Head Airway Research Articles

Characteristics of heavy metals in size-fractionated atmospheric particulate matters and associated health risk assessment based on the respiratory deposition.

The heavy metal distributions in size-fractionated atmospheric particulate matters and the associated health risks were investigated in a typical mining and smelting area in Southwest China. The Cd, Cr, Cu, Pb, and Zn concentrations were 19.28, 44.48, 100.0, 554.0, and 601.8ng/m3, respectively, in PM2.1; and 23.45, 60.99, 95.25, 559.3, and 813.7ng/m3, respectively, in PM10. Enrichment factors of heavy metals indicated that anthropogenic sources of Cd, Cu, Pb, and Zn in the size-fractionated particles. The elevated concentrations of Cd, Cu, Pb, and Zn were dominantly enriched in submicron particles (DP < 1.1μm), whereas Cr tended to be accumulated in coarse particles (2.1 < DP < 10μm). The deposition concentrations for multiple heavy metals in the head airway region, tracheobronchial region, and alveolar regions were 321.07, 21.58, and 51.96ng/h for children, and 634.49, 42.65, and 102.68ng/h for adults, respectively. The coarse particles contributed the most to the deposition concentration of HMs in head region, whereas submicron particles had relative higher proportions in the alveolar region. Heavy metals, especially Pb, caused noncarcinogenic risk to the children as the hazard index was 4.45. Moreover, total carcinogenic risks of heavy metals (Cr, Cd, and Pb) were 4.33 × 10-5 and 7.58 × 10-5 for adults and children, respectively, indicating potential carcinogenic risks. Overall, the results of this study revealed high health risks to the residents living around the mining and smelting areas, especially the children. It was therefore urgent to control the emission of heavy metals in the atmosphere.

Difficult airways: a 3D printing study with virtual fibreoptic endoscopy

Head and neck cancer patients present unique airway challenges, and oropharyngeal, laryngeal, and hypopharyngeal tumours considerably distort and narrow the anatomy of the airway. We describe the use of 3D augmented reality software combined with 3D printed models to assess the anatomy of difficult airways and to assist in the formulation of the most optimal airway management strategy in such patients. The reported patients had computed tomograms (CT) of the neck prior to their anaesthetic and surgical management. DICOM files of the respective scans were imported to 3D rendering software (OsiriX, Pixmeo). We constructed volume rendered models for initial assessment of the airway then generated serial surface rendered models to create a virtual endoscopic path of the airway to simulate the fibreoptic approach. To further facilitate the study of difficult airways we have subsequently printed 3D models of those that were most difficult using rapid prototyping. Head and neck tumours significantly distort the airway. Thorough study of the relevant anatomy prior to airway management for operating reasons enhances communication between the surgeon and anaesthetist, and aids selection of the most appropriate intubation approach. In conclusion, this paper highlights a useful and novel pre-assessment strategy that allows a virtual, visual, 3-dimensional assessment of the airway anatomy combined with 3D modelling and 3D printing. This enables the airway specialist, anaesthetist, and head and neck surgeon to anticipate any critical steps and adjust the plan accordingly.

Associations Among Temporomandibular Joint Osteoarthritis, Airway Dimensions, and Head and Neck Posture

This study sought to investigate associations among progressive temporomandibular joint osteoarthritis (TMJ OA), airway dimensions, and head and neck posture. In total, 114 temporomandibular disorders (TMDs) patients were enrolled. Among 114 patients, 28 had no pathologic bony changes in the TMJ condyles (TMDnoOA), 45 had progressive TMJ OA (TMJOApro), and 41 demonstrated TMJ OA which had not progressed for 12months (TMJOAnopro). TMJ OA was diagnosed based on the Diagnostic Criteria for TMD axis I. Computed tomography (CT) images and lateral cephalograms were obtained at baseline (T0) and 12months after treatment (T1). The head and neck posture and airway area in upright position were analyzed using lateral cephalograms whereas airway volume in supine position was determined by 3D reconstructed CT images. The volume change of the oropharynx in supine position was more prominent in the TMJOApro than in the TMDnoOA but no significant differences in changes in the pharyngeal airway while in upright position were detected. The retrognathic facial profile became more remarkable at T1 in the TMJOApro and TMJOAnopro compared to those at T0. The forward head posture seemed to be progressed in the TMJOApro than in either the TMJOAnopro or TMDnoOA. Progressive TMJ OA may have associations with retrognathia and decreased oropharyngeal airway volume in the supine position but not in the upright position. Progressive TMJ OA may be related with altered head posture in the upright position to compensate for reduced airway dimensions.

