Upper airway morphology in Down Syndrome patients under dexmedetomidine sedation / Morfologia das vias aéreas superiores em pacientes com síndrome de Down sob sedação com dexmedetomidina

Abstract Background and objectives: Children with Down Syndrome are vulnerable to significant upper airway obstruction due to relative macroglossia and dynamic airway collapse. The objective of this study was to compare the upper airway dimensions of children with Down Syndrome and obstructive sleep apnea with normal airway under dexmedetomidine sedation. Methods: IRB approval was obtained. In this retrospective study, clinically indicated dynamic sagittal midline magnetic resonance images of the upper airway were obtained under low (1 mcg/kg/h) and high (3 mcg/kg/h) dose dexmedetomidine. Airway anteroposterior diameters and sectional areas were measured as minimum and maximum dimensions by two independent observers at soft palate (nasopharyngeal airway) and at base of the tongue (retroglossal airway). Results and conclusions: Minimum anteroposterior diameter and minimum sectional area at nasopharynx and retroglossal airway were significantly reduced in Down Syndrome compared to normal airway at both low and high dose dexmedetomidine. However, there were no significant differences between low and high dose dexmedetomidine in both Down Syndrome and normal airway. The mean apnea hypopnea index in Down Syndrome was 16 ± 11. Under dexmedetomidine sedation, children with Down Syndrome and obstructive sleep apnea when compared to normal airway children show significant reductions in airway dimensions most pronounced at the narrowest points in the nasopharyngeal and retroglossal airways.

Resumo Justificativa e objetivos: As crianças com síndrome de Down (SD) são vulneráveis à obstrução significativa das vias aéreas superiores devido à macroglossia relativa e ao colapso dinâmico das vias aéreas. O objetivo deste estudo foi comparar as dimensões das vias aéreas superiores de crianças com SD e apneia obstrutiva do sono (AOS) com vias aéreas normais (VAN) sob sedação com dexmedetomidina (DEX). Métodos: Aprovação IRB foi obtida. Neste estudo retrospectivo, imagens clinicamente indicadas de ressonância magnética da dinâmica das vias aéreas superiores em plano sagital na linha média foram obtidas sob dose baixa (1 mcg/kg/h) e dose alta (3 mcg/kg/h) de DEX. Os diâmetros anteroposteriores das vias aéreas e as áreas seccionais foram medidas como dimensões mínimas e máximas por dois observadores independentes, no palato mole (região nasofaríngea) e na base da língua (região retroglossal). Resultados e conclusões: O diâmetro mínimo anteroposterior e a área seccional mínima das regiões nasofaríngea e retroglossal estavam significativamente reduzidos na SD em comparação com VAN, tanto com a dose baixa quanto com a dose alta de DEX. Contudo, não houve diferenças significativas entre as doses baixa e alta de DEX em SD e VAN. A média do índice de apneia e hipopneia na SD foi de 16 ± 11. Sob sedação com DEX, as crianças com SD e AOS, quando comparadas com as crianças com VAN, apresentaram reduções significativas nas dimensões das vias aéreas, mais pronunciadas nos pontos mais estreitos das regiões nasofaríngea e retroglossal.

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF individuals showed a ΔV suggesting impaired VP function (below the cutoff score of 3.0 cm3 which maximized both sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of VP activity which characterizes VPI. .

Nasopharyngeal angiofibroma: Our experience and literature review

Introduction: Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, and histologically benign tumor, generally observed in male adolescents. It shows very aggressive behavior due to local invasiveness and is associated with various symptoms. Juvenile nasopharyngeal angiofibroma originates in the sphenopalatine forame, causing epistaxes and nasal obstruction. Objective: To retrospectively describe our experience in the diagnosis and treatment of patients with juvenile nasopharyngeal angiofibroma. Scientific drawing: Retrospective, descriptive study conducted after approval from the Ethics Committee of the Federal University of Sergipe (protocol 0114.0.107.000 -11). Methods: We analyzed findings in 20 patients who underwent surgery between 2004 and 2011. Factors analyzed include patient age and gender, symptoms, stages, treatment, length of surgery, intraoperatory bleeding, postoperative need for nasal tampons, hospitalization time, complications, and tumor recurrence. Results: Patients were aged 10-29 years. All patients were treated surgically, including 17 who underwent endoscopic surgery. The mean operation time was 120 min, and the mean bleeding volume was 300 mL. Seventeen patients required clamping of the external carotids and tumor embolization. Conclusion: Endoscopic surgery alone or with other conventional techniques was safe for the treatment of angiofibromas of different stages...

