Airway Measurements Research Articles

Three-Dimensional Pharyngeal Airway Changes After 2-Jaw Orthognathic Surgery With Segmentation in Dento-Skeletal Class III Patients.

To investigate short- and long-term three-dimensional changes of pharyngeal airway morphology and hyoid bone position in dento-skeletal class III deformity patients after 2-jaw orthognathic surgery with segmentation. A retrospective analysis has been performed on patients with dento-skeletal class III deformity who had undergone orthognathic 2-jaw surgery with segmentations, presenting both pre- and post-surgical cone-beam computed tomographys. Three-dimensional skeletal movements, pharyngeal airway changes and hyoid bone position were measured and correlated. The mean short term postsurgical review period for all included 47 patients was 5.8 ± 2.2 months. Thirteen patients among them provided a mean long term period of 26.4 ± 3.4 months. The mean postsurgical maxillary movement was 2.29 ± 2.49 mm in vertical, 2.02 ± 3.45 mm in horizontal direction, respectively, while the mandibular movement was 6.49 ± 4.58 mm in vertical, and -5.85 ± 6.13 mm in horizontal direction. In short-term, the vertical length of nasopharynx was found to be reduced (P = 0.005) but increased for the oropharynx (P < 0.001). Furthermore, the oropharyngeal minimum cross-sectional area has decreased significantly (P = 0.013). The hyoid bone moved posterosuperiorly, however, with only its horizontal movement found to be significant (P = 0.043). No significant result was detected in long-term analyses, neither in postsurgical pharyngeal airway changes nor the hyoid bone movement. There were no significant differences in pharyngeal airway measurements (P > 0.05) detected between patients with and without genioplasty advancement. Two-jaw orthognathic surgery in dento-skeletal class III patients led to a statistically non-significant reduction of the post-surgical airway volume in both short- and long-term. Although the post-surgical oropharyneal minimum cross-sectional area was decreased significantly in the short term, this finding did not persist in the long term.

Quantitative assessment of airway remodelling and response to allergen in asthma.

In vivo evaluation of the microstructural differences between asthmatic and non-asthmatic airways and their functional consequences is relevant to understanding and, potentially, treating asthma. In this study, we use endobronchial optical coherence tomography to investigate how allergic airways with asthma differ from allergic non-asthmatic airways in baseline microstructure and in response to allergen challenge. A total of 45 subjects completed the study, including 20 allergic, mildly asthmatic individuals, 22 non-asthmatic allergic controls and 3 healthy controls. A 3-cm airway segment in the right middle and right upper lobe were imaged in each subject immediately before and 24 h following segmental allergen challenge to the right middle lobe. Relationships between optical airway measurements (epithelial and mucosal thicknesses, mucosal buckling and mucus) and airway obstruction (FEV1 /FVC (forced expiratory volume in 1 s/forced vital capacity) and FEV1 % (FEV1 as a percentage of predictive value)) were investigated. Significant increases at baseline and in response to allergen were observed for all four of our imaging metrics in the asthmatic airways compared to the non-asthmatic airways. Epithelial thickness and mucosal buckling exhibited a significant relationship to FEV1 /FVC in the asthmatic group. Simultaneous assessments of airway microstructure, buckling and mucus revealed both structural and functional differences between the mildly asthmatic and control groups, with airway buckling seeming to be the most relevant factor. The results of this study demonstrate that a comprehensive, microstructural approach to assessing the airways may be important in future asthma studies as well as in the monitoring and treatment of asthma.

Airway quantification using adaptive statistical iterative reconstruction-V on wide-detector low-dose CT: a validation study on lung specimen.

To evaluate the accuracy of airway quantification of adaptive statistical iterative reconstruction (ASIR)-V on low-dose CT using a human lung specimen. A lung specimen was scanned on Revolution CT with low-dose settings (20mAs, 40mAs and 60mAs/100kV) and standard-dose setting (100mAs/120kV). CT images were reconstructed using lung kernel with eleven ASIR-V levels from 0 to 100% with 10% interval. ASIR-V level from 0 to 100% with 10% interval was reconstructed on lung kernel. Wall area percentage (%WA) and wall thickness (WT) were measured. Radiation dose of 20mAs, 40mAs and 60mAs low-dose settings reduced by 87.6%, 75.2% and 62.8% compared to that on standard dose, respectively. Low-dose settings significantly decreased image SNR (p < 0.05) and increased noise (p < 0.001). ASIR-V level exponentially improved image SNR and linearly decreased image noise (all p < 0.001). The mean airway measurement ratios of low-dose to standard-dose were within 2% variation for %WA and within 3% variation for WT. Most %WA and WT values showed no obvious correlation with ASIR-V levels. ASIR-V showed to improve image quality in low radiation dose. However, low-dose settings and ASIR-V strength did not significantly influence airway quantification values, although variation in measurements slightly increased with dose reduction.

