Glossoptosis Research Articles

Efficacy of sniffing position in alleviating glossoptosis during emergence from anesthesia in children

Objective To evaluate the efficacy of sniffing position in alleviating glossoptosis during the emergence from anesthesia in children. Methods Two hundred pediatric patients who developed glossoptosis during the emergence from anesthesia, aged 2-8 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were randomly divided into 4 groups (n=50 each) using a random number table: head extension position group (group A), head tilted position group (group B), oropharyngeal airway group (group C) and sniffing position group (group D). Alleviation of glossoptosis, and occurrence of laryngospasm, agitation, vomiting and oral hemorrhage were recorded.Alleviation rate was calculated. Results Compared with group A, the alleviation rate was significantly increased in C and D groups, the alleviation rate was decreased in group B, and the incidence of laryngospasm, agitation and oral hemorrhage was increased in group C (P<0.05). Conclusion Sniffing position can effectively alleviate glossoptosis during the emergence from anesthesia in children with good safety. Key words: Posture; Tongue diseases; Postoperative complications; Anesthesia recovery period; Child

Clinical value of intranasal dexmedetomidine combined with intravenous propofol for analgesia during enteroscopy in children

Objective To compare the effect and safety of propofol with intranasal dexmedetomidine in analgesic enteroscopy for children. Methods Ninety children undergoing analgesic enteroscopy were randomly assigned to 3 groups. Intranasal dexmedetomidine followed by propofol was administered in the observing group; sufentanil and followed by propofol was intravenously given to the control group A; propofol was given to the control group B. The scale of anesthetic effect, HR, RR, MAP and SpO2 30 min after intranasal administration were monitored. The intranasal sedation satisfaction rate, the dose of propofol, wake-up time, hospitalization, hemodynamics, adverse reaction and complication after anesthesia were recorded. Results Intranasal sedation satisfaction rate of the observing group was 83.3%(25/30). The anesthetic effect in observing group(excellent/good/bad: 24/6/0) showed no significant difference from that in the control group A(excellent/good/bad: 25/5/0), but better than that in the control group B(excellent/good/bad: 12/14/4)(P<0.05). The amount of propofol in the observing group(96.2±5.3)mg showed no significant difference from that of group A(93.7±4.6)mg, but less than group B[(121.1±4.9)mg, P<0.05]. The time of recovery of infants in the control group A[(14.2±5.5)min] and the control group B[(13.7±3.9)min] were longer than that in observing group[(7.9±4.1)min, P<0.05]. The hospitalization time of observing group[(14.3±5.4)min] was shorter than those of group A[(27.5±3.7)min, P<0.05] and group B[(26.3±6.6)min, P<0.05]. The incidences of breath suppression, glossoptosis, nausea and dizziness were the lowest in the observing group, compared with the two others (all P<0.05). Conclusion Intranasal dexmedetomidine combined with propofol, increasing children compliance, decreasing the adverse reaction, is satisfactory and safe for children anesthesia. Key words: Child; Colonoscopy; Anesthesia; Dexmedetomidine; Propofol; Intranasal drop

Etiology analysis of upper airway obstruction in 54 newborn infants

Objective To explore the etiology of neonatal upper airway obstruction(UAO)in order to perform early diagnosis and treatment, and to improve the prognosis. Methods Retrospectively analysis of the clinical data of 54 cases of neonatal UAO in Shengjing Hospital of China Medical University from Jan.2005 to Dec.2011 was performed.All patients received CT three dimensional reconstruction reconstruction, 30 patients received the direct laryngoscopy, 5 cases received the video laryngoscope, 8 cases received pathological examination.All the cases received the determination of serum total calcium and ionized calcium, 6 cases received upper gastrointestinal imaging, 8 cases received chromosome inspection and 20 cases received echocardiography. Results CT scan: abnormal in 21 cases, among them 15 cases of congenital cyst, 5 cases of tongue fall blocking airway, and 1 case of choanal atresia(bilateral); another 33 patients were normal.Direct laryngoscopy results: abnormal in 13 cases, among them 12 cases of congenital cyst, and 1 case of glossoptosis; another 17 cases were normal.Electronic laryngoscopy results: 5 cases were diagnosed as congenital laryngomalacia.Pathological examination results: 7 cases of cyst wall by squamous epithelium composition, and 1 case of cyst wall by columnar epithelium composition.Serum total calcium and ion calcium level results: all patients were in the normal range.Chromosome examination results were normal.Upper gastrointestinal imaging results: 1 normal case, 5 cases of mild gastroesophageal reflux. Echocardiography results: 4 cases were normal, 10 cases of patent foramen ovale, 2 cases of patent ductus arteriosus, 4 cases of congenital heart disease (2 cases of atrial septum defect, 1 case of ventricular septal defect, and 1 case of interatrial septum merger ventricular septal defect). Conclusions In the etiology of neonatal UAO, there is a lot of organic diseases except for congenital laryngomalacia.For the UAO induced by laryngeal stridor or undefinitely cause, CT scan should be taken as soon as possible. Key words: Upper airway obstruction; CT scan; Newborn, infant

