Level Of Hyoid Research Articles

The vertical topography of the carotid bifurcation – original study and review

PurposeThe vertical level of carotid bifurcation (CB) is commonly indicated at the superior margin of the thyroid cartilage. Few studies observed the CB vertical topography. It was aimed at studying the vertical location of the CB as referred to vertebral and anterior cervical landmarks.MethodsAn archived lot of 147 computed tomography angiograms was documented for the vertical level of CB referred to vertebral and anterior cervical landmarks. The topography of the CB in relation to anterior landmarks was classified into seven types: (1) at the superior margin of the thyroid cartilage; (2) between the hyoid and the thyroid cartilage; (3) at the hyoid level; (4) between the hyoid and mandible; (5) subgonial or supragonial CB; (6) lower cervical level; (7) intrathoracic.ResultsThe most common locations of CB were at C3 (27.21%), C3/C4 (26.19%) and C4 (25.51%). Bilateral symmetry of CB was found in 51.7%, except for C2 and C5/C6. Type 7 was not found, type 3 occurred in 39.12%, type 2 in 24.49%, type 1 in 13.95%, type 4 in 13.61%, type 5 in 6.12%, and type 6 in 2.72% (294 CBs). Bilateral symmetry of anterior types was found in 59.86%. Statistically significant correlations were found between sex and both left and right types and vertebral levels of CB.ConclusionsThe vertical topography of the CB is highly variable and has sex-related specificity. This detail should be included in the teaching of anatomy. Surgeons and interventionists should better document the carotid anatomy on a case-by-case basis.

The Diversity of the Linguofacial Trunk.

Background and Objectives: Typically, the external carotid artery (ECA) sends off separate anterior branches: the superior thyroid, lingual, and facial arteries. These could, however, form common trunks: thyrolinguofacial, linguofacial (LFT), or thyrolingual. Although known, the LFT variant was poorly detailed previously, and most authors just counted the variant. We aimed to demonstrate the individual anatomical possibilities of the LFT on a case-by-case basis. Materials and Methods: 150 archived angioCT files were used. After applying inclusion and exclusion criteria, 147 files of 86 males and 61 females were kept for this study. Results: In 34/147 cases, LFTs were found (23.12%). Bilateral LFTs were found in 13/34 cases (38.24%) and unilateral LFTs in 21/34 (61.76%) cases. Forty-seven LFTs were thus identified and further studied for different variables. Regarding the vertical topography of LFT origin, type 1a (suprahyoid and infragonial) was found in 28 LFTs (59.57%), type 1b (suprahyoid and gonial) was found in eight LFTs (17.02%), type 3 (suprahyoid and supragonial) was found in two LFTs (4.25%), type 2 (hyoid level of origin) in eight LFTs (17.02%), and type 3 (infrahyoid origin) in just one LFT (2.12%). Types of the initial course of the LFT were determined: type I, ascending, was found in 22/47 LFTs; type II, descending, in 12/47 LFTs; and type III, transverse, in 13/47 LFTs. Regarding the orientation of the first loop of the LFT, 23/47 LFTs had no loop, 4/47 had anterior loops, 1/47 had a posterior loop, 5/47 had superior loops, 5/47 had inferior loops, and 9/47 had medial loops. The position of the LFT relative to the ECA was classified as medial, anterior, or antero-medial. An amount of 12/47 LFTs were anterior to the ECA, 22/47 were antero-medial, 10/47 were medial, 2/47 were inferior, and 1/47 was lateral. Regarding their general morphology, 23/47 LFTs had a rectilinear course, 22/47 had loops, and 2/47 were coiled. A case-by-case presentation of results further demonstrated the diversity of the LFT. Conclusions: In conclusion, the morphology and topography of the LFT are individually specific and unpredictable. It can be anticipated case-by-case by surgeons on CT or MR angiograms.