Sputum Autoantibodies Are More Relevant in Autoimmune Responses in Asthma than Are Serum Autoantibodies.

PurposeThe data on the differences between sputum autoantibodies (Sp-Abs) and serum autoantibodies (Se-Abs) in reflection of autoimmune responses to lungs is still lacking.MethodsTen types of Abs were investigated in matched Se and Sp samples collected from recruited subjects. Correlations between Ab levels and airway inflammatory parameters and measures of pulmonary function were assessed. The network-based and inter-correlated analysis was performed to explore the patterns of Sp- and Se-Ab profiles.ResultsFifty stable asthmatic patients and 24 healthy volunteers were recruited for our study, 15 with mild asthma, 18 with moderate asthma and 17 with severe asthma. The concentrations of Sp-Ab against U1 small nuclear ribonucleoprotein (Sp-anti-U1-SnRNP), Sp-Ab against Smith antigen and Se-Ab against thyroid peroxidase (anti-TPO) in severe asthmatics and Sp-anti-U1-SnRNP in moderate asthmatics were significantly higher compared to healthy controls and mild asthmatic subjects (P < 0.05). Sp-anti-U1-SnRNP levels were positively correlated with the dose of inhaled corticosteroids, Sp eosinophil counts and fractional exhaled nitric oxide (r = 0.326, P = 0.022; r = 0.356, P = 0.012; r = 0.241, P = 0.025, respectively) and negatively correlated with Sp neutrophil counts (r = −0.308, P = 0.031) with adjustment for age. Spearman's correlation matrix showed multiple inter-correlations among Sp-Abs and Se-Abs (P < 0.05) while only the levels of Ab against DNA topoisomerase and anti-TPO in Se were correlated with those Sp-Ab counterparts (P < 0.05). The network-based analysis defined 2 clusters: clusters 1 and 2 contained 10 Sp-Abs and 10 Se-Abs, respectively.ConclusionsThis study observes that Sp-Abs are more associated with clinical parameters and the severity of disease in asthma compared to Se-Abs. Targeting on Sp-Abs which are the hallmark of the localized autoimmune event might help us better understand the role of autoimmunity in the pathological mechanism of asthma.

A Review of Advancements in Nasal Airway Measurement

A Review of Advancements in Nasal Airway Measurement

Cephalometric and Pharyngometric Evaluation in Snoring Children with Sleep-Disordered Breathing and Adenotonsillar Hypertrophy Under an Orthodontic or Orthopedic Treatment

AbstractAltered craniofacial growth has been implicated in sleep-disordered breathing (SDB) in children. The authors aimed to evaluate the cephalometric measurements and pharyngeal dimensions related to SDB in snoring children with adenotonsillar hypertrophy (ATH) treated with an orthodontic and orthopedic oral appliance (OOA). Forty habitually snoring children, 6 to 9 years old with evidence of grade 3 to 4 ATH, maxillary constriction, and class II dental malocclusion were enrolled, with 24 children being treated with OOA, and 16 remaining untreated children as controls. All children underwent a cephalometric X-ray and acoustic pharyngometry for airway measurements at the start and 6 months after. Cephalometric measurements related to SDB reduced in the treated group (p &lt; 0.01) as follows: maxillary–mandibular relationship: –2.2 ± 1.70°; maxillary–mandibular planes angle: –2.4 ± 3.80°; and hyoid bone position: –4 ± 3.8 mm (p &lt; 0.001). OOA treatment revealed improvements in pharyngeal minimum cross-section area (MCA) (0.2 ± 0.2 cm2) and volume (V) (3.15 ± 2.5 cm3), while reductions in MCA (–0.2 ± 0.3 cm2) and in V (–1.25 ± 1.3 cm3) occurred in controls (p &lt; 0.001 vs. OOA). Six months of OOA treatment in snoring children with SDB promotes enlargement of the pharyngeal dimensions and beneficial cephalometric changes.

