CT and MR anatomy of the larynx and hypopharynx.

Imaging of the larynx and hypopharynx is frequently requested to assess the extent of neoplasms beyond the field of view of endoscopic evaluation. The combination of optical and cross-sectional imaging allows tumors to be classified according to AJCC/UICC guidelines. A thorough understanding of laryngeal and hypopharyngeal anatomy is crucial to guide the radiological eye along the possible pathways of the spread of diseases and to guide differential diagnoses. Computed tomography (CT) has been the first cross-sectional imaging technique used to evaluate the larynx and hypopharynx; its spatial resolution combined with volumetric capability and the use of injectable contrast medium made CT the working horse in the assessment of neoplastic and inflammatory diseases. In the last two decades, magnetic resonance (MR) supported CT in the most challenging cases, when the optimal contrast resolution due to the multisequence portfolio is needed to assess the neoplastic involvement of laryngeal cartilages, paraglottic space(s), and extra laryngeal spread. The aim of this paper is to give a comprehensive radiological overview of larynx and hypopharynx complex anatomy, combining in vivo images, anatomical sections, and images of ex vivo specimens.

An anatomical study of the anterior wall of the hypopharyngeal and the cervical esophageal junction.

OBJECTIVE: The upper esophageal sphincter plays a significant role by forming a physical barrier at the junction of the hypopharynx and the cervical esophagus. As few studies have focused on the ventral aspect of this junction, the contribution of the anterior wall of the cervical esophagus to upper esophageal sphincter function remains unknown. The purpose of this study was to examine the muscle fibers' arrangement at the junction, especially of those forming its anterior wall. METHODS: Thirteen specimens from 13 Japanese cadavers were analyzed. Six specimens were dissected macroscopically, while the remaining seven were examined histologically. RESULTS: The outer longitudinal layer of the proximal esophagus was well-developed anterolaterally. The uppermost fibers of the inner circular layer of the esophagus ascended longitudinally. The anterolateral part of the outer longitudinal layer and the uppermost region of the inner circular layer were continuous with the median tendinous band, in turn reaching superior to the cricoid cartilage. Histological analysis showed that the tendinous band was also continuous with the superior part of the perichondrium of the cricoid cartilage and with the aponeurosis of the transverse and oblique arytenoids. CONCLUSION: The well-developed anterolateral region of the outer longitudinal layer and the uppermost fibers of the inner circular layer were continuous with the median tendinous band, which reached superior to the cricoid cartilage. The contraction of the proximal esophagus may result in protrusion of the anteromedian esophageal wall into the lumen, thereby supporting the closure of the upper esophageal sphincter.

Cone-beam computed tomography airway measurements: Can we trust them?

INTRODUCTION: Pharyngeal airway space (PAS) assessment has been used in the past for a better understanding of orthodontic and surgical outcomes; however, this analysis could be unreliable. Our objective was to evaluate possible changes in the PAS reading in the same patient from their consecutive cone-beam computed tomography (CBCT) scans. METHODS: We evaluated a total of 27 patients' CBCT scans obtained at 2 time points with the use of a standardized acquisition protocol. The mean age at T0 was 31 years (range 17-62 years) and the follow-up records (T1) were taken after 4-6 months. Dolphin Imaging software was used to measure the volumes of the nasopharynx, oropharynx, and hypopharynx. We also evaluated the craniocervical position with the use of a lateral cephalogram. RESULTS: The variables exhibited high intraclass correlation coefficients (ICCs) when measuring the same CBCT scan twice (T0 and T0). However, The ICC between the measurements performed on the first and second CBCT scans (T0 and T1) showed that the only variable with high reproducibility between the 2 scans was cranial base, with an ICC >0.97. Average differences of 682.1 mm3, 2255.3 mm3, and 517.4 mm3 were found for the nasopharynx, oropharynx, and hypopharynx, respectively. Regarding the cephalometric angles, average differences between T0 and T1 scans were 0.6°, 2.7°, and 0.4° for OPT.CVT, OPT.SN, and cranial base, respectively. CONCLUSIONS: Different CBCT exams with equal scanning and patient positioning protocols can result in different 3D PAS readings. A more careful interpretation of CBCT volumetric data to achieve adequate conclusions of the clinical outcomes is necessary.

Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

OBJECTIVES/HYPOTHESIS: To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea-hypopnea syndrome (OSAHS) in awake patients. STUDY DESIGN: Prospective study. METHODS: Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal-epiglottic aerospace (RPEA), modified Cormack-Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS. RESULTS: The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack-Lehane scoring (κ = 0.38). The presence of a mega-epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega-epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23-18.56, P = .024), modified Cormack-Lehane score of 2 (aOR: 15.3, 95% CI: 1.8-130.3, P = .012), or modified Cormack-Lehane score of 3 (aOR: 10.03, 95% CI: 1.3-78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01-1.14, P = .025). CONCLUSIONS: Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega-epiglottis, and modified Cormack-Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:2782-2788, 2019.

Ultrastructure features of the surface of the gills and the lower pharyngeal jaw of the Tilapia Zilli, redbelly tilapia (Coptodon Zillii, Gervais, 1848).

The present investigation was designed to describe the surface ultrastructure of the gill system of tilapia Zilli. The gill system is formed from four gill arches and each gill arch carries a row of gill filaments on its convex border and two rows of the gill rakers on its concave border. The quadrilateral interbranchial septum has elevated part at the level of the third gill arch. By SEM observations, the gill arch was divided into three regions: rostral, middle and caudal region. The caudal region contained two characteristic structures: oval leaf-like structure and rounded-shaped structure. Each oval leaf-like structure carried two lateral rows of the triangular pointed spines separated by a median groove. All surfaces of gill arches, rakers and filaments were covered with a mosaic of the polygonal pavement cells, in addition to the opening of chloride cells and mucous cells. The gill arch and gill raker had only one appearance of taste buds named type I. Meanwhile, the filaments contained two types of different appearance of the taste buds named: type I and type II. Type I was the main common and similar to that present in gill arch and raker and characterized by its blunt end, while type II had hair-like structures that projected from the volcano-shaped depression. The gill rakers were formed from central axis surrounded by two lateral lobulated regions which carry pointed spines, taste buds and the opening of chloride cells. The surface of triangular lower pharyngeal jaw carries numerous teeth-like papillae which originated from the socket-like depression.

Measuring Hypopharyngeal Gland Acinus Size in Honey Bee (Apis mellifera) Workers.

The nurse hypopharyngeal glands produce the protein fraction of the worker and royal jelly that is fed to developing larvae and queens. These paired glands that are located in the head of the bee are highly sensitive to the quantity and quality of pollen and pollen substitutes that the nurse bee consumes. The glands get smaller when nurses are fed deficient diets and are large when they are fed complete diets. Because nurse hypopharyngeal gland size is a robust indicator of nurse nutrition, it is essential that those studying honey bee nutrition know how to measure these glands. Here, we provide detailed methods for dissecting, staining, imaging, and measuring nurse bee hypopharyngeal glands. We present comparisons of unstained and stained tissue and data that were used to study the impact of pollen on gland size. This method has been used to test how diet impacts hypopharyngeal gland size but has further use for understanding the role of these glands in hive health.

Accuracy of objective parameters in acute epiglottitis diagnosis: A case-control study.