Four novel prosthodontic methods for managing upper airway resistance syndrome: An investigative analysis revealing the efficacy of the new nasopharyngeal aperture guard appliance.

Statement of Problem: Obstructive sleep apnea is the most frequent cause for insomnia in the populace. Snoring is mulled over as the potential factor that can lead the sequel to obstructive sleep apnea. Although the etiology and deterrence measures for snoring are yet to be undoubtedly clarified by our scientific sorority, various means of surgical corrections have been affirmed and put into practice, with a substantial degree of success. Despite this, it is implicit that a noninvasive method of managing obstructive sleep apnea is more relevant for overcoming this condition. Purpose: This manuscript intends to establish how snoring can be controlled prosthodontically by different modalities of scientifically defensible approaches. The most effective among the modalities was affirmed as the investigative analyses of the treatment outcomes with each modality. Novel Methods: Four new methods of managing obstructive sleep apnea - uvula lift appliance, uvula and velopharynx lift appliance, nasopharyngeal aperture guard, and soft palate lift appliance were demonstrated through this article. Clinical Reports: The four new modalities stated and one conventional modality of mandibular advancement appliance for managing obstructive sleep apnea, a total of five types of appliance therapies, were described with case reports for each. Investigation: Five individuals undergoing the appliance therapy were chosen for each modality. The treatment outcome with each modality was examined by analysis of clinical predictors and also by means of standard investigation, with nasal and oral endoscopic analyses. Result: Among the five types of appliance therapies, the nasopharyngeal aperture guard provided the best treatment outcome in terms of clinical predictors and endoscopic analyses. Conclusion: Nasopharyngeal aperture guard, the novel method stated in this article is the better modality for managing obstructive sleep apnea, among the five different appliance therapies.

Estudo comparativo do padrão de respiração e a porcentagem de ocupação da nasofaringe pela tonsila faríngea em crianças com ou sem história de infecção pelo HIV / A comparative study of the breathing pattern and amount of nasopharynx obstruction by the pharyngeal tonsil in hiv infected and non infected children

OBJETIVO: o objetivo deste estudo foi estudar a associação entre o padrão de respiração e o tamanho da tonsila faríngea em 122 crianças (60 infectadas pelo HIV e 62 sem infecção). MATERIAL E MÉTODO: As crianças foram analisadas quanto ao padrão de respiração, fluxo nasal e ocupação da tonsila faríngea em radiografias cefalométricas de perfil, através de uma análise computadorizada. RESULTADOS: O padrão de respiração de maior ocorrência nos dois grupos foi o tipo misto. A maioria das crianças apresentou tipo de respiração bucal ou mista, não havendo associação entre o tipo de respiração e presença do HIV (p=0,091). O fluxo nasal mostrou predomínio do fluxo médio nos dois grupos. As crianças sem história de infecção pelo HIV apresentaram fluxo nasal de médio a grande e a maioria das crianças infectadas pelo HIV apresentou de pouco a médio fluxo nasal de ar, havendo uma associação positiva entre o fluxo nasal e a infecção pelo HIV (p<0,0001). A porcentagem média de ocupação da tonsila faríngea foi alta nos dois grupos, não havendo diferença estatisticamente significante entre eles. As crianças dos dois grupos apresentaram aumento moderado ou acentuado do tamanho da tonsila faríngea, não havendo associação entre o tamanho da tonsila faríngea e presença do HIV (p=0,201).