Relationship of the airway size to the mandible distance in Chinese skeletal Class I and Class II adults with normal vertical facial pattern.

This study aims to evaluate the pharyngeal airway dimensions among Chinese adults in relation to Class I and Class II facial skeletal patterns using three-dimensional cone-beam computed tomography (CBCT) images. A total of 156 initial CBCT images were evaluated, which were classified into skeletal Class I and Class II according to ANB angle with mean (SD) age being 22.56 ± 4.0 years and 22.32 ± 3.6 years. The pharyngeal airway volume, airway area, minimum cross-sectional area (MCA) and the distance from uvula (tip of the soft palate) to mental spine (U-MS distance) were assessed with Dolphin imaging software. Compared with Class I group, Class II group displayed significantly smaller pharyngeal airway volume, airway area and MCA (P <.01, P =0.03, and P =0.008, respectively), and shorter U-MS distance (P <.001). Comparing gender subgroups, the female subgroup showed the smallest airway measurement. Spearman correlation test results showed that the airway volume and area had a significant positive correlation with U-MS distance (r = 0.22, P = 0.005, and r = 0.28, P < 0.005, respectively) and negative correlation with ANB angle (r = -0.23, P = 0.002, and r = -0.21, P = 0.007, respectively). Pharyngeal airway volume, airway area, MCA, and the U-MS distance were smaller in skeletal Class II than Class I Chinese adult subjects and lower in female Class II subgroup. Additionally, there was a correlation observed between the mandibular distance (U-MS), ANB angle and airway size.

Validation of age and height based formulae to predict paediatric airway distances – a prospective observational study

Background:Preoperative airway evaluation in children is an important part of routine preanesthetic evaluation before surgery. External airway measurements, viz., thyromental, mentohyoid, and sternomental distances, while being growth dependent, could identify pediatric patients with potentially difficult airways.Objectives:This study was conducted to validate the age- and height-based formulae, derived from a previous study conducted in our institute, to predict thyromental distance, sternomental distance, and mentohyoid distance in relation with the height and age of pediatric patients.Design:Prospective cross-sectional single arm observational study.Setting:Tertiary level university teaching hospital from July 2015 to December 2016.Patients:Children (202) in the age group of 3-15 years with no obvious external airway anomaly scheduled for elective surgery under general anesthesia.Outcomes Measured:The thyromental, mentohyoid, and sternomental distances were measured preoperatively. The same parameters were then calculated based on age- and height-related formulae derived in the earlier study.Results:Bland-Altman analysis of the sample patients showed a mean difference (bias) between measured and calculated values ranging from 0.14 to –0.60 (3 - 13%). Overall agreement in terms of bias were found to be more with height-based equation for mentohyoid distance and thyromental distance and age-based equation for sternomental distance.Conclusion:Our study validates the formulae derived in the earlier study to predict thyromental, mentohyoid, and sternomental distances in children with no obvious external airway anomalies. Further studies are needed to extend the applicability of these formulae in obese children and those with craniofacial anomalies coming for general anesthesia and surgery.

Occupational Exposures and Computed Tomographic Imaging Characteristics in the SPIROMICS Cohort.

Quantitative computed tomographic (CT) imaging can aid in chronic obstructive pulmonary disease (COPD) phenotyping. Few studies have identified whether occupational exposures are associated with distinct CT imaging characteristics. To examine the association between occupational exposures and CT-measured patterns of disease in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Participants underwent whole-lung multidetector helical CT at full inspiration and expiration. The association between occupational exposures (self-report of exposure to vapors, gas, dust, or fumes [VGDF] at the longest job) and CT metrics of emphysema (percentage of total voxels < -950 Hounsfield units at total lung capacity), large airways (wall area percent [WAP] and square-root wall area of a single hypothetical airway with an internal perimeter of 10 mm [Pi10]), and small airways (percent air trapping [percent total voxels < -856 Hounsfield units at residual volume] and parametric response mapping of functional small-airway abnormality [PRM fSAD]) were explored by multivariate linear regression, and for central airway measures by generalized estimating equations to account for multiple measurements per individual. Models were adjusted for age, sex, race, current smoking status, pack-years of smoking, body mass index, and site. Airway measurements were additionally adjusted for total lung volume. A total of 2,736 participants with available occupational exposure data (n = 927 without airflow obstruction and 1,809 with COPD) were included. The mean age was 64 years, 78% were white, and 54% were male. Forty percent reported current smoking, and mean (SD) pack-years was 49.3 (26.9). Mean (SD) post-bronchodilator forced expiratory volume in 1 second (FEV1) was 73 (27) % predicted. Forty-nine percent reported VGDF exposure. VGDF exposure was associated with higher emphysema (β = 1.17; 95% confidence interval [CI], 0.44-1.89), greater large-airway disease as measured by WAP (segmental β = 0.487 [95% CI, 0.320-0.654]; subsegmental β = 0.400 [95% CI, 0.275-0.527]) and Pi10 (β = 0.008; 95% CI, 0.002-0.014), and greater small-airway disease was measured by air trapping (β = 2.60; 95% CI, 1.11-4.09) and was nominally associated with an increase in PRM fSAD (β = 1.45; 95% CI, 0.31-2.60). These findings correspond to higher odds of percent emphysema, WAP, and air trapping above the 95th percentile of measurements in nonsmoking control subjects in individuals reporting VGDF exposure. In an analysis of SPIROMICS participants, we found that VGDF exposure in the longest job was associated with an increase in emphysema, and in large- and small-airway disease, as measured by quantitative CT imaging.

