Change Of Minimal Cross-sectional Area Research Articles

Effect of maxillary expansion and protraction on the oropharyngeal airway in individuals with non-syndromic cleft palate with or without cleft lip.

IntroductionThe aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L).MethodsCBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 8 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison.ResultsThere was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group.ConclusionThe findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.

Upper Lateral Strut Graft: A Technique to Improve the Internal Nasal Valve

Internal nasal valve (INV) collapse can contribute significantly to nasal obstruction and may be caused by upper lateral cartilage (ULC) collapse medially or laterally. Surgical techniques addressing INV collapse have focused more on treating the narrowed INV angle, with less consideration of the lateral INV area. This article describes a technique to improve INV patency both medially and laterally. This study analyzes the changes in minimal cross-sectional area (MCA) at the INV after graft placement and determines whether these changes are significantly different for normal versus narrow INVs. Noses of six fixed cadavers were dissected by open rhinoplasty to release the ULCs from the septum. Upper lateral strut grafts were placed through subperichondrial pockets along the ULC undersurfaces and out over the piriform apertures into subperiosteal pockets. Grafts were secured to the dorsal septum. Acoustic rhinometry and nasal endoscopy were used to classify INVs before graft placement as narrow or normal and to assess changes at the INV after graft placement. Mean pregraft MCA was 0.58 cm(2). Mean MCA percent increase after graft placement was 22%. By INV type, percent increases were 51% for narrow INVs and 1% for normal INVs. Mean increases in MCA after graft placement were statistically significant for the entire group and for narrow INVs, with increases of 0.10 cm(2) (p = 0.03) and 0.22 cm(2) (p = 0.004), respectively. The upper lateral strut graft improved patency of cadaveric INVs, with statistically significant increases in the MCA most notable when placed for narrow INVs.

Nonspecific Hyper‐reactivity and Localized Allergy: Cause of Discrepancy Between Skin Prick and Nasal Provocation Test

Disagreement between results of skin prick test (SPT) and nasal provocation tests (NPT) causes difficulty in differential diagnosis of allergic rhinitis (AR) and nonallergic rhinitis (NAR). We hypothesized this discrepancy could be due to the nonspecific hyper-reactivity (NHR) and localized allergy of the nasal cavity. Prospective pilot. Academic tertiary rhinologic practice. Sixty patients with AR and 62 with NAR were enrolled. We categorized patients according to results of SPT and NPT. We compared: (1) the clinical characteristics and severity of the disease, (2) change of minimal cross-sectional area (MCA) and total nasal volume (TNV) after normal saline (NS) challenge, and (3) change of nasal symptoms and acoustic parameters after intranasal house dust mite (HDM) challenge between groups. Patients in groups A (SPT[+]/NPT[+]) and C (SPT[-]/NPT[+]) complained of more persistent discomfort than those in groups B (SPT[+]/NPT[-]) and D (SPT[-]/NPT[-]). The proportion of moderate to severe symptoms was significantly higher in groups A, B, and C compared to group D. After NS challenge, MCA/TNV showed a significantly greater decrease in groups A (MCA: 27.6% ± 21.3%, TNV: 24.6% ± 16.4%) and C (MCA: 31.2% ± 24.0%, TNV: 24.1% ± 23.4%) compared to groups B (MCA: 0.1% ± 13.2%, TNV: 3.9% ± 13.5%) and D (MCA: 2.1% ± 12.1%, TNV: 2.0% ± 17.2%) (P < .05). After HDM challenge, groups A/B showed a greater decrease in MCA (Group A: 62.4% ± 16.1%, Group B: 6.4% ± 11.3%) compared to groups C/D (Group C: 45.5% ± 14.4%, Group D: -3.0% ± 9.5%). NHR and/or localized allergy should be considered in patients with rhinitis whose SPT and NPT results are not in agreement.

