Pharyngeal Pathology Research Articles

Airway Analysis in Different Malocclusions - A Cephalometric Study

Background: It was essential to evaluate respiratory function when diagnosing and planning orthodontic treatment. Based on the correlation between pharyngeal airway space and craniofacial structure, airway width was hypothesized to be an indicator of airway patency in different groups of skeletal malocclusion. Aim: The purpose of this study was to investigate age and gender related changes in pharyngeal airway dimensions in different sagittal skeletal relationships Materials and Method: Sixty lateral cephalograms of patients aged 10-30 years with no pharyngeal pathology or nasal obstruction were retrospectively selected and categorized into skeletal Class I (n = 20), Class II (n = 20), and Class III (n = 20) malocclusion based on ANB angle. McNamara's airway analysis was used to quantify upper- and lower-airway dimensions. The analyses of intergroup differences were performed using a one-way ANOVA, an independent t-test, and Tukey's test as a post-hoc test. Results: Participants in the study ranged in age from 20.57 ± 5.41 years (males) and 20.03 ± 4.58 years (females) were included in the study. The upper pharyngeal airway (UPA) dimensions demonstrated a positive correlation with age. In both genders, the mean upper pharyngeal airway (UPA) size exceeded the lower pharyngeal airway (LPA) size, but neither age nor gender was associated with statistically significant differences in skeletal malocclusion. Conclusion: It was shown that skeletal malocclusions of different types have no effect on the upper and lower pharyngeal airways and that the upper and lower pharyngeal airways are not influenced by age or gender.

Imaging of pharyngeal pathology: A pictorial review.

The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who present with pharynx-related symptoms such as sore throat, globus, dysphagia or dysphonia will usually undergo visual and nasal endoscopic examination first. Imaging is frequently required to supplement clinical assessment and this typically involves MRI and CT. However, fluoroscopy, ultrasound and radionuclide imaging are of value in several clinical situations. The aforementioned complexity of the pharynx and the myriad of pathologies which may arise within it often make radiological evaluation challenging. In this pictorial review, we aim to provide a brief overview of cross-sectional pharyngeal anatomy and present the radiological features of a variety of pharyngeal pathologies, both benign and malignant.

Comparison of Baska Mask Versus Proseal Laryngeal Mask Airway in Elective Surgeries Under General Anaesthesia: A Randomized Clinical Trial.

Background Baska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. Methods This prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMAgroup (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI)of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patientswere insertedwitheither BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. Results Demographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which wasstatistically significant. The BMprovided a higher OSP(31.34 +1.638 cmH2O)when compared to PLMA(24.81±1.469 cmH2O) andwas statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. Conclusion BM had higher first-attempt successful insertion with better OSP compared to PLMAin patients under controlled ventilation.

Possibilities of phytopreparations in treatment of patients with pharyngeal pathology

Patients with infectious- inflammatory diseases of the pharynx make up a significant percentage on the intake of otorhinolaryngologists and therapists. Most pharyngeal diseases have pronounced clinical signs, have a significant impact on the performance and quality of life of patients, and have a fairly high risk of a complicated course. It is important for such patients to therapeutically provide relief of pain syndrome and stop inflammatory changes. Pharyngeal diseases and their consequences place a pronounced economic burden on the health system and society as a whole. Timely and correctly selected treatment contributes to a favorable resolution of the pathological process, against the background of preserving the protective functions of the pharyngeal mucosa and is economically feasible. Herbal preparations are effective drugs for this purpose. Phytopreparations have long been actively used in clinical practice due to their effectiveness, safety and accessibility. According to the literature, the administration of herbal preparations as monotherapy in patients with acute infectious and inflammatory pharyngeal diseases was found to be a highly effective way of treatment. The active ingredients, chamomile, marshmallow and horsetail contribute to the improvement of the body’s nonspecific defences due to enhancement of phagocytic activity of macrophages and granulocytes. Polysaccharides, essential oils and bioflavonoids of chamomile, marshmallow and yarrow have an anti-inflammatory effect and reduce oedema of the respiratory tract mucous membrane. In addition to antimicrobial and anti-inflammatory effects, herbal preparations have an immunomodulatory effect, which is particularly important because infectious inflammation, trauma, chronic stress entail a secondary immunodeficiency condition. Unnecessary prescriptions of antibacterial drugs, deterioration of the ecological situation contribute to the development of this condition. The immunomodulating effect of phytopreparations is promising not only in the treatment of upper respiratory tract pathology, but also in the secondary prophylaxis and the prevention of chronization of inflammation processes.