Spectrum of chronic lung allograft pathology in a mouse minor-mismatched orthotopic lung transplant model.

Chronic lung allograft dysfunction (CLAD) is a fatal condition that limits survival after lung transplantation (LTx). The pathological hallmark of CLAD is obliterative bronchiolitis (OB). A subset of patients present with a more aggressive CLAD phenotype, called restrictive allograft syndrome (RAS), characterized by lung parenchymal fibrosis (PF). The mouse orthotopic single LTx model has proven relevant to the mechanistic study of allograft injury. The minor-alloantigen-mismatched strain combination using C57BL/10(B10) donors and C57BL/6(B6) recipients reportedly leads to OB. Recognizing that OB severity is a spectrum that may coexist with other pathologies, including PF, we aimed to characterize and quantify pathologic features of CLAD in this model. Left LTx was performed in the following combinations: B10→B6, B6→B10, B6→B6. Four weeks posttransplant, blinded pathologic semi-quantitative assessment showed that OB was present in 66% of B10→B6 and 30% of B6→B10 grafts. Most mice with OB also had PF with a pattern of pleuroparenchymal fibroelastosis, reminiscent of human RAS-related pathology. Grading of pathologic changes demonstrated variable severity of airway fibrosis, PF, acute rejection, vascular fibrosis, and epithelial changes, similar to those seen in human CLAD. These assessments can make the murine LTx model a more useful tool for further mechanistic studies of CLAD pathogenesis.

Real-time robotic airway measurement: An additional benefit of a novel steady-hand robotic platform.

Describe the secondary capability of a robotic system to provide real-time measurements of airway dimensions with high fidelity. Seven unique phantoms of laryngotracheal stenosis (LTS) were modeled using a computer-aided design tool and were three dimensionally printed. These stenoses were of different dimensions and orientations, and some were purposefully oblique. The dimensions of the stenoses were then measured with the novel Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS; Galen Robotics, Inc., Sunnyvale, CA) because it is capable of tool position memory in three dimensional (3D) space. Five participants (two laryngologists, two otolaryngology-head and neck surgery residents, one neurotology fellow) measured each axis of stenosis (anteroposterior, lateral, and craniocaudal) three times for each of the seven stenosis phantoms. These measurements were then compared to the known design dimensions. Mean magnitude of error (MOE) and interrater reliability (IRR) using an intraclass correlation coefficient (ICC) were then calculated. Mean MOE and standard deviation for all measurements was 0.306 ± 0.247 mm. Mean MOE was 0.374 ± 0.292 mm, 0.300 ± 0.237 mm, and 0.244 ± 0.185 mm for the anteroposterior, lateral, and craniocaudal dimensions of stenosis, respectively. Eighty-two percent of all measurements had MOE < 0.5 mm. ICC was 0.945 (95% confidence interval [CI]: 0.847-0.989), 0.995 (95% CI: 0.984-0.999), and 0.993 (95% CI: 0.987-0.999) for anteroposterior, lateral, and craniocaudal dimensions, respectively, indicating excellent agreement among participants. The REMS can be used to reliably and accurately measure airway dimensions in 3D regardless of the orientation of stenosis. This ability may be easily extrapolated to the measurement of any airway lesion during laryngotracheal surgery. 4 Laryngoscope, 129:324-329, 2019.