Systematic review of international guidelines for tracheostomy in COVID-19 patients.

At this moment, the world lives under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that carry a particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures in demand at this moment is tracheostomy due the increasing ICU admissions. This review of international guidelines for tracheostomy in COVID-19 infected patients, aims to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy, from all over the world.

La otorrinolaringología y el riesgo de contraer el nuevo coronavirus humano COVID-19

La pandemia de enfermedad por coronavirus 2019 (COVID-19) ha producido cambios sin precedentes en la comunidad médica. Los médicos y trabajadores de la salud que realizan o participan en exámenes o procedimientos de cabeza y cuello y de la vía aérea son susceptibles en alto riesgo de adquirir la infección por COVID 19 debido a la alta exposición a aerosoles y contaminación por gotas. En la actualidad se carece de datos de riesgo específico de infección. Sin embargo, los otorrinolaringólogos y cirujanos de cabeza y cuello, junto con los oftalmólogos y los odontólogos, son los grupos de mayor riesgo dentro de los profesionales de la salud debido a las áreas que examinan. Este documento se desarrolla con base en pautas encontradas en la literatura disponible más reciente. Es seguro que serán modificadas según la experiencia de cada país.

Assessment of Injuries Following Terrorist Attacks: A Narrative Review

Background: In the few past decades, the world has experienced numerous terrorist attacks. Objectives: We sought to review the mechanisms and patterns of injuries in terrorist attacks; the main goal being better management of victims of these attacks. Methods: In current narrative review; electronic databases (PubMed, Wiley, EMBASE, ISI Web of Knowledge, and Scopus) were searched seeking relevant publications between 2000-2018. The keywords used when searching for articles included: violence, terrorism, disasters, trauma, trauma centers, war, mass casualties, wounds, and injuries. Searching, screening, and assessment of records were done separately by two authors; disagreements were resolved by discussion with a third reviewer. Results: Nine studies were found to be eligible for inclusion in this study. The most common device-related terrorist attacks were explosives and bombs. More than half of the victims suffered minor injured and could be treated promptly. The most common causes of mortality were head injuries, airway burns, and internal bleeding. The secondary and tertiary results of terrorist attacks were head and neck injuries. Pulmonary injuries were also common injuries in terrorist-attack victims. The most significant cause for emergency treatment was airway burns. The head, neck, pelvis, and hand were the most commonly exposed body areas. Limb amputation is a major result of complications and mortality. The mortality rate of victims that referred to a hospital was low; most deaths occurred at the scene of the attack. Aging victims, children, and women were most influenced by terrorist attacks. Immediate examination, long-term follow-up, and advanced therapeutics and psychological therapy are necessary. Conclusion: Differences in the severity and type of injuries among victims of terrorist attacks depend upon the various causes of blast injuries, the power of the explosion, the open or enclosed location setting, the destruction of structures, and the interval between cases and the explosion. The current results showed that head and lung injuries are major causes of mortality in victims of terrorism. Appropriate emergency medical services and early management could increase patient survival rates and reduce complications.

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Michigan Medicine: The University of Michigan Head and Neck Anesthesiology and Advanced Airway Management Fellowship

Exposure to Atmospheric Particulates and Associated Respirable Deposition Dose to Street Vendors at the Residential and Commercial Sites in Dehradun City

BackgroundStreet vendors spend relatively more time near roadways and are vulnerable to air pollution related health disorders. However, there is limited information on the quality of the air they breathe. The objectives of this present study were to calculate the mass concentration of atmospheric particulate matter (PM) in eight size fractions (PM0.4–0.7, PM0.7–1.1, PM1.1–2.1, PM2.1–3.3, PM3.3–4.7, PM4.7–5.8, PM5.8–9.0, and PM9.0-–0μm) at commercial (CML) and residential site (RSL) in Dehradun city from November 2015 to May 2016. To estimate the corresponding respiratory deposition dose (RDDs) in alveolar (AL), tracheobronchial (TB), and head airway (HD) region on street vendors working at CML and RSL. To find the association of atmospheric PM with RDDs and the incidence of respiratory related disorders among street vendors.MethodsAndersen cascade impactor was employed for calculating the PM mass concentration. Questionnaire based health survey among street vendors were carried out through personal interview.ResultsA significant difference (p < 0.05; t-test) between the mean PM0.4-10μm mass concentration at CML and RSL was observed with (mean ± SD) 84.05 ± 14.5 and 77.23 ± 11.7 μg m−3, respectively. RDDs in AL, TB and HD region at CML was observed to be 9.9, 7.8, and 7.3% higher than at RSL, respectively. Health survey revealed 1.62, 0.96, 0.04, and 0.57 times higher incidence of cold, cough, breathlessness, and chest pain, respectively with street vendors at CML compared to RSL.ConclusionThe site characteristics plays a major role in the respiratory health status of street vendors at Dehradun.

