Conventional Facemask Research Articles

Use of Proseal, as an alternative to conventional facemask, to facilitate ventilation in anticipated difficult mask ventilation

Use of Proseal, as an alternative to conventional facemask, to facilitate ventilation in anticipated difficult mask ventilation

Effects of modified and conventional facemask therapies with expansion on dynamic measurement of natural head position in Class III patients

The aim of this prospective clinical trial was to assess the effects of varying force directions on the dynamic measurement of natural head position and orofacial airway dimensions of Class III patients during maxillary orthopedic protraction compared with an untreated control group. The conventional facemask group comprised 15 patients (8 girls, 7 boys; mean age, 9.6 ± 1.3 years), the modified facemask group comprised 15 patients (7 girls, 8 boys; mean age, 9.5 ± 1.5 years), and the control group comprised 15 subjects (7 girls, 8 boys; mean age, 9.8 ± 1.6 years). Natural head position measurements and cephalometric records were obtained from all subjects before and after treatment or the control period (approximately 1 year). An inclinometer and a portable data logger were used to collect the dynamic natural head position data. For statistical comparisons, paired samples t tests, analysis of variance (ANOVA), and post-hoc Tukey tests were used at the P <0.05 level. Both treatment groups showed statistically significant changes in the sagittal (pitch) measurements of natural head position and upper pharynx, aerial, and total area of airway measurements during the treatment period. In the control group, the only statistically significant change was an increased upper pharynx measurement (P = 0.020). According to the intergroup comparisons, statistically significant natural head position differences were found in the conventional (6.4° flexion) and the modified (5.7° flexion) facemask groups when compared with the controls. The modified facemask group also showed significant changes in aerial (P = 0.003) and total (P <0.001) areas of the airway measurements compared with the control group. No statistically significant differences were observed between the 2 treatment groups. These findings suggest that modified and conventional facemask therapy with expansion have significant cranial flexion effects on the dynamic measurements of natural head position. Additionally, the modified facemask procedure showed significant effects on the orofacial airway dimensions compared with the initial values and the values of the untreated controls.

Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational study

PurposeThe purpose of this study was to determine the impact of high-flow nasal cannula oxygen (HFNC) on patients with acute respiratory failure (ARF) in comparison with conventional oxygen therapy. Materials and MethodsThis was a prospective observational study. Patients with persistent ARF despite oxygen with conventional facemask without indication for immediate intubation were treated with HFNC oxygen. Clinical respiratory parameters and arterial blood gases were compared under conventional and HFNC oxygen therapy. ResultsTwenty patients, aged 59 years (38-75 years) and SAPS2 (simplified acute physiology score) 33 (26.5-38), were included in the study. Etiology of ARF was mainly pneumonia (n = 11), sepsis (n = 3), and miscellaneous (n = 6). Use of HFNC enabled a significant reduction of respiratory rate, 28 (26-33) vs 24.5 (23-28.5) breath per minute (P = .006), and a significant increase in oxygen saturation, oxygen saturation as measured by pulse oximetry 93.5% (90-98.5) vs 98.5% (95.5-100) (P = .0003). Use of HFNC significantly increased Pao2 from 8.73 (7.13-11.13) to 15.27 (9.66-25.6) kPa (P = .001) and moderately increased Paco2, 5.26 (4.33-5.66) to 5.73 (4.8-6.2) kPa (P = .005) without affecting pH. Median duration of HFNC was 26.5 (17-121) hours. Six patients were secondarily intubated, and 3 died in the intensive care unit. ConclusionUse of HFNC in patients with persistent ARF was associated with significant and sustained improvement of both clinical and biologic parameters.