Clinical validation and reproducibility of endoscopic airway measurement in pediatric aerodigestive evaluation

BackgroundEndoscopic airway measurement (EAM) combines optical endoscopic instruments with open source image processing to accurately obtain airway dimensions. Preclinical models have demonstrated EAM as an accurate technique of airway measurement with the added advantage of characterizing multilevel stenosis, non-circular lesions, and distal obstruction. The aim of this prospective clinical study was to compare EAM to airway measurements obtained from endotracheal tube approximation (ETTA) during pediatric aerodigestive evaluation and to evaluate reproducibility of EAM across practitioners. MethodsThirty-seven pediatric patients undergoing routine microlaryngoscopy and bronchoscopy at a single tertiary care children's hospital were prospectively recruited. Patients undergoing emergent procedures were excluded. Two blinded reviewers performed airway measurements using ImageJ (NIH) as previously described and average values were compared to ETTA measurements. Additional EAMs were obtained from an ex vivo airway model by 28 separate clinicians and were analyzed by the same reviewers to evaluate reproducibility. ResultsEAM and ETTA measurements were themselves significantly different (p = 0.0003); however, the average absolute difference between the two methods was small (Mean: 0.5 mm, 95%CI: −2.6–1.6 mm). There were notable differences between raters such that estimates of raters with more experience were more similar to ETTA. Despite observed differences between EAM and ETTA, endoscopic airway measurement was highly correlated with ETTA (p = 0.0002, Spearman r = 0.4185), and strong agreement was observed (Bias: −0.4974 ± 1.083 mm, 95% LOA: −2.62–1.625 mm). ConclusionClinical use of EAM is a valid and precise approach for quantification of airway luminal dimensions. This method may provide advantages over traditional ETTAs for evaluation of asymmetric airway morphology in the pediatric population.

Rapid Maxillary Expansion and Naso-PharyngealAirway A Three Dimensional Assessment

The two dimensional plain cephalometric radiographs were widely used to assess the post-rapidmaxillary expansion (RME) effect on the naso-pharyngeal airway. However,volumetric changes inthe airway need proper assessment. The aim of this study was to assess the linear and volumetricchanges in the airway pre and post orthodontic RME using cone beam computed tomography(CBCT). A sample of 12 participants (8 males, 4 females with mean age 14+1.3) who needed RMEfor the management of posterior crossbite due to transverse maxillary deficiency was used in thisstudy. CBCT scans were acquired pre and post maxillary expansion. Linear and angular measurementswere calculated in addition to the volumetric measurements were obtained. There was astatistically significant increase in inter-molar width and molar tipping. The nasal cavity showedstatistically significant increase in the width of the nasal floor and the lateral nasal width. There wasalso statistical significant increase in naso and oropharygeal airway measurements post-expansion.RME using hyrax appliance increased the nasal floor width, nasal lateral width and the airway volumeat the naso and oropharyngeal level

Reliability of upper airway assessment using CBCT.

Upper airway analysis is an often-cited use of CBCT imaging by orthodontists; however, the reliability of airway measurements using this technology is not fully established. To determine the intra-examiner and inter-examiner reliability of the complete process of volumetric and cross-sectional area assessments of the upper airway using CBCT imaging. Six examiners of varying levels of education and clinical experience performed the steps necessary for airway analysis, including manual orientation, slice and threshold selection and measured nasopharyngeal, oropharyngeal, hypopharyngeal and total upper pharyngeal airway volumes in addition to minimum cross-sectional area on the CBCT images of 10 patients. All measurements were repeated after 4-weeks. Intra- and inter-examiner reliability was calculated using ICC and 95% CI. Threshold selection showed poor intra- and poor inter-examiner reliability, whereas minimum cross-sectional area showed moderate intra- and poor inter-examiner reliability. Intra-examiner reliability of volumetric measurements varied based on the region assessed with ICC ranging from 0.747 to 0.976, and was worst for hypopharynx and best for the oropharynx. Inter-examiner reliability of volume measurements was generally lower, with ICC ranging from 0.175 to 0.945, and was worst for nasopharynx and best for the oropharynx. This study, for the first time, assessed the reliability of upper airway analysis with CBCT when all steps of image processing and measurement are performed by each examiner. Reliability improved with examiner experience, though was generally low for the hypopharynx and nasopharynx volumes and overall minimal cross-sectional area. The oropharyngeal volume was the only parameter to have excellent intra- and inter-examiner reliability.

