Degree Of Upper Airway Obstruction Research Articles

Feasibility of neck electrical impedance tomography to monitor upper airway dynamics during sleep

BackgroundThere is a lack of non-invasive methods for monitoring the upper airway patency during sleep. Electrical impedance tomography (EIT) is a non-invasive, radiation-free tool that has been validated to monitor lung ventilation. We hypothesized that electrical impedance tomography (EIT) can be used for monitoring upper airway patency during sleep.MethodsSleep was induced in 21 subjects (14 males, age 43 ± 13 years, body mass index 32.0 ± 5.3 kg/m2) with suspected obstructive sleep apnea (apnea-hypopnea index: 44 ± 37 events/h, range: 1–122 events/h) using low doses of midazolam. Patients wore a nasal mask attached to a modified CPAP device, allowing variable and controlled degrees of upper airway obstruction. Confirmation of upper airway patency was obtained with direct visualization of the upper airway using nasofibroscopy (n = 6). The changes in total neck impedance and in impedance in four cranio-caudal regions of interest (ROIs) were analyzed.ResultsTotal neck impedance varied in concert with breathing cycles and peaked during expiration in all patients. Group data showed a high cross-correlation between flow and impedance curves (r = −0.817, p < 0.001). Inspiratory peak flow correlated with simultaneous neck impedance (r = 0.866, p < 0.001). There was a high correlation between total neck impedance and velopharynx area (r = 0.884, p < 0.001), and total neck impedance and oropharynx area (r = 0.891, p < 0.001).ConclusionsNeck EIT is sensitive and captures pharyngeal obstruction under various conditions. Neck EIT is a promising method for real-time monitoring of the pharynx during sleep.

Ventilatory Burden as a Measure of Obstructive Sleep Apnea Severity Is Predictive of Cardiovascular and All-Cause Mortality.

Rationale: The apnea-hypopnea index (AHI), used for the diagnosis of obstructive sleep apnea, captures only the frequency of respiratory events and has demonstrable limitations. Objectives: We propose a novel automated measure, termed "ventilatory burden" (VB), that represents the proportion of overnight breaths with less than 50% normalized amplitude, and we show its ability to overcome limitations of AHI. Methods: Data from two epidemiological cohorts (EPISONO [Sao Paolo Epidemiological Study] and SHHS [Sleep Heart Health Study]) and two retrospective clinical cohorts (DAYFUN; New York University Center for Brain Health) were used in this study to 1) derive the normative range of VB, 2) assess the relationship between degree of upper airway obstruction and VB, and 3) assess the relationship between VB and all-cause and cardiovascular disease (CVD) mortality with and without hypoxic burden that was derived using an in-house automated algorithm. Measurements and Main Results: The 95th percentiles of VB in asymptomatic healthy subjects across the EPISONO and the DAYFUN cohorts were 25.2% and 26.7%, respectively (median [interquartile range], VBEPISONO, 5.5 [3.5-9.7]%; VBDAYFUN, 9.8 [6.4-15.6]%). VB was associated with the degree of upper airway obstruction in a dose-response manner (VBuntreated, 31.6 [27.1]%; VBtreated, 7.2 [4.7]%; VBsuboptimally treated, 17.6 [18.7]%; VBoff-treatment, 41.6 [18.1]%) and exhibited low night-to-night variability (intraclass correlation coefficient [2,1], 0.89). VB was predictive of all-cause and CVD mortality in the SHHS cohort before and after adjusting for covariates including hypoxic burden. Although AHI was predictive of all-cause mortality, it was not associated with CVD mortality in the SHHS cohort. Conclusions: Automated VB can effectively assess obstructive sleep apnea severity, is predictive of all-cause and CVD mortality, and may be a viable alternative to the AHI.

