Anterior Soft Tissue Thickness Research Articles

Validation of anterior ankle soft tissue dynamics and shear modulus for anterior ankle impingement syndrome after ankle fracture surgery

Anterior ankle impingement syndrome (AAIS) has been reported to account for a high percentage of complications following ankle fracture surgery. The soft tissue etiology of AAIS is thought to be thickening and inflammation of the anterior ankle soft tissues intervening anteriorly at the tibiotalar joint, causing pain and functional limitation during dorsiflexion. However, the effects of anterior ankle soft tissue dynamics and stiffness on AAIS have yet to be clarified. This study aimed to determine the relationship between AAIS and the anterior ankle soft tissue thickness change ratio and shear modulus using ultrasonography (US). The participants were 20 patients with ankle joint fractures (AO classification A, B) who had undergone open reduction and internal fixation and 20 healthy adults. The evaluation periods were 3 months and 6 months postoperatively. US was used to delineate the tibialis anterior tendon, extensor hallucis longus tendon, and the extensor digitorum longus tendon over the talus and tibia on a long-axis image. Anterior ankle soft tissue thickness was measured as the shortest distance from the most convex part of the talus to the tendon directly above it. The Anterior ankle soft tissue thickness change ratio was determined by dividing the value at 0° dorsiflexion by the value at 10° plantarflexion. The same images as for the anterior soft tissue thickness measurement were drawn for the shear modulus measurement, and the average shear modulus (kPa) was calculated using shear-wave elastography. There was no significant difference in the thickness change ratio between the postoperative and healthy groups. Compared with the healthy group, the shear modulus was significantly higher at 3 and 6 months in the postoperative group (p < 0.01). The shear elastic modulus at 6-month postoperative group was significantly lower than at 3-month postoperative group (p < 0.01). Anterior ankle joint soft tissue stiffness may increase after surgery for an ankle fracture.

USG guided indices as a tool for prediction of difficult airway in obese: an observational study

Background: Now a days, Ultrasound has been the gold standard and an invaluable tool in the field of regional anaesthesia, especially for upper limb and truncal blocks where general anesthesia is associated with high risk and also in patients posted for general anesthesia with anticipated difficult airway. Recently, few studies have published the importance of Ultrasound in the evaluation of airway and related procedures. Aim of this study is to evaluate the use of USG guided indices for prediction of difficult airway in obese patients and correlating them with clinical parameters. Methods: This study was a prospective observational study done in a tertiary health care center, Government General hospital, Kakinada over a duration of two months from August 2022 to September 2022. Eight Ultrasound parameters like tongue thickness, skin to hyoid distance, pre-epiglottic space, skin to midpoint of vocal cords, skin to thyroid isthmus, anterior soft tissue thickness at suprasternal notch, hyomental distance and thyromental distance were correlated with clinical evaluation (Cormacke-lehane grading) in this study and conclusions were drawn. Results: Out of 30 cases studied, 20 (70%) were predicted to be difficult with Ultrasound airway examination and 16 (53.3%) were found to have difficulty in intubation clinically. Conclusions: The following USG indices like pre-epiglottic space, Skin to midpoint of vocal cords, Anterior soft tissue thickness at Suprasternal notch, Hyomental distance in mid-extended position and thyromental distance were found to be clinically correlated to predict difficult airway and intubation in obese patients.

Anterior neck soft tissue thickness for airway evaluation measured by MRI in patients with cervical spondylosis: prospective cohort study

ObjectivesAnterior neck soft tissue thickness, usually measured by ultrasound, is increasingly being investigated to predict difficult laryngoscopy, but the results have not been validated. Considering the conflicting measurement data, different...

Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position.

Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I-II patients between 18 and 70years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029-0.016) cm, p < 0.001 and at level of vocal cords was - 0.012 (- 0.017 to - 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.

Analysis of anterior soft tissue thickness using ultrasonogram, body mass index and neck circumference in predicting difficult intubation