Comparative health risk of inhaled exposure to organic solvents, toxic metals, and hexavalent chromium from the use of spray paints in Taiwan.

The study investigated the exposure of spray painters to organic solvents, toxic metals, and hexavalent chromium over 21 working days in 2017. The results found these concentrations of 12 VOCs to be below the short-term exposure limit (STEL) established by the US Occupational Safety and Health Administration (OSHA). The mass concentration of total particulate matter (PM) exposure to workers was 20.01±10.78mg/m3, which exceeds OSHA's permissible exposure level of 15mg/m3. The mean concentration of the total metals for all particle sizes was 109.1±12.0μg/m3, and those for lead (496,017.0ng/m3) and iron (252,123.8ng/m3) were the highest of metal elements. Significantly, the mean concentrations of Pb and As exceeded OSHA's permissible exposure limits (PELs) of 0.05 and 0.01mg/m3, respectively. The total hexavalent chromium concentration was 1163.01ng/m3, and the individual particle sizes (PM1-2.5, PM1, and PM0.25) were strongly and positively correlated with the Cr(VI) concentrations for PM2.5. The study determined that approximately 56.14% of the hexavalent chromium inhaled during the spray-painting process was deposited in the upper respiratory system of the head airway region, followed by the alveolar and tracheobronchial regions, with fractions of 11.93 and 0.05%, respectively. Although the mean ratio of hexavalent chromium to total chromium was only 3.6% for all particle sizes, the cancer risk of the total particles in Cr(VI) (1.6×10-3) exceeded the acceptable risk value (10-6). The cancer risks of As and Cr(VI) associated with quasi-ultrafine particles, PM0.5-1, PM1-2.5, and PM> 2.5, also exceeded 10-6. Comparison of the carcinogenicity risk of VOCs and metals suggests that the adverse health effect of inhaled particles on spray-painting workers is more serious than that from VOC exposure.

Traditional and novel halogenated flame retardants in urban ambient air: Gas-particle partitioning, size distribution and health implications

Urban ambient air samples, including gas-phase (PUF), total suspended particulates (TSP), PM10, PM2.5 and PM1 airborne particle fractions were collected to evaluate gas-particle partitioning and size particle distribution of traditional and novel halogenated flame retardants. Simultaneously, passive air samplers (PAS) were deployed in the same location. Analytes included 33 polybrominated diphenyl ether (PBDE), 2,2′,4,4′,5,5′-hexabromobiphenyl (BB-153), hexabromobenzene (HBB), pentabromoethylbenzene (PBEB), 1,2-bis(2,4,6-tribromophenoxy)ethane (BTBPE), decabromodiphenyl ethane (DBDPE), dechloranes (Dec 602, 603, 604, 605 or Dechorane plus (DP)) and chlordane plus (CP). Clausius-Clapeyron equation, gas-particle partition coefficient (Kp), fraction partitioned onto particles (φ) and human respiratory risk assessment were used to evaluate local or long-distance transport sources, gas-particle partitioning sorption mechanisms, and implications for health, respectively. PBDEs were the FR with the highest levels (13.9pgm−3, median TSP+PUF), followed by DP (1.56pgm−3), mirex (0.78pgm−3), PBEB (0.05pgm−3), and BB-153 (0.04pgm−3). PBDE congener pattern in particulate matter was dominated by BDE-209, while the contribution of more volatile congeners, BDE-28, -47, -99, and -100 was higher in gas-phase. Congener contribution increases with particle size and bromination degree, being BDE-47 mostly bounded to particles≤PM1, BDE-99 to > PM1 and BDE-209 to > PM2.5. No significant differences were found for PBDE and DP concentrations obtained with passive and active samplers, demonstrating the ability of the formers to collect particulate material. Deposition efficiencies and fluxes on inhaled PBDEs and DP in human respiratory tract were calculated. Contribution in respiratory track was dominated by head airway (2.16 and 0.26pgh−1, for PBDE and DP), followed by tracheobronchial (0.12 and 0.02pgh−1) and alveoli (0.01–0.002pgh−1) regions. Finally, hazard quotient values on inhalation were proposed (6.3×10−7 and 1.1×10−8 for PBDEs and DP), reflecting a low cancer risk through inhalation.

