The effects of backward, upward, rightward pressure maneuver for intubation using the OptiscopeTM: a retrospective study

Background: The OptiscopeTM and the backward, upward, rightward pressure (BURP) maneuver are widely used in clinical practice because the BURP maneuver facilitates intubation by improving visualization of the larynx. However, the effect of the BURP maneuver is unclear when using the OptiscopeTM. Therefore, we retrospectively investigated the effect of the BURP maneuver on intubation using the OptiscopeTM.Methods: Sixty-eight patients intubated with the OptiscopeTM were enrolled. We used the BURP maneuver in Group A (n = 33) and the conventional maneuver (which does not use the BURP maneuver) in Group B (n = 35). BURP application status was a binary variable representing whether the BURP maneuver was used during the intubation. A multiple linear regression analysis was performed to assess the effects of the BURP application status on intubation time controlling for body mass index, preoperative dental injury status, obstructive sleep apnea history, thyromental distance, sternomental distance (SMD), interincisor distance, history of neck rotation restriction, and Mallampati classification.Results: There was no difference in the intubation time between the two groups. According to the regression model (R2 = 0.308, P = 0.007), the BURP maneuver (Group A) decreased the intubation time by 6.089 seconds (95% confidence interval 1.303–10.875, P = 0.014) compared to Group B.Conclusion: The BURP maneuver reduced intubation time when using the OptiscopeTM.

Oral manifestations of patients with systemic sclerosis: a meta-analysis for case-controlled studies

Background Systemic sclerosis (SSc) is a multisystem rheumatic disease. Orofacial manifestations are commonly in SSc but maybe usually ignored and overshadowed by other systemic complications. Multiple comparative studies have been conducted to investigate the possible links between SSc and oral manifestations. The present study aimed to investigate the oral health status in patients with SSc. Methods Pubmed, Embase, Web of Science, and Scopus were searched up to July 2020. Following outcomes were evaluated: Probing depth (PD), Attachment loss (AL), Bleeding on probing (BOP), Number or percentage of Sites with PD ≥ 4 mm, Prevalence of periodontitis, Number of teeth, Decayed Teeth, Missing teeth, Filled teeth, DMFT index, and the interincisal distance. Newcastle-Ottawa Scale (NOS) were applied for quality assessment. The statistical analysis was processed using the software STATA. Results 11 eligible studies were included. The maximum interincisor distance was significantly restricted in SSc patients (SMD − 1.061; 95 %CI [− 1.546, − 0.576]; Z = 4.29, P = 0.000).The prevalence of Periodontitis (OR 7.007; 95 %CI [3.529, 13.915]; Z = 5.56, P = 0.000), PD (SMD 3.101; 95 %CI [1.374, 4.829]; Z = 3.52, P = 0.000), AL(SMD 2.584; 95 %CI [0.321, 4.846]; Z = 2.24, P = 0.025), sites with PD ≥ 4mm (SMD 2.071 ; 95 %CI [0.267, 3.875]; Z = 2.25, P = 0.024) and the number of decayed teeth (SMD, 0.186; 95 %CI [0.007, 0.365]; Z = 2.04, P = 0.041) were increased significantly in SSc population in comparison with the controls. Conclusions SSc patients have limited mouth opening, higher periodontitis prevalence, and worse periodontal status, as well as an increased number of decayed teeth. Routinely oral hygiene instruction and initial periodontal treatment is recommended for SSc patients.

Oral Manifestations of Patients with Systemic Sclerosis: A Meta-analysis for Case-controlled Studies.

