Number Of Anatomical Factors Research Articles

Airway Management: Difficulty of Intubation and Range of Movement of the Thyroid Cartilage

PurposeDifficult endotracheal intubation has been associated with a number of anatomic factors. According to our experience, the range of movement of thyroid cartilage can be used as a useful test to determine the difficulty in endotracheal intubation. The aim of this study was to evaluate the association between the range of movement of thyroid cartilage and difficulty in intubation. DesignCross-sectional study. MethodsThis study was carried out on 400 patients at (Shohada Ashayer Hospital, Khorramabad). After obtaining consent letters from the patients who were between 18 and 60 years of age, the patients underwent general anesthesia. The participants were evaluated by Mallampati and other evaluating tests. The range of movement of thyroid cartilage from the midline was measured and recorded. FindingsThere were significant correlation between the range of movement of thyroid cartilage and thyromental distance. In addition, in patients with Cormack-Lehane class 1, the mean range of movement of thyroid cartilage was significantly more than the patients with Cormack-Lehane class 3 and 4. ConclusionsThe outcomes of our study indicate that the range of movement of thyroid cartilage can be used for predication of difficult intubation. However, further randomized trials should be conducted in this regard.

Anatomic Factors Affecting Size of Suboccipital Decompression

Abstract INTRODUCTION Emergent suboccipital decompressions are not uncommon procedures for the management of cerebellar infarcts and hemorrhages with mass effect. While anatomic landmarks, such as the transverse sinus and foramen magnum, provide clear boundaries to the decompression, there are a multitude of patient-specific anatomic factors that complicate positioning, and make obtaining an adequate decompression challenging. METHODS We reviewed a consecutive series of patients undergoing emergent suboccipital decompressions. Patients in whom a unilateral decompression was performed were excluded from the study. A total of 43 patients met the inclusion criteria, and were further reviewed. The primary outcome was to determine what anatomic factors predicted maximal width and cranial-caudal extent of SOC bone flap. Head CTs, including scout film radiographs, and chest XRs in the pre- and perioperative period were reviewed to measure specific anatomic features. RESULTS The average patient age was 55 (19-85). 34% of patients were female. A bivariate analysis showed that AP diameter correlated to inion-to-foramen magnum distance (P = .001, r2 = 0.501), shoulder width (P = .001, r2 = 0.509), and soft tissue at C1 measured from posterior arch on CT (P = .004, r2 = 0.444). The angle measured from a plumb line through the CT scout radiograph and a line connecting the inion to the spinous process of C2 also correlated to AP diameter (P = .046, r2 = 0.309). The width of decompression also correlated to the cranial-caudal height (P < .001, r2 = 0.522). A linear regression model demonstrated that cranial-caudal height was predicted (F (16,22) = 2.654, P = .017, r2 = 0.659) by age, maximum SOC width, and BMI (ß = -0.421, P = .031, 95% CI = (-1.067, -0.058)). CONCLUSION We demonstrate that a number of anatomic factors affect the ability to achieve optimal SOC size. While these factors are not modifiable, awareness of these factors may help guide positioning and operative planning to achieve maximum cerebellar decompression and help improve patient functional outcomes after emergent suboccipital decompression.

Treatment Planning for Periimplant Mucositis and Periimplantitis.

A literature search was performed in a number of health care databases for articles published until January 2018. A number of anatomical factors, risk indicators, possible aesthetic complications, and financial implications have to be taken into consideration before treatment commences. When diagnosed early, periimplant mucositis is a problem that can be easily managed as long as the patient is motivated and maintains good levels of oral hygiene. Periimplantitis is more difficult to treat and results can be unpredictable. Nonsurgical therapy has limited effectiveness on the treatment of periimplantitis, but it should always precede a surgical intervention. Clinically predictable surgical outcomes seem to rely mainly on the configuration of the bone defect, the position of the affected implant, and the patient's ability to perform good oral hygiene. Thorough treatment planning of periimplant diseases is paramount for the success of the treatment that follows. Local and general factors as well as patients' expectations have to be considered before proceeding, but treatment planning should also allow for a degree of flexibility, which will accommodate the unknown parameters.

Trap-door durotomy for ventral calcified thoracic meningioma

Abstract Ventral calcified meningiomas of the upper thoracic spine provide a unique challenge due to their location. The posterior approach has long been utilized for resection of ventral meningiomas with high success rates and low morbidity. There are a number of anatomical factors that can increase the difficulty in the case including patient body habitus, calcified tumors ventrally located can be adherent to the cord or anterior spinal artery, angle of the ribs and the vascularity in and around the tumor. We present a very challenging case of a large ventral calcified meningioma at T4 in a patient with body mass index of 50 (5′6, 337 lbs) who presented with progressive paraplegia.

