ABSTRACT
Pierre Robin sequence (PRS), also called Robin sequence, is a congenital anomaly characterized by a triad of micrognathia, glossoptosis, and upper airway obstruction. Infants with PRS can present with varying degrees of respiratory difficulty secondary to upper airway obstruction. There has been no consensus for the treatment of upper airway obstruction in infants with PRS, but recent studies recommend attempting non-surgical interventions before surgical treatment. In this case report, we present 3 cases of infants diagnosed with PRS who showed persistent respiratory difficulties after birth. Before considering surgical intervention, insertion of a nasopharyngeal airway was attempted in these infants. Following this procedure, symptoms of upper airway obstruction were relieved, and all infants were discharged without surgical interventions; the nasopharyngeal airway was removed 1 to 2 months later. To date, no infant has shown signs of upper airway obstruction. Nasopharyngeal airway insertion is a highly effective and less invasive treatment option for infants with PRS. However, it is not widely known and used in Korea. Nasopharyngeal airway insertion can be preferentially considered before surgical intervention for upper airway obstruction in such infants.
Subject(s)
Humans , Infant , Airway Obstruction , Consensus , Glossoptosis , Korea , Micrognathism , Parturition , Pierre Robin SyndromeABSTRACT
OBJECTIVE: To evaluate the shapes and sizes of nasopharyngeal airways by using cone-beam computed tomography and to assess the relationship between nasopharyngeal airway shape and adenoid hypertrophy in children. METHODS: Linear and cross-sectional measurements on frontal and sagittal cross-sections containing the most enlarged adenoids and nasopharyngeal airway volumes were obtained from cone-beam computed tomography scans of 64 healthy children (11.0 +/- 1.8 years), and the interrelationships of these measurements were evaluated. RESULTS: On the basis of frontal section images, the subjects' nasopharyngeal airways were divided into the following 2 types: the broad and long type and the narrow and flat type. The nasopharyngeal airway sizes and volumes were smaller in subjects with narrow and flat airways than in those with broad and long airways (p < 0.01). Children who showed high adenoid-nasopharyngeal ratios on sagittal imaging, indicating moderate to severe adenoid hypertrophy, had the narrow and flat type nasopharyngeal airway (p < 0.01). CONCLUSIONS: Cone-beam computed tomography is a clinically simple, reliable, and noninvasive tool that can simultaneously visualize the entire structure and a cross section of the nasopharyngeal airway and help in measurement of adenoid size as well as airway volume in children with adenoid hypertrophy.
Subject(s)
Child , Humans , Adenoids , Cone-Beam Computed Tomography , HypertrophyABSTRACT
A redução do espaço aéreo nasofaríngeo pode estar associada a vários fatores, em especial à hipertrofia das tonsilas. Estudos mais recentes, entretanto, apontam que este estreitamento também pode ser decorrente de más oclusões esqueléticas, em especial da Classe II. Objetivou-se com esta revisão de literatura estudar a influência desta displasia e o tratamento da mesma com aparelho extraoral, no tamanho do espaço aéreo nasofaríngeo.
Nasopharyngeal airway space reduction can be associated to various factors, especially to hypertrophic tonsils. Most recent studies, however, demonstrate that this constriction can also be related to skeletal malocclusions, most specifically, the Class II malocclusion. The purpose of this literature review was to report the influence of this skeletal dysplasia, and its treatment with headgear appliances, on the size of the nasopahryngeal airway.
Subject(s)
Malocclusion, Angle Class II , Orthodontic AppliancesABSTRACT
Objective To compare the efficacy of combined intravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask versus laryngeal mask airway (LMA).Methods Seventy-two children,scheduled for elective high ligation of indirect inguinal hernia,were randomly divided into 2 groups (n =36 each):nasopharyngeal airway-face mask group (group M) and LMA group (group L).Propofol 1.0 mg/kg and fentanyl 2.0μg/kg were injected intravenously.The spontaneous breathing was kept.After lass of consciousness,a face mask was placed for inhalation of pure oxygen at 2 L/min and 3 ％ sevoflurane.When BIS value reached 50-60,a size 2 LMA was inserted in group L and a nasopharyngeal airway was placed via the left nasal cavity and the face mask was held tightly and connected to the anesthesia machine in group M.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane.Fentanyl 1 μg/kg was injected intravenously 5 min before skin incision.The concentration of sevoflurane was adjusted to maintain BIS value at 40-60 during surgery.Mean arterial pressure,heart rate,partial pressure of end-tidal carbon dioxide and pulse oxygen saturation were recorded before induction,at 3 min during induction,immediately after successful insertion of the airway,at skin incision,3 min after skin incision,and immediately after removal of the airway.The airway insertion time,success rate of insertion at first attempt,emergence time,and adverse reactions were recorded.Results Compared with group L,mean arterial pressure and heart rate were significantly decreased during airway insertion or removal,nasopharyngeal airway insertion time was shortened and the success rate of nasopharyngeal airway insertion at first attempt (100％) was increased,and the agitation score and incidence of obstruction of the upper respiratory tract were decreased in group M (P ＜ 0.05).Conclusion Combined inravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane is easy to establish the airway,can maintain spontaneous breathing,has little influence on circulatory function and reduce complications during recovery from anesthesia in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask,and the efficacy is better than that with LMA.