AIM: the goal of the present investigation was to study the association between breathing pattern and pharyngeal tonsil size in 122 children (60 HIV infected and 62 without such infection). MATERIAL AND METHODS: The children were analyzed as to their breathing pattern, nasal flow and pharyngeal tonsil obstruction seen in side cephalometric x-rays, by means of a computerized analysis. RESULTS: The pattern that most occurred in both groups was the mixed type. Most of the children presented oral or mixed type breathing and there was no association between the type of breathing and HIV presence (p=0.091). Nasal flow was mainly medium in both groups. Children without prior history of HIV infection had medium to large nasal flow and most of the HIV-infected children had medium nasal airflow. There was a positive association between nasal flow and HIV infection (p<0.0001). The average percentage of nasopharynx obstruction by the pharyngeal tonsil was high in both groups, and there was no statistically significance difference between them. Children from both groups had a moderate or large size of pharyngeal tonsil, and there was no association between tonsil size and HIV (p=0.21).

Videonasofaringoscopía para retroalimentación del habla en pacientes con paladar hendido / Videonasopharingoscopy for visual biofeedback during speech in cleft palate patients

Propósito: Estudiar el uso de la videonasofaringoscopía como un instrumento para la retro-alimentación visual durante el habla en pacientes con paladar hendido reparado quirúrgicamente y con insuficiencia velofaríngea residual. Material y Métodos: Diecisiete pacientes con paladar hendido fueron seleccionados al azar para el estudio. Todos los pacientes mostraron insuficiencia velofaríngea (IVF), articulación compensatoria (AC) y movimiento negativo de las paredes faríngeas laterales (MNPFL) durante el habla. Nueve pacientes recibieron terapia del lenguaje para corregir la AC. Ocho pacientes recibieron terapia del lenguaje y videonasofaringoscopía como un instrumento para retro-alimentación visual del esfinter velofaríngeo. Resultados: Después de 12 semanas, el MNPFL se modificó en los pacientes que recibieron terapia del lenguaje y retro-alimentación visual. En contraste, el MNPFL se encontró presente en ocho de nueve pacientes que recibieron terapia del lenguaje. Posteriormente, estos pacientes también recibieron retro-alimentación visual y el MNPFL se corrigió en todos los caos. Después de seis meses, todo los diecisiete pacientes habían corregido al AC durante el habla aislada. A todos los pacientes se les practicó un colgajo faríngeo hecho a la medida. La IVF se corrigió en forma completa en quince casos. En los dos casos restantes en los que la IVF continuó presente en forma postoperatoria, el tamaño del defecto esfinter velofaríngeo se redujo significativamante. En estos dos pacientes, la retro-alimentación visual fue posterior a la cirugía para mejorar el movimiento de las paredes faríngeas laterales (PFL) hacia el borde del colgajo. Después de dieciocho meses desde el inicio de la terapia de lenguaje, todos los pacientes presentaban resonancia nasal y articulación normal durante el habla conectada. Conclusiones: La videonasofaringoscopía es una herramienta útil para mejorar la IVF en pacientes con MNPFL

Avaliaçäo nasofibroscópica e rediológica de pacientes com hiperplasia da amígdla faríngea / Endoscopic and roentgenographic approach in patients with adenoids hyperplasia

O presente estudo avaliou a fidedignidade do uso da nasofibroscopia e da radiografia lateral do cavum faríngeo na indicação cirúrgica de crianças portadoras de hiperplasia da amígdala faríngea. A análise dos exames realizados, com a determinação da relação adenóide/nasofaringe descrita por Fujioka, em 1979, e da relação adenóide/coana descrita por Demain e Goetz, em 1995, permitiu-nos uma comparação com a sintomatologia descrita pelos responsáveis dos pacientes portadores da patologia em questão.