Correlation of Rhinomanometry Measurement and True Lateral Radiography towards the Degree of Upper Airway Obstruction in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is one of the most common disorders in children which may lead to upper airway obstruction. Various modalities to measure airway obstruction in patients with adenoid hypertrophy, including true lateral radiographs, nasoendoscopy, and rhinomanometry are available; however, the results from different studies are still controversial. This study aimed to determine the relationship between the results of rhinomanometry and the true lateral radiographs to the degree of upper airway obstruction in patients with adenoid hypertrophy. Methods: This cross-sectional study included a total of 33 patients with adenoid hypertrophy aged 5-18 years using a purposive sampling technique. Patients diagnosed with adenoid hypertrophy were subjected to a true lateral examination using lateral neck radiographs to measure the degree of airway obstruction. Subsequently, an active anterior rhinomanometry was performed by measuring resistance and nasal airflow and then measuring the degree of airway obstruction. Data analysis was done using Chi-Square test. Results: The rhinomanometric nasal resistance in the inspiratory phase was 0.4159 ± 0.15201 Pa/cm3/s and 0.3694 ± 0.13717 Pa/cm3/s in the expiration phase. The results showed a significant relationship between the true lateral radiographs and both nasal inspiratory (p=0.005) and expiratory resistance (p=0.004). Similarly, the relationship between the true lateral radiographs and nasal airflow on both inspiratory and expiratory rhinomanometry was significant (p<0.05). Conclusion: Rhinomanometric measurements can be used as an additional objective examination in assessing the degree of upper airway obstruction in patients with adenoid hypertrophy prior to surgery.

A Clinical Analysis of Pharyngeal Bronchogenic Cysts in the Pharynx of Children.

Objective: This study was designed to summarize the clinical characteristics, diagnosis and treatment of pharyngeal bronchogenic cysts in children to help in making the correct diagnosis and developing an appropriate treatment plan.Methods: The clinical data of 13 children with bronchogenic cysts in the pharynx, who were treated in otolaryngology head and neck surgery department between September 2013 and July 2019, were analyzed retrospectively. The clinical characteristics were evaluated, and the related factors for diagnosis and treatment were analyzed. Clinical characteristics and imaging features of three cases whose lesions located in the nasopharyngeal, oropharynx, and laryngopharyngeal were demonstrated.Results: All 13 children were male, the youngest being 4 days old, the oldest 6 years and 6 months, and the median age being 1 year and 4 months. Eight patients were diagnosed during a physical examination, and five patients visited the doctor with different degrees of upper airway obstruction. The mass was located in the nasopharynx in one patient, in the oropharynx in eight patients, and in the laryngopharynx in the other four patients. Computed tomography (CT) scanning, which is helpful for a topical diagnosis, showed a dense homogeneous mass. Electronic nasopharyngoscopy showed cystic masses of different sizes in the pharynx. All the children underwent cyst resection under general anesthesia, and the postoperative pathology result was a bronchogenic cyst. One child was lost to follow-up, but the remaining 12 children were followed up for between 6 months and 6 years, during which no recurrence of a cyst was found.Conclusion: Bronchogenic cysts are a rare cyst of the head and neck, and the most common site of the cyst is the oropharynx. The impact on airway obstruction depends on the location and size of the cyst. CT scanning is of great significance for diagnosis. Surgical treatment should be carried out as soon as possible after diagnosis, as surgery is the most effective way to treat bronchogenic cysts. Follow-ups should be carried out regularly to prevent cyst recurrence.

The Animal Health Trust (1942–2020)

The significance of cardiac arrhythmias and their possible association with upper airway obstruction are frequently considered in the clinical investigation of poor performance. The specific aims of this retrospective study of a group of poorly performing Standardbred and Norwegian–Swedish Coldblooded trotters were to: (1) describe the overall frequency and frequency distributions of arrhythmias; (2) describe arrhythmia characteristics including percent prematurity, relative recovery cycle lengths and QRS morphology; (3) describe variability of normal RR intervals; and (4) explore possible associations between upper airway abnormalities and arrhythmia categories during peak exercise and recovery.The records of 103 trotters presented to the Norwegian University of Life Sciences for high-speed treadmill testing were reviewed. The occurrence of at least one arrhythmic event was high (77–78%) when considering all exercise periods and 6–10% prematurity criteria. Triplets, salvos, and/or paroxysmal tachyarrhythmias occurred in 8% of horses during peak exercise. Complex ventricular arrhythmias occurred in 15% of horses in the first 2 min of recovery. Evaluation of QRS morphology and return cycle lengths demonstrated areas of overlap in characteristics typically attributed to either supraventricular or ventricular arrhythmias. There was no association between airway diagnosis and arrhythmias during any exercise period. The maximum average HR during peak exercise was an excellent predicter for complex ventricular arrhythmias during recovery. Because perfect categorization of arrhythmias is not possible, future studies should report descriptive arrhythmia information. Prospective studies that evaluate various degrees of upper airway obstruction and the effect on known initiators of arrhythmogenesis are needed.