Evaluation of Ultrasonography with Conventional Clinical Parameters for Predicting Difficult Laryngoscopy

Background: Unanticipated difficult intubation poses a challenge in routine practice for anaesthesiologists. A preoperative airway evaluation helps in the identification of a difficult airway. Airway assessment with ultrasound is a modality recently being used to predict difficult airway. In this study we evaluate ultrasonography parameters with conventional clinical parameters for predicting difficult airway in adults undergoing elective surgeries.
 Methods: This cross sectional randomised clinical trial analyses ASA class 1 and 2 adults requiring endotracheal intubation for surgeries under general anaesthesia were enrolled following which Modified Mallampatti score and thyromental distance as well as ultrasound distance to epiglottis (DSE) and distance to hyoid bone (DSHB) were measured and based on Cormack Lehane grading they were categorised into easy and difficult airway groups.
 Results: DSE had the highest sensitivity of 90.48% whereas Modified Mallampatti grading had least sensitivity of 66.67%.
 Conclusion: The results of this study showed that ultrasonographic measurements at the thyrohyoid and hyoid level have higher sensitivity and specificity than the clinical parameters for airway assessment.

Value of the Hyomental Distance Measured With Ultrasound in Forecasting Difficult Laryngoscopy in Newborns

PurposePreoperative evaluations of difficult airways are imperative, especially in newborns. The hyomental distance is a reliable index for predicting difficult airways in adults. However, few studies have evaluated the value of the hyomental distance for predicting difficult airways in newborns. It is unclear whether the hyomental distance forecasts a restricted or difficult view when using direct laryngoscopy. We intended to develop an effective system for predicting difficult tracheal intubation in newborns. DesignA prospective observational clinical study. MethodsNewborns aged 0 to 28 days undergoing oral endotracheal intubation with direct laryngoscopy for elective surgery under general anesthesia were enrolled. The hyomental distance and hyoid level tissue thickness were assessed by ultrasound. Other parameters, such as the mandibular length and sternomental distance, were also evaluated before anesthesia. The glottic structure view under laryngoscopy was graded according to the Cormack-Lehane classification. The patients with Grade 1 and 2 laryngeal views were assigned to Group E. Those with Grade 3 and 4 views were assigned to Group D. FindingsA total of 123 newborns were recruited for our study. The incidence of poor visualization of the larynx during laryngoscopy in our study was 10.6%. The multifactor logistic regression results showed that the hyomental distance was a powerful predictor of difficult laryngoscopy (OR = 0.16, 95% CI 0.03-0.74, P = .019). The curve with the highest sensitivity and specificity and the maximum area under the curve (AUC) was the hyomental distance. The receiver operating characteristic (ROC) curve for the hyomental distance suggested that the best cut-off value was less than equal to 2.74 cm, with an AUC of 0.80 (95% CI 0.64-0.95). ConclusionsIt is noninvasive and feasible to accurately measure the hyomental distance with ultrasound in newborns, and the results are reliable. We believe that the hyomental distance measured with ultrasound could be used as a marker for predicting difficult laryngoscopy in newborns.

Clinical and ultrasonographic assessment of airway indices among non-pregnant, normotensive pregnant and pre-eclamptic patients: a prospective observational study

BackgroundPrediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound. MethodsFifty-five non-pregnant females, 55 normotensive pregnant females and 55 females with pre-eclampsia were included in this prospective study. Clinical airway assessment was the modified Mallampati score, thyromental distance, hyomental distance, hyomental distance ratio, chest circumference, neck circumference and chest-to-neck circumference ratio. Sonographic assessment included tongue width, tongue volume, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, subglottic diameter, ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. ResultsSeveral significant differences were observed between pregnant and non-pregnant females, with additional changes in pre-eclamptic females. These included clinical parameters such as the modified Mallampati score and sonographic measurements of tongue width, tongue volume, subglottic diameter, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, and the ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. ConclusionRoutinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.

Correlation between upper airway ultrasound and Cormack–Lehane grading during laryngoscopy – A prospective study