Lateral neck radiography is often used as a screening tool in emergency departments for suspected acute epiglottitis. The qualitative radiographic signs have been mainly used. The aim of this study was to evaluate the accuracy of objective radiographic parameters to aid diagnosis of acute epiglottitis.Patients who were diagnosed with acute epiglottitis from January 2006 to December 2016 were included in this case-control study. Control subjects with normal lateral neck radiograph findings were included at a 1:4 ratio during the same period. The clinical findings of the patients were assessed from electronic medical records and radiographs were interpreted by a board-certified radiologist and a board-certified emergency medicine physician. The widths of the 3rd cervical vertebral body, epiglottis base (EWB), epiglottis tip (EWT), aryepiglottic fold (AFW), and hypopharynx, as well as the dimensions of the retropharyngeal and retrotracheal soft tissues, were retrospectively measured. The sensitivity, specificity, and receiver operating characteristic (ROC) curves were analyzed for the measured parameters, and cutoff values were determined to predict acute epiglottitis. The predictive cutoff values of radiologic parameters were evaluated using 5-fold cross-validation.A total 260 epiglottitis patients and 1166 controls were included in the study. In the ROC curve analysis, the EWB had an area under the ROC curve (AUROC) of 0.99 for a cutoff value of 5.02 mm (sensitivity, 96.2%; specificity, 98.2%). The EWT had an AUROC of 0.97 for a cutoff value of 4.84 mm (sensitivity, 91.2%; specificity, 97.3%). The AFW had an AUROC of 0.88 for a cutoff value of 6.59 mm (sensitivity, 86.5%; specificity, 78.8%). The 5-fold cross-validation achieved AUROCs of 0.97 for EWB, 0.94 for EWT, and 0.83 for AFW.The objective radiographic parameters in lateral neck radiography may be useful in diagnosing acute epiglottitis. Further prospective studies may be warranted to evaluate the diagnostic performance in actual clinical practice.

Microarchitecture of the tsetse fly proboscis.

BACKGROUND: Tsetse flies (genus Glossina) are large blood-sucking dipteran flies that are important as vectors of human and animal trypanosomiasis in sub-Saharan Africa. Tsetse anatomy has been well described, including detailed accounts of the functional anatomy of the proboscis for piercing host skin and sucking up blood. The proboscis also serves as the developmental site for the infective metacyclic stages of several species of pathogenic livestock trypanosomes that are inoculated into the host with fly saliva. To understand the physical environment in which these trypanosomes develop, we have re-examined the microarchitecture of the tsetse proboscis. RESULTS: We examined proboscises from male and female flies of Glossina pallidipes using light microscopy and scanning electron microscopy (SEM). Each proboscis was removed from the fly head and either examined intact or dissected into the three constituent components: Labrum, labium and hypopharynx. Our light and SEM images reaffirm earlier observations that the tsetse proboscis is a formidably armed weapon, well-adapted for piercing skin, and provide comparative data for G. pallidipes. In addition, the images reveal that the hypopharynx, the narrow tube that delivers saliva to the wound site, ends in a remarkably ornate and complex structure with around ten finger-like projections, each adorned with sucker-like protrusions, contradicting previous descriptions that show a simple, bevelled end like a hypodermic needle. The function of the finger-like projections is speculative; they appear to be flexible and may serve to protect the hypopharynx from influx of blood or microorganisms, or control the flow of saliva. Proboscises were examined after colonisation by Trypanosoma congolense savannah. Consistent with the idea that colonisation commences in the region nearest the foregut, the highest densities of trypanosomes were found in the region of the labrum proximal to the bulb, although high densities were also found in other regions of the labrum. Trypanosomes were visible through the thin wall of the hypopharynx by both light microscopy and SEM. CONCLUSIONS: We highlight the remarkable architecture of the tsetse proboscis, in particular the intricate structure of the distal end of the hypopharynx. Further work is needed to elucidate the function of this intriguing structure.

Hypopharynx in termites: Morphological and functional aspects.

The hypopharynx morphology in workers, pseudergates, and soldiers was described in six families of Isoptera using scanning electronic microscopy. This is the first comparative study to detail the hypopharynx among different species of termites, and included 4 one-piece type (OP) and 9 multiple-pieces type termites (MP). The results showed different arrangements of the hypopharynx trichomes, with fewer of these structures in the frontal region of the hypopharynx in pseudergates and soldiers of OP termites. These characteristics did not apply to Serritermes serrifer, since its pseudergates displayed a large quantity of trichomes on the frontal surface. This species may not resemble other OP termites because it does not live inside a piece of wood, but rather are inquilines inside Cornitermes spp. nests. Similar morphology of this mouthpart was observed in the different species of MP termites, with workers exhibiting many unidirectional trichomes on the frontal surface and soldiers presenting fewer of these trichomes. The morphology of the hypopharynx seems to reflect the lifestyle of these species, because MP termites are able to exploit external water sources. Since different arrangements of hypopharynx trichomes are used for water intake via capillary action, the present data reinforce the soldiers' dependence on workers to obtain water and food through the process of trophallaxis. Three different types of sensilla were observed on the lateral region of the hypopharynx: chaetica, basiconica and campaniformia. Chaetica act as chemoreceptors, while basiconica and campaniformia are mechanoreceptors, used in feeding and environmental perception. Better understanding of hypopharynx morphology permits the inference of ecological habits among OP and MP termites, and reflects the physiological differences between workers and soldiers.

