RESUMO
The glossopharyngeal nerve (GPN) is a rarely considered cranial nerve in imaging interpretation, mainly because clinical signs may remain unnoticed, but also due to its complex anatomy and inconspicuousness in conventional cross-sectional imaging. In this pictorial review, we aim to conduct a comprehensive review of the GPN anatomy from its origin in the central nervous system to peripheral target organs. Because the nerve cannot be visualised with conventional imaging examinations for most of its course, we will focus on the most relevant anatomical references along the entire GPN pathway, which will be divided into the brain stem, cisternal, cranial base (to which we will add the parasympathetic pathway leaving the main trunk of the GPN at the cranial base) and cervical segments. For that purpose, we will take advantage of cadaveric slices and dissections, our own developed drawings and schemes, and computed tomography (CT) and magnetic resonance imaging (MRI) cross-sectional images from our hospital's radiological information system and picture and archiving communication system. TEACHING POINTS: ⢠The glossopharyngeal nerve is one of the most hidden cranial nerves. ⢠It conveys sensory, visceral, taste, parasympathetic and motor information. ⢠Radiologists' knowledge must go beyond the limitations of conventional imaging techniques. ⢠The nerve's pathway involves the brain stem, cisternal, skull base and cervical segments. ⢠Systematising anatomical references will help with nerve pathway tracking.
RESUMO
STUDY OBJECTIVE: Morbid obesity is associated with a difficult management of the airway. There is no agreement on these patients being difficult to intubate, but if they are difficult to ventilate with facial mask, then the fast control of their airway becomes a priority. This study compares the quickness and success in tracheal intubation, glottic view, hemodynamic response, and complications from the use of the Macintosh and Airtraq laryngoscopes in morbidly obese patients for scheduled surgery. DESIGN: Prospective, observational, and randomized study. SETTING: Operating room. PATIENTS: Forty-six American Society of Anesthesiologists III patients. INTERVENTIONS: Patients were randomly assigned to undergo tracheal intubation using a Macintosh (n=23) or an Airtraq laryngoscope (n=23). MEASUREMENTS: The following were compared: intubation time, laryngeal vision, the necessity of additional maneuvers to carry out the tracheal intubation, the success of the maneuvers, complications, and hemodynamic response. MAIN RESULTS: The preoperative conditions of the studied patients were similar in both groups. The average time of the intubation was 17.27±16.1 seconds and 22.11±13.62 seconds in the Airtraq and Macintosh groups, respectively (P=.279). With the Airtraq device, 95.65% of patients presented a glottic view 1 and 2a (P=.006) and less optimizing maneuvers were needed to perform the tracheal intubation (P=.001). There were no cases of difficult intubation, failed intubation, or difficult ventilation. A statistically significant increase in the heart rate was detected with the use of the Macintosh laryngoscope. A patient with redundant epiglottis could not be intubated with the Airtraq laryngoscope. CONCLUSION: Both devices allow quick and safe management of the airway. The Airtraq laryngoscope improved the glottic view by the modified Cormack-Lehane classification, reduced the need for additional maneuvers for tracheal intubation, and also reduced the degree of sympathetic stimulus detected by a minor increase in heart rate after tracheal intubation.
