Postoperative Airway Research Articles

Retrospective analysis of factors contributing to poor prognosis among 271 pediatric patients with tracheal stenosis treated with slide tracheoplasty.

To determine factors contributing to adverse postsurgical outcomes in children with congenital tracheal stenosis (CTS) treated with slide tracheoplasty (STP). We employed regression models to evaluate the impact of preoperative or intraoperative features on postoperative airway complications, mechanical ventilation time, hospitalization, and survival among STP-treated patients with CTS. Outcomes from 271 patients with CTS undergoing STP were analyzed. Multivariate analysis showed that unilateral lung hypoplasia (OR=4.859, 95% CI: 1.355-17.427) and bilateral bronchomalacia (OR=3.774, 95% CI: 1.364-10.440) contributed to postoperative airway complications. Full-length stenosis (β=0.192, 95% CI: 0.077-0.308), bilateral bronchomalacia (β=0.153, 95% CI: 0.039-0.266), and secondary surgery (β=0.269, 95% CI: 0.154-0.384) accounted for increased mechanical ventilation time. Using 99-hours as a benchmark, weight (OR=0.818, 95% CI: 0.677-0.988) and bilateral bronchomalacia (OR=2.960, 95% CI: 1.314-6.666) were factors for prolonged mechanical ventilation time. Additionally, full-length stenosis (β=0.221, 95% CI: 0.108-0.334), unilateral lung hypoplasia (β=0.170, 95% CI: 0.060-0.280), unilateral bronchomalacia (β=0.151, 95% CI: 0.038-0.265), and secondary surgery (β=0.247, 95% CI: 0.138-0.356) were positively associated with the duration of hospitalization, whereas weight (β=-0.307, 95% CI: -0.561--0.054) was negatively correlated. Taking 21-days as a benchmark, weight (OR=0.712, 95% CI: 0.569-0.891), full-length stenosis (OR=2.997, 95% CI: 1.530-5.871), unilateral lung hypoplasia (OR=10.079, 95% CI: 2.267-44.811), and reoperation (OR=24.176, 95% CI: 2.685-217.667) associated with prolonged hospital stay. Weight (HR=0.167, 95% CI: 0.030-0.949) and tracheal diameter (HR=0.172, 95% CI: 0.043-0.684) were positively correlated with survival. Careful assessment and management of perioperative conditions are essential to minimize risk of adverse postsurgical outcomes in CTS patients undergoing STP.

Effectiveness of different pharmacological or non-pharmacological interventions on preventing coughing during extubation: a protocol for a systematic review and network meta-analysis

IntroductionCoughing during extubation can lead to several postoperative complications, including surgical site bleeding, intracranial hypertension and high intraocular pressure. Currently, various pharmacological and non-pharmacological interventions are employed in clinical practice...

Visual rigid laryngoscopy versus video laryngoscopy for endotracheal intubation in elderly patients: A randomized controlled trial.

To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. The intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. ChiCTR2100054174.

Dynamic shunt flow alterations through patent foramen ovale during off-pump coronary artery bypass grafting induced by airway pressure changes: a case report.

Interatrial right-to-left shunt flow through a patent foramen ovale (PFO) can be caused by changes in heart position for anastomosis during off-pump coronary artery bypass (OPCAB). We herein present a case in which the direction of PFO shunt flow changed with heart position during OPCAB and the ventilation settings after sternal closure. A 66-year-old man with interstitial pneumonia underwent OPCAB. Preoperative transesophageal echocardiography revealed right-to-left shunt flow through a PFO induced by the Valsalva maneuver. During OPCAB, heart displacement resulted in right-to-left shunting and acute hypoxemia, which quickly improved with increase of inspired oxygen fraction. After chest closure, bidirectional shunt flow developed under increased airway pressure. Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO.

A new video laryngoscope combined with flexible laryngeal mask insertion: A prospective randomized study

BackgroundThe video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method. MethodsOne hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity. ResultsThe first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH2O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups. ConclusionsThe new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events. Trial registrationChinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn).

Quantitative assessment of preoperative and postoperative brachycephalic airway obstruction syndrome surgery using clinical grading questionnaires and 6-minute walk test in French bulldogs

Quantitative assessment of preoperative and postoperative brachycephalic airway obstruction syndrome surgery using clinical grading questionnaires and 6-minute walk test in French bulldogs

The impact of exvivo lung perfusion location on lung transplant outcomes.