Background: Securing airway and adequate ventilation after induction of anesthesia is the utmost priority of anesthesiologists, failure of that can lead to hypoxic brain injury and death in a few minutes. Aims and Objectives: The aims of this study were to ascertain the role of ultrasonography in predicting difficult intubation by comparing different ultrasonographic parameters. Materials and Methods: One hundred patients posted for elective surgery under general anesthesia were studied. The study was carried out in two phases. The first phase – during the pre-anesthetic checkup, ultrasonographic measurements of Anterior neck soft-tissue thickness at the level of hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of vocal cords (ANS-VC), pre-epiglottic space (Pre-E), distance from the epiglottis to the mid-point of the distance between the vocal cords (EVL), and the ratio of both (PES/EVL) was also done. In the second phase, Cormack–Lehane (CL) grade was noted during intubation. A Chi-square test was applied to correlate ultrasonographic parameters and CL grade. Sensitivity, specificity, an area under the receiver operating characteristic (ROC) curve, negative predictive value, and positive predictive value were calculated for various parameters. Results: In this study among the studied parameter, only ANS–VC was statistically significant in predicting difficult intubation (P<0.0001). ANS-VC >0.32 cm was 93.3% sensitive and 84.7% specific and had Area under the ROC curve of 85% in predicting CL grade 3 and 4 (difficult intubation). Conclusion: USG is a useful tool in predicting difficult intubation. ANS-VC >0.32 cm is a highly sensitive and specific predictor of difficult intubation, while other USG parameters are not indicative of difficult intubation.

Mapping of PET/CT-based regional nodes distribution of recurrent/advanced breast cancer and comparison with current delineation atlas.

To localize the distribution of regional nodes in recurrent/advanced breast cancer patients based on 18-fludeoxyglucose (FDG) positron emission tomography/CT (PET/CT) images and validate the coverage of clinical target volumes (CTVs) for regional nodes with current contouring guidelines. We enrolled 154 recurrent/advanced breast cancer patients with FDG-avid regional nodes who underwent PET/CT between January 2018 and June 2020. Involvement of lymph node regions including axillary lymph node level I-III (ALN-I, ALN-II, ALN-III), Rotter's nodes (RN), medial supraclavicular (SC-M), lateral supraclavicular (SC-L) and internal mammary nodes (IMN) was recorded respectively. Coverage of the CTVs in different atlases and the locations of out-of-field were evaluated. A total of 348 lymph node regions containing disease were identified, including ALN-I 109, ALN-II 46, ALN-III 36, RN 17, SC-M 68, SC-L 36 and IMN 36. Recurrent ALNs mainly located cranially and ventrally to the axillary vein (AV). Ipsilateral cervical nodes were simultaneously affected in 33/76 SC positive patients. RADCOMP (306/348) and RUIJIN (291/348) guidelines had higher coverage compared with RTOG (205/348) and ESTRO (202/348) guidelines (p < 0.001, respectively). In primary non-metastastic and recurrent patients, major missings located in SC-L (7/7, 17/17) and IMN (7/10, 15/19) for RTOG guideline while SC-L (7/7, 17/17) for ESTRO guideline (p < 0.001, respectively). Among recurrent patients, SC-M (22/31) was another major missing area for ESTRO guideline (p < 0.001). The current guidelines effectively cover most regional nodes in postoperative breast cancer patients. SC-L and IMN were the major missing regions. Recurrent ALNs were most often seen in cranial and ventral to the AV. The CTV of patients with clinically positive SC was recommended to extend up to the hyoid level. The CTVs should be adjusted based on risks of recurrence individually. The difference of regional nodes delineation between current guidelines mainly located in SC and IMN regions. High axilla including subclavicular nodes and the RN above AV for recurrent patients and the region between cricoid and hyoid for positive SC patients should be meticulously contoured.

Clinical Presentation of Thyroglossal Cysts and Sinuses

Objective: To see the clinical presentation of thyroglossal cysts and sinuses.&#x0D; Methods: Observational type of Cross sectional study. Department of ENT &amp; Head-Neck Surgery in Sher-E-Bangla Medical College Hospital, Barishal from September 2014 to February 2015. All patients attended in the Department of ENT and Head Neck Surgery in Sher-E-Bangla Medical College Hospital, Serum TSH, USG of thyroid swelling and FNAC were done for diagnoses and for evaluation.&#x0D; Results: Thyroglossal cysts and sinuses were found in 23(63.9%) and 13(36.1%) cases respectively. The mean age of presentation was found 16.6±11.3 years in cysts group and 15.5±7.2 years in sinus group. Regarding the site of cysts 4(17.4%) cases was suprahyoid, 11(47.8%) infrahyoid and 8(34.8%) at the level of hyoid. Regarding the site of sinus 1(7.7%) case was suprahyoid, 9(69.2%) infrahyoid and 3(23.1%) at the level of hyoid. All the patients had normal thyroid gland in both group, all of them had normal serum TSH level. FNAC was done in all cyst patients and shows normal cystic lesion with no malignancy. But in sinus patients only one FNAC was done and reported as cystic lesion.&#x0D; Conclusion: Thyroglossal cysts and sinuses were more common in 2nd decade and male predominant. Majority of the cysts are Infrahyoid and on the right side of midline and majority of sinuses are Infrahyoid and on the right side. Development of sinuses is due to operation following abscess formation in majority of cases.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 7-15