Effect of hyoid suspension with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome

To discuss the methodology and therapeutic effect of hyoid suspension in association with uvulopalatopharyngoplasty (UPPP) in the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS). Sixty-nine patients with severe OSAHS (apnea hyponea index, AHI > 30) were treated with hyoid suspension and UPPP. Sixty-one patients were followed for 6 months (48 of them for 12 months). Polysomnogram (PSG) tests were performed and an Epworth sleepiness scale (ESS) was recorded preoperatively and postoperatively in these patients. After the surgery,the snoring of the patients disappeared or was alleviated to varing degrees. Eighteen patients underwent fiberoptic nasopharyngolaryngoscopic examination. Twelve of them showed palatopharyngeal and glossopharyngeal stenosis was improved 6 months after surgery. Six patients showed no change, but had no glossoptosis. Fourteen patients underwent fiberoptic nasopharyngolaryngoscopic examination 1 year after surgery, with no recurrence of the stenosis being found. A decrease of 50% in the AHI was considered effective, and in patients the effective rate was 78.7% (48/61) 6 months after the operation and 75.0% (36/48) 1 year after the operation. The average AHI decreased from 44.8 to 15.1 and 17.2, and the minimum arterial oxygen saturation average increased from 0.512 to 0.880 and 0.730. Matching t tests were utilized and the results of follow-up indicated that there was a significant improvement in the indexes in those cases which could be followed up (P < 0.01). The average of the ESS was 6.7 six months after operation and 7.2 one year after operation, with a significant decrease compared to the preoperative (16.6) data (P < 0.01). Modified hyoid suspension in association with UPPP has the advantage of a simple operation, short hospitalization and less expense, and the effect of the operation was significant. Patients with palatopharyngeal and glossopharyngeal stenosis should be chosen for this operation.

The review of Pierre Robin sequence

The Pierre Robin sequence (PRS)is a congenital abnormality which is not only causally heterogeneous but also with a group of physical findings, characterized by the presence of the combination of underdeveloped(micrognathia) or retropositioned(retrognathia) mandible,glossoptosis that leads to respiratory tract obstruction with or without cleft palate. PRS is clinically defined by obstruction of the upper airways, feeding difficulties, inspiration pneumonia and some accompany with multiple -anomalies that are more frequent and more severe during the immediate postnatal and neonatal period. Diagnosis of PRS may be made immediately when a neonate presents in respiratory distress with micrognathia. Further examination may show the posterior placement of the tongue and possibly a cleft palate. Now that the strong association of PRS with many multiple - anomaly syndromes is recognized, treatment must be individualized to optimize the outcome. Most PRS children have failure to thrive,and long -term outcomes vary greatly,depending on whether the PRS is an isolated occurrence or part of an associated syndrome and on whether the infant experienced any obstructive-hypoxic episodes. Key words: Pierre Robin sequence; Micrognathia; Glossoptosis; Cleft palate

BİR OLGU NEDENİYLE PIERRE ROBIN ANOMALİSİ (*)-A CASE REPORT OF PIERRE ROBIN ANOMALY

OZET Pierre Robin sendromundan konjenital kalp defektle-ri, iskeletsel anomaliler, g oz hasarlari gibi sistemik bulgularda bulunmaktadir. Bununla birlikte, bu hastalarin bir cogunda zeka geriligi de gorulebilmektedir. Dogumdan sonraki 5 yil icinde bicimsiz dokular normale yakin iliskilere getirilmeye calisilir fakat dilin veya alveoler procesin intrauterin basincla nekroze oldugu durumlarda iyilesme potansiyeli azalmaktadir. Pierre Robin olgusu sunulmustur. Pierre RobIn anomalisi, mikrog-nati, glossoptosis. ABSTRACT Other systemic findings may also be present in the Pierre Robin syndrome, including congenital heart defects, other skeletal anomalies and oculer lesions. In addition mental retardation is present in a significant number of these patients. Catch-up growth in the 5 years after birth frequently restores the distorted tissues to near, normal relationships, but where intrauterine pressure necrosis oj the tongue or alveolar process has occured, the potential recovery reduced. In this article, a case report of Pierre Robin syndrome is presented who was diagnosed at birth and associated cleft palate has been treated through the intervening years and at present his orthodontic treatment is contiuing. Key words: Pierre Robin anomaly, mikrognathi, glossoptosis.

Micrognathia and glossoptosis in the newborn. Surgical tacking of the tongue in small jaw syndromes.

This report discusses airway obstruction in newborn infants with micrognathia and glossop tosis, and describes three patients who required surgical relief of obstruction from glossoptosis. In two, glossoptosis was controlled by construction of lingual-labial flaps under local anesthesia. The third required tracheostomy because of absence of the mandibular symphysis; to be effective, a lingual-labial flap requires a complete mandibular arch for support.The lingual-labial flap is the best surgical procedure for glossoptosis of the newborn. It can be constructed under local anesthesia in the nursery or in the operating room. It holds the tongue forward, yet it allows adequate tongue mobility for feeding. Composed of the patient's own tissues, it can remain for an indefinite time.