Ex vivo lung perfusion (EVLP) conducted outside of the transplant center has increased in recent years to mitigate its limitation by resources and expertise. We sought to evaluate EVLP performed at transplant centers and externally. Lung transplant recipients were identified from the United Network for Organ Sharing Database. Recipients were then stratified into two groups based where they were perfused: Transplant Program (TP) or External Perfusion Centers (EPC). The groups were assessed with comparative statistics and long-term survival was assessed by Kaplan-Meier method. The groups were then 1:1 propensity and this process was repeated. EPC use was generally restricted to the Southern United States. Following matching, there were no significant differences in post-operative outcomes to include post-operative stroke, dialysis, airway dehiscence, ECMO use, ventilator use or incidence of primary graft dysfunction Grade 3. Adjusted 3-year survival was 68.9% (95% Confidence Interval [CI]: 60.9%-77.9%) for the TP group and 67.6% (95% CI: 61.0%-74.9%) for the EPC group (p = 0.69). In allografts with extended ischemia (14+ h), those in the TP group had significantly longer length of stay, prolonged ventilation and treated rejection in the 1st year, though no significant difference in mid-term survival (p = 0.66). EVLP performed at an EPC can be carried out with results and survival similar to allografts undergoing EVLP at a TP. EPCs will extend the valuable resource of EVLP to lung transplant programs without the resources to perform EVLP.

Airway Events and Critical Care Requirements in Patients with Robin Sequence after Palatoplasty.

Patients with Robin sequence (RS) are often thought to be at high-risk for airway complications after cleft palate repair, and may be routinely admitted to the intensive care unit after surgery. This study compares frequency of postoperative airway events in patients with and without RS undergoing palatoplasty, and assesses potential risk factors for needing intensive care. A matched cohort study of patients with and without RS undergoing palatoplasty from February 2014 to February 2022 was conducted. Variables of interest included prior management of micrognathia, comorbidities, polysomnography, age and weight at the time of palatoplasty, operative techniques, intubation difficulty, anesthesia duration, and postoperative airway management. Airway events were defined as airway edema, secretions, stridor, laryngospasm, obstruction, and/or desaturation requiring intervention. Logistic regression was performed to identify factors predictive of airway events. Thirty-three patients with RS and 33 controls were included. There were no statistically significant differences in airway events between groups (eight RS, four controls, P = 0.30). Anesthetic duration over 318 minutes was associated with increased risk of postoperative airway events [(OR) 1.02 (1.00-1.04) (P = 0.04)] for patients with RS, but not for patients in the control cohort. Postoperative intensive care unit admission is not universally necessary for patients with RS after palatoplasty if intubation was straightforward and there were no concomitant procedures being performed. Patients with longer anesthesia durations were more likely to have postoperative airway events and may need a higher level of care postoperatively.

Three-Dimensional Morphological Changes in the Upper Airway After Maxillary Reconstruction With an Anterolateral Thigh Flap

BackgroundReconstruction of maxillary defects may lead to changes in the upper airway. These changes may cause postoperative airway obstruction issues. PurposeThe purpose was to evaluate the postoperative changes in the upper airway following maxillary reconstruction with an anterolateral thigh flap (ALTF) and to identify the factors associated with these changes. Study design, setting, sampleThis retrospective cohort study involved 26 patients who underwent maxillectomy for maxillary tumors, followed by reconstruction using an ALTF. Patients with a history of upper respiratory system disease and sleep-disorder breathing were excluded. Predictor variableThe predictor variable was the residual rate of ALTF volume (ALTF-RS), calculated as the ratio of ALTF volume at 6 months post-surgery (T2) to that at 2 weeks post-surgery (T1). The outcome variablesThe outcome variables were the upper airway parameters. The upper airway was assessed at 3 time points: one week preoperatively (T0), T1, and T2. Ratios were used to represent airway changes over time. CovariatesThe covariates are age, sex, Brown classification, body mass index (BMI), hypertension, neck dissection, and tracheostomy, etc. AnalysesAirway measurement differences between the three time points were analyzed by one-way ANOVA. Pearson correlation and Spearman correlation analysis were used to analyze the correlation coefficients between airway changes and ALTF-RS. Statistical significance was established at a P value < 0.05. ResultsThe sample included 26 subjects with a mean age of 55.6±15.2 years and 15/26 (57.7%) were male. Compared to T0, the nasopharyngeal and retropalatal airway volumes at T1 significantly decreased (P<0.05) but recovered or surpassed preoperative levels by T2. The minimum cross-sectional airway area (S-min) significantly decreased by T1 (P < 0.05), but increased by T2 (P<0.05). The narrowest airway section was predominantly in the palatopharyngeal airway. The airway changes of T2/T1 and ALTF-RS were not correlated (P > 0.05) except for anterior-inferior point of CV4 cross-sectional area (P < 0.05). Conclusions and RelevanceThe volumetric changes in the airway were not associated with ALTF-RS. The substantial narrowing of S-min at T1 emphasized the need for vigilant airway management in these patients.