English

Deep neck spaces are regions of loose connective tissue present between three layers of deep cervical fascia, namely, superficial, middle, and deep layers. The investing layer is the superficial layer, the pre-tracheal layer is the intermediate layer, and the prevertebral layer is the deep layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries. These deep neck spaces may be further classified into 3 anatomic groups, relative to the hyoid bone: Those located above the level of the hyoid, those that involve the entire length of the neck, those located below the level of hyoid. The patterns of infection may include abscess formation, cellulitis, and necrotizing fasciitis. Antibiotics and surgical drainage form the mainstay of treatment. There are some spaces in the neck present between these layers of deep cervical fascia. These deep neck spaces are filled with loose connective tissue. Deep neck space infection involves the spaces and fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries after overcoming the natural resistance of the fascial planes. With relation to the hyoid bone, these deep neck spaces are further classified as follows: 1. Spaces above the level of the hyoid bone (peritonsillar, submandibular, parapharyngeal, masticator, buccal, and parotid spaces). 2. Spaces that involve the entire length of the neck (retropharyngeal, prevertebral, and carotid spaces). 3. Spaces located below the level of hyoid bone (anterior visceral or pre - tracheal space). Infection may present either as abscess, cellulitis, or necrotizing fasciitis. The mainstay of the management are antibiotics and surgical drainage.

Face lift with U threads

The main and more frequent problem in face lift is recurrence of platysma bands, and of skin excess at the bitterness and naso-jugal folds. To improve face lift stability, a new aging analysis is proposed. The visible sign of face aging is skin excess. SMAS retraction is a much less visible sign. Nevertheless, botulinum toxin injections elongate muscles of the SMAS and rejuvenate the face. In the Face Recurve Concept, MRI studies prove the mimic muscles retraction that comes with aging. Face lift techniques that are used today include SMAS plication, traction or excision, which increases discrepancy between the envelop, the skin and the core, the SMAS. As skin excision is poorly efficient because performed posteriorly, far from the anterior skin excess located at the medial neck or at the bitterness fold, the association to SMAS retraction exacerbates the gradient difference between envelop and core. This analysis shows first of all that it is paramount to preserve the SMAS. Secondly, that the sub-skin dissection has to be executed moving beyond the paramedian folds. Then permanent tensor threads anchored in the malar, parotid and mastoid aponeurosis with a U pass flatten the folds and reposition sub cutaneous tissue excess backward to the SMAS. No action is performed on the SMAS, only an horizontal section of the platysma at the hyoid level will avoid platysma band recurrence. Botulinum toxin injections performed just after block muscle regeneration. 35 patients have been operated on a one year period. Results are a lot more stable and swelling is lowered down to the minimum.

Comparative Study of Preoperative Airway Assessment by Conventional Clinical Predictors and Ultrasound-Assisted Predictors.

Aims:The aim of this study is to evaluate the effectiveness of airway sonographic parameters as the predictors of difficult laryngoscopy and to evaluate the validity of combined sonographic and clinical tests.Materials and Methods:This prospective and observational study analyzed a sample of 200 patients who were categorized as having easy (Grades 1 and 2) or difficult (Grades 3 and 4) laryngoscopy based on the laryngoscopic criteria of Cormack-Lahane (CL). Sonographic parameters, including the anterior neck soft-tissue thickness at the level of vocal cord (ANS-VC), ANS tissue thickness at the level of hyoid, and ratio of depth of pre-epiglottic space to distance from epiglottis to midpoint of the distance between vocal cords and clinical parameters, including modified Mallampati class, thyromental distance, and hyomental distance ratio (HMDR), were analyzed. Univariate and multivariate regression analysis was used for the statistical analysis.Results:Twenty patients (10%) were categorized as having difficult laryngoscopy. Statistically significant differences between patients with difficult and easy laryngoscopy were noted for 5 of 6 parameters. The diagnostic validity profiles showed variable sensitivity (26.5%–87.5%) and good specificity (58.9%–94.2%) and negative predictive value (88.8%–97.03%). ANS-VC has the highest sensitivity (87.50%) and area under curve value (0.887), whereas HMDR showed highest specificity (94.2%) and highest accuracy (89.60%) which means it has low false-positive prediction rate. The combination of tests improved the diagnostic validity profile (highest area under the curve, 0.897).Conclusion:Sonographic predictors can help in identifying difficult laryngoscopy. Combined clinical and ultrasonographic parameters showed better validity profiles in comparison to the individual tests.