Severity of Airway Obstruction May Not Correlate With Weight Gain or Failure to Thrive in Infants With Robin Sequence: A Pilot Study.

Patients with Robin sequence (RS) can present with varying degrees of upper airway obstruction, difficulty maintaining adequate weight gain, and failure to thrive (FTT). Although inductive reasoning would suggest that these issues should be interrelated, the relationships between these factors have not been formally studied. This investigation explores the correlation between polysomnographic (PSG) findings, weight gain, and FTT in patients with RS. A prospective database for baseline PSG parameters and serial weight measurements in infants with RS who were admitted for airway obstruction was reviewed. The association between PSG variables and calorie intake with FTT was assessed using univariate and multivariable logistic regression. Categorical analysis of the PSG variables against FTT was explored with a Poisson regression, and linear regression was performed to evaluate the correlation between PSG parameters and percentage of weight gain. Univariate and multivariate logistic regression in RS patients with (n = 13) and without (n = 20) FTT showed no significant association between apnea-hypopnea index (adjusted odds ratio [aOR]: 0.99, P-value = 0.403), O2 nadir (aOR: 0.98, P-value = 0.577), time of O2 saturation below 90% (aOR: 1.03, P-value = 0.574), maximum end tidal carbon dioxide (aOR: 1.0, P-value = 0.977), and average calorie intake (OR:1.02; P-value = 0.984). Furthermore, no significant associations were identified between these variables and weight gain. This pilot study questions the widely held and intuitively logical belief that poor weight gain and/or FTT should correlate with the severity of upper airway obstruction in patients with RS. Large prospective investigations should be initiated to better explore the authors' findings. Our results also underscore the importance of individualized treatment for these challenging patients.

A comparison of cannula insufflation device performance for emergency front of neck airway.

Pediatric emergency front of neck airway guidelines recommend oxygenation via cannula cricothyroidotomy or tracheotomy. The primary aim was to measure test lung pressures and volumes generated by cannula insufflation devices recommended for emergency front of neck airway compared with a pressure limit of 50cm H2 O and volume limit of 20ml/kg. The secondary aim was to calculate pressure and volume variability. The primary end point was test lung expansion. Adult, child, and infant airway models, each with three degrees of upper airway obstruction, were oxygenated using six cannula insufflation devices: 3-way stopcock, Rapid-O2 , Manujet, Enk oxygen flow modulator, Ventrain, and self-inflating bags. Test lung pressures and volumes were recorded. Pressures and volumes from all devices were highly variable, despite oxygen flow calibration and strict adherence to oxygen insufflation protocols. With upper airway occlusion, pressures >50cm H2 0 were produced by Rapid-O2 and Enk oxygen flow meter in adult and infant lungs, 3-way stopcock in adult and child lungs, and Manujet in all lung sizes. Ventrain produced acceptable pressures <35cm H2 O in all models. Test lung volumes >20ml/kg were recorded in airway models with fully obstructed proximal airways using Rapid-O2 and Enk oxygen flow meter in infant lungs, and Manujet in all lung sizes. Rapid-O2 produced lung volumes >20ml/kg in the infant model with partially obstructed and open upper airways. Test lung volumes >20ml/kg were produced by the 3-way stopcock in adult, child, and infant models. Insufflation was unsuccessful with the self-inflating bag. Ventrain produced acceptable volumes <7ml/kg in all airway models. Rapid-O2 , Enkoxygen flow meter, Manujet, and 3-way stopcock oxygenation devices produced highly variable and excessive airway pressures and volumes in models with obstructed upper airways. Self-inflating bag insufflation was unsuccessful. Ventrain was the only device that insufflated oxygen with acceptable pressures and volumes in adult, child, and infant airway models with any degree of airway obstruction.