Pharyngeal pathology in a mouse model of oculopharyngeal muscular dystrophy is associated with impaired basal autophagy in myoblasts.

Oculopharyngeal muscular dystrophy (OPMD) is a late-onset dominant disease that primarily affects craniofacial muscles. Despite the fact that the genetic cause of OPMD is known to be expansion mutations in the gene encoding the nuclear polyadenosine RNA binding protein PABPN1, the molecular mechanisms of pathology are unknown and no pharmacologic treatments are available. Due to the limited availability of patient tissues, several animal models have been employed to study the pathology of OPMD. However, none of these models have demonstrated functional deficits in the muscles of the pharynx, which are predominantly affected by OPMD. Here, we used a knock-in mouse model of OPMD, Pabpn1 +/A17 , that closely genocopies patients. In Pabpn1 +/A17 mice, we detected impaired pharyngeal muscle function, and impaired pharyngeal satellite cell proliferation and fusion. Molecular studies revealed that basal autophagy, which is required for normal satellite cell function, is higher in pharynx-derived myoblasts than in myoblasts derived from limb muscles. Interestingly, basal autophagy is impaired in cells derived from Pabpn1 +/A17 mice. Pabpn1 knockdown in pharyngeal myoblasts failed to recapitulate the autophagy defect detected in Pabpn1 +/A17 myoblasts suggesting that loss of PABPN1 function does not contribute to the basal autophagy defect. Taken together, these studies provide the first evidence for pharyngeal muscle and satellite cell pathology in a mouse model of OPMD and suggest that aberrant gain of PABPN1 function contributes to the craniofacial pathology in OPMD.

Treatment principles of children with pharyngeal tonsil pathology in the background of allergic rhinitis (literature review): A review

This article provides a review of different treatment for children with adenoids against a background of allergic rhinitis. An analysis of 35 papers published in Scopus and PubMed was carried out. Evaluation of the research results has shown that treatment of patients with pathology of lymphoid structures of the pharynx on the background of allergic rhinitis should be complex and individual in each clinical case.

English

BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy

Suspension laryngoscopy experiences in a tertiary airway service: A prospective study of 150 procedures.

In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post-procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates. Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8-month period between November 2019 and July 2020. Patients were assessed preoperatively for pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery. Tertiary adult airway service for predominantly benign pathology. Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r=.22, p=.008) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r=-.20, p=.014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r=-.19, p=.023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r=.45, p=1.611×10-8 ). In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms.

Prospects of antimicrobial peptides application in otorhinolaryngology in conditions of increasing antibiotic resistance

The use of antibacterial drugs has become widespread over the past 10-15 years. In this regard, there is a significant increase in antibiotic resistance in the world. Combating this problem has been one of the priorities of WHO since 2015. In light of this situation, the use of antimicrobials with no antibiotic resistance is of paramount importance. Topical antimicrobial peptides are used to treat infectious skin and mucosal diseases. The review highlights the role of the antimicrobial polypeptide thyrotricin and the complex drug doritricin in the treatment of pharyngeal pathology in adults and children according to foreign and domestic literature. The obtained data indicate the effectiveness and safety of a topical complex preparation containing thyrotricin, benzalkonium chloride and benzocaine (doritricin) as a monopreparation in the treatment of viral and bacterial tonsillopharyngitis, as well as in the complex therapy of streptococcal tonsillopharyngitis.

A Comparative Study of Laryngeal Mask Airway and Air-Q Intubating Laryngeal Airway Using Parker Flex Tip Tube