INTRODUCTION AIRWAY ASSESSMENT: The purpose of undertaking airway assessment is to diagnose the potential for difficult airway for: a. Optimal patient preparation b. Proper selection of equipment and technique, and c. Participation of personnel experienced in the difficult airway management. This usually leads to a successful airway management. On the other hand, determining that the airway is normal, avoids time consuming, invasive, and potentially more traumatic methods of securing the airway, from being adopted. The essential components of airway assessment are history taking, general examination of the patient and specific tests/indices to predict difficult airway. Previous anesthesia records may reveal a documented history of difficult airway. History of previous surgery, burns, trauma or tumor in and around the oral cavity, neck or cervical spine should be asked. A general examination of the patient should include recognition of anatomic factors that cause difficult laryngoscopy and intubation. This requires a disciplined, complete examination. The anesthesiologist must understand and identify pathologic and physiologic factors that may impair laryngoscopy and intubation. Carrying out assessment tests/indices of difficult airway should follow a general examination and if time permits, try to use more than one assessment method to increase the accuracy of airway assessment. DIFFICULT AIRWAY: Difficult airway clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficult tracheal intubation (or) both. ULTRASONAGRAM TO MEASURE THE PRETREACHEAL SOFT TISSUE THICKNESS: Patient shifted to ultrasongram room and measures the pretreacheal soft tissue thickness at three levels: 1. Vocal cords (Zone I), 2. Thyroid isthmus (Zone II), 3. Suprasternal notch (Zone III). NECK CIRCUMFERENCE: Measured in cm at the level of thyroid notch. BODY MASS INDEX: Body mass index is the body weight in kilograms over height in meters squared. AIM OF STUDY: The aim of the study is to analyse pretracheal soft tissue using ultrasonagram, body mass index and neck circumference in predicting intubation difficulties. METHODOLOGY: It was a prospective, double blinded study conducted in Department of Anaesthesiology, Madras Medical College-GGH. 200 adult patients satisfying inclusion criteria were enrolled in this study. Inclusion Criteria: 1. Elective adult surgical patient requiring general endotracheal anaesthesia. 2. Males and Females. 3. ASA Physical Status 1-2. 4. Age 18 years of age and older. 5. Who have given valid informed consent. Exclusion Criteria: The patients with following conditions are not included in this study. 1. Patients not satisfying inclusion criteria. 2. Patients requiring special techniques for intubation such as rapid sequence induction. 3. Patients intubated prior to surgery. 4. Patients with severe cardiovascular, hepatic or renal disease, mental illness. 5. Are unconscious or very severely ill. 6. Need for nasal intubation. Materials : 1. Macintosh laryngoscope - current standard Device. 2. High frequency (7.5mhz) Ultrasound machine. 3. Weighing machine calibrated to 1 Kg. 4. Measuring tape calibrated to 0.5 cm. 5. Goniometer. SUMMARY: This study was conducted in the Department of Anaesthesiology, Madras Medical College, Chennai-3. 200 patients were selected randomly and after taking history, airway assessment, anterior soft tissue thickness using ultrasound, Body mass index and neck circumference taken up for the study. After analysing the statistical data it is found that the anterior soft tissue thickness using ultrasound, Body mass index and neck circumference, significantly predicted the difficult intubation. CONCLUSION: It can be concluded that the anterior soft tissue thickness using ultrasound, Body mass index and Neck circumference, significantly predicted the difficult intubation and can be an important aid for the anaesthesiologist.

An Evaluation of Ultrasound Measurements of Anterior Neck Soft Tissue and Other Predictors of Difficult Laryngoscopy in Morbidly Obese Patients

Objective: The aim of this study was to compare the ultrasonography (USG) measurements of anterior neck soft tissue and other clinical screening tests used to evaluate difficult laryngoscopy in morbidly obese patients. Materials and Methods: A total of 130 morbidly obese patients were scheduled for laparoscopic bariatric surgery. USG examination was performed of the vocal cords, thyroid isthmus, and suprasternal notch. Results: Analysis was made of 74 patients. Difficult laryngoscopy was considered as grade 3 or 4 on the Cormack and Lehane scale. In seven (9.5%) patients the classification was made of difficult laryngoscopy. The incidence of difficult laryngoscopy was significantly higher in patients with older age, hypertension, and obstructive sleep apnea syndrome. Grades of ≥5 on the intubation difficulty scale, which is a requirement for a styleted endotracheal tube and a high number of intubation attempts, were found to be significantly higher in the difficult laryngoscopy group. Sternomental distances for difficult and easy laryngoscopy were 11.5 ± 3.75 and 14.18 ± 2.63 cm, respectively. Conclusion: USG measurements of the anterior soft tissue thickness of the neck remain debatable for the prediction of difficult laryngoscopy in the literature. The results of this study demonstrated that USG measurements of anterior neck soft tissue have no advantage in the determination of difficult laryngoscopy in morbidly obese patients scheduled for bariatric surgery.