Changes in head posture after rapid maxillary expansion in patients with nasopharyngeal obstruction

Introduction: Nasopharyngeal obstruction is an important etiologic factor in the development of an extreme vertical growth facialpattern, and insufficient transversal growth of the maxilla. The treatment outcomes associated with rapid maxillary expansion in theliterature are mainly discussed in terms of changes in dentofacial morphology, without special reference to changes in the pharyngealairway, the position of the mandible, hyoid bone and the tongue.Aim: The aim of this study was to evaluate the effects of rapid maxillary expansion (RME), on changes in head posture and airway dimension.Materials and methods: The cephalometric evaluation was conducted on thirty lateral cephalograms of patients with nasopharyngeal obstruction (mean age 9.11 years; standard deviation (SD) ± 2.0; range 8-14 years) treated with appliance for rapid maxillary expansion. Patients were randomly divided into two groups: 1) study group comprised of 15 patients treated with RME immediately after the first visit; 2) a control group comprised of 15 subjects monitored for approximately 12 months prior to commencing therapy, who became untreated controls. Lateral cephalograms, taken in the natural head position, were obtained at the first visitand 6 months later for all subjects. Six angular measurements were measured to describe craniocervical angulation, and five linear measurements were measured to describe airway dimension.Results: The investigated group treated with RME shows a statistically significant decrease in craniocervical angulation, especially at the angleof interaction between palatal plane and the tangent odontoid processus (4.07 degrees, for PP/OPT angle) and angle interaction between palatal plane and the tangent of cervical vertebra (4.95 degrees for PP/CVT angle). Airway dimension in the treated group increased, especially at the levels PNS-ad1 (2.52 mm), ve-pve (2.97 mm), and uv-puv (2.88 mm). No significant changes were observed in the control group.Conclusions: RME is a treatment procedure capable of providing increased nasopharyngeal airway adequacy, changing the head posture as well as position of the mandible and tongue, creating the conditions for myofunctional balance and proper development of craniofacial complex and changing mode of respiration.

Pharyngeal Airway Dimensions and Head Posture in Obstructive Sleep Apnea Patients with and without Morphological Deviations in the Upper Cervical Spine.

ABSTRACTObjectivesThe aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample.Material and MethodsThe sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis.ResultsOSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume.ConclusionsThe results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.

Respiratory deposition and health risk of inhalation of particle-bound heavy metals in the carbon black feeding area of a tire manufacturer

The health effects of metal-containing carbon black (CB) particles obtained from the CB feeding area of a tire manufacturing plant were investigated. Atmospheric samples were collected over 24 h for 20 working days in 2016 using the 12 impaction stages of micro-orifice uniform deposit impactor, and metal-containing particles were analyzed using an inductively coupled plasma optical emission spectrometer. The concentration of total particulate matter in the CB feeding area was 944.8 ± 456.4 μg/m3, and the most abundant elements in the samples include Zn (8622.0 ± 5679.0 ng/m3), Al (3113.3 ± 2017.1 ng/m3), and Fe (1519.1 ± 875.0 ng/m3). Carcinogenic metals (Cd, Co, Cr, and Ni) with the mass median diameter were incorporated in submicron particles. The mean total deposition flux in the head airway (HA) region was approximately 16–30 times higher than that in the tracheobronchial (TB) region and alveolar region (AR). The most abundant deposition flux of heavy metals in the AR and TB region was distributed in particles of less than 3.2 μm. The cancer risk presented by carcinogenic metals (Cd, Co, Cr, and Ni) in total particles to CB feeding workers ranged from 5.52 × 10−4 to 5.65 × 10−2, which is substantially higher than the acceptable cancer risk range 10−6–10−4. In particular, the cancer risk presented by these four metals in ultrafine particles (UFPs) exceeded the 10−6 benchmark level. These results demonstrate the high health risk presented by particle-bound heavy metals to workers in a CB feeding area via inhalation exposure.