Background：Systemic sclerosis (SSc) is a multisystem rheumatic disease. Orofacial manifestations are commonly in SSc but maybe usually ignored and overshadowed by other systemic complications. Multiple comparative studies have been conducted to investigate the possible links between SSc and oral manifestations. The present study aimed to investigate the oral health status in patients with SSc. Methods：Pubmed, Embase, Web of Science, and Scopus were searched up to July 2020. Following outcomes were evaluated: Probing depth (PD), Attachment loss (AL), Bleeding on probing (BOP), Number or percentage of Sites with PD ≥ 4 mm, Prevalence of periodontitis, Number of teeth, Decayed Teeth, Missing teeth, Filled teeth, DMFT index, and the interincisal distance. Newcastle-Ottawa Scale (NOS) were applied for quality assessment. The statistical analysis was processed using the software STATA.Results: 11 eligible studies were included. The maximum interincisor distance was significantly restricted in SSc patients (SMD -1.061; 95%CI [-1.546, -0.576]; Z=4.29, P=0.000).The prevalence of Periodontitis (OR 7.007; 95%CI [3.529,13.915]; Z=5.56, P=0.000) , PD (SMD 3.101; 95%CI [1.374, 4.829]; Z=3.52, P=0.000), AL(SMD 2.584; 95%CI [0.321, 4.846]; Z=2.24, P=0.025) , sites with PD≥4mm (SMD 2.071 ; 95%CI [0.267, 3.875]; Z=2.25, P=0.024) and the number of decayed teeth (SMD, 0.186; 95%CI [0.007, 0.365]; Z= 2.04, P=0.041) were increased significantly in SSc population in comparison with the controls. Conclusions: SSc patients have limited mouth opening, higher periodontitis prevalence, and worse periodontal status, as well as an increased number of decayed teeth. Routinely oral hygiene instruction and initial periodontal treatment is recommended for SSc patients.

The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study

Background Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. Methods Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. Results Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286–0.612) and its OR value was 10.09 (95%CI: 4.19–24.28), sensitivity was 0.469 (95%CI: 0.325–0.617), specificity was 0.929 (95%CI: 0.877–0.964), positive predictive value was 0.676 (95%CI: 0.484–0.745), negative predictive value was 0.847 (95%CI: 0.825–0.865). Conclusion Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. Trial registration The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract: a prospective observational study

Background: Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati classification, ULBT, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was intubation time. The second outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD＞1 finger group 46.8±7.3s, compared with the C-TMD＜1 finger group 50.8±8.6s (p＜0.01). First attempt success rate was higher in the C-TMD＞1 finger group 98.9% than in the C-TMD＜1 finger group 87.1% (P＜0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI:0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

The value of a method to reduce the exposure of the upper respiratory tract for predicting difficult laryngoscopy

Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati test result, ULBT result, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 , the number of intubation attempts and intubation time.Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD ＞1 finger group 46.8±7.3s, compared with the C-TMD ＜1 finger group 50.8±8.6s (p＜0.01).First attempt success rate was higher in the C-TMD ＞1 finger group than in the C-TMD ＜1 finger group (P＜0.01).The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI: 0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy, which can become a more favorable airway assessment method during the epidemic of COVID-19.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

The value of a relatively safe method for predicting difficult laryngoscopy during the COVID-19 epidemic

Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance, Mallampati classification, and the upper lip bite test have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, interincisor distance, and upper lip bite test) remains unknown. The purpose of this study was to observe the value of condyle-tragus maximal distance to predict difficult laryngoscopy, and provide a new idea for preoperative airway assessment during epidemic. Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The interincisor distance, Mallampati test result, upper lip bite test result, and the condyle-tragus maximal distance of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2. Results: A total of 304 patients were successfully included in the study ,39 patients were identified as difficult laryngoscopy. The correlation between the condyle-tragus maximal distance and Cormack-Lehane Level was the highest (Spearman correlation coefficient, -0.317; P＜0.001), and the area under the ROC curve was the highest (AUC：0.699,P＜0.01). The condyle-tragus maximal distance <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;99% CI,0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865). Conclusion: Compared with the interincisor distance , Mallampati classification and the upper lip bite test, the condyle-tragus maximal distance has higher value in predicting difficult laryngoscopy, which can become a safer airway assessment method during the epidemic of COVID-19. Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

The “BURP” maneuver improves the glottic view during laryngoscopy but remains a difficult procedure