Cardiac arrhythmias in poorly performing Standardbred and Norwegian–Swedish Coldblooded trotters undergoing high-speed treadmill testing

The significance of cardiac arrhythmias and their possible association with upper airway obstruction are frequently considered in the clinical investigation of poor performance. The specific aims of this retrospective study of a group of poorly performing Standardbred and Norwegian–Swedish Coldblooded trotters were to: (1) describe the overall frequency and frequency distributions of arrhythmias; (2) describe arrhythmia characteristics including percent prematurity, relative recovery cycle lengths and QRS morphology; (3) describe variability of normal RR intervals; and (4) explore possible associations between upper airway abnormalities and arrhythmia categories during peak exercise and recovery.The records of 103 trotters presented to the Norwegian University of Life Sciences for high-speed treadmill testing were reviewed. The occurrence of at least one arrhythmic event was high (77–78%) when considering all exercise periods and 6–10% prematurity criteria. Triplets, salvos, and/or paroxysmal tachyarrhythmias occurred in 8% of horses during peak exercise. Complex ventricular arrhythmias occurred in 15% of horses in the first 2 min of recovery. Evaluation of QRS morphology and return cycle lengths demonstrated areas of overlap in characteristics typically attributed to either supraventricular or ventricular arrhythmias. There was no association between airway diagnosis and arrhythmias during any exercise period. The maximum average HR during peak exercise was an excellent predicter for complex ventricular arrhythmias during recovery. Because perfect categorization of arrhythmias is not possible, future studies should report descriptive arrhythmia information. Prospective studies that evaluate various degrees of upper airway obstruction and the effect on known initiators of arrhythmogenesis are needed.

Propofol versus dexmedetomidine during drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea.

To test for differences in DISE findings in children sedated with propofol versus dexmedetomidine. We hypothesized that the frequency of ≥ 50% obstruction would be higher for the propofol than dexmedetomidine group at the dynamic levels of the airway (velum, lateral walls, tongue base, and supraglottis) but not at the more static adenoid level. A single-center retrospective review was performed on children age 1-18 years with a diagnosis of sleep disordered breathing or obstructive sleep apnea (OSA) who underwent DISE from July 2014 to Feb 2019 scored by the Chan-Parikh scale sedated with either propofol or dexmedetomidine (with or without ketamine). Logistic regression was used to test for a difference in the odds of ≥ 50% obstruction (Chan-Parikh score ≥ 2) at each airway level with the use of dexmedetomidine vs. propofol, adjusted for age, sex, previous tonsillectomy, surgeon, positional OSA, and ketamine co-administration. Of 117 subjects, 57% were sedated with propofol and 43% with dexmedetomidine. Subjects were 60% male, 66% Caucasian, 31% obese, 38% syndromic, and on average 6.5 years old. Thirty-three percent had severe OSA and 41% had previous tonsillectomy. There was no statistically significant difference in the odds of ≥ 50% obstruction between the two anesthetic groups at any level of the airway with or without adjustment for potential confounders. We did not find a significant difference in the degree of upper airway obstruction on DISE in children sedated with propofol versus dexmedetomidine. Prospective, randomized studies would be an important next step to confirm these findings.

THE COMPARISON OF CONFIGURATION, DEGREE AND SITES OF OBSTRUCTION IN PATIENTS WITH SLEEP DISORDERED BREATHING: EXAMINATION USING DRUG-INDUCED SLEEP ENDOSCOPY, MUELLER MANEUVER AND POLYSOMNOGRAPHY

Objective: The purpose of this study is to evaluate the location, configuration, and degree of differences in upper airway obstruction between the Mueller Maneuver (MM) and Drug-induced sleep endoscopy (DISE), thus acquiring a better diagnostic value for SDB patients.&#x0D; Methods: A cross-sectional and analytical descriptive study using retrospective secondary data to evaluate the location, configuration and degree of upper airway obstruction in SDB subjects using the Mueller Maneuver and DISE. Polysomnography (PSG) type 2 was used to determine the SDB degree.&#x0D; Results: Subjects with SDB non-Obstructive sleep apnea (OSA) and OSA show a multilevel obstruction with a different location and configuration due to the various risk factors, such as nasal congestion, laryngopharyngeal reflux, obesity and menopause.&#x0D; Conclusion: Statistical differences in upper airway obstruction configuration between MM and DISE were found in the level of the velum (p=0,036), oropharynx (p&lt;0,001) and epiglottis (p=0,036) and were also found in the obstruction degree of the velum, oropharynx, tongue base and epiglottis with p=0,002; p&lt;0,001; p&lt;0,001 and p&lt;0,001. No statistical difference was found on the lowest oxygen saturation between PSG and DISE (p=0,055).