Background: To facilitate tracheal intubation, intubating laryngeal mask airway(ILMA) was designed specifically. A relatively new supraglottic airway device, air-Q ILA is an alternative to ILMA to facilitate endotracheal intubation. Considering advantages of air-Q over ILMA are that the breathing tube of the device is shorter, wider and due to removable connector, a standard e Parker Flex Tip tracheal tube (product of Parker Medical Company) has a curved, centered, flexible and tapered distal tip that is designed to facilitate easy, rapid and non-traumatic intubation. It has double murphy eyes with an anterior curvature and a posterior opening bevel. It is designed so that the posterior bevel will decrease the incidence of the tube catching at the anterior or the lateral laryngeal structures during tracheal intubation.Subjects and Methods: This is a randomized, single-blind study. Total of 100 patients of either sex aged 18–60 years belonging to American Society of Anaesthesiologists (ASA) physical status I or II scheduled for elective surgery under general anesthesia with endotracheal intubation were included in the study and the patients with respiratory or pharyngeal pathology, mouth opening < 2.5 cm, body mass index ≥35 kg/m2, pregnancy and anticipated difficult airway were excluded from the study. The duration of the study was one year. The ethical clearance was taken from the institutional ethical committee. Written informed consent from all participants was obtained for participation in the study. Results: A total of 100 patients were allocated for the study. The insertion of the airway device was successful in all the patients of group 1. So, 50 patients were analysed for intubation in group 1. Air-Q ILA could not be inserted and resulted in failure in two cases. Hence, 48 patients were analysed statistically for intubation in group 2. The two groups were comparable with respect to age, weight and sex distribution. The mean age of patients in group 1 was 40.00 ± 10.76 years and in group 2 it was 40.56 ± 11.0 years (P = 0.651). There were 30 females and 20 males both in group 1 and group 2 (P = 1.000). The mean weight of patients in group 1 was 60.34 ± 8.06 kg and in group 2 was 60.10 ± 10.05 kg (P = 0.924). Conclusion:The overall success rate using Parker Flex Tip tube was more with ILMA (99%) as compared to air-Q ILA (78%). It can be further suggested that Parker Flex Tip tube can be used as an alternative to silicone tube with ILMA, but more multicentre studies are required over larger populations to evaluate the utility of Parker Flex Tip tube with air-Q ILA.

Complex topical treatment of patients with infectious and inflammatory pharyngeal pathology

Pharyngalgia is one of the most common complaints in both children and adults seeking medical advice. The causes of throat discomfort and pain vary and are explained by anatomo-physiological characteristics of pharynx. The lesion of pharyngeal mucosa and mucosal associated lymphoid tissue develops in 80% of acute respiratory disease cases. Detailed history taking and additional tests are required to confirm the etiology of pharyngalgia that is not related to respiratory infection and to provide appropriate treatment for the patient. Fixed topical combination with complex effectiveness established itself as a leading choice of inflammatory pharynx diseases treatment. Such treatment has the following advantages: the precise point of drug effect, minimal amount of side effects or its complete absence and risk reduction of general micro biome affection. The treatment should also be able to reach hard-to-reach areas and have good sensory properties. The purpose of topical treatment in patients with pharyngeal pathology is to relieve pain quickly, to reduce the inflammation and to prevent secondary infection of mucosa. The drug containing tyrothricin as antibiotic, benzocaine as antiseptic provides antibacterial and benzalkonium chloride as antiseptic, antiviral and analgetic effects. Not only do the early diagnosis and treatment meet the need of the patient to relieve the symptoms quickly but also have a positive impact on disease course and prevent the development of complications.

Interexaminer reliability of pharyngeal injection and palatine tonsillar hypertrophy in a pediatric emergency department

ObjectivesTo evaluate the interrater reliability of throat examinations in children according to the major and training stage. Study designWe performed a prospective observational study of interrater reliability. The participants included physicians with various amounts of experience and majors who were working in an urban, tertiary hospital. We collected 20 photos of the throats of children who presented to the pediatric emergency department (ED) and performed 2 surveys (with or without medical history). The primary outcome was the interrater agreement for pharyngeal injection (PI) and palatine tonsillar hypertrophy (PTH), and the secondary outcome was the interrater agreement for PI and PTH in subgroups of examiners divided by major and duration of clinical experience. ResultsThirty-three examiners participated in this study. The overall percent agreement for PI was 0.669, and Fleiss' kappa was 0.296. The interrater reliability was similar before and after providing patients' medical history. The overall percent agreement for PTH was 0.408, and Kendall's W was 0.674. When the patients' medical history was provided, Kendall's W increased (0.692). In the subgroup analysis, Fleiss' kappa for PI ranged from 0.257 to 0.33, and Kendall's W for PTH ranged from 0.593 to 0.711. ConclusionExaminers' agreement for PTH was more reliable than that for PI when evaluating children who visited the ED. The interrater reliability did not improve with increased clinical experience. These findings should be considered in the examination of pharyngeal pathology.