Size-segregated particulate matter and its association with respiratory deposition doses among outdoor exercisers in Dhanbad City, India

ABSTRACTRegular exercise improves physiological processes and yields positive health outcomes. However, it is relatively less known that particulate matter (PM) exposure during outdoor exercises may increase several respiratory health problems depending on PM levels. In this study, the respiratory deposition doses (RDDs) in head airway (HD), tracheobronchial (TB), and alveolar (AL) regions of various PM size fractions (<10, <2.5, and <1 μm; PM10, PM2.5, and PM1) were estimated in healthy male and female exercisers in urban outdoors and within house premises. The highest RDDs were found for PM during morning hours in winter compared with remaining periods. RDDs in AL region for males and females, respectively, were 34.7 × 10−2 and 28.8 × 10−2 µg min−1 for PM10, 65.7 × 10−2 and 56.9 × 10−2 µg min−1 for PM2.5, and 76.5 × 10−2 and 66.3 × 10−2 µg min−1 for PM1. The RDD values in AL region were significantly higher in PM1 (27%) compared with PM2.5 (13%) and PM10 (2%) during exercise in all periods. This result showed that the morning peak hours in winter are more harmful to urban outdoor exercisers compared with other periods. This study also showed that the AL region would have been the main affected zone through fine particle (PM1) to all the exercisers.Implications: Size-segregated particle concentrations in urban outdoors and within house premises were measured. The highest respiratory deposition doses (RDDs) were found for PM during morning hours in winter compared with remaining periods. During light exercise, the RDD values in alveolar (AL) region for PM10, PM2.5, and PM1 for male exercisers were significantly higher, 20.4%, 15.5%, and 15.4%, respectively, compared with female exercisers during morning peak hours in winter.

Multistage Sclerotherapy for Extensive Lymphatic Malformations With Airway Involvement in Infant: A Protocol to Prevent Tracheotomy

The management of extensive head and neck lymphatic malformations (LMs) in infants is challenging because of life-threatening upper airway compression. The aim of this study was to present a management protocol and evaluate the clinical outcomes for preventing tracheotomy in these patients. Fifteen infants with extensive head and neck LMs and airway involvement were enrolled from August 2010 through September 2015 at the Qilu Hospital of Shandong University (Jinan, China). According to various key factors associated with airway compression of patients in the perioperative period, different anesthesia types, treatment times, sclerosant concentrations, and sclerotherapy protocols were used. Multistage sclerotherapy was performed with bleomycin A5. All patients were followed at 1, 3, 6, and 12months. More extended follow-up was offered if patients had a residual lesion requiring supplementary sclerotherapy. Reviews on the site and size of the lesion, timesand durations of treatments, therapeutic response, airway complications, and conduction of tracheotomy were performed. LM lesions in the head and neck were located in the floor of the mouth, tongue, and neck. An overall average of 5 treatments was required; a lesion volume decrease of more than 50% was achieved in all patients. For efficacy, morphologic resolution was achieved in 3 of 15 cases (20%), and there was a substantial response in 12 of 15 cases (80%). Eight of 15 patients (53.3%) with microcystic LMs exhibited immediate swelling and had more serious upper airway symptoms than preoperatively, and 2 of 15 patients (13.3%) had feeding difficulty. No upper airway obstruction occurred and no tracheotomy was performed in the patients in this study. Multistage sclerotherapy with bleomycin A5 is a safe and effective treatment for extensive head and neck LMs in infants with airway involvement. A routine perioperative protocol is essential for decreasing airway complications.

The airway device preference may affect the overlapping of the common carotid artery by the internal jugular vein.

