Level Of Soft Palate Research Articles

A comparative CT evaluation of pharyngeal airway changes in class III patients receiving bimaxillary surgery or mandibular setback surgery

The purpose of this study was to compare the morphologic changes of the upper airway space in Class III patients who underwent mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback) by computed tomography at 2 levels: soft palate and base of tongue. The sample consisted of 47 subjects in 2 groups who had been diagnosed as having Class III skeletal deformities and had been treated by mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback). Anteroposterior, lateral, and cross-sectional area dimensions of the airway at the level of soft palate and base of tongue were measured pre- and postoperatively on computed tomography images. Anteroposterior dimensions of the airway decreased in both groups (P < .0001); however, the reduction was significantly less in cases treated with bimaxillary surgery (P < .05). In the mandibular setback surgery group, the cross-sectional area of the airway decreased significantly (P < .001). Although the cross-sectional area of the airway decreased in the bimaxillary surgery group, the reduction was not statistically significant (P > .05). This study suggests that bimaxillary surgery can prevent narrowing of the upper airway in the correction of Class III deformities in comparison with mandibular setback surgery used as the sole treatment. Computed tomography was valuable in determining the effects of surgical treatment on pharyngeal airway dimensions.

The study of the upper airway in obstructive sleep apnea hypopnea syndrome with multi-slice spiral CT

目的 应用多层螺旋CT(MSCT)对确诊阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者进行上气道成像,回顾性分析其上气道形态特点,探索该方法在OSAHS临床综合诊断及病因研究中的应用价值.方法经多导睡眠监测(PSG)确诊的OSAHS患者28例,年龄、性别相近的健康成年人14例,于深吸气末、深呼气末、平静呼吸、闭口堵鼻深吸气(Muller)动作时行上气道MSCT扫描,测量各咽部水平的截面积及相应的矢径和横径、软腭的长度及厚度、判断上气道的阻塞情况、计算气道塌陷度.结果 (1)结合运用MSCT图像后处理功能可理想观察上气道的形态特征,准确测量各所需数据并判断上气道阻塞情况.(2)OSAHS组腭后区及舌后区截面积与正常组相比存在明显的狭窄或阻塞,且多发生在吸气时相(P值均<0.05).(3)OSAHS组腭后区及舌后区的气道塌陷度较正常人高,气道容易塌陷(F=15.133,P＝0.001;F=5.552,P＝0.025).(4)OSAHS组软腭厚度较正常人厚(F=15.908,P＝0.000).结论腭后区及舌后区气道明显狭窄或堵塞伴气道塌陷度的增加可能是OSAHS患者发病的主要因素,运用MSCT观察上气道简便、快捷、准确,在OSASH临床综合诊断及病因研究中具有实用价值。

Manoeuvres used to clear the airway during fibreoptic intubation

Fibreoptic orotracheal endoscopy under general anaesthesia may be more difficult to perform if the upper airway cannot be fully cleared. We have studied the effectiveness of jaw thrust, lingual traction and the application of both manoeuvres simultaneously, in opening up the orolaryngeal airspace in 30 ASA group 1 or 2 patients aged between 16 and 70 yr undergoing elective general surgery requiring orotracheal intubation. Airway clearance was assessed fibreoptically at soft palate level by observing whether or not the uvula or soft palate was apposed to the base of the tongue, and at epiglottic level by observing whether or not the epiglottis was apposed to the posterior pharyngeal wall. Lingual traction with Duval's forceps cleared the tongue away from the uvula and soft palate significantly more times than did jaw thrust (P<0.05). Jaw thrust cleared the epiglottis away from the posterior pharyngeal wall more frequently than did lingual traction (P=0.052). Applying both jaw thrust and lingual traction simultaneously cleared the airway at both soft palate and epiglottic level in every patient. When used alone, jaw thrust and lingual traction fail to produce full airway clearance in a significant number of patients. Combined jaw thrust and lingual traction clears the airway more effectively but requires two assistants.

Evaluation of Uvulopalatopharyngoplasty in Treatment of Obstructive Sleep Apnea Syndrome

Many methods have been reported to select the proper candidates for uvulopalatopharyngoplasty (UPPP) among obstructive sleep apnea patients. Polysomnography with intraluminal pressure recordings in the upper airway was found useful to predict obstructive site(s) and hence the success of surgery. According to the pressure analysis, 11 cases with high negative pressure at the mesopharynx were selected for UPPP, while UPPP combined with midline partial glossectomy (UPPP-MLG) was done in 18 cases proved to have high negative pressure difference between the mesopharynx and esophagus. A reduction of the apnea/hypopnea index (AHI) of more than 50% after UPPP was found in 8 cases (72.7%) and in 11 cases (61.1%) after UPPP-MLG. It was found that the response rate was lower among the second group if compared to that of the first because of other aggravating factors rather than simple obstruction at the level of the soft palate and/or tonsils-tongue base level.

A CASE OF EXFOLIATION OF THE ANTERIOR ARCH OF THE ATLAS.

J. P., aged 30, a Bohemian, was employed in a carriage factory. He was extremely pale and emaciated, and the principal symptom that at once attracted attention was the fact that he carried his head and shoulders as rigidly immovable as though clamped in a vise. In expectorating, he would bend from the waist, shielding his neck in every movement. He complained of very severe pain in his throat and in the muscles of his neck. Examination. —An angry ulcer was found, oval in outline, and about a centimeter in its longest diameter, on the posterior wall of the pharynx, a little above the level of the soft palate. There was a profuse purulent discharge and great inflammation of the parts around. Further examination showed marked enlargement of the glands over the entire body, with a mottled eruption, mucous patches in the mouth, and a low-grade fever. There was no difficulty