Abstract PR183

Background & Objectives: The airway of preeclamptic women during the course of labour has yet to be studied. Therefore the aim of this study was to observe airway changes during labour and delivery in severely preeclamptic parturients as compared to normotensive parturients. Total fluids administered, IV oxytocin given and duration of labour were evaluated for their predictive value. Materials & Methods: A prospective observational study was conducted after obtaining approval from institutional ethical commitee. Twenty five severely preeclamptic and 25 normotensive women admitted to labour room for normal vaginal delivery were enrolled. Airway assessment was performed at three times, first at the time of admission to labour room before the patient went into active stage of labour (T1). Second assessment was done within one hour of delivery of the baby (T2), and the third assessment within 24–48 hours postpartum (T3). Each of these times, airway assessment was done using 2 methods. In method 1, Mallampati grade of each participant was recorded using digital photography and a class assigned later to each photograph by a blinded anaesthetist. In method 2, airway sonography was performed in the submandibular region to measure anteroposterior thickness of the tongue, anterior soft tissue thickness at the level of hyoid and vocal cords. Results: Method 1 depicted increase in Mallampati grade from prelabour to postlabour period in both preeclamptics and normotensives (p=0.001; p=0.002 respectively) The changes in Preeclamptics were significantly more as compared to Normotensives. In method 2, significant difference in anterior soft tissue thickness at the level of hyoid was observed between preeclamptics and normotensives, even before the parturient entered active stage of labour (p=0.035). This difference remained statistically significant post labour (p=0.05). A strong correlation was found between total duration of labour and Mallampati change by one grade (correlation coefficient 0.473). A stronger correlation between worsening in Mallampati grade and duration of labour was observed in preeclamptic women as compared to normotensive group (correlation coefficient 0.637versus 0.387 respectively)Conclusion: Our study showed that airway worsening during labour is seen more frequently in preeclamptic women than normotensive women. Prolonged labours cause greater susceptibility to airway changes, especially in preeclamptic women. Mallampati grading used in conjunction with airway ultrasonography aids in detecting a potentially difficult airway of a labouring parturient.

Anterior Pelvic Soft Tissue Thickness Influences Acetabular Cup Positioning with Imageless Navigation

The purpose of this study was to investigate acetabular component position after total hip arthroplasty correlating both version and inclination to anterior pelvic soft tissue thickness. Thirty patients with a mean age of 66.5 ± 14 (28-87) years and an average body mass index of 30.04 ± 4.6 were included. The same surgeon operated on all 30 patients, using an anterolateral approach in a supine position and an imageless navigation system. Postoperative assessment of cup inclination, cup anteversion, and soft tissue thickness was measured by an independent research associate using computed tomographic scans. Pearson's moment correlations did not reveal any significant relationships between body mass index, soft tissue thickness, final intraoperative, or postoperative cup position. Anterior soft tissue thickness had no significant effect on the accuracy of acetabular cup positioning.

Ultrasound Quantification of Anterior Soft Tissue Thickness Fails to Predict Difficult Laryngoscopy in Obese Patients

Morbid obesity is associated with difficult laryngoscopy and intubation. In the general population, bedside indices for predicting difficult intubation (i.e. Mallampati classification, thyromental distance, sternomental distance, mouth-opening and Wilson risk score) have poor-to-moderate sensitivity (20-62%) and moderate-to-fair specificity (82-97%). In the obese population, although the risk of difficult intubation after a positive Mallampati test is 34%, it is still not sufficient to be used as a single predictive test. An abundance of pretracheal soft tissue anterior to the vocal cords, as quantified by ultrasound, was a better predictor of difficult laryngoscopy than body mass index (BMI) in Israeli patients. Obesity is a growing problem in the United States: therefore we sought to confirm this finding in the obese population in the United States. We used ultrasound to quantify the neck soft tissue, from the skin to the anterior aspect of the trachea at the vocal cords, in 64 obese patients (BMI > 35). We assessed thyromental distance, mouth-opening, jaw movement, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference, confirmed obstructive sleep apnoea, BMI, age, race and gender as predictors. Twenty patients were classified as difficult laryngoscopy; they were older (47 +/- 9 vs 42 +/- 1 years; P = 0.048; mean +/- SD) and had less soft pretracheal tissue (20.4 +/- 3.0 vs 22.3 +/- 3.8 mm; P = 0.049) than did easy laryngoscopy patients. Multivariate regression indicated that none of the factors was an independent predictor of difficult laryngoscopy. We conclude that the thickness of pretracheal soft tissue at the level of the vocal cords is not a good predictor of difficult laryngoscopy in obese patients in the United States.

Ultrasound quantification of anterior soft tissue thickness fails to predict difficult laryngoscopy in obese patients

Ultrasound quantification of anterior soft tissue thickness fails to predict difficult laryngoscopy in obese patients