Comparative evaluation of maxillary protraction with or without skeletal anchorage

The aim of this prospective clinical study was to evaluate the skeletal, dentoalveolar, and soft-tissue effects of maxillary protraction with miniplates compared with conventional facemask therapy and an untreated Class III control group. Forty-five subjects who were in prepubertal or pubertal skeletal growth periods were included in the study and divided into 3 groups of 15 patients each. All subjects had skeletal and dental Class III malocclusions with maxillary deficiency, vertically normal growth pattern, anterior crossbite, Angle Class III molar relationship, normal or increased overbite, and retrusive nasomaxillary complex. Before maxillary protraction, rapid maxillary expansion with a bonded appliance was performed in both treatment groups. In the first group (MP+FM), consisting of 5 girls and 10 boys (mean age, 10.91 years), facemasks were applied from 2 titanium miniplates surgically placed laterally to the apertura piriformis regions of the maxilla. The second group (FM) of 7 girls and 8 boys (mean age, 10.31 years) received maxillary protraction therapy with conventional facemasks applied from hooks of the rapid maxillary expansion appliance. The third group of 8 girls and 7 boys (mean age, 10.05 years) was the untreated control group. Lateral cephalometric films were obtained at the beginning and end of treatment or observation in all groups and analyzed according to a structural superimposition method. Measurements were evaulated statistically with Wilcoxon and Kruskal-Wallis tests. Treatment periods were 6.78 and 9.45 months in the MP+FM and FM groups, respectively, and the observation period in the control group was 7.59 months. The differences were significant between the 3 groups (P <0.05) and the MP+FM and FM groups (P <0.001). The maxilla moved forward for 2.3 mm in the MP+FM group and 1.83 mm in the FM group with maxillary protraction. The difference was significant between 2 groups (P <0.001). The protraction rates were 0.45 mm per month in the MP+FM group and 0.24 mm per month in the FM group (P <0.001). The maxilla showed anterior rotation after facemask therapy in the FM group (P <0.01); there was no significant rotation in the MP+FM group. Posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the MP+FM group (P <0.01). Both the maxilla and the mandible moved forward significantly in the control group. Protrusion and mesialization of the maxillary teeth in the FM group were eliminated in the MP+FM group. The maxillomandibular relationships and the soft-tissue profile were improved remarkably in both treatment groups. The undesired effects of conventional facemask therapy were reduced or eliminated with miniplate anchorage, and efficient maxillary protraction was achieved in a shorter treatment period.

Effect of modified and conventional facemask therapy on condylar position in Class III patients

To assess the effects of varying force direction of maxillary orthopedic protraction on mandibular condylar position. The conventional facemask group (Group 1) comprised 22 patients, 11 girls, and 11 boys (mean age: 9.3 ± 1.3 years); the modified facemask group (Group 2) comprised 22 patients, 12 girls, and 10 boys (mean age: 9.4 ± 1.5 years); and the control group (Group 3) comprised 21 subjects, 11 girls, and 10 boys (mean age: 9.8 ± 1.9 years). Changes in mandibular position indicator (MPI ®) measurements of the SAM ® 3 articulator were evaluated. Treatment and control changes within groups and between groups were analyzed statistically. Intra-group comparisons were tested with the non-parametric Wilcoxon's test and inter-group changes with Kruskal-Wallis. The statistical significance of inter-group differences was further assessed with the Mann-Whitney test for independent samples with Bonferroni's correction. Antero-posterior positional changes of the left condyle were found higher in the controls than in Group 1 (p<0.016). Superior-inferior positional changes of the left condyle were also found significantly higher in controls than in Group 2 (p<0.016). No other significant changes in condylar position were determined in either group. In the treatment groups, asymmetrical condylar position diminished and became symmetrical with treatment in the antero-posterior direction (Group 1: 13.64%, Group 2: 36.37%) plane. In controls, the antero-posterior change of asymmetry was smaller (antero-posterior change: 7.60%). These findings generally suggest that modified and conventional facemask therapy with expansion had no adverse effects on the temporomandibular and masticatory system.

Are Oxygen Uptake Kinetics Modified When Using a Respiratory Snorkel?