Upper Airway Anatomical Changes after Velopharyngeal Surgery in Obstructive Sleep Apnea Patients with Small Tonsils

To evaluate the relationships between anatomical changes and treatment outcomes after velopharyngeal surgery in obstructive sleep apnea (OSA) patients with small tonsils (grade 0-2 on the Brodsky scale). Case series with planned data collection. University medical center. Thirty-six OSA patients with small tonsils underwent velopharyngeal surgery including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. Pre- and postoperative upper airway 3-dimensional computed tomography and polysomnography findings were obtained for comparison and analysis. The overall apnea hypopnea index (AHI) decreased from 56.8 (interquartile range, 37.5-70.1) preoperatively to 16.1 (10.8-33.5) postoperatively (P < .001). The change in minimal cross-sectional area of the velopharynx (VmCSA) was independently associated with the change in AHI (P = .001, R (2) = 0.271). Preoperative VmCSA was the only preoperative anatomical variable that was an independent predictor of change in VmCSA (P = .009, R (2) = 0.184). Postoperative VmCSA was independently associated with postoperative AHI (P < .001, R (2) = 0.341). In patients with small tonsils, an adequate increase in VmCSA is associated with a successful outcome after surgery. Patients with a relatively small preoperative VmCSA are more likely to have favorable anatomical changes after surgery.

Velopharyngeal Surgery for Patients with Small Tonsils

Objective: To explore the relationship between anatomical changes and treatment response in obstructive sleep apnea (OSA) patients with small tonsils (tonsil grades 0-2 according to Friedman staging system) after velopharyngeal surgery. Method: Thirty-six patients with small tonsils underwent velopharyngeal surgery that consisted of revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) and concomitant transpalatal advancement pharyngoplasty, 3-dimensional CT of upper airway, and polysomnography performed before and after surgery were obtained for comparison and analysis. Results: Overall apnea-hypopnea index (AHI) decreased from 56.8 (37.5, 70.1) to 16.1 (10.8, 33.5) ( P &lt; .001) after surgery. The changes of several anatomical parameters differed significantly between responders and non-responders ( P &lt; .05), and the change of minimal cross-sectional area of velopharynx (VmCSA) was independently predictive of the change of AHI ( P &lt; .001, r2 = 0.271). The correlation analysis showed that the change of VmCSA significantly correlated with preoperative VmCSA ( r = −0.383, P = .021). Conclusion: In patients with small tonsils an increase in VmCSA is related to a good surgical response, and such patients who have a relatively smaller preoperative VmCSA are more likely to get favorable anatomical changes.

Use of Porous High-Density Polyethylene (Medpor) for Spreader or Extended Septal Graft in Rhinoplasty

In this study, 29 patients with porous high-density polyethylene (group A) and 29 patients with septal cartilage (group B) were enrolled for either spreader or extended septal graft. By questionnaire or telephone survey, the authors evaluated patients' cosmetic satisfaction and complications. The authors also used postoperative photographs to evaluate cosmetic results. For the functional analysis, the change of visual analog scale of nasal obstruction and change of minimal cross-sectional area using acoustic rhinometry were compared. Of 29 patients in group A, 27 were totally satisfied with the results. There was no complication except for 2 cases of extrusion during 5.3 ± 1.8 years. The patients in group A showed more decrease of nasal obstruction by visual analog scale and more improvement of minimal cross-sectional area as compared with those in group B. Therefore, porous high-density polyethylene is an ideal alloplastic material for spreader or extended septal graft in rhinoplasty in both cosmetic and functional aspects. And it is also safe and stable over a long-term period.

Anatomical and functional changes in the upper airways of sleep apnea patients due to mandibular repositioning: A large scale study

The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a sleep related breathing disorder. A popular treatment is the use of a mandibular repositioning appliance (MRA) which advances the mandibula during the sleep and decreases the collapsibility of the upper airway. The success rate of such a device is, however, limited and very variable within a population of patients. Previous studies using computational fluid dynamics have shown that there is a decrease in upper airway resistance in patients who improve clinically due to an MRA. In this article, correlations between patient-specific anatomical and functional parameters are studied to examine how MRA induced biomechanical changes will have an impact on the upper airway resistance. Low-dose computed tomography (CT) scans are made from 143 patients suffering from OSAHS. A baseline scan and a scan after mandibular repositioning (MR) are performed in order to study variations in parameters. It is found that MR using a simulation bite is able to induce resistance changes by changing the pharyngeal lumen. The change in minimal cross-sectional area is the best parameter to predict the change in upper airway resistance. Looking at baseline values, the ideal patients for MR induced resistance decrease seem to be women with short airways, high initial resistance and no baseline occlusion.