Efficacy of tracheostomy for respiratory management in patients with advanced oral cancer

BackgroundMany studies have been reported on tracheostomy to prevent upper airway obstruction after surgery. Among these, the scoring system proposed by Cameron et al. quantifies various factors that influence postoperative respiratory failure. This system provides a basis for surgeons to decide whether to perform an elective tracheostomy. In this study, the authors applied the Cameron scoring system retrospectively to patients undergoing severe oral cancer surgery to reevaluate the indications for elective tracheostomy and to investigate its clinical efficacy in airway management. In this study, a sample of 20 patients who underwent oral cancer surgery was selected and divided into two groups: 10 underwent tracheostomy and 10 did not. The Cameron scoring scores for each patient were extracted, to verify whether elective tracheostomy was performed in accordance with the threshold scores. Differences in scores and significant clinical impact factors between the two groups were analyzed and compared.ResultThe 10 patients who underwent tracheostomy had an average Cameron score of 6.4, all scoring above the recommended threshold of 5 for tracheostomy. For the 10 patients who did not undergo tracheostomy, the average score was 2.5, with 8 out of these 10 patients scoring below 5. Significant clinical impact factors observed included the location and size of the tumor, the performance of mandibulectomy and neck dissection, and the type of reconstruction surgery.ConclusionIn planning surgery for oral cancer patients, it is essential to consider the use of elective tracheostomy based on preoperative assessment of the risk of postoperative airway obstruction using tools like the Cameron scoring system, and patients’ condition. Research confirms that elective tracheostomy effectively enhances airway management in patients with severe oral cancer.

Continuous cuff pressure control on middle-aged and elderly patients undergoing endoscopic submucosal dissection of the esophagus effect of airway injury.

Assessment of the effect of continuous cuff pressure control on airway injury in middle-aged and elderly patients undergoing endoscopic submucosal dissection (ESD). A total of 104 eligible middle-aged and elderly patients requiring esophageal ESD from July 2022-September 2023 at the First Affiliated Hospital of Nanchang University were selected and randomly divided into two groups: the group undergoing general anesthesia tracheal intubation with continuous control of cuff pressure after intubation (Group A, n = 51) and the group undergoing general anesthesia tracheal intubation with continuous monitoring without control of cuff pressure (Group B, n = 53). After endotracheal intubation in Group A, under the guidance of an automatic cuff pressure controller, the air was used to inflate the tracheal cuff until the cuff pressure was 25-30cmH2O. The cuff pressure after intubation was recorded, and then the cuff pressure parameters were directly adjusted in the range of 25-30cmH2O until tracheal extubation after the operation. After endotracheal intubation, patients in Group B inflated the tracheal cuff with clinical experience, then monitored and recorded the cuff pressure with a handheld cuff manometer and instructed the cuff not to be loosened after being connected to the handheld cuff manometer-continuous monitoring until the tracheal extubation, but without any cuff pressure regulation. The patients of the two groups performed esophageal ESD. The left recumbent position was taken before the operation, and the cuff's pressure was recorded. Then, insert the gastrointestinal endoscope to find the lesion site and perform appropriate CO2 inflation to display the diseased esophageal wall for surgical operation fully. After determining the location, the cuff pressure of the two groups was recorded when the cuff pressure was stable. After the operation, the upper gastrointestinal endoscope was removed and the cuff pressure of the two groups was recorded. Postoperative airway injury assessment was performed in both groups, and the incidence of sore throat, hoarseness, cough, and blood in sputum was recorded. The incidence of postoperative airway mucosal injury was also observed and recorded in both groups: typical, episodic congestion spots and patchy local congestion. The incidence of normal airway mucosa in Group A was higher than that in Group B (P < 0.05). In comparison, the incidence of occasional hyperemia and local plaque congestion in Group A was lower than in Group B (P < 0.05). Continuous cuff pressure control during operation can reduce airway injury in patients with esophageal ESD and accelerate their early recovery after the operation.