Ultrasound measurement of anterior neck soft tissue and tongue thickness to predict difficult laryngoscopy - An observational analytical study.

Background and Aims:Airway ultrasound is an emerging tool to predict difficult laryngoscopy. This study aimed to determine the utility of ultrasound measurement of the anterior soft tissue neck thickness at the level of hyoid, thyrohyoid membrane and thickness of tongue to predict difficult laryngoscopy and compare them with clinical parameters for airway assessment.Methods:The distance from skin to hyoid bone, skin to the thyrohyoid membrane in neutral and sniffing position and maximum tongue thickness was measured by ultrasound and correlated with Cormack Lehane (CL) laryngoscope view in 310 adult surgical patients. Receiver operating characteristic curve was plotted and the area under the curve was calculated for each parameter. The sensitivity and specificity of ultrasound-guided parameters were compared with clinical parameters like the inter-incisor gap, modified Mallampatti classification, thyromental, sternomental distance and neck circumference.Results:Incidence of difficult laryngoscopy (CL grade-III and IV) was 11.3%. A significant difference was observed in the ultrasound parameters between the easy and difficult laryngoscopy (P-value = 0.001). Sensitivity and specificity to predict difficult airway was 69.6% and 77% for tongue thickness, 68% and 73% for the skin to hyoid bone distance in a neutral position and found to be higher than clinical parameters.Conclusion:The ultrasound measurements of soft tissue thickness of the anterior neck and tongue thickness along with the clinical assessment of airway can be useful in predicting difficult laryngoscopy.

Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position.

Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I-II patients between 18 and 70years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029-0.016) cm, p < 0.001 and at level of vocal cords was - 0.012 (- 0.017 to - 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.

Abstract P-004: SONOGRAPHIC APPEARANCE OF PRE-EPIGLOTTIC CYST CAUSING STRIDOR- A CASE REPORT

Aims & Objectives: To show sonographic appearance of larynx before and after aspiration of a pre-epiglottic cyst. Methods Airway ultrasound (US) was performed to asses the airway to find a cause of stridor. We used a high frequency (7.5 MHz), linear transducer of Aloka SSD-90 machine. The patient was in supine position with the neck a little extended, to facilitate the probe. Axial images were taken by putting the probe at the level of hyoid and thyroid cartilage. Images were obtained at two time points, pre and post aspiration. The findings were confirmed on CT scan of the neck. Results A well-defined hypodense round mass measuring 3 × 3 cm with regular margins was seen pre-surgery (left panel figure 1). The margin is very thick and hyperechoic because it is formed by thyrohyoid membrane anteriorly(upper margin); pre-epiglottic space with air-mucosal interface posteriorly(lower margin). This mass obscured laryngeal structures like vocal cords, glottis and arytenoid cartilage. After aspiration of the cyst these structures became visible (right panel figure 1). Conclusions Airway US is a very useful investigation for quick diagnosis of mass lesions of the larynx and epiglottis in children presenting with stridor.

Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study

BackgroundPreeclampsia is associated with greater narrowing of the airway than normal pregnancy, but it is not known if these changes worsen during labor and delivery. The aim of the study was to evaluate the airway during and after labor in women with or without preeclampsia. MethodsTwenty-five normal and 25 severely preeclamptic pregnant women in early labor were recruited in this single-center, prospective, case-control study. Airway assessment was performed (a) before active labor (b) within one hour of delivery and (c) 24–48 h postpartum. The Mallampati grade was the primary outcome. Sonographic measurements of tongue thickness, anterior neck soft tissue at the level of the hyoid bone and the vocal cords, thyromental distance, and neck circumference, were secondary outcomes. ResultsThe Mallampati score increased from the pre-labor to the post-labor period in both preeclamptic and normotensive patients (P=0.001 and P=0.002 respectively). A significant difference in tissue thickness at the hyoid level was observed between preeclamptic and normotensive patients pre-labor (P=0.035), post-labor (P=0.05) and postpartum (P=0.05). There was no significant difference in thyromental distance or neck circumference between groups at any time. The total duration of labor and a Mallampati change by one grade correlated (Spearman correlation coefficient 0.473). ConclusionAirway sonography may provide useful bedside anatomical information for prediction of difficult laryngoscopy. The change in airway dimensions and the Mallampati score during labor may persist for 48 h postpartum in both groups. Those with prolonged labor are more susceptible to changes in airway dimensions.

Abstract PR183

Background & Objectives: The airway of preeclamptic women during the course of labour has yet to be studied. Therefore the aim of this study was to observe airway changes during labour and delivery in severely preeclamptic parturients as compared to normotensive parturients. Total fluids administered, IV oxytocin given and duration of labour were evaluated for their predictive value. Materials & Methods: A prospective observational study was conducted after obtaining approval from institutional ethical commitee. Twenty five severely preeclamptic and 25 normotensive women admitted to labour room for normal vaginal delivery were enrolled. Airway assessment was performed at three times, first at the time of admission to labour room before the patient went into active stage of labour (T1). Second assessment was done within one hour of delivery of the baby (T2), and the third assessment within 24–48 hours postpartum (T3). Each of these times, airway assessment was done using 2 methods. In method 1, Mallampati grade of each participant was recorded using digital photography and a class assigned later to each photograph by a blinded anaesthetist. In method 2, airway sonography was performed in the submandibular region to measure anteroposterior thickness of the tongue, anterior soft tissue thickness at the level of hyoid and vocal cords. Results: Method 1 depicted increase in Mallampati grade from prelabour to postlabour period in both preeclamptics and normotensives (p=0.001; p=0.002 respectively) The changes in Preeclamptics were significantly more as compared to Normotensives. In method 2, significant difference in anterior soft tissue thickness at the level of hyoid was observed between preeclamptics and normotensives, even before the parturient entered active stage of labour (p=0.035). This difference remained statistically significant post labour (p=0.05). A strong correlation was found between total duration of labour and Mallampati change by one grade (correlation coefficient 0.473). A stronger correlation between worsening in Mallampati grade and duration of labour was observed in preeclamptic women as compared to normotensive group (correlation coefficient 0.637versus 0.387 respectively)Conclusion: Our study showed that airway worsening during labour is seen more frequently in preeclamptic women than normotensive women. Prolonged labours cause greater susceptibility to airway changes, especially in preeclamptic women. Mallampati grading used in conjunction with airway ultrasonography aids in detecting a potentially difficult airway of a labouring parturient.

Thyroglossal Duct Cyst &amp; Sistrunk, a Case Series; Personal Experience and Literature Review

Objectives: The purpose of this article is to describe a modified surgical approach to the Thyroglossal duct cyst (TGDC) where the incision is given at upper pole of cyst which offers easy cephalic dissection which is at times difficult and required multiple incisions like sistrunk operation. Further it gives better cosmetic results with no recurrence. Study Design: A total of 48 Patients with the diagnosis of TGDC were assigned from sep 2012 to oct 2014 to have either sistrunk (n=20) or sistrunk with modified incision (n=28) after clinical and radiological assessment in the department of otolaryngology, Pt. B.D Sharma PGIMS Rohtak, Haryana. Ease of resection, recurrence rate and cosmetic outcome were noted. Results: There was no significant difference in the rate of complications and operative time of the procedure between the two procedures. There was statistically significant difference in recurrence rate in sistrunk procedure (3/20 ) as compared to sistrunk procedure with modified incision(0/28) (P = 0.04). All of whom presented with an infected neck mass and were treated with a second Sistrunk procedure. Conclusion: Modified incision gave good results in our series with decrease operative time of the procedure, allow the surgeon to achieve and maintain an excellent exposure at the level of hyoid as well as foramen ceacum making it easy for complete excision and decrease recurrence rate. Further it has better cosmetic outcome as high scar is not visible as it merges within langers lines.