Natural head posture changes after maxillomandibular procedures – A prospective study

Purpose of the Study: The aim of this study is to evaluate the natural head posture changes in the individuals after orthognathic surgery assessed using cone-beam computed tomography (CBCT) scan. Materials and Methods: The study was conducted in the age group above 18 years who underwent mandibular advancement for the correction of the skeletal deformity. The difference was evaluated in cases with the help of CBCT scan which was taken preoperatively and 3 months postoperatively. The inclusion criteria were patients undergoing mandibular advancement with or without maxillary procedures. The CBCT scan was taken in a natural head position with lips in a relaxed position and without any other tongue movements like swallowing. The exclusion criteria include patients with pharyngeal pathology, syndromic conditions, and history of orthognathic surgery. The head posture was determined by measuring the craniocervical angle (CCA) before and after surgery to evaluate the changes. The study was divided among bilateral sagittal split osteotomy (BSSO) advancement cases and maxillomandibular procedures. The statistical analysis was done using a paired t-test. Results: The head posture changes present in mandibular advancement cases show a decrease in the angulation of CCA in both types. The P value of head posture in BSSO advancement cases was 0.25, and for maxillomandibular cases, it was 0.007. Conclusion: The study was concluded by showing a decrease in the angulation of the CCA after orthognathic surgery. This shows improvement in the facial profile and structural positions.

Отражение современных концепций патогенеза экссудативного среднего отита у детей в клинической практике

The scientific work presents the data of observation of 52 patients with combined lymphoepithelial pharyngeal ring pathology and exudative otitis media (EOM), admitted for routine surgical treatment. The study results indicate, that the pathology of the lymphoepithelial pharyngeal ring was accompanied by a significant Eustachian tube dysfunction with the development of catarrhal and serous stages of secretory otitis media in 90.38% (47 patients) and mucoid stage (the «glue ear») in 9.62% (5 children) who needed tympanostomy tube. The authors have considered the key problems of etiopathogenesis of suppurative otitis media in children based on the analysis of their own clinical experience and the present-day clinical experimental works, reputable monographs. According to some authors, some cases of tympanic cavity exudate are supposedly the result of incomplete resolution of previous acute purulent inflammation. It is indirectly indicated by the data of inoculation of material for detection of bacterial flora and identification of cellular composition (the signs of infectious etiology). The results prove, that the viral and bacterial infections play an important role in the pathogenesis of EOM. The use of antibacterial therapy in some cases will probably result in a sluggish inflammatory process and the preservation of exudation in the tympanic cavity. However, in 46.2% cases, the patients diagnosed with the exudative otitis media had no acute otitis media in anamnesis. The aseptic nature of ear secret was revealed by bacteriological method in 88.5% cases, but the data of cytological analysis in 57.7% cases indirectly indicate the previous inflammation of infectious etiology. The allergic anamnesis in 73% (38 people), in particular, allergic rhinitis in 36.5% (19 people), could also accelerate and/or trigger the development of EOM.

Сравнительное морфометрическое изучение носоглоточного пространства у детей с хроническим аденоидитом и челюстно-лицевой дизморфией

The growth and function of the nasal cavity, nasopharynx, and oropharynx are closely related to the normal growth of the skull in children. The lack of theoretical knowledge, the demand for knowledge, the complexity of prediction impelled the authors to conduct a comparative morphometric study of MRI scans of the nasopharyngeal space in children with chronic adenoiditis and maxillofacial dysmorphism to search for a rational approach and technology that preclude the progression of irreversible craniofacial changes. The study was performed by a group of authors in the premises of the University clinic. A total of 490 patients suffering from chronic adenoiditis were examined. The authors established the prevalence of comorbid pathology of chronic adenoiditis with hypertrophy of the pharyngeal tonsil and neurological pathology of the brain, which allowed substantiating the performance of brain MRI, it constituted 3.2%. This comorbid pathology was studied in conjunction with the acquired maxillofacial dysmorphism. For statistical calculation, the authors chose non-parametric methods with the use of affine relationships space theory from the section of Riemannian Geometry. The authors pointed out topographic landmarks and formed the control points which made it possible to evaluate the nasopharyngeal spaces, changing under the effect of the pharyngeal tonsil, taking into account the complexity of the anatomical three-dimensional structure. The measurements and control point calculations were carried out using the software RadiantDicomViewer v4.2 Identification of the dependence made it possible to calculate the adeno-nasopharyngeal index, which provides the assessment of maxillofacial dysmorphism risk and its reversibility.