Risk factors of postoperative airway obstruction complications in children with oral floor mass.

The aim of the present study was to explore the risk factors of postoperative airway complications in children with oral floor mass. The first choice of auxiliary examination method for children with oral floor mass is also proposed. This retrospective study included 50 children with floor-of-mouth (FOM) masses. Medical records were reviewed, and information on age of onset, functional impacts present, age at consultation, imaging findings, history of preoperative aspiration, pathology findings, properties of biopsied fluid, treatment modality, postoperative outcomes, and operation were recorded. A total of 20 patients exhibited functional impacts such as difficulty in breathing and feeding. Ultrasound examination was performed in 28 cases; and magnetic resonance imaging, in 38 cases. The diagnosis was lymphatic malformation in 12 cases, developmental cyst in 29 cases, and solid mass in 7 cases. There were 28 cases of surgical resection, 9 cases underwent multiple puncture volume reduction followed by surgery, 11 cases treated using sclerotherapy injection, and 1 case treated using sclerotherapy injection and surgical resection. Young age, functional impact, and high grade of lymphatic duct malformation increased the risk of surgical treatment. B-scan ultrasound is the first choice for the diagnosis of FOM masses in children.

Postoperative Airway Management after Anterior Cervical Spine Surgery: Retrospective Neurosurgical Multicenter Study.

Airway complications that occur after anterior cervical spine surgery pose a life-threatening risk, which encompasses complications including prolonged intubation, unplanned reintubation, and/or necessity of tracheostomy. The present study aimed to identify the surgical risks associated with postoperative airway complications in neurosurgical training institutes. A retrospective, multicenter, observational review of data from 365 patients, who underwent anterior cervical spine surgery between 2018 and 2022, at three such institutes was carried out. Postoperative airway complication was defined as either the need for prolonged intubation on the day of surgery or the need for unplanned reintubation. The perioperative medical information was obtained from their medical records. The average age of the cohort was over 60 years, with males comprising approximately 70%. Almost all surgeries predominantly involved anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion, with most surgeries occurring at the level of C5/6. In total, 363 of 365 patients (99.5%) were extubated immediately after surgery, and the remaining two patients were kept under intubation because of the risk of airway complications. Of the 363 patients who underwent extubation immediately after surgery, two (0.55%) required reintubation because of postoperative airway complications. Patients who experienced airway complications were notably older and exhibited a significantly lower body mass index. The results of this study suggested that older and frailer individuals are at an elevated risk for postoperative airway complications, with immediate postoperative extubation generally being safe but requiring careful judgment in specific cases.

The Postoperative Airway Compromise Score—First Steps to Developing a Postoperative Tool for the Assessment of Upper Airway-Related Complications Following Anterior Cervical Spine Surgery

BackgroundAcute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion (ACDF). This study aims to develop a score to identify patients at risk for acute postoperative airway compromise (PAC). MethodsPotential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified out of 1,466 patients who underwent elective ACDF between July 2014 - May 2019. A comparison group was created by a randomized selection process (non-PAC group). Associated factors with PAC and a p-value <.10 were entered into a logistic regression model and coefficients contributed each risk factor's overall score. Calibration of the model was evaluated by Hosmer-Lemeshow (H-L) goodness-of-fit test. Quantitative discrimination was calculated and the final model was internally validated with bootstrap sampling. ResultsWe identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, ASA >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (>C4), and duration of surgery >179 min. The final prediction model included five predictors with very strong performance characteristics. These five factors formed the PAC-Score (PACS) which had a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%). ConclusionsThe acute Postoperative Airway Compromise Score (PACS) demonstrates strong performance characteristics. The PAC score may help identify patients at risk for upper airway compromise caused by surgical site abnormalities.