The aim of this study was to compare VO2 kinetics during constant power cycle exercise measured using a conventional facemask (CM) or a respiratory snorkel (RS) designed for breath-by-breath analysis in swimming. VO2 kinetics parameters-obtained using CM or RS, in randomized counterbalanced order-were compared in 10 trained triathletes performing two submaximal heavy-intensity cycling square-wave transitions. These VO2 kinetics parameters (ie, time delay: td1, td2; time constant: τ1, τ2; amplitude: A1, A2, for the primary phase and slow component, respectively) were modeled using a double exponential function. In the case of the RS data, this model incorporated an individually determined snorkel delay (ISD). Only td1 (8.9 ± 3.0 vs 13.8 ± 1.8 s, P < .01) differed between CM and RS, whereas all other parameters were not different (τ1 = 24.7 ± 7.6 vs 21.1 ± 6.3 s; A1 = 39.4 ± 5.3 vs 36.8 ± 5.1 mL x min(-1) x kg(-1); td2 = 107.5 ± 87.4 vs 183.5 ± 75.9 s; A2' (relevant slow component amplitude) = 2.6 ± 2.4 vs 3.1 ± 2.6 mL x min(-1) x kg(-1) for CM and RS, respectively). Although there can be a small mixture of breaths allowed by the volume of the snorkel in the transition to exercise, this does not appear to significantly influence the results. Therefore, given the use of an ISD, the RS is a valid instrument for the determination of VO2 kinetics within submaximal exercise.

Effects of conventional and modified facemask therapies on dentofacial structures

Objective: The purpose of this prospective study was to evaluate the dentofacial effects of conventional and modified facemask therapies with rapid maxillary expansion, in a group of Class III patients; and compared with an untreated control group. Methods: The conventional facemask group (Group 1) comprised of 24 patients, 13 girls and 11 boys (mean age, 9.2 ± 1.4 years); the modified facemask treatment group (Group 2) comprised of 24 patients, 12 girls and 12 boys (mean age, 9.3 ± 1.6 years); and the control group (Group 3) comprised of 21 subjects, 11 girls and 10 boys (mean age, 9.8 ± 1.9 years). Treatment and control changes within the groups and the differences between the groups were analyzed statistically. Intra-group comparisons were evaluated using the non-parametric Wilcoxons test and intergroup changes were analyzed using the Kruskal-Wallis test. The statistical significance of intergroup differences was further assessed with the Mann-Whitney test for independent samples and applying Bonferronis correction (p ＜ 0.016). Results: In group 1, SNB changes were less than the control. There were increases in SNA, ANB, SN-MP, A to N perp and Upper lip to E plane. In group 2, SNB, U1-NA (mm) U1-NA (o) and Pog to N perp (mm) changes were less than the control. There were increases in SNA, ANB, SN-MP, A to N perp and Upper lip to E plane. Conclusions: Modified facemask appliance can be used effectively in Class III patients with a retrognathic maxilla. Facemask therapies with expansion resulted in an anterior advancement and translation of maxilla without rotation; and the mandible moved downward and backward in both treatment groups. (Korean J Orthod 2010;40(6):432-443)

SU-FF-T-25: A Modified Azakawa Technique for Total Scalp and Neck Irradiation Utilizing a Custom Wax Bolus

Purpose: To develop a durable custom bolus helmet for Total Scalp and Neck Irradiation and to quantify the dosimetric aspects using a Modified Azakawa Technique for treatment delivery. Method and Materials: A custom bolus helmet for total scalp and neck treatment was fabricated from dental wax overlaid on a dual exoskeleton of Med Tech™ face mask mesh that conformed to the patients head. With helmet on, the patient was immobilized with a conventional facemask. Following CT simulation, treatment planning was performed in ADAC™ Pinnacle 3 planning system in heterogeneous mode for the combined photon and electron treatment fields. Opposed photons fields (6x) treat the sagital scalp and posterior neck; lateral scalps are treated with en face electrons that overlap the photon fields by 3–4 mm. Lateral necks were treated with en face electron fields that abutted the electron scalp fields. Beam central axes were kept coincident to provide ease of setup for the 6 customized ports. After half of the dose was delivered all field junctions were “feathered” by altering the junction locations by about 1 cm. A diode with 2mm build‐up was calibrated as a point detector to validate the dosimetry at multiple patient points. Results: Compared to the maximum dose of the prescription, the measured doses typically ranged from −5% to +15%; a single point yielded +20% at a photon and electron junction. Conclusion: The wax helmet proved to be extremely durable for more than 30 fractions. Additionally, the helmet provided “instant bolus” easily accommodated by the patient, appreciated by the RTT staff, and aided in reproducible dosimetry for this challenging treatment site.

