RELATION BETWEEN SAGITTAL POSITION OF THE MANDIBLE AND PHARYNGEAL AIRWAY VOLUME IN ADULTS USING CONE BEAM COMPUTED TOMOGRAPHY

Introduction: Many authors have discussed the relationship between craniofacial morphology and pharyngeal airway spaces in different malocclusions and skeletal patterns. So the aim of this work was to study the relation between sagittal position of the mandible and pharyngeal airway volume in adults using CBCT. Materials And Methods:Twentyone CBCT radiographs were collected from the archive of Radiology Department at Suez Canal University and were divided into 3 groups according to the measured SNB angle. Group 1 normal mandibular position, group 2 retrognathic mandible and group 3 prognathic mandible. Dolphin 3D imaging software was used to measure the airway volume for all the radiographs. Nasopharyngeal, oropharyngeal, hypopharyngeal and total pharyngeal airway volumes were measured for all the radiographs. F-test (ANOVA) was used for comparison between groups and Tukey test for pairwise comparisons. Correlations between variables were tested using PearsonÂ’s correlation coefficient. Results: there was statistically significant difference in the mean total pharyngeal airway volume and oropharyngeal airway volumes between the three groups. Nasopharyngeal airway volume and hypopharyngeal airway volume had non-significant difference between groups. There was a significant positive correlation between total pharyngeal airway volume (mm3) and SNB angle. Conclusion: Pharyngeal airway volume differs with different sagittal positions of the mandible. Pharyngeal airway volume decreases with mandibular retrognathism and increases with mandibular prognathism.

Inhibition of Stress and Spontaneous Respiration: Efficacy and Safety of Monitored Anaesthesia Care by Remifentanil in Fibreoptic Bronchoscopy for Patients with Severe Tracheal Stenosis

Objective To determine the effective concentration of target-controlled infusion (TCI) of remifentanil used to inhibit stress during the treatment of severe tracheal stenosis with fibreoptic bronchoscopy and to evaluate the safety of the monitored anaesthesia care (MAC) by remifentanil.Methods A study of 60 patients with severe tracheal stenosis who underwent diagnostic and therapeutic fibreoptic bronchoscopy at Shanghai Pulmonary Hospital affiliated with Tongji University was performed. Dexmedetomidine was initially administered at a bolus dose (0.8 mcg/kg), followed by a 0.5 mcg/(kg·h) continuous infusion. Remifentanil was administered by TCI. When the target concentration was reached, the nasopharyngeal airway was inserted, and then oxygen was supplied by a connected anaesthesia machine. The effective concentration of remifentanil was titrated by the improved sequential method, and 30 patients were included. The EC95 of remifentanil was set as the plasma target concentration to evaluate the safety of the MAC, and another 30 patients were included. Remedy measures: Propofol (10-20 mg) was injected intravenously. The primary outcome measures were the cough score and the incidence and severity of hypoxemia. The tolerance score for nasopharyngeal airway placement, Ramsay sedation score, haemodynamic changes, satisfaction score, patients’ 24 h recall score, patients’ willingness to re-receive the procedure, and related adverse events were recorded.Results On the basis of sedation with dexmedetomidine, the EC95 of remifentanil for inhibiting the stress response in fibreoptic bronchoscopy performed on patients with severe tracheal stenosis was 2.710 ng/ml (95% CI, 2.471-4.473 ng/ml), and the EC50 was 2.243 ng/ml (95% CI, 2.061-2.446 ng/ml). Among the 30 patients who received an EC95 of remifentanil as the target concentration, 1 patient was remedied by injecting propofol; the tolerance score for insertion of the nasopharyngeal airway was 2, the score of Ramsay sedation was 3, and the cough score was 1. The incidence of respiratory depression was 50%, the incidence of hypoxemia was 20%, and 86.7% of patients with respiratory depression returned to normal by awakening. One patient returned to normal by mask-assisted ventilation, and another returned to normal by laryngeal mask mechanical ventilation. The satisfaction score of the operator was 9, the satisfaction score of the anaesthesiologist was 8, the satisfaction score of the patients was 10, the score of the patients' 24 h operative recall was 1, the rate of patient willingness to re-accept the procedure was 93.3%, the incidence of throat pain at 30 min after the end of the operation was 16.7%, and the circulation was stable during the operation. No pruritus, nausea, vomiting or other related adverse reactions were reported.Conclusion MAC using TCI of remifentanil can effectively inhibit the stress response to fibreoptic bronchoscopy in patients with severe tracheal stenosis while maintaining spontaneous breathing. The patients are safe and comfortable and express high satisfaction, making this method worthy of clinical application.Trial registration Registration date : 12/02/2021, Registration number: ChiCTR2100043380.

Classification, evaluation, and management of the neonate with a cleft

Numerous classifications, including LAHSAL and Kernahan’s striped Y, aid organizing the heterogeneous nature of typical orofacial clefts. Antenatal diagnosis occurs in approximately 80% of births and is more accurate for diagnosing cleft lip than cleft palate. Most parents find antenatal diagnosis beneficial for psychological adjustment and planning prior to the birth. Airway assessment is vital in neonates with a cleft. Most, even those with severe Robin sequence, can be managed non-surgically with lateral or prone positioning, a nasopharyngeal airway, and supplemental oxygen. Sleep studies are an important means of assessing the airway. Feeding is a major concern in babies with a cleft; early feeding intervention and parental education is important. Other conditions, including Robin sequence, 22q11 deletion syndrome, Stickler syndrome, and van der Woude syndrome, must be identified early in conjunction with the cleft multidisciplinary team. Genetic analysis and counselling should be considered.

Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases

Objectives: To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. Design: A retrospective single-center study of 150 children with PRS. Setting: Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. Patients: A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. Main outcome measures: Evolution and results of the initial treatment of PRS. Results: Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 ( P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. Conclusions: Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.

Postoperative Changes in Tongue Area and Pharyngeal Airway Space following Mandibular Setback Surgery through Intraoral Vertical Ramus Osteotomy

Purpose. The aim of this study was to determine changes in the tongue area and pharyngeal airway space (PAS) after intraoral vertical ramus osteotomy (IVRO). Materials and Methods. Serial lateral cephalograms of 40 patients with mandibular prognathism who underwent IVRO were evaluated before (T1), immediately after (T2), and more than 1 year after (T3) surgery. Paired t -tests and Pearson’s correlation analysis were used to evaluate the postoperative changes in the mandible, nasopharyngeal airway (NOP), retropalatal pharyngeal airway (RPP), retroglossal pharyngeal airway (RGP), hypopharyngeal airway (HOP), PAS, and tongue area (TA). The null hypothesis states that there are no significant correlations among the extent of mandibular setback and the changes in the TA and PAS after IVRO. Results. Immediately after the operation (T12), the mandible was set back by 12.6 mm. The NOP, HOP, and PAS were significantly reduced by 35.7 mm2, 116 mm2, and 185 mm2, respectively. The TA was increased by 69.6 mm2. The changes in PAS and TA revealed no significant difference between female and male patients at T12, T23, and T13. Moreover, no significant correlations were found among the extent of mandibular setback, TA changes, and PAS changes after IVRO. Thus, the null hypothesis was accepted. Conclusions. At the final follow-up (T13), no significant change was found in the PAS (including NOP, RPP, RGP, and HOP) and TA. The changes in PAS and TA revealed no significant difference between female and male patients at T12, T23, and T13.