Age‐Related Changes of Muscular Thickness of the Pharyngeal Constrictors in Healthy Adults

Objectives: Age-related sarcopenia has been recognized in skeletal muscles in relation to the decreased body mass index (BMI). In the swallowing muscles, however, there have been few findings concerning sarcopenia. We studied whether muscle volume of the pharyngeal constrictors decreases with age in healthy adults. Methods: A retrospective review of head and neck magnetic resonance imaging (MRI) of 207 adults (138 males and 69 females, 21-96 years old) examined at the Department of Otolaryngology–Head and Neck Surgery of Kyushu University Hospital between 2010 and 2013 was performed. We measured muscle thickness at 4 levels (mid-mandibular level, hyoid level, vocal fold level, and cricopharyngeal level) with OsiriX software. In each level, measuring points were set at median and 3 points with equal intervals in both sides on axial view of T2-weighted MRI images. Averaged values of constrictor thickness were statistically analyzed in correlation to their age and BMI. Results: The pharyngeal constrictor muscles appeared thickest at the hyoid level (male: 2.18 ± 0.77 mm, female: 1.79 ± 0.83 mm), which showed no significant correlation to age ( r = 0.03 in male and 0.07 in female, P &gt; .1) and BMI ( r = 0.27 and 0.33, respectively, P &gt; .1). Results at other levels were almost the same as those at the hyoid. Laterality of the muscle thickness was observed at the cricopharyngeal level (left &gt; right). Conclusions: The pharyngeal constrictors appear not to become thin in proportion to age and BMI, unlike skeletal muscles. Branchiogenic swallowing muscles may be tolerable against aging, as compared to skeletal muscles.

Thyroglossal Duct Cyst, Variation in Presentation, Our Experience.

Thyroglossal duct cysts are most common midline congenital swelling in head and neck region. It results from incomplete involution of thyroglossal duct. They present as midline painless swelling in neck. We have studied variation in their presentation. The retrospective study carried out in department of ENT in Gandhi Medical College Bhopal from Jan 2009 to Sept 2013. Objective of this study is, to study incidence of Thyroglossal Duct Cyst in different age and sex group and variation in presentation. Clinical records, medical records and histopathological records were studied. 10 patients diagnosed as Thyroglossal Duct Cyst included in study. 10 patients were found to be diagnosed as Thyroglossal Duct Cyst. Out of 10 pt. 6 were pediatric patients and 4 were adults. 8 patients presented with cyst while 2 presented with fistula. Out of 10 patients 3 presented with suprahyoid, 2 at the level of hyoid and 5 had infrahyoid presentation. 7 patients undergone sistrunk operation procedure while 3 undergone simple excision. Out of 3 patients who undergone simple excision 1 patient develop recurrence. Thyroglossal Duct Cyst are one of the most common asymptomatic midline neck swelling and should be differentiated with other swellings with proper investigations.

Successful resection of malignant hemangiopericytoma originating from left neck and involving superior vena cava

Background and methods We report a case of a giant malignant hemangiopericytoma in the left neck and involving and growing in left internal jugular, left subclvian, left brachiocephalic vein, superior vena cava (SVC) and occupying part of the right atrium. Tumor was causing severe dyspnea, dysphagia and initial SVC syndrome. A 77-year-old male was admitted to our hospital due to progressive dyspnea and dysphagia. Physical examination present large tumor mass in left supraclavicular and neck region with listening a trill. CT scan explain a large tumor mass started in level of hyoid in left side neck that involve deep veins and expand vessels. Tumor have a arterial blood circulation in SVC. Transthoracic echocardiography showed a mass occupying a space of the right atrium originating from the SVC. Cervicosternotomy used for surgical access. After bluntly removed the tumor from the left neck and ligation of the jugular and subclavian vein proceed to the vascular reconstruction. SVC reconstruction was performed between the right brachiocephalic vein and the right atrial appendage with ringed pericardial graft. Atrial part of tumor was shoved into a SVC. Tumor with vena cava was removed after reconstruction.