Clinical Characteristics and Therapeutic Outcomes of Patients with Localized Mucosal Allergy

Many researchers have focused on the definition and pathophysiology of localized mucosal allergy. However, there are few studies on its clinical characteristics and therapeutic outcomes. The goal of this study was to analyze the prevalence, epidemiology, clinical characteristics, and response to antiallergic medication of localized mucosal allergy patients compared with those in patients with allergic rhinitis. Among 836 patients suspected to have rhinitis, 29 patients with localized mucosal allergy (group A) and 29 patients with allergic rhinitis (group B) were selected. Medical history, family history, symptoms, and their severity were obtained using a questionnaire. The change in minimal cross-sectional area (MCA) after provocation was measured by acoustic rhinometry. After 2 weeks of antihistamine medication, the changes in symptoms were compared between groups. The prevalence of localized mucosal allergy was approximately 3.5%. There were no differences in patient history, symptoms, or symptom severity. The decrease in MCA after provocation was not significantly different. After two weeks of oral antihistamine (ebastine 10 mg once daily), group A reported significantly less symptom improvement than group B. Because patient or family history and clinical picture are very similar in localized mucosal allergy and allergic rhinitis, clinicians should take more care in differentiating them. Based on the reduced effectiveness of an oral antihistamine alone, a combined regimen of oral and topical antihistamine or anti-inflammatory medication is recommended for patients with localized mucosal allergy.

Effects of urokinase and heparin on minimal cross-sectional area of the culprit narrowing in unstable angina pectoris

The immediate and delayed effects of urokinase and heparin on minimal cross-sectional area of a patent ischemia-producing coronary artery were prospectively investigated in 43 patients with unstable angina. After baseline angiography, patients were randomized to 3 different treatment groups: group I — urokinase (1,000,000 U intravenous bolus dose), followed by heparin infusion 3 hours later; group II — heparin (10,000 U intravenous bolus, followed by continuous infusion); and group III — conventional therapy only (intravenous nitroglycerin, β Mockers and calcium antagonists). Angiography was repeated at 1 hour and at 8 days of treatment and minimal cross-sectional area was determined in the 35 patients who completed the study. In group I, minimal cross-sectional area increased from 0.84 ± 0.48 mm 2 at baseline to 0.94 ± 0.49 mm 2 at 1 hour (p < 0.05), and to 1.00 ± 0.51 mm 2 at 8 days (p < 0.01 vs baseline). In group II, a significant increase in minimal cross-sectional area was observed only at the 8-day angiography (0.64 ± 0.39 mm 2 at baseline; 0.67 ± 0.37 mm 2 at 1 hour [p = not significant]; and 0.79 ± 0.48 mm 2 at 8 days [p < 0.01] vs baseline). In group III, no significant changes in minimal cross-sectional area occurred either at 1 hour or at 8 days. Thus, both urokinase and heparin improved lesion geometry in patients with unstable angina, although a large individual variation was noticed. The effect occurred earlier with urokinase than with heparin.

Changes in cross-sectional area of the coronary lumen in the six months after angioplasty: a quantitative analysis of the variable response to percutaneous transluminal angioplasty.

Although immediate and late changes in coronary stenoses after percutaneous transluminal coronary angioplasty (PTCA) have been reported, most investigators have employed qualitative or semiquantitative techniques to analyze the angiograms. Such data is not optimal because of considerable interobserver variability and the use of relative instead of absolute changes in lesion geometry. Analysis is further compounded by the indistinct edges that characterize coronary lesions immediately after angioplasty. To quantify the changes in minimal cross-sectional area (MCSA) of the coronary lumen that occur during and after PTCA, we analyzed the angiograms of 23 patients before PTCA, immediately after PTCA, and at 7.2 +/- 3.0 (mean +/- SD) months follow-up using two computer-assisted methods of angiographic analysis--quantitative coronary angiography (QCA) and videodensitometry (VID). QCA provides an absolute measure of the area of the lumen; VID is a nongeometric method that is not dependent on exact border recognition. Based on these quantitative methods, we found that successful angioplasty is associated with about a three-fold increase in the MCSA of the lesion (from 1.0 to 3.2 mm2). This area is, however, well below normal and is less than half of the average MCSA of the inflated dilating balloon. Analysis of follow-up angiograms demonstrated that eight of 23 patients had a substantial late increase in the MCSA of the lesion (from 2.7 to 4.1 mm2) after the angioplasty procedure. Clinical, hemodynamic, and angiographic characteristics immediately after PTCA were not predictive of MCSA of the lumen at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)