Anatomical variation in the internal jugular vein (IJV), as well as its small size, tendency to collapse, and proximity to the common carotid artery (CCA) makes central venous cannulation via the IJV a technically challenging procedure, especially in pediatric patients. We evaluated the effects of laryngeal mask airway insertion and endotracheal intubation (ETT) on the anatomical relationship between the IJV and the CCA in neutral and 40° head away positions. After parental consent 92 patients with ASA physical status I-II, aged 0-17, undergoing elective urological surgery were enrolled and divided into two groups according to the airway management device used for anesthesia: Group laryngeal mask airway (n=63) and Group ETT (n=29). An ultrasonographic evaluation was performed before and after airway instrumentation at neutral and 40° head rotation. The IJV position in relation to the CCA was noted, and the overlap percentage of the CCA was calculated as the ratio of the CCA length covering by the internal jugular vein to the transverse diameter of the CCA. With no airway device insertion, the position of the IJV was found to be anterolateral to the CCA in the majority of patients (48.8% vs 35.3%, right vs left IJV) in the neutral head position. While there was no significant change in the overlap percentages of the CCA after laryngeal mask airway insertion in the neutral head position [48.71% vs 57.30% for the right IJV (difference in median: -21.20; 95% confidence interval (CI) of difference: -56.92 to 14.52; P=0.133); 52.54% vs 60.36% for the left IJV (difference in median: -10.3; 95% CI of difference: -41.49 to 20.89; P=0.128)], it increased significantly in the 40° head away position on both sides [50.11% vs 64.83% for the right IJV (difference in median: -55; 95% CI of difference: -84 to -25.24; P=0.01); 53.82% vs 71.20% for the left IJV (difference in median: -46; 95% CI of difference: -86.85 to -5.15; P=0.004)]. However, the overlap percentages of CCA decreased significantly on the right side with patients in a neutral head position (31.23% vs 6.27%, difference in median: 19; 95% CI of difference: -5.68 to 43.68; P=0.002) and on both sides in the 40° head away position [29.50% vs 16.19%, difference in median: 26; 95% CI of difference: 2.84 to 49.16; P=0.03 and 47% vs 31.94%, difference in median: 9.50; 95% CI of difference: -40.87 to 59.87; P=0.03 for the right and left sides, respectively] after ETT insertion. Laryngeal mask airway with 40° head rotation increases, whereas ETT decreases, the overlap percentage of CCA by IJV. Both head position and airway management methods have an influence on the overlap of the CCA by the IJV in pediatric patients.

Cancer mortality in a population exposed to nephrite processing

ObjectivesAlthough asbestos has been recognised as a strong carcinogen, many asbestos minerals exist in concrete masses, and the health risks of these materials remain inconclusive. Nephrite jade is a concrete...

Airway Management in Post Chemo radiotherapy Head and Neck Cancer Patients Presenting for Dental Procedures in Ambulatory Setting-Case series

Dental complications of chemo radiation in head and neck cancer patients often require surgical treatment under general anaesthesia. Patients usually scheduled as day care basis that warrants early discharge. Most of these have very limited mouth opening or distorted anatomy of face as a result of previous surgery and radiation. Airway management remains central to perioperative care. The decision whether to manage a patient with anticipated difficult airways in ambulatory care requires a multidisciplinary approach. Many factors will influence this decision including the cause and severity of the airway problem, the type of procedure, the experience of the perioperative staff, and the availability of difficult airway management devices. Patients with head and neck cancer chemoradiation present airway management problems as difficult as any we confront. Our knowledge, skills, and judgment are routinely and rigorously tested in our care of these patients. Present case series highlights some important aspects regarding management of anticipated difficult airways in ambulatory setting.

The revolution of overground respiratory video-endoscopy in exercising horses

The revolution of overground respiratory video-endoscopy in exercising horses

Medrobotics Flex System for Laryngeal Surgery: A Feasible Study in Two Cadavers

ABSTRACT Objective To report the feasibility of Medrobotics Flex® System for laryngeal surgery. Materials and methods Cadaver study in research laboratory. Results The Medrobotics Flex System was utilized with the Medrobotics Flex Retractor to evaluate robotic laryngeal surgery in a cadaver model. Two surgeons using two cadavers tested the robotic system to expose the larynx and facilitate robotic airway surgery using the Flex Instruments. In both cadavers, these procedures were performed transorally with excellent visualization: supraglottoplasty, arytenoidectomy, epiglottectomy, vocal cord lesion excision, posterior cordotomy, hemilaryngectomy, and endoscopic anterior/posterior cricoid split. Laryngeal cleft repair was limited by availability of suture to close the interarytenoid band. Laryngeal exposure was rated as “excellent” by both surgeons using the robotic platform. Conclusion Robotic surgery for the head and neck, while still in relative infancy, remains one of the newest platforms for the otolaryngologist. Currently available robotic platforms, while adapted to head and neck and airway surgery, were not designed for this purpose and pose challenges in size and accessibility to the larynx. The Flex System is specifically designed for head and neck and laryngeal surgery. This system provides outstanding visualization of hard to access areas in the larynx and hypopharynx. The flexible surgical instruments used with the Flex System allow for reasonable surgical exposure and technique. The Flex System may provide an improved robotic experience for transoral laryngeal and head and neck surgery. How to cite this article Roy S, Naqvi SHS, Karni RJ. Medrobotics Flex System for Laryngeal Surgery: A Feasible Study in Two Cadavers. Int J Head Neck Surg 2016;7(4):204-206.