Correlation between the position of hyoid bone and subregions of the pharyngeal airway space in lateral cephalometry and cone beam computed tomography.

OBJECTIVE: To correlate the pharyngeal airway subregions with the positioning of the hyoid bone. MATERIAL AND METHODS: The study examined 107 lateral cephalometric (LC) and cone beam computed tomography (CBCT) images. Linear and volumetric measurements of the pharyngeal subregions were made and correlated to linear measurements using hyoid triangle analysis on images of LC and multiplanar (MPR) and three-dimensional (3D) reconstructions of CBCT. RESULTS: There was significant correlation between linear measurements of the pharyngeal subregions and hyoid bone position in LC images and in MPR and 3D reconstructions of the CBCT. Correlations were more frequent in the oropharynx and hypopharynx, especially for LC images. No correlations were observed between LC images or CBCT reconstructions and the volumetric measurements of the pharyngeal subregions and the position of the hyoid bone. CONCLUSION: The hyoid bone position showed more correlations with oropharynx and hypopharynx airway measurements. The hyoid triangle method was not applicable to 3D images, since it showed a smaller number of measures correlated to the hyoid bone position.

Two-dimensional and three-dimensional assessment of the upper airway / Evaluación bidimensional y tridimensional de la vía aérea superior

The aim of this study was to validate and correlate the two-dimensional (2D) with the three-dimensional (3D) measures of the upper airway assessment. Lateral cephalograms and cone beam CT of 100 adult subjects were used to perform a 2D and 3D assessment of the upper airway. Spearman correlation coefficient was used to determine whether there was correlation between variables. Additionally, specificity, sensitivity, negative predictive value and positive predictive value was calculated for the 2D assessment of the upper airway. Correlation between all two and three dimensional variables was found. In the nasopharynx and oropharynx, a weak correlation (r <0.51) was found; in the oropharynx a moderate one (0.50

El objetivo de este estudio fue validar y correlacionar las medidas bidimensionales (2D) con las medidas tridimensionales (3D) de la evaluación de las vías aéreas superiores. Se realizaron cefalogramas laterales y cone beam CT en 100 sujetos adultos para realizar una evaluación 2D y 3D de la vía aérea superior. Se utilizó el coeficiente de correlación de Spearman para determinar si había correlación entre las variables. Además, para la evaluación 2D de la vía aérea superior, se calculó la especificidad, sensibilidad, valor predictivo negativo y valor predictivo positivo. Se encontró correlación en todas las variables entre dos y tres dimensiones. En la nasofaringe y la orofaringe, se encontró una correlación débil (r <0,51) mientras que en la orofaringe moderada (0,50

Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis.

OBJECTIVE: This study is aimed at assembling, through a systematic review and meta-analysis, scientific evidence related to the effects of mandibular setback (MdS) surgery and bimaxillary surgery for the correction of Class III malocclusion on the cross-sectional area (CSA) and volume of the upper airway as assessed using CT. METHODS: An electronic search was conducted on Cochrane Library, EMBASE, PubMed, Scopus and Web of Science up to June 20, 2016. The inclusion criteria were prospective or retrospective studies, with the aim of comparing the impact on the upper airway space of orthognathic surgery for the treatment of the skeletal class III malocclusion. The methodological index for non-randomized studies (MINORS) was chosen as the evaluation instrument and Revman5.3 was used for the meta-analysis. RESULTS: A total of 1213 studies were retrieved, of which only 18 met the eligibility criteria. The results of meta-analysis showed that the mean decrease in the upper airway volume after MdS surgery was 3.24 cm3 [95%CI (-5.25,-1.23), p = 0.85]; the mean decrease in minimum CSA after a combined surgery of maxillary advancement with mandibular setback (MdS + MxA) was 27.66 mm2 [95%CI (-52.81,-2.51), p = 0.51], but there was no significant decrease in upper airway volume (mean 0.86 cm3); comparison between MdS + MxA and isolated MdS showed significant differences in the CSA of the posterior nasal spine plane (PNS) and epiglottis plane (EP); statistically significant differences in nasopharynx volume (P < 0.0001) and upper airway total volume (P = 0.002) were observed, but no statistically meaningful variations existed in oropharynx volume (P = 0.08) and hypopharynx volume (P = 0.64). CONCLUSION: The results of this study suggest that bimaxillary surgery promotes less decrease on the upper airway than mandibular setback surgery alone for the correction of the skeletal class III malocclusion.

A retrospective cephalometric study on pharyngeal airway space changes after rapid palatal expansion and Herbst appliance with or without skeletal anchorage.

BACKGROUND: The aim of this study is to investigate the pharyngeal airway space changes in patients treated with rapid palatal expansion (RPE) and Herbst appliance with or without skeletal anchorage. METHODS: A 40-patient study group treated with the Herbst RME combination was included; moreover, a comparison between two subgroups based on whether miniscrews were used was evaluated. A subgroup 1 included 20 patients who were treated with RPE and an acrylic splint Herbst with miniscrews, and subgroup 2 included 20 patients who were treated with RPE and an acrylic splint Herbst. A cephalometric analysis was performed before (T1) and after (T2) treatment. The skeletal parameters of the sagittal occlusion analysis of Pancherz were utilized together with some extra measurements to evaluate the airways. RESULTS: An increased nasopharyngeal airway space was observed in group 1 (p < 0.05) from T1 to T2. Furthermore, the increase in nasopharyngeal airway space was significantly higher in subgroup 1 (p < 0.05) in comparison to the subgroup 2. Oropharyngeal (OA) and laryngopharyngeal (LA) dimensions were significantly increased in the subgroup 1 at the end of the treatment. In the subgroup 1, a significant decrease in SNA, a significant increase in SNB, and a significant decrease in ANB were observed from T1 to T2. In the subgroup 2, the treatment resulted in a significant decrease in ANB. In both groups, Pogonion increased significantly from T1 to T2. CONCLUSIONS: The results suggest that the RPE and the Herbst appliance allow a slight improvement of the sagittal dimensions of the airways. The oropharyngeal dimension increased significantly more in the skeletal anchorage group.

Histoanatomical characteristics to increase the success in transoral surgery for hypopharyngeal cancer.

OBJECTIVES/HYPOTHESIS: Transoral laser microsurgery (TLM) for hypopharyngeal cancer results in a lower incidence of complications than conventional open surgery. However, additional knowledge regarding the histoanatomical characteristics of the hypopharynx is necessary to prevent severe complications during TLM. The purpose of this study is to investigate the histoanatomical characteristics of the hypopharynx for TLM. STUDY DESIGN: Histoanatomical study. METHODS: Whole organ serial sections of three hypopharynges and larynges from autopsy cases were subjected to hematoxylin & eosin and Elastica van Gieson staining. Surgical histoanatomy of the hypopharynx was observed with each section, and the histoanatomical characteristics directly related to TLM performance were examined microscopically. RESULTS: The histological structures of muscle layers showed obvious differences between each hypopharyngeal subsite. The posterolateral wall had two kinds of pharyngeal elevator muscles. These fasciae were connected to the perichondrium of the thyroid cartilage. The anterolateral wall between the superior horn and the lamina of the thyroid cartilage had no muscle layer. The superior laryngeal artery and the internal branch of the superior laryngeal nerve run into the larynx and hypopharynx at that site. The inner perichondrium of the thyroid cartilage was present beneath the mucosa. The dihedral angle of the anterior piriform fossa had a deep propria mucosa and paraglottic space. The postcricoid wall consisted of a multilayered structure, including cricoid cartilage covered with laryngeal muscles and mucosa. CONCLUSION: A precise understanding of the histoanatomical characteristics of the hypopharynx increases the success of TLM, decreases complication rates, and improves laryngeal preservation. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:1783-1789, 2016.

Effects of Le Fort I Osteotomy on the Nasopharyngeal Airway-6-Month Follow-Up.

PURPOSE: The literature discussing the impact of a single Le Fort I osteotomy on nasopharyngeal airways is limited. This study assessed the volumetric changes in the nasopharyngeal airway after a single Le Fort I osteotomy and explored the correlation between these changes and 3-dimensional surgical movements of the upper jaw. MATERIALS AND METHODS: This retrospective study was conducted in 40 patients who had undergone a single Le Fort I (maxillary advancement with or without impaction) to correct Class III malocclusion with maxillary hypoplasia. Preoperative (T1) and 6-month postoperative (T2) cone-beam computed tomographic (CBCT) scans of these patients were used for analysis. Maxillary surgical movements and volumetric changes in the nasopharyngeal airway were measured. The reproducibility of the measurements was evaluated using paired t tests and intraclass correlation coefficients. The Wilcoxon test and Pearson correlation coefficient were applied to evaluate the volumetric changes in the nasopharyngeal airway space and assess the correlations of these changes to the maxillary surgical movements. RESULTS: Six patients were excluded from the study owing to major differences (>5°) in their head and neck posture between the T1 and T2 CBCT scans. The errors of the repeated measurements were insignificant (P > .05), with a high level of agreement (r = 0.99; P < .05) between the repeated digitization of the landmarks. There was a statistically significant impact of a Le Fort I osteotomy on the right maxillary sinus (decreased by 17.8%) and the lower retropalatal space (expanded by 17.3%; P < .05). The correlation between the change in airway volume and the magnitude of surgical maxillary movements was moderate (r = .4). Similarly, there was a moderate correlation between changes in the upper nasopharynx and those in the hypopharynx. CONCLUSION: The single Le Fort I osteotomy was found to increase the retroglossal airway volume. This could be important for the treatment of obstructive sleep apnea in patients with maxillary deficiency. A long-term follow-up assessment of a larger sample with a functional assessment of airway would be beneficial to confirm these findings.

Lower Vocal Tract Morphologic Adjustments Are Relevant for Voice Timbre in Singing.

The vocal tract shape is crucial to voice production. Its lower part seems particularly relevant for voice timbre. This study analyzes the detailed morphology of parts of the epilaryngeal tube and the hypopharynx for the sustained German vowels /a/, /e/, /i/, /o/, and /u/ by thirteen male singer subjects who were at the beginning of their academic singing studies. Analysis was based on two different phonatory conditions: a natural, speech-like phonation and a singing phonation, like in classical singing. 3D models of the vocal tract were derived from magnetic resonance imaging and compared with long-term average spectrum analysis of audio recordings from the same subjects. Comparison of singing to the speech-like phonation, which served as reference, showed significant adjustments of the lower vocal tract: an average lowering of the larynx by 8 mm and an increase of the hypopharyngeal cross-sectional area (+ 21:9%) and volume (+ 16:8%). Changes in the analyzed epilaryngeal portion of the vocal tract were not significant. Consequently, lower larynx-to-hypopharynx area and volume ratios were found in singing compared to the speech-like phonation. All evaluated measures of the lower vocal tract varied significantly with vowel quality. Acoustically, an increase of high frequency energy in singing correlated with a wider hypopharyngeal area. The findings offer an explanation how classical male singers might succeed in producing a voice timbre with increased high frequency energy, creating a singer`s formant cluster.

Visual evaluation of the larynx and hypopharynx during esophagogastroduodenoscopy: a safety and feasibility study.