Predicting difficult intubation - any one test is not enough

AnaesthesiaVolume 57, Issue 12 p. 1226-1227 Free Access Predicting difficult intubation – any one test is not enough First published: 18 November 2002 https://doi.org/10.1046/j.1365-2044.2002.02913_22.xCitations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat I must congratulate Dr Yentis on his lucid explanation of the basis of predictive tests and the problems faced in using them (Yentis. Anaesthesia 2002; 57: 105–9). However, I take exception to the first part of his conclusion that ‘attempting to predict difficult intubation is unlikely to be useful’ because of the large number of false negative results and the rarity of truly difficult intubation. If I may make an analogy to the pre-anaesthetic equipment check, we do not calculate the false negatives and positive predictive value of each test, our aim is to avoid trouble by ensuring that all necessary components of equipment are functioning adequately. Similarly, when we manage the airway, our aim is to avoid the ‘cannot intubate, cannot ventilate’ situation; and routine examination of the airway, with the possibility of a false positive result, is a small price to pay for this. One of the problems with airway assessment is the common misconception that a single test can accurately predict difficulty, for example ‘doing a Mallampati’. The truth is that laryngoscopic exposure of the vocal cords depends on a number of anatomical factors. Therefore, it is just not possible for a single test to fit the bill. Just as we test each component of the anaesthetic equipment separately, each of the following aspects of the airway should be looked at specifically: ? Limitation of head extension, possibly due to a narrow atlanto-occipital gap ? Limitation of neck flexion, possibly due to a short, thick neck ? Small mandibular space, which can be detected by a thyromental distance < 7 cm or the presence of a receding chin ? Mouth opening ? Amount of tongue tissue which needs to be retracted into the mandibular space, assessed by the Mallampati test ? Protruding upper incisors, which encroach upon the line of vision. In practice, it is really not necessary to calculate or indeed be guided by predictive values or likelihood ratios. Extreme unfavourability of any one of the above factors or moderate impairment of two or more factors should alert the anaesthetist to the possibility of difficulty. I do agree with Dr Yentis that routine pre-operative airway assessment ‘forces the anaesthetist to think of the airway’. But I would emphasise that a multifactorial approach is very important [1-3]. Depending on any one test, such as the Mallampati, though it may be the ‘best of a bad bunch’[4], leaves the assessment incomplete. G. Nath AI Jazeira and Central Hospitals, PO Box 2427, Abu Dhabi, UAE References 1 Nath G, Sekar M. Predicting difficult intubation – a comprehensive scoring system. Anaesthesia and Intensive Care 1997; 25: 482– 6.CrossrefCASPubMedWeb of Science®Google Scholar 2 El-Ganzouri AR, McCarthy RJ, Tuman KJ, Tahck EN, Ivankovich AD. Preoperative airway assessment. Predictive value of a multivariate risk index. Anesthesia and Analgesia 1996; 82: 1197– 204.CrossrefPubMedWeb of Science®Google Scholar 3 Karkouti K, Rose DK, Wigglesworth D, Cohen MM. Predicting difficult intubation: a multivariate analysis. Canadian Journal of Anaesthesia 2000; 47: 730– 9.CrossrefCASPubMedWeb of Science®Google Scholar 4 Calder I. Useless ritual? Anaesthesia 2002; 57: 612.Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Citing Literature Volume57, Issue12December 2002Pages 1226-1227 ReferencesRelatedInformation

CLOSED REDUCTION OF FRACTURED LUMBAR SPINE WITH UNILATERAL DISLOCATION

Fracture dislocations of the lumbar vertebrae are rare. According to Frazier and Allen1the infrequency of lumbar dislocations may be attributed to a number of anatomic factors. Unlike the cervical region, where dislocations are most common, there is a comparatively limited range of motion in the lumbar region; the bodies of the lumbar vertebrae are much larger in every dimension the intervertebral disks are thicker and more elastic; the ligaments at this level of the spine have great strength, and finally—what is probably a factor of greatest importance—the articular processes interlock. These authors have stated that with one exception in all cases dislocations of the lumbar vertebrae have been either backward or forward. In the exceptional case, reported by Schmid,1a rotary dislocation is seen in roentgenograms with the second, or proximal, vertebra projected to the right 1.5 cm. beyond the third, or distal, vertebra and the alinement