Analysis of Related Risk Factors for Artificial Airway Management in Postoperative Patients with No Throat in Laryngeal Cancer

&amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: To analyze the relevant factors affecting artificial airway management in postoperative non laryngeal patients with laryngeal cancer. &amp;lt;i&amp;gt;Method&amp;lt;/i&amp;gt;: A total of 150 patients who underwent total laryngectomy in a tertiary hospital between January 2020 and January 2023 were selected as the study subjects. Their clinical data were retrospectively analyzed, and they were divided into two groups based on whether they had postoperative artificial airway problems: one group had no airway problems (n=52) and the other group had artificial airway problems (n=98). Conduct univariate analysis on factors that may affect artificial airways, and conduct multivariate logistic regression analysis on factors with statistically significant differences. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: Among the 150 patients, a total of 98 experienced postoperative artificial airway problems, with an incidence rate of 65.33%. Gender, age, diabetes, tumor stage, wound healing, sputum viscosity after artificial airway, room temperature and humidity, occurrence of multiple drug resistance, and neck lymph node dissection were included in the univariate analysis of the occurrence of artificial airway problems. The results showed that wound healing, sputum viscosity after artificial airway, room temperature and humidity, occurrence of multiple drug resistance were related to the artificial airway problems of laryngocarcinoma patients without larynx after surgery (P&amp;lt;0.05). Four statistically significant single factors, including wound healing, sputum viscosity after artificial airway, room temperature and humidity, and the occurrence of multiple drug resistance, were included in the multivariate logistic regression analysis. The results showed that wound healing, sputum viscosity after artificial airway, and the occurrence of multiple drug resistance were closely related to the occurrence of artificial airway problems in non laryngeal patients after laryngeal cancer surgery, and were independent risk factors (P&amp;lt;0.05). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: For patients with laryngeal cancer treated with total laryngectomy, wound healing, sputum viscosity after artificial airway, and the occurrence of multidrug resistance are high-risk influencing factors for postoperative artificial airway problems, which should be taken seriously in clinical work.

New Insight into Laryngo-Tracheal Surgery: High-Flow Oxygen Therapy to Prevent Early Complications after Surgery.

Early post-operative airway management after laryngo-tracheal surgery is crucial. Acute respiratory failure due to glottis' edema may occur, requiring reintubation. This can prolong ventilatory assistance, jeopardizing anastomosis. To date, only judicious steroid administration and fluid management are available to avoid more invasive procedures. High-flow oxygen therapy (HFOT) is a noninvasive O2 support method providing humidification, warmed air, and Positive End-Expiratory Pressure (AIRVO2). No data about HFOT use to prevent early complications after laryngo-tracheal surgery are reported in the literature. Between September 2020 and September 2022, 107 consecutive patients who underwent laryngo-tracheal surgery received HFOT (Group A). Data and long-term results were compared with those of 80 patients operated between September 2018 and August 2020 (Group B), when HFOT was not available. All patients were operated in a single center. No pre- or post-operative settings changed, except for HFOT introduction. We analyzed and compared the risk for "delayed" reintubation (unexpected reintubation within the first 24-48 h after extubating/laryngeal mask removal) in the two groups. No patients reported HFOT-related adverse events. The control group (B) presented "delayed" reintubation in 37% (p = 0.027), intensive care unit admission in 67% (p = 0.005) and longer hospital stay (p = 0.001) compared to the HFOT group (A). The minor complications' rate was 3% in both group and overall mortality was 0%. Re-stenosis was described in 4.6% of the HFOT group, without a statistically significant difference (p = 0.7006). Our study is the first to investigate HFOT use in patients undergoing laryngo-tracheal surgery, potentially representing a consistent innovation in the peri-operative management of these patients. With the limitation of a retrospective series, we would suggest HFOT use for preventing post-operative reintubation rate, possibly reducing ICU admissions and hospital stays.

Changes in the upper airway and its surrounding structures after bimaxillary surgery in patients with cleft-related Class III deformity.

To compare upper airway changes following bimaxillary surgery for correction of Class III deformity between patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) and to compare the preoperative and postoperative upper airway among patients with UCLP and BCLP to healthy controls. Sixty adults with CLP-related skeletal Class III deformity (30 UCLP and 30 BCLP) who consecutively underwent bimaxillary surgery were studied retrospectively. Cone-beam computed tomography (CBCT) was performed before and after surgery to measure upper airway and movements of facial skeletal and surrounding structures. CBCT images from 30 noncleft skeletal Class I adults, matched by age, gender, and body mass index and without surgical intervention, served as controls. After surgery, the volume of the nasopharynx increased in patients with CLP (both P < .001). Patients with CLP did not differ from controls in postoperative volume of the nasopharynx or oropharynx. However, the nasal cavity differed significantly between patients with CLP and controls (P < .001). After bimaxillary surgery, the nasal cavity of patients with CLP differed significantly compared with the controls. Volumes of the nasopharynx and oropharynx did not differ between patients with CLP after surgery and controls.

Correlation between oral cavity volume and upper airway changes in skeletal Class III patients undergoing bimaxillary orthognathic surgery: a pilot cone-beam computed tomography study.

To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction. Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans. The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001). Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

Lateral Deviation of the Hyoid Bone and Thyroid Cartilage Influences Prevertebral Soft-Tissue Swelling and Dysphagia After Anterior Cervical Diskectomy and Fusion.

Prevertebral soft-tissue swelling (PSTS) after anterior cervical diskectomy and fusion (ACDF) is known to be influenced by several factors. We considered the effect of lateral deviation on the traction force and attempted to find a relationship with the PSTS. This study was designed to evaluate the preoperative lateral deviation of the hyoid bone and thyroid cartilage and its effect on PSTS, airway collapse, and clinical outcomes after ACDF. Preoperative lateral deviations of the hyoid bone and thyroid cartilage at the superior cornu and inferior cornu were measured. To assess the effect of lateral deviation, patients who underwent 1 or 2 level ACDF with the left-sided approach were divided into a deviation group (left-sided deviation >5 mm or >10 mm) and a nondeviation group (left-sided deviation <5 mm or <10 mm). Difference of preoperative and postoperative PSTS (dPSTS), airway collapse, dysphagia score, and Neck Disability Index were compared between the 2 groups. Lateral deviation was measured in 290 patients, and 145 were enrolled to assess the effect of lateral deviation. Left-sided deviation was more common than right-sided deviation in all 3 structures (the hyoid bone, superior cornu, and inferior cornu of the thyroid cartilage). The deviation group demonstrated a significantly larger dPSTS at the C3 and C4 levels, more airway collapse at the C4 level, and a higher dysphagia score. There was no significant difference in the Neck Disability Index between the 2 groups. Lateral deviation significantly correlated with dPSTS (C3, C4, C5, and C6 levels) and airway collapse (C3 and C4 levels). A left-sided deviation of more than 5 mm of the hyoid bone or thyroid cartilage discouraged the left-sided approach for ACDF because of the aggravation of dPSTS, airway collapse, and dysphagia postoperatively.

Postoperative Upper Airway Volume Measurements Among Children With Craniofacial Abnormalities.

To measure postoperative airway volumes among patients with craniofacial abnormalities and compare them to normative values. Retrospective, comparative study. Academic Medical Center. Retrospective analysis of imaging of children with craniofacial abnormalities treated at NYU Langone Health from January 2013 to February 2021. Upper airway volumes postcraniofacial surgery were measured using 3D processing software (Dolphin 3D, version 11.95). These values were compared with published normative values. Twenty-one subjects were identified and compared to normative values. The postoperative oropharyngeal volumes were on average 43.7% smaller than the normative values (P < .001), and the total upper airway volumes were 31.6% smaller (P = .003). No significant differences were observed in the nasopharyngeal or hypopharyngeal volumes of the study cohort compared to the normative data. Among children ages 12 to 17 years (n = 13), the mean oropharyngeal volumes were 47.6% smaller than normal (P < .001), and the mean total upper airway volumes were 34.6% smaller than normal (P < .001). Among children ages 7 to 11 years (n = 8), the mean oropharyngeal volumes were 35.1% smaller than normal (P = .049), but no difference in mean total upper airway volume was observed. In children with craniofacial anomalies, postoperative airway volumes remain lower than normative values. However, even a slight increase in airway volume can yield a substantial increase in flow rate. 3D airway evaluations are a valuable tool for surgical planning and analysis and can help with optimizing airway dynamics.