Objective We investigated the “BURP” maneuver’s effect on the association between difficult laryngoscopy and difficult intubation, and predictors of a difficult airway. Methods Adult patients who underwent general anesthesia and tracheal intubation from September 2016 to May 2018 were included. The “BURP” maneuver was performed when glottic exposure was classified as Cormack–Lehane grade 3 or 4, suggesting difficult laryngoscopy. The thyromental distance, modified Mallampati score, and interincisor distance were assessed before anesthesia. Results Among this study’s 2028 patients, the “BURP” maneuver decreased difficult laryngoscopies from 428 (21.1%) to 124 (6.1%) cases and increased the difficult intubation to difficult laryngoscopy ratio from 53/428 (12.4%) to 52/124 (41.9%). For laryngoscopies classified as difficult without the “BURP” maneuver, the area under the curve (AUC) of the thyromental distance, modified Mallampati score, and interincisor distance was 0.60, 0.57, and 0.66, respectively. In difficult laryngoscopies using the “BURP” maneuver, the AUC of the thyromental distance, modified Mallampati score, and interincisor distance was 0.71, 0.67, and 0.76, respectively. Conclusions The “BURP” maneuver improves the laryngoscopic view and assists in difficult laryngoscopies. Compared with difficult laryngoscopies without the “BURP” maneuver, those with the “BURP” maneuver are more closely associated with difficult intubations and are more predictable. Trial registration: www.chictr.org.cn identifier: ChiCTR-ROC- 16009050.

Occlusion and Functional Outcomes after Complete Temporomandibular Joint Resection with Soft Tissue Reconstruction

Reconstructive outcomes after complete temporomandibular joint (TMJ) resection, including the condyle and glenoid fossa bone, are poorly defined in the literature. We described our technique and reviewed occlusion and functional outcomes of 6 consecutive patients undergoing complete TMJ resection and reconstruction with anterolateral thigh free tissue transfer and intermaxillary fixation with elastic bands for 6 to 8 weeks. At median follow-up of 14 months, median Mandibular Function Impairment Questionnaire score was 32 (range, 4-38), indicating mild to moderate impairment. Subjective occlusion was normal in 4 of 6 patients. Premature occlusal contact was seen in 2 of 6 patients. Maximal interincisor distance and horizontal mandibular shift with jaw abduction ranged from 29 to 40 mm and 5 to 8 mm, respectively. Four of 6 tolerated regular diets while 2 adhered to mechanical soft diets; no patients were feeding tube dependent. Soft tissue–only reconstruction after complete TMJ resection resulted in good subjective and objective occlusion in 4 of 6 patients and no cases of severe functional impairment.

Surgical management of advanced oral submucous fibrosis: our experience

<p class="abstract"><strong>Background:</strong> Severe oral submucous fibrosis (OSMF) poses problem with maintenance of oral hygiene,detection of malignancies and maintenance of nutrition. Surgical treatment includes release of fibrous bands with or without reconstruction for the raw area and postoperative physiotherapy.</p><p class="abstract"><strong>Methods:</strong> All cases with OSMF who underwent surgical management at our institute were included in our study. The demographic data, preoperative interincisor distance, local examination was recorded. All patients underwent contrast enhanced computed tomography scan of head and neck to rule out hidden malignancy. All cases underwent OSMF band release with or without reconstruction. All patients were instructed for vigorous mouth opening exercise. All patients were followed upto 6 months and further divided into two groups depending upon whether they followed physiotherapy advice or not.</p><p class="abstract"><strong>Results:</strong> 13 patients of age group 18-47 years were included in our study. Male to female ratio was 1.6:1. Pre-operative mean interincisor distance was 7.5 mm whereas post-operative it was 19.5 mm. Patients who had followed mouth opening exercise were having a mean increase of 15 mm more as compared to those who did not.</p><p><strong>Conclusions:</strong> Even after surgical management of severe OSMF, mouth opening exercise remains the key factor for maintenance of mouth opening.</p>