometry can quantify upper airway condition of air draft by drawing a graph plotting the distance from the nostril vs. the cross-sectional area. Some decrease on the graph corresponds to the typical anatomic structures of human nasal cavity. The 3-dimensional, computing fluid dynamic model of the same person was developed based on computed tomography scans. The veracity of the CFD model were valued by contrasting the relevant areas of stenosis site between the model and the AR graph. The aim in this study is to make clear how to use an AR to help improve and enrich the CFD model with the information of graph acquired from the measurement. The combination of AR and CT can be used to establish a living human nasal cavity model with higher significant information content.

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