OP03-5 - A retrospective analysis of double-lumen tube size and hypoxaemia during lung resection

There continues to be significant variation in double-lumen tube (DLT) size selection among anaesthesiologists for thoracic surgery. Advocates for placing the largest possible DLT argue that smaller DLTs have a greater risk of dislodgement and of bronchial mucosal injury. Advocates for smaller DLTs argue that they are easier to place and are not definitively associated with airway trauma. DLT size is commonly selected using patient height and sex, but can also be chosen by radiographic airway measurements. A previous pilot study with 300 patients at our institution found no difference in hypoxaemia, inadequate lung isolation, or need for DLT repositioning when using a smaller DLT. Given these findings, we sought to review whether DLT size was associated with hypoxaemia during one-lung ventilation (OLV) in a larger patient population.

The evaluation of the relationship between cervical vertebral anomalies with skeletal malocclusion types and upper airway dimensions

ABSTRACTObjectives: To compare the prevalence of cervical vertebral anomalies (CVAs) in different skeletal malocclusions and to evaluate the relationship between upper airway dimension and vertebral anomalies.Methods: A retrospective study was performed on lateral cephalometric radiographs of 2062 patients aged 7–49 years. Skeletal malocclusion type, presence of CVAs, and upper airway area of 1856 patients who met the inclusion criteria of the study were recorded. The obtained data were transferred to the SPSS program for statistical analysis.Results: The mean age of the patients was 13.8 ± 3.7 years. The prevalence of CVAs was 45.7%. There was no significant difference in prevalence between skeletal malocclusions (p = 0.89). According to airway measurements, no significant difference was found between patients with and without CVAs (p = 0.718).Conclusion: The present results suggest that there is no direct effect of skeletal malocclusion type and upper airway dimension in the etiology of CVAs.

Correlation of CT small airway measurement with clinical and inflammation factors in asthma patients

Objective: To evaluate the correlation of CT small airway measurement with clinical and inflammatory factors in asthma patients. Methods: From November 2014 to December 2015, a total of 20 patients with asthma were recruited in outpatient department of Peking University Third Hospital. All underwent asthma control test (ACT), CT and pulmonary function test. Serum leptin, immunoglobulin E(IgE) and transforming growth factor-β1(TGF-β1), induced sputum eosinophil percentage(Eos%) and matrix metalloproteinase(MMP-9) results were collected.Using GE airway analysis software and adjusted by body surface area, luminal diameter(LD(adjusted)), luminal area(Ai(adjusted)), wall thickness(WT(adjusted)) and wall area%(WA%)at the end of 6th generation airway were recorded. Results: In asthma patients with smoking history, both LD(adjusted) and Ai(adjusted) were significantly lower than patients without smoking history(LD(adjutsed) (1.19±0.14)vs(1.34±0.11) mm, Ai(adjusted) (1.13±0.32) vs (1.43±0.24) mm(2,) t=-2.459, -2.267, all P<0.05); in asthma patients with induced sputum Eos%≥3%, both LD(adjusted) and Ai(adjusted) were significantly lower but WA% significantly higher than patients with induced sputum Eos%<3% (LD(adjutsed) (1.26±0.05) vs (1.44±0.09) mm, Ai(adjusted)(1.27±0.11) vs (1.66±0.17) mm(2,) WA%(83.96%±1.26%) vs (81.20%±2.26%), t=-3.935, -4.492, 2.448, all P<0.05). LD(adjutsed) and Ai(adjusted) had negative correlation with course of disease and induced sputum Eos%(LD(adjutsed) r=-0.512, -0.841, Ai(adjusted) r=-0.489, -0.841, all P<0.05), and positive correlation with FEV(1)/FVC and serum leptin(LD(adjutsed) r=0.669, 0.533, Ai(adjusted) r=0.681, 0.552, all P<0.05). Ai(adjusted) also showed positive correlation with FEV(1)%(r=0.452, P<0.05). WT(adjusted) and WA% were significantly negative correlated with FEV(1)/FVC and FEV(1)%(WT(adjusted) r=-0.621, -0.483, WA% r=-0.729, -0.548, all P<0.05). WA% also showed positive correlation with serum IgE and induced sputum MMP-9(r=0.509, 0.636, all P<0.05). CT airway indexes showed no significantly correlation with age, ACT scores and serum TGF-β1. Conclusions: CT airway indexes are found partially associated with course of disease, smoking history, serum leptin and IgE, induced sputum Eos% and MMP-9. CT airway indexes show correlation with FEV(1)/FVC and FEV(1)%.