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

To compare infants' discomfort, nursing-time and caregiver preference, and assess the clinical efficiency (as a secondary outcome) of hood versus facemask nebulization in infants with evolving bronchopulmonary dysplasia (BPD) in the neonatal intensive care unit. A prospective, open, randomized, controlled crossover clinical trial. In total, 10 infants with BPD who were on inhaled beta-agonist bronchodilators and corticosteroids were randomly assigned to receive their nebulized treatments either by a facemask, or by a hood for 2-3 days, and then crossover to receive the same treatments with the other technique for another 2-3 days. Infants' discomfort, nursing-time, caregiver preference and clinical efficiency were compared. At baseline there was no significant clinical difference between the groups. Nurse-time required for administering the hood nebulization (mean+/-s.e.m.: 1.9+/-0.1 min) was significantly shorter than the time for mask nebulization (12.0+/-0.6 min, P<0.0001). Infants' discomfort score was significantly lower (0.1+/-0.04) for hood versus mask nebulization (2.5+/-0.2, P<0.0001). Nurses and parents unequivocally preferred the hood treatment. During both mask and hood nebulization therapies (2-3 days) clinical efficiency was comparable. While both methods caused an immediate (20 min post) clinical improvement, the immediate respiratory assessment change score was significantly greater for the hood versus the mask nebulization (0.62+/-0.27 versus 0.13+/-0.14, P<0.05). Nebulization of aerosolized medications in infants with evolving BPD by hood was less time-consuming for caregivers and was much better tolerated by the infants while being at least as effective as the conventional facemask nebulization.

Skeletal stability after correction of maxillary hypoplasia by the Glasgow extra-oral distraction (GED) device

Maxillary distraction osteogenesis delivers excellent results, particularly in patients with clefts. In the past, devices such as the conventional facemask and the rigid external distraction device have been used to correct maxillary hypoplasia after a Le Fort I osteotomy. We describe a new device, the Glasgow extra-oral distraction device. The extent of skeletal and dental stability of corrections achieved in 10 patients with maxillary hypoplasia associated with clefts was satisfactory. This device costs little, can be produced in developing countries, and provides effective treatment for severe secondary deformity associated with clefts.

Comparison of conventional facemask ventilation with nasal mask ventilation after induction of anaesthesia

Comparison of conventional facemask ventilation with nasal mask ventilation after induction of anaesthesia

A tube in the pharynx for emergency ventilation

If the endotracheal placement of a nasal advanced tube fails, ventilation via this tube could bridge the time until a fibreoptic bronchoscope is available. This study investigates the efficiency of ventilation via a tube resting with its tip in the pharynx near the glottis. In 20 patients respiratory data during ventilation via a pharyngeally placed tube were recorded by means of pulse oximetry, capnometry and side-stream spirometry. Results were compared with those measured previously in the same patients during conventional facemask ventilation. Oxygen saturation and end-tidal carbon dioxide concentration remained unchanged using ventilation via facemask (SO2 98.5 +/- 0.9%, FECO2 4.5 +/- 0.7 vol%) or pharyngeal tube (SO2 98.6 +/- 0.7%, FECO2 4.8 +/- 0.4 vol%). No significant differences were found between the two groups with regard to peak airway pressure, tidal volume leakage, compliance and resistance of the respiratory system. Our results suggest an effective ventilation and oxygenation via a tube placed with its tip in the pharynx. This technique may be helpful during difficult and prolonged nasal intubation.