ABSTRACT
OBJECTIVE: This study examined the craniofacial morphology of young patients in their prepubertal stage showing class I, II malocclusion, by analyzing lateral cephalograms, and analyzed its relationship with tongue position, tongue space, and airway space in order to ascertain the effects of nasopharyngeal airway and tongue morphology on the form of the malocclusion. METHODS: Seventy-six patients aging from 9 to 11 were divided into two groups depending on the ANB difference on the lateral cephalogram: Experimental group (Cl II malocclusion group) showing 0 ANB difference < or = < 4.0; Control group (Cl I malocclusion group) showing 0 < ANB difference < 4.0. The tongue space, space between palate and tongue, nasopharyngeal airway space and craniofacial morphology were compared between the two groups. RESULTS: Tongue space, palate-tongue space, nasopharyngeal airway space showed no significant differences between class I and class II malocclusion groups. Hyperdivergent faces were associated with smaller nasopharyngeal airway space. Longer anterior facial height and posterior facial height were associated with larger tongue space, and greater anterior facial height were associated with lower tongue position. Smaller nasopharyngeal airway space showed smaller tongue space. CONCLUSIONS: Tongue space and nasopharyngeal airway space showed no significant differences between class I malocclusion group and class II malocclusion group. Only anterior facial height and posterior facial height had an influence on tongue space and nasopharyngeal airway space.
Subject(s)
Child , Humans , Aging , Malocclusion , Palate , TongueABSTRACT
BACKGROUND: The insertion of a nasogastric tube can be difficult in an anesthetized patient who has a cuffed endotracheal tube in place. The placement of a silastic nasogastric (NG) tube can lead to nasal bleeding or a submucosal dissection in the posterior pharynx. The aim of this study was to determine if the insertion of a nasogastric tube with a nasophryngeal airway can be made easy. METHODS: Sixty patients were randomly assigned to one of two groups; Group 1 and Group 2. For Group 1, a nasogastric tube was inserted first. If this method was not successful with two consecutive attempts, then a nasogastric tube with a nasopharyngeal airway was inserted and if unsuccessful again with two attempts, then Magill forceps were used under laryngoscopy. For Group 2, a nasogastric tube with a nasopharyngeal airway was inserted first. If this method was not successful with two consecutive attempts, then a nasogastric tube was inserted and if unsuccessful again with two attempts, then Magill forceps were used under laryngoscopy. RESULTS: The success rate of the 1st pass in Group 2 was significantly higher than in Group 1 (P < 0.05). The success rate with the 1st intended method in Group 2 was significantly higher than in Group 1 (P < 0.05). The rate of using Magill forceps was not significantly different between the two groups. CONCLUSIONS: The insertion of a nasogastric tube with a nasopharyngeal airway in anesthetized and intubated patients is effective in increasing success rate of insertion. Nasopharyngeal airway traverses the nasopharynx atraumatically and serves as a conduit for the smaller nasogastric tube.
Subject(s)
Humans , Epistaxis , Laryngoscopy , Nasopharynx , Pharynx , Surgical InstrumentsABSTRACT
BACKGROUND: When the insertion of endotracheal tube (ETTs) though the nostril, the tube may be encountered some resistance. Forcing ETTs into the nasal cavity develope mucosal and soft tissue injuries and subsequent epistaxis during passage of the tube even when vasoconstictor and/or lubricant tube are employed. Therefore, We determined whether nasopharyngeal airway (NPA) insertion reduces the incidence of epistaxis and increase the ease of the tube advancement in the nasal cavity during nasotracheal intubation. METHODS: Two hundred adult patients who schesuled for elective surgery were divided into two groups, control (n=100), and NPA (n=100). The NPA insertion group received an armored tube after nasoparyngeal airway inserts, while control group received a plain armored tube. All patients in both groups was inserts ETTs by conventional nasotracheal insertion techniques. RESULT: The NPA insertion group had a significantly low incidence of epistaxis (11%) than control group (34%) (p<0.05). But, provided not easier passage during nasotracheal intubation than control group. CONCLUSION: We conclude that nasophryngeal airway reduces the incidence of epistaxis during nasotracheal intubation, but not to increase easy passage of the tube advancement.
Subject(s)
Adult , Humans , Control Groups , Epistaxis , Incidence , Intubation , Nasal Cavity , Soft Tissue InjuriesABSTRACT
BACKGROUND: When the insertion of endotracheal tube (ETTs) though the nostril, the tube may be encountered some resistance. Forcing ETTs into the nasal cavity develope mucosal and soft tissue injuries and subsequent epistaxis during passage of the tube even when vasoconstictor and/or lubricant tube are employed. Therefore, We determined whether nasopharyngeal airway (NPA) insertion reduces the incidence of epistaxis and increase the ease of the tube advancement in the nasal cavity during nasotracheal intubation. METHODS: Two hundred adult patients who schesuled for elective surgery were divided into two groups, control (n=100), and NPA (n=100). The NPA insertion group received an armored tube after nasoparyngeal airway inserts, while control group received a plain armored tube. All patients in both groups was inserts ETTs by conventional nasotracheal insertion techniques. RESULT: The NPA insertion group had a significantly low incidence of epistaxis (11%) than control group (34%) (p<0.05). But, provided not easier passage during nasotracheal intubation than control group. CONCLUSION: We conclude that nasophryngeal airway reduces the incidence of epistaxis during nasotracheal intubation, but not to increase easy passage of the tube advancement.