Utility of polysomnography and video swallow studies in the management of pediatric patients with congenital idiopathic bilateral vocal fold dysfunction

ObjectivesCongenital idiopathic bilateral vocal fold dysfunction (BVFD) is an uncommon cause of neonatal stridor and respiratory distress postnatally. Approximately 50% of affected neonates or infants will historically require tracheostomy for this condition. Timing and candidacy for tracheostomy in BVFD patients is often subjective and poorly understood. Polysomnography (PSG) and video swallow studies (VSS) may be helpful in the management of patients with BVFD prior to tracheostomy by quantifying their degree of upper airway obstruction during sleep and feeding dysfunction while awake. MethodsWe performed a single-institution retrospective case series of BVFD patients from 2000 to 2018 who had postnatal PSGs performed prior to tracheostomy. Demographics, gestational age, and VSS results prior to PSG were recorded for all patients. Findings from PSGs included non-REM AHI, REM AHI, oxygen nadir, % total sleep time (TST) O2<90%, peak end-tidal (ET) CO2, % TST ETCO2 >52 torr. Rates of post-PSG tracheostomy, gastrostomy tube (G-tube) placement, and home O2 supplementation were noted for all patients. ResultsFrom 2000 to 2018, 12/46 (26%) BVFD patients had postnatal PSGs performed prior to tracheostomy. Median patient age at BVFD diagnosis, VSS, and PSG was 5.5 days, 12.5 days, and 17.5 days, respectively. Mild, moderate, and severe obstructive sleep apnea (OSA) was found in 7/12, 3/12, and 4/12 patients, respectively. Hypercapnia (ETCO2 >52 torr) was found in 5/12 patients on PSG while hypoxemia (SpO2 <90% for >4% TST) was not found in any patient. VSS results demonstrated normal swallowing, inconsistent laryngeal penetration, and silent aspiration in 7/12, 2/12, and 3/12 patients, respectively. Tracheostomy and G-tube placement was performed in 3/12 and 2/12 patients, respectively. There was no association between the severity of OSA or any PSG abnormality, VSS findings, and the performance of tracheostomy in any BVFD patient. ConclusionsOSA was found in all BVFD patients undergoing postnatal PSG at our institution while feeding dysfunction was found in approximately 50% of patients. The presence of feeding dysfunction, severe OSA, or any PSG abnormality was not individually associated with the subsequent performance of a tracheostomy in our patients. PSG is likely useful in supporting but not supplanting one's clinical decision-making in the management of patients with congenital idiopathic BVFD.

Royal Perth Hospital airway &amp; head and neck anesthesiology fellowship

Royal Perth Hospital airway &amp; head and neck anesthesiology fellowship

Comparison of level and degree of upper airway obstruction by Müller's maneuver and drug-induced sleep endoscopy in obstructive sleep apnea patients

ObjectiveThis study aimed to compare and analyze the level and degree of observed upper airway obstruction in patients with obstructive sleep apnea (OSA) using Müller's maneuver (MM) and drug-induced sleep endoscopy (DISE). We sought to find a method for evaluating the upper airway that could be used to determine surgical sites. MethodsThis study included 80 OSA patients who visited Kyung Hee Medical Center and underwent polysomnography (PSG) from March 2013 to March 2014. Obstructive levels observed by MM were classified into retropalatal level, or the lateral wall and retroglossal level. These levels were compared with those determined by DISE through the VOTE classification. ResultsBased on the results of MM and DISE, lateral wall and retropalatal level obstructions showed relatively high conformity, while retroglossal level obstruction exhibited considerable differences. When evaluated at each level, patients with obstruction on MM also showed partial or complete obstruction on DISE at same level, and patients with no obstruction on DISE also showed no obstruction on MM at same level. ConclusionBoth examination methods revealed the same obstruction levels in all cases except epiglottic level, but there were some differences in obstructive degree. MM is capable of detecting obstruction levels in the upper airway and can be used to determine surgical sites in cases when DISE cannot be used due to a patient's condition or a clinic's circumstances.

Surgical Management of Pierre Robin Sequence: Using Mandibular Distraction Osteogenesis to Address Hypoventilation and Failure to Thrive in Infancy.

Mandibular hypoplasia may present in isolation or in the context of glossoptosis and a U-shaped, incomplete cleft palate. This latter triad is referred to as Pierre Robin sequence. Deleterious effects of micrognathia that may present during infancy are due primarily to glossoptosis or posterior displacement of the tongue. This tongue base prolapse may cause varying degrees of upper airway obstruction. A surgical option for management of tongue base airway obstruction secondary to mandibular hypoplasia is neonatal mandibular distraction osteogenesis. Herein, the author seeks to outline the benefits and limitations of early mandibular distraction osteogenesis as a way of managing airway obstruction and feeding difficulty in newborns with micrognathia. A description of the author's operative technique as well as potential complications and pitfalls will also be discussed.

Utilizing inspiratory airflows during standard polysomnography to assess pharyngeal function in children during sleep.

Obstructive sleep apnea (OSA) is the result of pharyngeal obstruction that occurs predominantly during REM in children. Pathophysiologic mechanisms responsible for upper airway obstruction, however, are poorly understood. Thus, we sought to characterize upper airway obstruction in apneic compared to snoring children during sleep. We hypothesized that apneic compared to snoring children would exhibit an increased prevalence and severity of upper airway obstruction, that would be greater in REM compared to non-REM, and would improve following adenotonsillectomy. Apneic children were assessed with routine polysomnography before and after adenotonsillectomy, and compared to snoring children matched for gender, age, and BMI z-score. In addition to traditional scoring metrics, the following were used to characterize upper airway obstruction: maximal inspiratory airflow (%VI max) and percent of time with inspiratory flow-limited breathing (%IFL). OSA compared to snoring children had similar degrees of upper airway obstruction in non-REM; however, during REM, children with sleep apnea exhibited a higher %IFL (98 ± 2% vs.73 ± 8%, P < 0.01) and lower %VI max (56 ± 6 vs.93 ± 10%, P < 0.01). In children with OSA, CO2 levels were elevated during both wake and sleep. Following adenotonsillectomy, upper airway obstruction improved during REM manifest by decreased %IFL (98 ± 2 to 63 ± 9%, P = 0.04), increased %VI max (56 ± 6 to 95 ± 5%, P = 0.01) and decreased CO2 levels. Differences in the prevalence and severity upper airway obstruction suggest impaired compensatory responses during REM in children with OSA, which improved following adenotonsillectomy.

Mandibular distraction osteogenesis for neonates with Pierre Robin sequence and airway obstruction

Neonates with Pierre Robin Sequence (PRS) usually present with varying degrees of upper airway obstruction and difficulty feeding. Early treatment is important for such children in order to prevent impaired cognitive development resulting from hypoxemic episodes. Various procedures aimed at widening the pharyngeal space have been proposed, including prone position, tongue-lip adhesion, mandibular traction, non-invasive ventilation and palatal plates. Mandibular distraction osteogenesis (MDO) using external or internal devices has become increasingly popular as an alternative treatment option when other medical or surgical techniques do not prove to be satisfactory. This review summarizes current evidence on the effectiveness of MDO in infants with PRS. Because of a lack of studies comparing this treatment with other procedures, general recommendations cannot be drawn and treatment of infants with PRS still requires individualization.

Znaczna Poprawa Kliniczna u Chorego z Niewydolnością Serca i Zespołem Obturacyjnego Bezdechu Sennego po Właściwym Ustaleniu Stałego, Dodatniego Ciśnienia w Drogach Oddechowych

Sleep disordered breathing (SDB) is frequently present in heart failure (HF), and it may take the form of obstructive (OSA) and central (CSA) sleep apnea. The use of continuous positive airway pressure (CPAP) in patients with OSA and HF is associated with an improved neuroendocrine profile and cardiac function. The degree of upper airway obstruction and the airway closing pressure (and the PAP pressure used to relieve it) may all be highly variable in a setting of uncontrolled HF, mostly due to variable airway oedema. We present a case of a man with HF whose cardiac symptoms radically improved after adequate treatment of his OSA with an auto-adjusting PAP device.

