Aerodynamic characteristics in upper airways among orthodontic patients and its association with adenoid nasopharyngeal ratios in lateral cephalograms.

BACKGROUND: Adenoid hypertrophy among orthodontic patients may be detected in lateral cephalograms. The study investigates the aerodynamic characteristics within the upper airway (UA) by means of computational fluid dynamics (CFD) simulation. Furthermore, airflow features are compared between subgroups according to the adenoidal nasopharyngeal (AN) ratios. METHODS: This retrospective study included thirty-five patients aged 9-15 years having both lateral cephalogram and cone beam computed tomography (CBCT) imaging that covered the UA region. The cases were divided into two subgroups according to the AN ratios measured on the lateral cephalograms: Group 1 with an AN ratio < 0.6 and Group 2 with an AN ratio ≥ 0.6. Based on the CBCT images, segmented UA models were created and the aerodynamic characteristics at inspiration and expiration were simulated by the CFD method for the two groups. The studied aerodynamic parameters were pressure drop (ΔP), maximum midsagittal velocity (Vms), maximum wall shear stress (Pws), and minimum wall static pressure (Pw). RESULTS: The maximum Vms exhibits nearly 30% increases in Group 2 at both inspiration (p = 0.013) and expiration (p = 0.045) compared to Group 1. For the other aerodynamic parameters such as ΔP, the maximum Pws, and minimum Pw, no significant difference is found between the two groups. CONCLUSIONS: The maximum Vms seems to be the most sensitive aerodynamic parameter for the groups of cases. An AN ratio of more than 0.6 measured on a lateral cephalogram may associate with a noticeably increased maximum Vms, which could assist clinicians in estimating the airflow features in the UA.

Reliability of alternative devices for postoperative patient temperature measurement: two prospective, observational studies.

Peri-operative hypothermia is associated with significant morbidity, yet limitations exist regarding non-invasive temperature assessment in the post-anaesthesia care unit (PACU). In this prospective study of 100 patients, we aimed to determine the reliability of two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, in addition to an indwelling urinary catheter with temperature probe, in comparison with the final nasopharyngeal core temperature at the end of surgery. Agreement of forehead measurement with nasopharyngeal temperature showed a mean bias (±95% limits of agreement) of 0.15 °C (±1.4 °C), with a steep slope of the relationship on the Bland-Altman plot of -0.8, indicating a tendency to normalise patient temperature readings to 36.4 °C. Only 54% of hypothermic cases were correctly detected by the forehead measurement device. Agreement of tympanic measurement with nasopharyngeal core temperature measurement was marginally improved with a mean bias of 0.13 °C (95% limits of agreement ±1.15 °C). In contrast, agreement of bladder temperature with nasopharyngeal temperature showed a mean (SD) bias of 0.19 (0.28) °C (95% limits of agreement ±0.54 °C), with a relatively flat line of best fit. We demonstrated that two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, compared with nasopharyngeal core temperature, were imprecise and unreliable following major surgery. However, the indwelling catheter with temperature sensor was precise and acceptable for continuous core temperature measurement in the PACU.

Study of the Anatomical Structure of the Nasopharyngeal Cavity and Distribution of the Air Flow Field.

To build a biomechanical numerical model of the nasopharynx, construct an accurate computerized numerical description of its specific anatomical structures, analyze the distribution of air flow field, starting with the anatomical structure of the pharyngeal recess, correlate its anatomical characteristics with the occurrence and development of nasopharyngeal carcinoma from the perspective of biomechanics. In this study, the nasal and nasopharyngeal cavities of healthy male adult, with the pharyngeal recess in an open state, were scanned by CT to obtain DICOM imaging data. Then, they were imported into Mimics 20.0 to build a model which was recorded in binary STL format. Each file was imported into Geomagic studio 12.0 to construct a 3D model saved in an IGES format. Then, it was imported into ANSYS Workbench for numerical simulation of air flow field. The authors found that:Above all, the causes and pathogenesis of nasopharyngeal carcinoma can be identified from the perspective of biomechanics through the construction of a 3D model and analysis of the characteristics of air flow field. With more in-depth research, it is expected that a more solid scientific foundation will be created for related quantitative analysis.

Postoperative Skeletal Stability and Pharyngeal Airway: Counterclockwise versus Clockwise Rotation during Mandibular Setback Surgery.

PURPOSE: To compare the effects of counterclockwise rotation (CCR) and clockwise rotation (CR) of the mandible on the pharyngeal airway during mandibular setback surgery. Materials and Methods. Serial cephalograms of 40 patients with mandibular prognathism, including 20 who underwent CCR and 20 who underwent CR, were taken at the following time intervals: preoperatively (T1), immediately postoperatively (T2), >1 year after surgery (T3), final surgical changes (T31), postoperative stability (T32), and immediate surgical change (T21). Changes in menton (Me) and hyoid (H) positions, soft palate width, soft palate length, soft palate angle and craniovertebral angle (C2C4-SN), and pharyngeal airway spaces (nasal pharyngeal airway (NOP), uvula pharyngeal airway (UOP), tongue pharyngeal airway (TOP), and epiglottis pharyngeal airway (EOP)) were evaluated. RESULTS: The mean Me (T31) setback for CCR and CR was 12.56 and 13.06 mm, respectively, with 2.41 mm upward and 3.29 mm downward, respectively. The vertical Me position of CR exhibited significant downward movement compared with that of CCR. The mean H setback results for CCR and CR were 4.42 and 5.75 mm, respectively, with 1.47 mm downward and 2.97 mm downward, respectively. The C4C2-SN angles for CCR and CR increased by 2.68° and 3.65°, respectively, whereas their palatal angles increased by 2.35° and 5.25°, respectively. Pearson's correlation analysis (T31) revealed that for CCR, no pharyngeal airway spaces were significantly correlated with any measured variables. In CR, NOP was significantly correlated (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (. CONCLUSION: Pharyngeal airway space narrowed postoperatively, and its patency was appropriately maintained through natural physiological regulation of the craniovertebral angle (C2C4-SN). Significant postoperative relapse was correlated with CR.

A Preliminary Dynamic Investigation on Velopharyngeal Movements During Blowing: A New Approach for Evaluation.

PURPOSE: To explore an alternative approach to evaluate velopharyngeal function on those speakers with compensatory misarticulation. METHOD: Nasopharyngeal endoscopy was used to observe the velopharyngeal movement on 26 adult Mandarin speakers during articulation and different nonverbal state, including SCPS, DCPS, and ABS. RESULTS: There were significant differences for the rate of velopharyngeal incompetence (RVPI) among the 4 different states. The RVPI was least for the Articulation State, followed by the Air Blowing and DCPS. The RVPI was largest for the SCPS. CONCLUSION: The result indicated that the ABS may be used as an alternative approach to evaluate the velopharyngeal function instead of the articulation samples while patients cannot make clear articulation due to compensatory misarticulation habits. It merits further study on nonverbal activities, which could lay a foundation for exploring more effective approach for evaluation of the velopharyngeal function.

Air-splinting Maneuver During Flexible Bronchoscopy: A Cross-sectional Study.

BACKGROUND: Magazine's maneuver was developed for ease of insertion of the flexible bronchoscope, on encountering a closed lumen at the nasopharynx-oropharynx junction. The purposes of this study were to find the frequency of occurrence of such luminal closures and to compare the efficacy of Magazine's maneuver, with other variations of the maneuver, in improving visualization of the upper airway. MATERIALS AND METHODS: Patients aged 18 years and above who were undergoing flexible bronchoscopy were included, and their demographic and clinical data were noted. The bronchoscope was inserted using the transnasal approach, and, at the junction of nasopharynx with oropharynx, the patency of the lumen between the soft palate and the posterior pharyngeal wall was recorded. The subjects were instructed to perform 4 variations of the maneuver. Observations at each variation were recorded as lumen open or closed; if the lumen was open, the size was noted as small or large and whether it closed during expiration. RESULTS: Among 443 subjects, obstruction at the nasopharynx-oropharynx junction was observed, at baseline, in 105 (23.7%); whereas 338 (76.3%) had an open lumen. An open lumen was observed during nose and mouth breathing in 294 (66.4%) subjects, and, when head-tilt chin-lift was added to it, it was observed in 303 (68.4%). During Magazine's maneuver the lumen remained open in all 443 (100%) subjects. Half of the subjects (n=8) with body mass index >30 and one-third (n=29) above 65 years of age had luminal closure at baseline. CONCLUSION: Magazine's maneuver opens up the obstruction at the nasopharynx-oropharynx junction, whereas mouth and nose breathing mostly fails to do so. Adding head-tilt chin-lift to either of the 2 breathing techniques does not provide any additional benefit.

Acoustic Rhinometry for Evaluation of Velopharyngeal Function in Preschool Children Post Palatoplasty.

PURPOSE: To assess the feasibility of acoustic rhinometry for the evaluation of velopharyngeal function in preschool children by detecting changes in nasal cavity volume (NV) and minimal cross-sectional area (MCSA) after palatoplasty. MATERIALS AND METHODS: Sixty-one preschool children with incomplete cleft palate who underwent Sommerlad palatoplasty were examined by acoustic rhinometry. MCSA, distance of the MCSA from the nostril (DMCA), NV, and nasopharyngeal volume (NPV) were measured. Patients were grouped according to velopharyngeal state and lateral cephalographic findings. RESULTS: MCSA, NV, and NPV showed a meaningful difference between the experimental and control groups. DMCA in the experimental group (7.09 ± 1.33 mm) was not markedly different between the 2 sides. NV, NPV, and MCSA in the velopharyngeal insufficiency (VPI) subgroup were obviously larger than those in the velopharyngeal competence (VPC) and marginal VPI subgroups. NV in the VPC group showed no relevant difference from that in the control group. No relevant difference in MCSA, DMCA, and NPV was observed among the 3 subgroups at radiographic evaluation. NV in the noncontact group was markedly larger than in the control group. The curve showed marked constriction in the anterior part but an elevation in the posterior part, especially at a distance of 7.09 cm. CONCLUSION: Acoustic rhinometry is a rapid, noninvasive, and reproducible method that can be used in lieu of lateral cephalography for quantitative evaluation of the NV and MCSA. It can be used to assess postoperative velopharyngeal function in children and has good adaptability.

The selective cytotoxicity of DSF-Cu attributes to the biomechanical properties and cytoskeleton rearrangements in the normal and cancerous nasopharyngeal epithelial cells.

Cancer initiation and progression follow complex changes of cellular architecture and biomechanical property. Cancer cells with more submissive (or "softer") than their healthy counterparts attributed to the reorganization of the complex cytoskeleton structure, may be considered as a potential anti-tumor therapeutic target. In this study, atomic force microscopy (AFM) was carried out to detect the topographical and biophysical changes of nasopharyngeal carcinoma CNE-2Z cells and normal nasopharyngeal epithelial cells NP69-SV40T by treating the Disulfiram chelated with Cu2+ (DSF-Cu). DSF-Cu induced the apoptotic population, ROS production and decreased the NF-κB-p65 expression of CNE-2Z cells, which was much higher than those of NP69-SV40T cells. DSF-Cu caused the obvious changes of cell morphology and membrane ultrastructure in CNE-2Z cells. The roughness decreased and stiffness increased significantly in CNE-2Z cells, which correlated with the rearrangement of intracellular F-actin, FLNa and α-tubulin structures in CNE-2Z cells. And the adhesion force of CNE-2Z cells was also increased accompanied with the increased E-cadherin expression. However, these results could not be observed in the NP69-SV40T cells even the concentration of DSF reached up to 400nM. Finally, the detection of cell wound scratch assay confirmed DSF-Cu could inhibit the migration of CNE-2Z cells, but no effect on NP69-SV40T cells. These findings demonstrated the selective cytotoxicity of DSF-Cu in CNE-2Z cells may attribute to the different mechanical properties and cytoskeleton rearrangement from the normal nasopharyngeal epithelial cells.

Creation of an idealized nasopharynx geometry for accurate computational fluid dynamics simulations of nasal airflow in patient-specific models lacking the nasopharynx anatomy.

Virtual surgery planning based on computational fluid dynamics (CFD) simulations has the potential to improve surgical outcomes for nasal airway obstruction patients, but the benefits of virtual surgery planning must outweigh the risks of radiation exposure. Cone beam computed tomography (CT) scans represent an attractive imaging modality for virtual surgery planning due to lower costs and lower radiation exposures compared with conventional CT scans. However, to minimize the radiation exposure, the cone beam CT sinusitis protocol sometimes images only the nasal cavity, excluding the nasopharynx. The goal of this study was to develop an idealized nasopharynx geometry for accurate representation of outlet boundary conditions when the nasopharynx geometry is unavailable. Anatomically accurate models of the nasopharynx created from 30 CT scans were intersected with planes rotated at different angles to obtain an average geometry. Cross sections of the idealized nasopharynx were approximated as ellipses with cross-sectional areas and aspect ratios equal to the average in the actual patient-specific models. CFD simulations were performed to investigate whether nasal airflow patterns were affected when the CT-based nasopharynx was replaced by the idealized nasopharynx in 10 nasal airway obstruction patients. Despite the simple form of the idealized geometry, all biophysical variables (nasal resistance, airflow rate, and heat fluxes) were very similar in the idealized vs patient-specific models. The results confirmed the expectation that the nasopharynx geometry has a minimal effect in the nasal airflow patterns during inspiration. The idealized nasopharynx geometry will be useful in future CFD studies of nasal airflow based on medical images that exclude the nasopharynx.

Dimensões nasofaríngeas em indivíduos sem anomalias craniofaciais: dados normativos / Nasopharyngeal dimensions in normal individuals: normative data

RESUMO Objetivo Determinar os valores controles da área de secção transversa mínima nasofaríngea de indivíduos sem anomalias craniofaciais e em diferentes faixas etárias. Material e Método Participaram do estudo 96 indivíduos sem anomalias craniofaciais, de ambos os sexos, com índice de massa corpórea e circunferência cervical normais, subdivididos em 4 grupos etários: crianças com idade entre 6 e 10 anos (G1), adolescentes de 11 a 17 anos (G2), adultos jovens entre 18 e 39 anos (G3) e adultos de meia-idade entre 40 e 59 anos (G4). A área seccional transversa mínima nasofaríngea (área nasofaríngea – ANF) foi determinada por meio de rinomanometria anterior modificada (técnica fluxo-pressão), utilizando o sistema PERCI-SARS (versão 3.50 – Microtronics Corp.). Resultados Os valores médios±DP da ANF foram de 1,025±0,054cm2, 1,055±0,081cm2, 1,050±0,083cm2 e 1,054±0,081cm2, respectivamente, para G1, G2, G3 e G4, não havendo diferença entre as 4 faixas etárias. Conclusão Os valores controles da ANF foram determinados para indivíduos sem anomalias craniofaciais de diferentes faixas etárias e servirão de referência na rotina clínica e em estudos envolvendo diagnóstico de obstrução nasofaríngea, principalmente na presença de anomalias craniofaciais.

ABSTRACT Objective To establish normative values of minimum cross-sectional nasopharyngeal area in individuals without craniofacial anomalies at different age ranges. Material and Method Ninety-six individuals of both genders, without craniofacial anomalies, and with normal body mass index and neck circumference were evaluated. Participants were divided into 4 age groups: children, aged 6 to 10 years (G1); adolescents, aged 11 to 17 years (G2); young adults, 18 to 39 years (G3), and middle-aged adults, 40 to 59 years (G4). Minimum cross-sectional nasopharyngeal area (nasopharyngeal area – NPA) was assessed by means of modified anterior rhinomanometry (pressure-flow technique) using a PERCI-SARS system (version 3.50 – Microtronics Corp.). Results Mean±SD values of NPA were 1.025±0.054cm2, 1.055±0.081cm2, 1.050±0.083cm2, and 1.054±0.081cm2, respectively for groups G1, G2, G3, and G4, showing that there were no differences between the four age groups. Conclusion Normative data of NPA were established for individuals without craniofacial anomalies from different age ranges, and they may be used as reference values in the clinical routine and for future studies regarding nasopharyngeal obstruction diagnosis, particularly in cases of craniofacial anomalies.

Type IV Pilus Expression Is Upregulated in Nontypeable Haemophilus influenzae Biofilms Formed at the Temperature of the Human Nasopharynx.

UNLABELLED: Nontypeable Haemophilus influenzae (NTHI), a commensal of the human nasopharynx (hNP), is a common cause of biofilm-associated diseases of the respiratory tract. However, NTHI biofilm biology at the average hNP temperature, i.e., 34°C, has not been well studied. Here we grew NTHI biofilms at 34°C and 37°C, to evaluate relative biofilm growth, expression, and function of the type IV pilus (Tfp), a critical adhesin important for NTHI biofilm formation. The kinetics and regulation of Tfp expression in NTHI biofilms are unclear, especially at 34°C. Tfp expression, as estimated by pilA promoter activity, was distributed throughout the biofilms, with a unique pattern that was dependent on temperature, time in culture, and position within the maturing biofilm. Tfp expression was required for the formation of the characteristic tower structures of NTHI biofilms and was significantly upregulated in NTHI biofilms formed at 34°C versus 37°C. This increase correlated with significantly greater twitching motility at 34°C than at 37°C. Treatment with antisera targeting the major subunit of Tfp (PilA) significantly inhibited NTHI biofilm formation at both temperatures, confirming the importance of this critical adhesin in biofilm formation. Additionally, treatment of preestablished biofilms with antisera against PilA significantly decreased biofilm biomass and mean thickness at both temperatures. These results demonstrated a pivotal role for Tfp in NTHI biofilm formation and stability at the temperature of the hNP, and they underscore the utility of PilA as a vaccine candidate for treatment and/or prevention of NTHI biofilm-associated diseases. IMPORTANCE: NTHI is an important cause of chronic respiratory tract infections, including otitis media, chronic rhinosinusitis, and exacerbations of chronic obstructive pulmonary disease and cystic fibrosis. The chronic and recurrent nature of these diseases is attributed to the presence of bacterial biofilms, which are highly resistant to antimicrobials. We characterized NTHI biofilm growth and expression of PilA, the major subunit of the Tfp, at the temperature of the hNP, which is the commensal habitat of NTHI. Our results expand the current understanding of the role of Tfp during biofilm formation and maturation at the temperature of both the hNP and the middle ear, and they strengthen support for PilA as a vaccine candidate for the prevention and treatment of NTHI biofilm-associated diseases.

Transverse Retropalatal Collapsibility Is Associated with Obstructive Sleep Apnea Severity and Outcome of Relocation Pharyngoplasty.

OBJECTIVE: The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller's maneuver were associated with apnea-hypopnea index (AHI), positional dependency, and surgical outcome of relocation pharyngoplasty in patients with obstructive sleep apnea. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary referral center. SUBJECTS AND METHODS: A total of 45 obstructive sleep apnea patients were included who underwent conservative treatment (n = 13) or relocation pharyngoplasty (n = 32), and their baseline and postoperative polysomnographies and awake nasopharyngoscopies with Müller's maneuver were reviewed. Shape ratio (transverse diameter [TD] / longitudinal diameter [LD]) in the stationary and Müller's phases and collapsibility (ColTD and ColLD) of the airway at the level of the uvular base were measured with a picture archiving and communication system. Intra- and interrater reliabilities were assessed. Associations among nasopharyngoscopic measurements, AHI, positional dependency, and surgical success (defined as a reduction of AHI ≥50% and a postoperative AHI ≤20/h) were statistically analyzed. RESULTS: Reliability tests indicated substantial agreements of all nasopharyngoscopic measurements between raters and within raters. A higher baseline ColTD was significantly associated with an elevated AHI (r = 0.49, P = .001), whereas a lower postoperative ColTD was significantly related to surgical success (r = -0.38, P = .034). Nasopharyngoscopic findings were not statistically significantly correlated with positional dependency. CONCLUSION: Transverse retropalatal collapsibility measured by awake nasopharyngoscopy with Müller's maneuver helps to predict individuals with moderate to severe sleep apnea and surgical outcome.

Core temperature--the intraoperative difference between esophageal versus nasopharyngeal temperatures and the impact of prewarming, age, and weight: a randomized clinical trial.

Unplanned perioperative hypothermia is a well-known complication to anesthesia. This study compares esophageal and nasopharyngeal temperature measured in the same patient for a period of 210 minutes of anesthesia. Forty-three patients undergoing colorectal surgery were randomly assigned in 2 groups, with or without a prewarming period (group A = prewarming [n = 21] or group B = no prewarming [n = 22]). Demographics were similar in both groups. Mean temperatures at 210 minutes were statistically different between the groups at both sites of measurement. Esophageal temperature in group A was 36.5 ± 0.6 vs 35.8 ± 0.7 in group B (P = .001), and nasopharyngeal temperature was 36.7 ± 0.6 and 36.0 ± 0.6 in group A and group B, respectively (P = .002). A negative correlation was found between esophageal temperature and age (r2 = -.381, P < .012). Esophageal temperature was different with respect to BMI below or above 25. The temperatures were 35.81 ± 0.66 in the lower BMI group vs 36.46 ± 0.59 (P < .001). These results demonstrate a difference between the 2 measurement techniques and that prewarming, age and BMI have an impact on measured temperatures.

Intraoperative temperature monitoring with zero heat flux technology (3M SpotOn sensor) in comparison with sublingual and nasopharyngeal temperature: An observational study.

BACKGROUND: Perioperative hypothermia is common in patients undergoing general anaesthesia and is associated with important adverse events. The 'gold standard' for monitoring body core temperature - the pulmonary artery catheter - is invasive and unsuitable for most patients. For routine clinical practice, other sites and methods of temperature monitoring are commonly used. OBJECTIVE: The aim of this study was to evaluate a new temperature sensor (3M SpotOn) using the 'zero heat flux' method attached to the forehead, and compare it to sublingual and nasopharyngeal sensors in terms of correlation, accuracy and precision. DESIGN: An observational study. SETTING: University Medical Center Schleswig Holstein, Campus Kiel, Germany from October 2013 to January 2014. PATIENTS: One hundred and twenty patients scheduled for elective gynaecological or trauma surgery undergoing general anaesthesia were enrolled into this study. Data of 83 patients were finally analysed. Patients with unexpected blood loss, haemodynamic instability determined by the need for continuous norepinephrine infusion and/or need for postoperative ventilation were excluded from this study. INTERVENTION: Temperature monitoring was established after induction of anaesthesia with sublingual and nasopharyngeal probes, and the SpotOn sensor. MAIN OUTCOME MEASURES: Body temperature was measured 15, 45 and 75 min after induction of anaesthesia from sublingual and nasopharyngeal probes and the 3M SpotOn sensor at precisely the same moment. RESULTS: Analysis of 83 data sets revealed that 3M SpotOn temperatures were almost identical with nasopharyngeal temperatures (mean difference 0.07 °C; P = 0.1424) and slightly lower than sublingual temperatures by 0.35 °C (P < 0.0001). Coefficients of determination (r) for both methods were between 0.87 (SpotOn vs. nasopharyngeal measurement) and 0.77 (SpotOn vs. sublingual measurement). Bland-Altman analysis revealed a bias (SD) between 0.07 °C (0.21) (SpotOn vs. nasopharyngeal) and -0.35 °C (0.29) (SpotOn vs. sublingual measurement). CONCLUSION: With respect to correlation, accuracy and precision, the 3M SpotOn sensor provides a good measurement of body temperature in comparison to the nasopharyngeal probe and an acceptable measurement in comparison with sublingual thermometry. It is adequate for clinical use. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02031159.

Improving the endoscopic endonasal transclival approach: the importance of a precise layer by layer reconstruction.

BACKGROUND. The endoscopic endonasal transclival approach (EETCA) is a minimally-invasive technique allowing a direct route to the base of implant of clival lesions with reduced brain and neurovascular manipulation. On the other hand, it is associated with potentially severe complications related to the difficulties in reconstructing large skull base defects with a high risk of postoperative cerebrospinal fluid (CSF) leakage. The aim of this paper is to describe a precise layer by layer reconstruction in the EETCA including the suture of the mucosa as an additional reinforcing layer between cranial and nasal cavity in order to speed up the healing process and reduce the incidence of CSF leak. METHODS. This closure technique was applied to the last six cases of EETCA used for clival meningiomas (2), clival chordomas (2), clival metastasis (1), and craniopharyngioma with clival extension (1). RESULTS. After a mean follow-up of 6 months we had no one case of postoperative CSF leakage or infections. Seriated outpatient endoscopic endonasal controls showed a fast healing process of nasopharyngeal mucosa with less patient discomfort. CONCLUSIONS. Our preliminary experience confirms the importance of a precise reconstruction of all anatomical layers violated during the surgical approach, including the nasopharygeal mucosa.

Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle.

BACKGROUND: Nasal high flow (NHF) oxygen therapy and CPAP are modes of noninvasive respiratory support used to improve respiratory function in multiple patient groups. Both therapies provide positive pressure, although this varies during the respiratory cycle. The purpose of this study was to measure and compare the airway pressure generated during different phases of the respiratory cycle in patients receiving NHF at various gas flows. METHODS: Patients scheduled for elective cardiac surgery were invited to participate. Nasopharyngeal pressure measurements were performed using NHF with gas flows of 30, 40, and 50 L/min. All measurements were performed in random order, with the subject breathing with mouth closed. RESULTS: During NHF the mean ± SD nasopharyngeal airway pressures were 1.5 ± 0.6, 2.2 ± 0.8, and 3.1 ± 1.2 at 30, 40, and 50 L/min using NHF. Analyses also determined the mean peak expiratory and mean expiratory plateau pressures. CONCLUSIONS: The expiratory pressure during NHF was higher than the mean pressure previously reported for NHF. This may account in part for the disproportional clinical effects seen with NHF. (Australian Clinical Trials Registry www.anzctr.org.au ACTRN12609000305224).

Deglutitive tongue movement after correction of mandibular protrusion.

OBJECTIVE: To investigate any change in deglutitive tongue movement following the correction of malocclusion by orthognathic surgery. MATERIALS AND METHODS: The subjects were nine patients with mandibular protrusion. A control group consisted of 10 individuals with a similar age range and normal occlusion. Swallowing events before and after mandibular setback via sagittal split ramus osteotomy were recorded by cineradiography, and the tongue movement was analyzed. Time and linear measurements were compared before and after surgical treatment by the Wilcoxon signed rank test; control and test subjects were compared with the Mann-Whitney U-test. RESULTS: Tongue-palate contact and the tongue-tip position changed after orthognathic surgery and became similar to those of the controls. Movements of the anterior and middorsal regions of the tongue did not change after orthognathic surgery and remained different from those of the controls. CONCLUSION: Our findings suggest that tongue-palate contact and tongue-tip position during deglutition adapted to the corrected oral and maxillofacial morphology, but the anterior and middorsal regions of the tongue during deglutition may have been affected by pharyngeal constrictors rather than by the oral and maxillofacial morphology.

Controversies in the management of neonatal micrognathia: to distract or not to distract, that is the question.

Symptomatic micrognathia, as seen in syndromic and isolated presentations of the Robin sequence (RS), can pose immediate an ongoing threats to the well-being of neonates. Upper airway obstruction can manifest as acute respiratory insufficiency requiring postpartum intubation and mechanical ventilation or as a mild irregularity in the oropharyngeal airflow that can be managed by positioning the newborn in a prone or decubitus position. Clinically significant micrognathia is often accompanied by some degree of feeding difficulty, obstructive sleep apnea, and gastroesophageal reflux disease, all of which should be evaluated by a multidisciplinary team of specialists before a definitive treatment plan is formulated. Numerous surgical and nonsurgical options have been described for airway management in RS; there is no single agreed-upon therapy. Most recently, our expanding experience with craniofacial distraction has resulted in greater application of distraction osteogenesis to the congenitally hypoplastic mandible. Rather than serve as a panacea, however, the practice of neonatal mandibular distraction for infants with upper airway obstruction has probably given rise to more questions than it has answered. The debate over its most appropriate indication in the micrognathia patient is quite current. In this article, we consider some of the controversies surrounding the use of distraction compared with other techniques in the management of the neonatal airway.