Assessment of the upper respiratory tract in patients eligible for treatment with transverse maxillary expansion

Transverse maxillary hypoplasia may negatively affect respiration. Maxillary narrowing has to be treated early. An appliance for Rapid Maxillary Expansion (RME) is the most common method, and it aims to expand the skeletal base and maintain this width until a new bone has been formed to fill in the fissure. Aim. Comparison of the results of measurements of bone structures and of the upper airways on lateral teleroentgenograms of the head in patients with transverse maxillary hypoplasia and in patients with normal dimensions of the maxilla. Material and methods. The study was carried out in a group of 20 people with maxillary narrowing (10 girls and 10 boys) aged 7 to 10 years. The control group consisted of 20 lateral teleroentgenograms of patients (9 girls and 11 boys) of similar age treated for other malocclusions. The structures of the facial skeleton and the upper respiratory tract were assessed in teleroentgenograms after earlier determination of measurement points and planes according to selected parameters of the McNamara and Preston et al. methodology. The obtained results were analysed statistically using the Mann-Whitney's test. Results. Angular measurements showed statistically significantly smaller SNA and SNB angles in the study group compared to the control group. The analysis of linear measurements indicated a statistically significant larger dimension of the actual length of the midfacial segment (Co-A) and distance between the Sella point and the posterior nasal spine (PNS-S), and a smaller dimension of the posterior facial height (PFH) in the study group compared to the control group. The highest differences in upper respiratory tract measurements were noted in the Ba-ho-PNS angle, which was lower in the study group. The result was not statistically significant. Conclusions. No significant differences in cephalometric measurements of the upper airways were observed. There is a need to extend studies to include groups of patients with features of night apnoea and maxillary narrowing. &lt;b&gt;(Dargiewicz E, Szarmach IJ, Sawczuk M. Assessment of the upper respiratory tract in patients eligible for treatment with transverse maxillary expansion. Orthod Forum 2018; 14: 97-105)&lt;/b&gt;

Pharyngeal airway increases with LARS treatment for retrognathia

ObjectiveTo assess the lower pharyngeal airway sagittal width on lateral cephalograms before and after the use of a mandibular advancement device (MAD) on Class II patients and to compare the results to a control group of non-treated Class II individuals.MethodsAll patients were Class II, ranging in age from 9 to 12 years. They were all treated with a MAD, referred to as a ligated anterior repositioning splint, which was fixed in the mouth for full-time wear. Measurements of the lower pharyngeal airway were made on before- and after-treatment cephalograms. A control group of Class II patients of similar age were selected from several growth studies, and comparisons were made.ResultsA significant increase (p < .01) resulted from the treatment group; there was no change from the controls.ConclusionThese findings support the effectiveness of a MAD to increase the lower pharyngeal airway in growing Class II patients.

Airway dimensions from fetal life to adolescence-A literature overview.

Data on airway dimensions in pediatric patients are important for proper selection of pediatric airway equipment such as endotracheal tubes, double-lumen tubes, bronchial blockers, or stents. The aim of the present work was to provide a synopsis of the available data on pediatric airway dimensions. A systematic literature search was carried out in the PubMed database, Scopus, Embase, Web of Science, Prisma, and Google Scholar and secondarily completed by a reference search. Based on inclusion and exclusion criteria, a final selection of 109 studies with data on pediatric airway dimensions published from 1923 to 2018 were further analyzed. Six different airway measurement methods were identified. They included anatomical examinations, chest X-ray, computed tomography, magnetic resonance tomography, bronchoscopy, and ultrasound. Anatomical studies were more abundant compared to other methods. Data provided were very heterogeneously presented and powered. In addition, due to different study conditions, they are hardly comparable. Among all, anatomical and computer tomography studies are thought to provide the most reliable data. Ultrasound is an upcoming technique to estimate airway parameters of fetus and premature infants. There was, in general, a lack of comprehensive studies providing a complete range of airway dimensions in larger groups of patients from birth to adolescence. This work revealed a large heterogeneity of studies providing data on pediatric airway dimensions, making it impossible to compare, or assemble them to normograms for clinical use. Comprehensive studies in large population of children are needed to provide full range nomograms on pediatric airway dimensions.