Tratamiento del ronquido y de las apneas del sueño obstructivas con dispositivo de ortosis dental / Treatment of snoring and obstructive sleep apnea with an orthotic device

El propósito de este estudio es comunicar los resultados del tratamiento del ronquido y la apnea del sueño obstructiva con un dispositivo ortósico dental removible utilizado durante el sueño. Se seleccionaron 7 pacientes con diagnóstico de ronquido patológico y apnea del sueño obstructiva de grado leve a moderado (Indice A + H/hora menor de 50), peso corporal normal (IMC 26,3 +- 0.5 K/m2) y maloclusión ostensible. Se estudiaron con polisomnografía nocturna completa, telerradiografía con análisis cefalométrico. El uso del DOD (dispositivo de ortosis dental), disminuyó el ronquido, el índice de apneas y aumentó el porcentaje de tiempo en sueño profundo. Fue bien tolerado en 6 de los 7 pacientes. Se concluye que el DOD es una alternativa de tratamiento efectiva factible, no invasiva y con ventajas sobre otros tratamientos más engorrosos

Rinofaringolaringoscopia flexible en la evaluación de pacientes con problemas alérgicos y de vías respiratorias altas / Rhinofaringoscopy flexible in the evaluation of patient for problem. allergics upper respirator arrways

La rinofaringolaringoscopia flexible es un procedimiento muy útil y valioso en nuestra práctica diaria, capaz de aportar hasta 60 por ciento de información adicional en el diagnóstico y abordaje de pacientes con enfermedad alérgica y de vías respiratorias superiores. Se describe el procedimiento endoscópico en nuestro Instituto privado así como los hallazgos más importantes en 423 pacientes. El 49 por ciento presentó alguna anormalidad en la mucosa nasal y meato medio, sitio relacionado con el drenaje de senos paranasles. En 23 pacientes encontramos alteraciones en los cornetes, cambios polipoideos, degeneración o presencia de concha bulosa. Un gran porcentaje de esta afección no se diagnostica mediante el examen convencional. El 7 por ciento presentó cambios significativos en el área relacionada con el epitelio olfatorio, edema e inflamación con la consecuente alteración en el olfato y gusto. 56 pacientes presentaron inflamación e hipertrofia en el complejo adenoideo, y la mitad de éstos, 28 pacientes con algún grado de obstrucción del tubo faringó-auditivo (trompa de Eustaquio). En el área laríngea, 58 pacientes (14 por ciento) tuvieron anormalidades, predominando cambiso inflamatorios y edema en epiglotis y glotis (8 por ciento), secundaria al mal uso de la voz, requiriendo terapia de lenguaje y en 4 por ciento patología de cuerdas vocales, predominando los pólipos y la parálisis. Encontramos dos pacientes con carcinoma que requirieron biopsia, y tratamiento específico. Es un procedimiento que puede aprenderse fácilmente en 2 o 3 sesiones y que repercutirá directamente en nuestra capacidad para diagnosticar enfermedad de la vía aérea superior

unusual foreign body in the nasopharynx

Foreign body [F.B.] is seldom seen in the nasopharynx, that is the condition does not merit mention in standard text books. We report a case of a 4 year old girl who choked during eating and mother tried to remove it digitally. Anterior rhinoscopy was normal. Digital palpation and removal by adenoid curette was done

Anomalías dentomaxilofaciales: su relación con el sindrome de obstrucción respiratoria / Dento-maxillofacial abnormalities: their relation to the respiratory obstruction syndrome

Se estudiaron 27 pacientes con sindrome de obstrucción respiratoria. Por medio de telerradiografías laterales se evaluaron dimensiones de nasofaringe midiendo sobre las mismas hipertrofia de cornetes y adenoides. Otros estudios fueron realizados sobre telerradiografías frontales y rinomanometrias. Se realizaron cefalomgramas Ricketts y McNamara. Se obtuvo como resultado que el área libre en respiradores bucales por hipertrofia de cornetes y adenoides disminuye significativamente dificultando el pasaje aéreo normal y que el valor medio de H.C. es de 8,2 mm. En el estudio de estructuras profundas el plano palatino, el mandibular, profundidad facial y altura facial inferior fueron los más significativamente alterados

Foreign body in the nasopharynx

A case is reported of a long standing, ignored, Foreign Body, a large piece of wood which entered after penetrating injury in a road traffic accident near the medial canthus of right eye and was lodged in Nasopharynx. Nasopharynx is a site which is rarely mentioned in books and literature, a brief review of the subject is included