Lung volume and pharyngeal stability in sleeping humans: the knee bone is connected to the thigh bone

in 1988 the Journal of Applied Physiology published a seminal article by William Van de Graaff ([13][1]) demonstrating that inflation of the thorax in anesthetized dogs decreased upper airway resistance independently of upper airway muscle activity. The mechanism underlying this effect was shown to

Highlights of Archives of Facial Plastic Surgery

Archives of Facial Plastic SurgeryVol. 12, No. 1 Free AccessHighlights of Archives of Facial Plastic SurgeryPublished Online:1 Jan 2010AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Nimodipine and Acceleration of Functional Recovery of the Facial Nerve After Crush InjuryFacial nerve injury often results in devastating emotional and functional impairment. Commonly, a patient must endure a challenging and protracted recovery period in which further ocular, nutritional, and expressive complications may develop. Robin W. Lindsay, MD, and colleagues present their findings of accelerated facial nerve recovery in the rat animal model with nimodipine administration. Statistically significant improvements in whisking amplitude, velocity, and acceleration were observed in comparison with control animals. These findings demonstrate the first pharmacologic therapy to improve facial nerve recovery in an animal model that is safe for routine clinical use.See page 49Reconstruction of the Nasal Septum Using Polydioxanone PlateAs the central divide of the nasal cavity, the nasal septum is an integral component in air passage and structural support. Abnormalities in nasal airflow and external nasal appearance are often intimately related to architectural deviations or disruption of this important structure. Miriam Boenisch, MD, PhD, and Gilbert J. Nolst Trenité, MD, PhD, review their 10-year experience using the polydioxanone plate as a scaffold for septal reconstruction in 396 patients with severe nasal deformities. In their modification of the extracorporeal septoplasty, the authors remodeled and secured the quadrangular cartilage to the resorbable matrix prior to reimplantation. They present their notable functional and cosmetic outcomes as well as variations in their novel operative technique.See page 4Mandibular Distraction Osteogenesis Used to Treat Upper Airway ObstructionThe facial skeleton is an integral element in the establishment and maintenance of a patent airway. To this end, congenital and syndromic causes of mandibular deficiency often result in oropharyngeal narrowing and a variable degree of upper airway obstruction. Tracheostomy is required in nearly 25% of these patients but not without associated risks. Craig W. Senders, MD, and colleagues investigate mandibular distraction osteogenesis (MDO) as an alternative to tracheostomy tube placement in micrognathic patients with tongue-based obstruction. Multiplanar advancement was performed with the application of an external distractor in newborn patients and those with long-standing tracheostomies. The findings observed reveal the significant impact of MDO in the treatment of upper airway obstruction in select pediatric patients.See page 11Orbicularis Suspension Flap and Its Effect on Lower Eyelid Position: A Digital Image AnalysisAge-related changes of the lower eyelid tissues often produce redundancy in eyelid skin, pseudoherniation of orbital fat, and a ptotic laxity of the orbicularis oculi muscle. Some individuals also display a hollowing along the inferior orbital rim. It is this subset of patients that represent a complex challenge in periorbital rejuvenation. Christopher I. Zoumalan, MD, and colleagues discuss changes in lower eyelid position as related to performing an orbicularis suspension flap in combination with an inside-out blepharoplasty in this patient population. Digital analysis of 68 patients revealed a statistically significant decrease in postoperative margin reflex distance in addition to a more natural anatomic position of the lower eyelid.See page 24Hope by Sir Edward Coley Burne-Jones (1833-1898).See page 76This issue's Highlights were written by James Ridgway, MD.FiguresReferencesRelatedDetails Volume 12Issue 1Jan 2010 InformationCopyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Highlights of Archives of Facial Plastic Surgery.Archives of Facial Plastic Surgery.Jan 2010.3-3.http://doi.org/10.1001/archfaci.2009.112Published in Volume: 12 Issue 1: January 1, 2010PDF download

Outcome of mandibular distraction for the management of micrognathia and obstructive apnoea

Background and Objectives: Infants and children with craniofacial anomalies, such as Robin sequence, craniofacial microsomia and Treacher Collins syndrome, often present with varying degrees of upper airway obstruction due to micrognathia. The aim of this study is to present the outcome of the management of 32 neonatal, infants and young children with micrognathia who had undergone mandibular distraction for severe upper airway obstruction.