Surgical interventions on the pharynx in the structure of otorhinolaryngological care to the population of the city of Moscow

The authors studied the reporting documentation of otorhinolaryngological hospitals of the city of Moscow on the surgical treatment of pharyngeal pathology in adults from 2002 to 2017. It was found that for 16 years surgical treatment of 290 362 patients with ENT-diseases was performed: 181.206 (62.4%) patients with diseases of the nose and paranasal sinuses, 24.981 (8.6%) patients with ear pathology, 60.346 (20.8%) patients with diseases of the pharynx and 23.829 (8.2%) - with diseases of the larynx. The assessment of the overall dynamics of the studied indicators was carried out on the 'trend lines'. For the considered period, the number of patients with surgical pathology of the pharynx increased by 33.2%. The proportion of tonsillectomies increased by 1.85 times to 56.5%, drainage of peritonsillar abscesses and abscesses-tonsillectomies decreased by 19%, uvulopalatoplastic increased 4.1 times, removal of neoplasms of the pharynx increased 2.2 times, adenotomies decreased by 2.4 times. Analysis of the data allowed to establish that, against the background of an ever-increasing number of surgical interventions for diseases of the pharynx in adults, a descending trend was noted only in the treatment of complicated forms of chronic tonsillitis and hypertrophy of the pharyngeal tonsil.

Predisposing Sinonasal Disease Foci: Do They Really Affect Mucosal Chronic Otitis Media?

Abstract Background This study aimed to find the relationship between sinonasal predisposing foci in chronic otitis media mucosal disease (COMMD) and risk from these predisposing disease foci, and to identify the correlation of bacterial flora of the ear and nose in chronic otitis media. Materials and Methods This was a prospective case–control study with 100 cases and 100 controls. All patients underwent a detailed clinical ear-nose-throat (ENT) examination and diagnostic nasal endoscopy to look for sinonasal and pharyngeal pathology. In all patients, ear and nasal swabs were taken at the first visit. The relationship between these factors and COMMD was studied by appropriate statistical tests. Observations and Results Extremely significant association between tubal tonsil hypertrophy and COMMD, very significant association between adenoid hypertrophy and COMMD, and just significant association between deviated nasal septum, inferior turbinate hypertrophy, concha bullosa, and COMMD were found. No significant association was found between sinusitis and COMMD. In this study Staphylococcus aureus (51%) was the predominant organism isolated from ear swab, followed by Pseudomonas (27%). The same organism in nasal and ear swabs was demonstrated only in eight (13%) cases. Conclusion Sinonasal predisposing foci play a substantial role in the development of COMMD and observed in 97% of the cases with bilateral disease and 91% with unilateral disease in this study. Hence, every case of COMMD must undergo investigations such as diagnostic nasal endoscopy to discover these foci. Because sinonasal disease is one of the important factors contributing to otitis media, timely detection and management of symptomatic sinonasal disease must precede surgical management of COMMD.

Acute infectious inflammatory throat diseases: some aspects of diagnostics and the possibility of medicamental correction

Acute inflammatory diseases of the pharynx are frequent enough pathology of a person, especially in childhood and young age. Etiotropic factors of tonsillopharyngitis in most cases are viruses. Determination of the pathogen and the type of pathological process plays a key role in the choice of tactics of patient management. The introduction of new rapid diagnostic methods into clinical practice is relevant for clinical medicine. Topical medicines for the treatment of patients with pharyngeal pathology are effective and safe. It is preferable to use combination drugs containing several components acting on different parts of the pathological process.

Comparison between Growth Patterns and Pharyngeal Widths in Different Skeletal Malocclusions in South Indian Population.

Aim:The main aim is to determine whether growth pattern had an effect on the upper airway by comparing different craniofacial patterns with pharyngeal widths and its importance during the clinical examination.Methodology:Sixty lateral cephalograms of patients aged between 16 and 24 years with no pharyngeal pathology or nasal obstruction were selected for the study. These were divided into skeletal Class I (n = 30) and skeletal Class II (n = 30) using ANB angle subdivided into normodivergent, hyperdivergent, and hypodivergent facial patterns based on SN-GoGn angle. McNamara's airway analysis was used to determine the upper- and lower-airway dimensions. One-way ANOVA was used to do the intergroup comparisons and the Tukey's test as the secondary statistical analysis.Results:Statistically significant difference exists between the upper-airway dimensions in both the skeletal malocclusions with hyperdivergent growth patterns when compared to other growth patterns.Conclusion:In both the skeletal malocclusions, vertical growers showed a significant decrease in the airway size than the horizontal and normal growers. There is no statistical significance between the lower airway and craniofacial growth pattern.

Intubation failure during gastroscopy: incidence, predictors and follow-up findings.

Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus. To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF. All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into 'failure to tolerate' and 'failure to progress' based on endoscopy reports. The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker's diverticulum in 73.2%. 'Failure to progress' predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age >/=65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001). Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age >/=65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy.