Tongue Thickness Research Articles

A study of the effects of housing tongue design on radial turbine performance

The nozzleless volute housings can generate non-uniform flow distributions to the downstream radial turbine rotors, which not only affects turbine aerodynamic performance but also poses a threat to the fatigue life of the rotors. It is believed that the housing tongue is the main factor in generating this non-uniformity. Tongue design is based on experience and the geometric parameters of tongue, such as the distance between the tongue and rotor, the thickness of the tongue, and tongue shape are to be specified in the design. A few studies on housing tongue can be found in the literature, but in these investigations of the influences of tongue geometric parameters, factors such as mass flow rate and volute A/R distribution were not kept constant, thus introducing additional factors and reducing the persuasiveness of the results. Therefore, three new housings with different tongue-rotor distances are designed with a two-dimensional method for comparative CFD studies. The results indicate that when the mass flow of the turbines is kept, the distance between the tongue and the rotor has little impact on the turbine efficiency (about 0.1%), while the blade excitation forces from the housing increase with the decrease of the distance by more than 50%. Two further new housings are then created by modifying the housing inlet pipe to minimize tongue thickness, one of the housings is more practical with a short and thin tongue. CFD results indicate 0.2%∼0.4% improvement of turbine efficiency and reduction of housing excitation forces by more than 50% using these two thin tongue housings.

A Comparison of Airway Ultrasound and Clinical Parameters for Predicting Difficult Laryngoscopy in the Emergency Department: A Study Protocol.

Airway assessment plays an important part in airway management. Over the years, ultrasound has emerged as an alternative modality for airway assessment. We aim to assess the accuracy of clinical parameters, ultrasonographic upper airway parameters, and laryngoscopic grade, using the Cormack-Lehane classification, to predict difficult laryngoscopy in the emergency department (ED). The primary objective is to determine the accuracy of ultrasonography parameters compared to Cormack-Lehane grading in predicting difficult laryngoscopy in adults. The secondary objective is to assess the accuracy of clinical parameters compared to Cormack-Lehane grading in predicting difficult laryngoscopy in adults. A sample of 62 adult patients over 18 years who come to the emergency department and require endotracheal intubation will undergo an ultrasonographic examination of the upper airway. During this examination, an emergency medicine physician will measure the skin-to-epiglottis distance and tongue thickness using the GE Healthcare (Chicago, IL) ultrasound and color Doppler (model: Logic E). The results of the study will be drawn in 2025 upon its completion. The conclusion will be drawn regarding the correlation between ultrasound parameters and Cormack-Lehane grading and clinical parameters in predicting difficult laryngoscopy.

Chicken swarm algorithm with deep convolutional neural network based tongue image analysis for gastric cancer classification

Tongue images (the size, shape, and colour of tongue and the thickness, colour, and moisture content of tongue coating), reflecting the medical condition of entire body based on the model of traditional Chinese medicine (TCM) are extremely utilized in China for millions of years. Gastric cancer (GC) is great lethal kind of cancer in countries and societies. The screening and analysis of GC yet depend on gastroscopy, however its application was significantly restricted due to its invasive, maximum rate and the requirement for expert endoscopists. Early recognition in GC patients and direct treatment contribute significantly to safety for health. Consequently, this study introduces a Chicken Swarm Algorithm with Deep learningbased Tongue Image Analysis for Gastric Cancer Classification (CSADL-TIAGCC) system. The projected CSADL-TIAGCC approach studies the input tongue images for the identification and classification of GC. To accomplish this, the CSADL-TIAGCC system uses improved U-Net segmentation approach. Besides, residual network (ResNet-34) model-based feature extractor is used. Furthermore, long short term memory (LSTM) approach was exploited for GC classification and its hyperparameters are selected by the CSA. The simulation outcome of the CSADL-TIAGCC algorithm was examined under tongue image database. The experimental outcomes illustrate the enhanced results of the CSADL-TIAGCC technique with respect of different evaluation measures.

A Comprehensive Examination of the Medvezhiy Glacier’s Surges in West Pamir (1968–2023)

The Vanj River Basin contains a dynamic glacier, the Medvezhiy glacier, which occasionally poses a danger to local residents due to its surging, flooding, and frequent blockages of the Abdukahor River, leading to intense glacial lake outburst floods (GLOF). This study offers a new perspective on the quantitative assessment of glacier surface velocities and associated lake changes during six surges from 1968 to 2023 by using time-series imagery (Corona, Hexagon, Landsat), SRTM elevation maps, ITS_LIVE, unmanned aerial vehicles, local climate, and glacier surface elevation changes. Six turbulent periods (1968, 1973, 1977, 1989–1990, 2001, and 2011) were investigated, each lasting three years within a 10–11-year cycle. During inactive phases, a reduction in the thickness of the glacier tongue in the ablation zone occurred. During a surge in 2011, the flow accelerated, creating an ice dam and conditions for GLOF. Using these datasets, we reconstructed the process of the Medvezhiy glacier surge with high detail and identified a clear signal of uplift in the surface above the lower glacier tongue as well as a uniform increase in velocities associated with the onset of the surge. The increased activity of the Medvezhiy glacier and seasonal fluctuations in surface runoff are closely linked to climatic factors throughout the surge phase, and recent UAV observations indicate the absence of GLOFs in the glacier’s channel. Comprehending the processes of glacier movements and related changes at a regional level is crucial for implementing more proactive measures and identifying appropriate strategies for mitigation.

Ultrasound-based assessment of tongue thickness for prediction of difficult laryngoscopy and intubation.

Predicting difficult airway and preparedness for the same can help prevent catastrophic situations while handling the airway. With the increasing familiarity of anaesthesiologists to the use of ultrasound machine and its easy availability and non-invasiveness, we sought to study its utility in airway assessment, by measuring the thickness of tongue, to predict difficult laryngoscopy and intubation. A total of 85 patients undergoing elective surgeries under general anaesthesia with endotracheal intubation were examined preoperatively. Tongue thickness was measured using submental ultrasonography in the median sagittal plane along with other tests of airway assessment. Cormack Lehane grade on laryngoscopy and Intubation Difficulty Scale Score was recorded. The sensitivity, specificity, positive and negative predictive value, and accuracy was calculated for tongue thickness for predicting difficult intubation. The tongue thickness in those with difficult intubation (4.83 ± 0.62) was significantly higher than those without difficult intubation (4.38 ± 0.65). The ratio of tongue thickness to thyromental distance was also significantly higher in difficult intubation group. The area under the receiver operating characteristic curve for predicting difficult laryngoscopy and intubation was higher for tongue thickness as compared to other clinical parameters. The sensitivity and specificity of tongue thickness to predict difficult laryngoscopy was 100% and 83%, respectively, and to predict difficult intubation was 72% and 59%, respectively, with an accuracy of 72%. Ultrasound based assessment of tongue thickness can be a useful predictor of difficult airway along with clinical assessment of the airway.

The diagnostic accuracy of point-of-care ultrasound parameters for airway assessment in patients undergoing intubation in emergency department—an observational study

BackgroundEndotracheal intubation is an essential resuscitative procedure in the emergency setting. Airway assessment parameters such as the Mallampati classification are difficult to perform in an emergency setting. As point-of-care ultrasound (POCUS) assessment of airway parameters does not require patients to perform any mandatory action, ultrasound may become the potential first-line noninvasive airway assessment tool in the emergency department (ED). The use of POCUS in the ED has not been sufficiently studied. Using POCUS in airway assessment for predicting difficult intubation may be the next step in successful airway management.MethodologyThe study was an observational study conducted at the ED of the All India Institute of Medical Sciences (Rishikesh). The treating emergency physician recorded the patient history and systemic examination along with an indication for intubation. The POCUS assessment of airway parameters pre-epiglottis to epiglottic vocal cord ratio (Pre-E/E-VC), tongue thickness, hyomental distance, and distance from skin to the hyoid bone was performed by the study investigator. During laryngoscopy, Cormack-Lehane (CL) grading was assessed. The data was entered and analyzed.ResultsSeventy patients who required intubation in the ED were enrolled in the study. Among the study population, 48.6%, 28.6%, 14.3%, 1.4%, and 7.1% were classified with the following CL grading: 1, 2a, 2b, 3a, and 3b, respectively. At a cutoff of ≥ 1.86, Pre-E/E-VC predicts difficult laryngoscopy (AUC 0.835) with a sensitivity of 83% and a specificity of 94%. At a cutoff of ≥ 5.98 cm, tongue thickness predicts difficult laryngoscopy (AUC 0.78) with a sensitivity of 83% and a specificity of 88%. At a cutoff of hyomental distance ≤ 6 cm, it predicts difficult laryngoscopy with a sensitivity of 83% and a specificity of 88%. All parameters can act as a promising tool for predicting difficult laryngoscopy, with the single best parameter being Pre-E/E-VC.ConclusionAssessment of the airway with POCUS may be helpful to the emergency physician when the clinical airway assessment parameters fail to predict difficult laryngoscopy as most patients requiring intubation are uncooperative. Assessment of the parameters in our study Pre-E/E-VC, tongue thickness, and hyomental distance can act as a promising tool for predicting difficult laryngoscopy in the emergency scenario.

Clock gene Per2 modulates epidermal tissue repair in vivo.

Wound healing can be influenced by genes that control the circadian cycle, including Per2and BMAL1, which coordinate the functions of several organs, including the skin. The aim of the study was to evaluate the role of PER2 during experimental skin wound healing. Two groups (control and Per2-KO), consisting of 14 male mice each, were anesthetized by inhalation, and two 6 mm wounds were created on their dorsal skin using a punch biopsy. A silicone ring was sutured around the wound perimeter to restrict contraction. The wound healing process was clinically measured daily (closure index) until complete wound repair. On Day 6, histomorphometric analysis was performed using the length and thickness of the epithelial migration tongue, in addition to counting vessels underlying the lesion by immunofluorescence assay and maturation of collagen fibers through picrosirius staining. Bromodeoxyuridine(BrdU) incorporation and quantification were performed using the subcutaneous injection technique 2 h before euthanasia and through immunohistochemical analysis of the proliferative index. In addition, the qualitative analysis of myofibroblasts and periostin distribution in connective tissue was performed by immunofluorescence. Statistically significant differences were observed in the healing time between the experimental groups (means: 15.5 days for control mice and 13.5 days for Per2-KO; p = 0.001). The accelerated healing observed in the Per2-KO group (p < 0.05) was accompanied by statistical differences in wound diameter and length of the migrating epithelial tongue (p = 0.01) compared to the control group. Regarding BrdU immunoreactivity, higher expression was observed in the intact epithelium of Per2-KO animals (p = 0.01), and this difference compared to control was also present, to a lesser extent, at the wound site (p = 0.03). Immunofluorescence in the connective tissue underlying the wound showed a higher angiogenic potential in the Per2-KO group in the intact tissue area and the wound region (p < 0.01), where increased expression of myofibroblasts was also observed. Qualitative analysis revealed the distribution of periostin protein and collagen fibers in the connective tissue underlying the wound, with greater organization and maturation during the analyzed period. Our research showed that the absence of the Per2 gene positively impacts the healing time of the skin in vivo.This acceleration depends on the increase of epithelial proliferative and angiogenic capacity of cells carrying the Per2 deletion.

Point-of-care ultrasound for airway management in the emergency and critical care setting.

Airway management is a common procedure within emergency and critical care medicine. Traditional techniques for predicting and managing a difficult airway each have important limitations. As the field has evolved, point-of-care ultrasound has been increasingly utilized for this application. Several measures can be used to sonographically predict a difficult airway, including skin to epiglottis, hyomental distance, and tongue thickness. Ultrasound can also be used to confirm endotracheal tube intubation and assess endotracheal tube depth. Ultrasound is superior to the landmark-based approach for locating the cricothyroid membrane, particularly in patients with difficult anatomy. Finally, we provide an algorithm for using ultrasound to manage the crashing patient on mechanical ventilation. After reading this article, readers will have an enhanced understanding of the role of ultrasound in airway management.

Ultrasound predictors of difficult airways

The objectives was to evaluate the effectiveness of diagnosing predictors of difficult airways with ultrasound.Materials and methods. 70 patients were examined. Before the surgery, we assessed the risk of difficult intubation by the LEMON scale and ultrasound methods using the following criteria: tongue thickness, vertical distance from the highest point of the hyoid bone to the mandible, neck soft tissue thickness, and epiglottis thickness. The diagnostic ability of the LEMON scale and ultrasound diagnosis of difficult laryngoscopy was assessed by determining the sensitivity, specificity and cut-off point using the ROC-AUC analysis. Results. The analysis of the obtained data showed a higher sensitivity of ultrasound criteria for difficult airways compared with the LEMON scale. Conclusion. Ultrasound diagnostic methods are effective for assessing difficult laryngoscopy. Ultrasound diagnostic criteria for difficult laryngoscopy are more sensitive compared to the LEMON scale. Diagnostic criteria for difficult laryngoscopy are: tongue thickness &gt; 61 mm, vertical distance from the highest point of the hyoid bone to the mandible &gt; 12.85 mm, neck soft tissue thickness &gt; 5.15 mm, and epiglottis thickness &gt; 2.85 mm.

Evaluation and comparison of sonographic difficult airway assessment parameters with clinical airway predictors.

None of the clinical difficult airway predictors are 100% sensitive and specific. Ultrasound is being used for airway assessment, but there is still no established parameters or model to predict difficult laryngoscopy. This observational study was planned to determine the predictive ability of clinical and sonography-based airway assessment parameters for difficult laryngoscopy and intubation. A total of 130 patients of 18-60 years of age undergoing elective intubation were included. The distribution of Cormack-Lehane (CL) grade and intubation difficulty scale (IDS) was correlated with the clinical and sonographic screening parameters for difficult airways. The prevalence of difficult laryngoscopy and difficult intubation in our study was 17.6% and 11.5%, respectively. Mallampati grade (MMG), upper lip bite test (ULBT), neck circumference, hyomental distance ratio (HMDR), tongue thickness (TT), skin to epiglottis/epiglottis to vocal cord distance (SED/E-VC), and mandibular condylar mobility (MCM) had significant association with the difficult laryngoscopy and MMG, neck circumference, SED, SED/E-VC; MCM had significant association with the difficult intubation. The combination of these predictors showed better diagnostic ability for difficult airways. Model 1 based on ultrasound parameters showed an area under the curve (AUC) of 0.848 (CI- 0.748-0.947, P value < 0.0001) and model 2 based on combined clinical and ultrasound parameters showed an AUC of 0.755 (95% CI- 0.631-0.879, P value < 0.0001). Ultrasound-based airway predictors can help in predicting difficult laryngoscopy and intubation along with the clinical parameters. Individual sonographic predictors have moderately satisfactory diagnostic profiles. The models based on combined tests have better diagnostic value.

Accuracy of Sonographic Airway Parameters in Difficult Laryngoscopy Prediction: A Prospective Observational Cohort Study from Central India.

Though airway ultrasonography (USG) is used to assess difficult laryngoscopy (DL), there is still ambiguity about approach followed and parameters assessed. There is need of a simple, stepwise sonographic assessment with clearly defined parameters for DL prediction. The primary objective of this study was to find diagnostic accuracy of sonographic parameters measured by a stepwise Airway-USG in DL prediction (DLP). This prospective, observational cohort study was done in 217 elective surgical adult patients administered general anaesthesia with tracheal intubation using conventional laryngoscopy from 1st May 2019 to 31st July 2020, after ethical approval. A sagittal Airway-USG was done using 2-6 Hz transducer in three steps specifying probe placement and head position. Demographic, clinical and Airway-USG measurements were noted. Correlation of the clinical/sonographic parameters was made with Cormack-Lehane score on DL. After receiver operating characteristic curve plotting, the sensitivity, specificity, positive predictive value, negative predictive value (NPV) of DL was calculated for each parameter using open-epi software. DL was observed in 19/217 patients. Airway-USG parameters of skin to epiglottis distance >2.45 cm, hyomental distance with head extension <5.13 cm, head neutral <4.5 cm, their ratio <1.18, maximum tongue thickness >3.93 cm and maximum skin to tongue distance >5.45 cm were statistically significant in predicting DL. DLP score with presence of >3 positive parameters showed 98% specificity, 98% NPV and 96% diagnostic accuracy to predict DL. DLP score derived from Airway-USG may be used as a screening and diagnostic tool for DL.

Evaluation of Ultrasound Guided Measurement of Tongue Thickness in Predicting Difficult Tracheal Intubation in Patients Undergoing Elective Surgery: A Cross Sectional Study

Background: Preoperative airway assessment is necessary to identify airway difficulties to the earliest, ensure adequate preparation to airway management before induction and to avoid airway related complications. Various Imaging techniques have been studied for prediction of the difficult airway. the ultrasound is a quick and simple technique. Aim of the study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in patients undergoing elective surgery.&#x0D; Methods: Sixty-one patients American Society of Anesthesiologist class I and II,18-65 years of age, either sex, were included. Tongue thickness was measured by ultrasound as the distance from the surface of tongue to the submental skin. Modified mallampatti score was also recorded.&#x0D; Results: Receiver operating characteristic (ROC) curve of tongue thickness showed an AUC of 0.879 for a cut off value of &gt;6 cm. This shows it has an excellent predictive value. Tongue thickness (&gt;6cm) was found to have 90.16% combined diagnostic accuracy with 75% sensitivity and 94.74% specificity for prediction of difficult intubation. No correlation between tongue thickness and modified mallampatti score. (Correlation coefficient was 0.013, p value 0.920).&#x0D; Conclusion: We conclude that ultrasound guided measurement of tongue thickness&gt; 6 cm can reliably predict difficult tracheal intubation in patients undergoing elective surgery.

Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children

ObjectivesStudies have shown that some ultrasonic indicators can predict difficult airways in adults to an extent. However, whether ultrasonic parameters can be used to predict difficult airways in children is unclear. This study investigated the predictive value of several ultrasonic indices for difficult laryngoscopy (DL) in children.MethodsPediatric patients aged 5 to 12 years who underwent endotracheal intubation under general anesthesia were enrolled. The hyomental distance in the extended position (HMDE), tongue thickness, midsagittal tongue cross-sectional area, tongue width, and distance from skin to epiglottis (DSE) were measured by ultrasound before anesthesia. The study end point was DL. The receiver operating characteristic curve was used to evaluate the predictive value of each parameter.ResultsThree hundred and ten children were included in the final analysis, and fifteen (4.8%) children had DL. The shortened HMDE assessed by ultrasound could help identify children aged 5 to 12 years with DL (5–8 years: area under the curve (AUC) 0.74, sensitivity 0.88, specificity 0.60; 9–12 years: AUC 0.72, sensitivity 0.71, specificity 0.83). An increased DSE could help identify children aged 5 to 8 years with DL (AUC 0.76, sensitivity 0.88, specificity 0.69).ConclusionsUltrasonic measurement of the HMDE can be used to predict DL in children aged 5 to 12 years. The DSE measured by ultrasound can be used to predict DL in children aged 5 to 8 years.Clinical relevance statementThe hyomental distance and the distance from skin to epiglottis measured by ultrasound can be used to predict difficult laryngoscopy in children, which can help reduce serious complications caused by unanticipated difficult airways in children during anesthesia.Key Points• Ultrasonic measurement of the hyomental distance in the extended position may be an effective predictor of difficult laryngoscopy in children aged 5 to 12 years.• The distance from skin to epiglottis measured by ultrasound can be used to predict difficult laryngoscopy in children aged 5 to 8 years.• Preoperative airway assessment using ultrasound can be effectively applied in children and has a great application prospect.

USG guided indices as a tool for prediction of difficult airway in obese: an observational study

Background: Now a days, Ultrasound has been the gold standard and an invaluable tool in the field of regional anaesthesia, especially for upper limb and truncal blocks where general anesthesia is associated with high risk and also in patients posted for general anesthesia with anticipated difficult airway. Recently, few studies have published the importance of Ultrasound in the evaluation of airway and related procedures. Aim of this study is to evaluate the use of USG guided indices for prediction of difficult airway in obese patients and correlating them with clinical parameters. Methods: This study was a prospective observational study done in a tertiary health care center, Government General hospital, Kakinada over a duration of two months from August 2022 to September 2022. Eight Ultrasound parameters like tongue thickness, skin to hyoid distance, pre-epiglottic space, skin to midpoint of vocal cords, skin to thyroid isthmus, anterior soft tissue thickness at suprasternal notch, hyomental distance and thyromental distance were correlated with clinical evaluation (Cormacke-lehane grading) in this study and conclusions were drawn. Results: Out of 30 cases studied, 20 (70%) were predicted to be difficult with Ultrasound airway examination and 16 (53.3%) were found to have difficulty in intubation clinically. Conclusions: The following USG indices like pre-epiglottic space, Skin to midpoint of vocal cords, Anterior soft tissue thickness at Suprasternal notch, Hyomental distance in mid-extended position and thyromental distance were found to be clinically correlated to predict difficult airway and intubation in obese patients.

Diagnostic Performance of Airway Ultrasound for the Assessment of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis

This study aimed to review and appraise the evidence regarding airway ultrasound assessment in predicting difficult laryngoscopy in adult patients. A systematic review of the literature was conducted according to the Cochrane collaboration guidelines and the recommendations for the systematic review and meta-analysis of diagnostic studies. Observational studies that evaluated the diagnostic performance of airway ultrasound for the prediction of difficult laryngoscopy were included for consideration. Literature searches were performed in 4 databases (PubMed [Medline], Embase, Clinical Trials, and Google Scholar) to identify all observational studies using any ultrasound technique to assess difficult laryngoscopy. The search terms included "sonography," "ultrasound," "airway," "difficult airway," "difficult laryngoscopy," "Cormack," "risk factors," "ultrasound at the point of care," "difficult ventilation," "difficult intubation" and others, combined with sensitive filters. The search was done for studies performed in the last 20 years in English or Spanish. Adult patients older than 18 years old under general anesthesia for an elective procedure. Evident anatomic airway abnormalities, obstetric populations, those using an alternative imaging method besides ultrasound, and animal studies were excluded. Preoperative bedside ultrasound measuring distances and ratios from the skin to different reference points, such as the ratio of the hyomental distance in a neutral position (HMDN) and hyomental distance in extension (HMDR), HMDN, and the skin-to-epiglottis distance (SED), the preepiglottic area, and tongue thickness, among others. A total of 24 studies evaluated the prediction of a difficult laryngoscopy using airway ultrasound. The diagnostic performance and the number of ultrasound parameters reported in the studies were variable. Meta-analysis was performed for 3 measurements consistently included in most studies. The SED and the HMDR ratio presented a sensitivity of 75% and 61%, respectively, and a specificity of 86% and 88%, respectively. The ratio of the preepiglottic distance to the epiglottic distance at the midpoint of the vocal cords (pre-E/E-VC) presented the best performance for predicting a difficult laryngoscopy (sensitivity: 82%, specificity: 83%, diagnostic odds ratio: 22.2). With the currently available evidence, the 3 commonly used point-of-care ultrasound measures used to identify difficult laryngoscopy, (SED, HMDR, and pre-E/E-VC), showed better sensitivity and similar specificity to clinical measures. Future studies and more data may change the authors' confidence in these conclusions, given the wide variability of measurements noted in studies.

Facial and Intraoral Photographic Traits Related to Sleep Apnea in a Clinical Sample with Genetic Ancestry Analysis.

Rationale: Craniofacial and pharyngeal morphology influences risk for obstructive sleep apnea (OSA). Quantitative photography provides phenotypic information about these anatomical factors and is feasible in large samples. However, whether associations between morphology and OSA severity differ among populations is unknown. Objectives: The aim of this study was to examine this question in a large sample encompassing people from different ancestral backgrounds. Methods: Participants in SAGIC (Sleep Apnea Global Interdisciplinary Consortium) with genotyping data were included (N = 2,393). Associations between photography-based measures and OSA severity were assessed using linear regression, controlling for age, sex, body mass index, and genetic ancestry. Subgroups (on the basis of 1000 Genomes reference populations) were identified: European (EUR), East Asian, American, South Asian, and African (AFR). Interaction tests were used to assess if genetically determined ancestry group modified these relationships. Results: Cluster analysis of genetic ancestry proportions identified four ancestrally defined groups: East Asia (48.3%), EUR (33.6%), admixed (11.7%; 46% EUR, 27% Americas, and 22% AFR), and AFR (6.4%). Multiple anatomical traits were associated with more severe OSA independent of ancestry, including larger cervicomental angle (standardized β [95% confidence interval (CI)] = 0.11 [0.06-0.16]; P < 0.001), mandibular width (standardized β [95% CI] = 0.15 [0.10-0.20]; P < 0.001), and tongue thickness (standardized β [95% CI] = 0.06 [0.02-0.10]; P = 0.001) and smaller airway width (standardized β [95% CI] = -0.08 [-0.15 to -0.002]; P = 0.043). Other traits, including maxillary and mandibular depth angles and lower face height, demonstrated different associations with OSA severity on the basis of ancestrally defined subgroups. Conclusions: We confirm that multiple facial and intraoral photographic measurements are associated with OSA severity independent of ancestral background, whereas others differ in their associations among the ancestrally defined subgroups.

Evaluation of ultrasound airway assessment parameters in pregnant patients and their comparison with that of non-pregnant women: a prospective cohort study

BackgroundClinical airway assessment parameters differ significantly between pregnant and non-pregnant patients, however literature comparing their ultrasound (US) airway parameters is limited. We planned a prospective cohort study to compare US-assessed airway parameters between pregnant and non-pregnant women. MethodsWe enrolled 82 pregnant females scheduled for elective cesarean section under neuraxial anesthesia and 80 age-matched non-pregnant females scheduled for elective surgery. Pre-operative clinical airway assessment was performed in both groups. The US airway assessment was done pre-operatively in non-pregnant and postoperatively in pregnant patients. Our primary objective was to compare US-assessed parameters, and secondary objectives included a comparison of clinical airway assessment parameters and investigating a relationship between a difficult airway (defined as a modified Mallampati grade (MMG) ≥ 3) and other airway assessment parameters. ResultsAmong several US airway parameters, pregnant patients had significantly higher hyomental distance, anterior neck soft tissue thickness at the hyoid and vocal cord level, and oral cavity height, while the tongue thickness and mandibular condylar movements were significantly lower than in non-pregnant patients. Similarly, for the clinical airway assessment, pregnant patients had significantly higher MMG and upper lip bite test scores, mentohyoid distance, and neck circumference. Pregnancy, the ratio of pre-epiglottic space and epiglottis-to-vocal cords distance (Pre-E/E-VC), and hyoid bone visibility were independent predictors of a difficult airway. ConclusionThe US airway assessment parameters differ significantly between pregnant and non-pregnant patients. Pregnancy, hyoid bone visibility, and Pre-E/E-VC ratio were independent predictors of the difficult airway in female patients.

Ultrasonographic and manometric study of the tongue as biomarkers of dysphagia in patients with amyotrophic lateral sclerosis.

The possibility of having methods to assess dysphagia in amyotrophic lateral sclerosis (ALS) patients in a minimally invasive manner could facilitate follow-up and allow performing of therapeutic interventions at earlier stages of the disease. The aim of the study was to analyze the role of tongue strength and thickness in ALS patients and their correlation with dysphagia and bulbar function. A sample of outpatients with ALS was evaluated for demographic and clinical features. Tongue thickness and strength have been measured for each patient, and quantitative and qualitative data of the videofluoroscopy swallow study have been analyzed. Of the 38 ALS patients studied, 47.4% were women, and 26.3% had bulbar onset. The median time between symptom onset and the study was 24months (IQR 11.5-48), and 55.3% of the patients were carriers of non-invasive mechanical ventilation. Tongue strength identified patients with impaired oral and pharyngeal transit and those with bolus residue scale (BRS) > 1 or penetration-aspiration scale (PAS) ≥ 3. In contrast, tongue thickness is only associated with impaired oral transit. Finally, anterior tongue strength ≤ 34kPa and posterior tongue strength ≤ 34.5kPa detected ALS penetrators/aspirators (PAS ≥ 3) and patients with ALS with post-swallow residue (BRS > 1). Our results suggest that measures that assess the functionality (strength) of the tongue are more valuable than morphological measurements (thickness) for the follow-up of patients with ALS. Alterations of the anterior and posterior lingual strength correlate with the presence of bronchoaspiration and post-swallowing residue (BRS > 1).

Measurement of Neck Circumference, Tongue thickness and Skin to Epiglottis Distance as Predictors of Difficult Intubation: A Prospective Study

Airway Assessment is essential in pre anesthetic assessment. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Routine pre operative airway examination usually includes mouth opening and dentition, Mallampati classification, thyromental distance and neck movements. Neck circumference is a quick bedside test to determine difficult laryngoscopy. Increased tongue thickness and skin to epiglottis distance affects performance of laryngoscopy and tracheal intubation increasing the risk of difficult airway. Presently there is a search for non-invasive and accurate tools to overcome limitations of clinical airway assessment tests. Ultrasonography has been evolving as a useful device for airway assessment especially soft tissue structures in anterior surface of neck. Here we studied the measurement of neck circumference and ultrasound measurement of tonguethickness and skin to epiglottis distance as predictors for difficult intubation. The Aim of the study is to predict difficulty in intubation by measuring neck circumference, thickness of tongue and thickness of skin to epiglottis. Prospective observational study, 120 patients posted for surgery under general anesthesia, Department of anesthesia, Meenakshi medical college, Kanchipuram. After institutional Human ethical committee clearance, 120 Patients were screened during preoperative assessment for undergoing procedures under general anaesthesia. Neck circumference and other airway parameters were measured with measuring tape and distance between Skin to epiglottis and tongue thickness were measured with ultrasound linear probe. Patients were grouped into Group E( Easy Intubation) whose Cormack-lehane grade was 1 and 2 and Group D ( Difficult intubation) whose Cormack-lehane grade was 3 and 4. SPSS version 16 was used for statistical analysis. There was no statistical significance seen between age, sex, height among easy and difficult intubation but significance was seen with weight (p &lt;0.05), Thyromental distance(p&lt;0.05) and Sterno-mental distance(p&lt;0.05). High significance was seen in Distance between skin to epiglottis distance(p&lt;0.001), Tongue thickness(p&lt;0.001) and Neck Circumference(p&lt;0.001) in difficult intubation cases. Neck circumference and ultrasonographic measurement of tongue thickness and skin to epiglottis can avoid unanticipated difficult intubation.

The value of multiparameter combinations for predicting difficult airways by ultrasound

BackgroundBased on the upper airway anatomy and joint function parameters examined by ultrasound, a multiparameter ultrasound model for difficult airway assessment (ultrasound model) was established, and we evaluated its ability to predict difficult airways.MethodsA prospective case-cohort study of difficult airway prediction in adult patients undergoing elective surgery with endotracheal intubation under general anesthesia, and ultrasound phantom examination for difficult airway assessment before anesthesia, including hyomental distance, tongue thickness, mandibular condylar mobility, mouth opening, thyromental distance, and modified Mallampati tests, was performed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the effectiveness of the ultrasound model and conventional airway assessment methods in predicting difficult airways.ResultsWe successfully enrolled 1000 patients, including 51 with difficult laryngoscopy (DL) and 26 with difficult tracheal intubation (DTI). The area under the ROC curve (AUC) for the ultrasound model to predict DL was 0.84 (95% confidence interval [CI]: 0.82–0.87), and the sensitivity and specificity were 0.75 (95% CI: 0.60–0.86) and 0.82 (95% CI: 0.79–0.84), respectively. The AUC for predicting DTI was 0.89 (95% CI: 0.87–0.91), and the sensitivity and specificity were 0.85 (95% CI: 0.65–0.96) and 0.81 (95% CI: 0.78–0.83), respectively. Compared with mouth opening, thyromental distance, and modified Mallampati tests, the ultrasound model predicted a greater AUC for DL (P < 0.05). Compared with mouth opening and modified Mallampati tests, the ultrasound model predicted a greater AUC for DTI (P < 0.05).ConclusionsThe ultrasound model has good predictive performance for difficult airways.Trial registrationThis study is registered on chictr.org.cn (ChiCTR-ROC-17013258); principal investigator: Jianling Xu; registration date: 06/11/2017).