BACKGROUND: The larynx and hypopharynx are common sites for head and neck cancer, which shares many risk factors with upper digestive tract disease. Patient survival with malignancies depends on stage at the time of diagnosis. Endoscopic screening of the hypopharynx is neither routinely performed in clinical practice nor has it been evaluated in a formal study. METHODS: This is a prospective pilot study of patients undergoing routine EGD. Demographic data were collected from patients prior to the procedure. All patients in the study underwent an EGD and prior to performing the standard portion of the EGD procedure, the endoscopist evaluated the larynx and hypopharynx with both white light endoscopy (WLE) and narrow band imaging (NBI). Details of the procedure, including ability to see all anatomic structures, time spent, complications, and findings, were recorded. RESULTS: A total of 111 patients were included in the study. The exam of the laryngopharynx was completed in 87% of patients (97/111). Reasons for incomplete exam included intubated patients (2/14), inadequate sedation (9/14), and inability to see the entire hypopharynx (3/14). The mean time of the WLE was 20.2 s, while the NBI evaluation took 15.6 s for a mean and 35.8 s for the entire exam of the larynx and hypopharynx. Minor procedural complications occurred in 3/11 (2.7%) of the patients and included hypotension, tachycardia, and hypoxia. There were 6 patients who had hypopharyngeal abnormalities seen on both WLE and NBI (5.4%) and were subsequently referred to otolaryngology. Of the six referrals, one patient had a vocal cord biopsy showing leukoplakia, while the others were deemed normal anatomic variants. CONCLUSIONS: Evaluation of the hypopharynx can be accomplished by gastrointestinal endoscopists at the time of EGD in the vast majority of patients in a safe manner while adding only about 35 s to the overall exam time.

[Cone-beam computed tomography evaluation of upper airway change in skeletal Class III patients after orthodontic-mandibular setback surgery].

OBJECTIVE: To evaluate the short-term and long-term effects of pharyngeal airway in mandibular prognathism patients after the combined orthodontic and orthognathic treatment. METHODS: The sample included 28 skeletal Class III patients (13 males, 15 females) who had undergone mandibular setback surgery and orthodontic treatment. Cone-beam CT was taken one week before treatment (T0), 6 months (T1) and 3 years after surgery (T2). Raw data were reconstructed into three-dimensional model. Sagittal and transversal measurements, cross sectional areas, partial and total volumes were computed. RESULTS: Six months after surgery, oropharyngeal volume [(9 021 ± 4 263) mm³], hypopharyngeal volume [(9 236 ± 5 963) mm³] and total volume [(28 619 ± 9 854) mm³] decreased significantly (P < 0.05). Three years after surgery, only sagittal diameters [(15.9 ± 3.5) mm] and cross sectional areas [(996 ± 398) mm²] in the first cervical vertebra plane came back to the original levels (P > 0.05). CONCLUSIONS: The pharyngeal airway space decreased after orthodontic-orthognathic therapy in the short term and it increased in some areas in the long term.

Pharyngeal airway space in subjects with class II and class III facial deformities / Espacio de la vía aérea faríngea en sujetos con deformidad facial clase II y clase III

Facial deformities are related to morphological differences and the mandible position shows differences in maxillomandible relation. The aim of this research was to compare the pharyngeal airway space (PAS) in subjects with class II and class III facial deformities We included 28 adult subjects with skeletal characteristics associated to class II or class III according to the SNA angle and dental overjet; subjects with facial asymmetry and other facial deformities and subjects with facial trauma or facial surgery history were excluded. Cone beam computed tomography was realized (CBCT) to asses the nasopharynx, oropharynx, hypopharynx, as well as the distance measured between the mandible genial spine and hyoid bone; data analysis were realized by descriptive analysis and statistical analysis using t test with 0.05 to show statistical differences. Class II subjects presented minor values in all of the measurements; in the oropharynx and the hypopharynx we observed the most important differences, with nasopharynx showing statistically significant differences (p<0.05). In conclusion class II subjects presented a minor pharyngeal airway space and it is suggested that this information should be used in the diagnosis process and prior to surgical treatment.

Las deformidades faciales son asociadas a diferencias en la posición mandibular evidenciando diferencias en la relación maxilomandibular. El objetivo de esta investigación fue comparar el espacio aéreo faríngeo en sujetos con deformidad facial clase II y clase III. Se incluyeron 28 sujetos con características esqueletales asociadas a clase II o clase III seguidos de la evaluación del angulo SNA y el resalte dentario; se excluyeron los sujetos con asimetría facial y otras deformidades faciales y sujetos con historia de trauma facial o historia de cirugía facial; se realizó la tomografía computadorizada cone beam para evaluar el área de nasofaringe, orofaringe, hipofaringe y la distancia entre la espina geni mandibular y el hueso hioides; los datos se analizaron con estadística descriptiva y la prueba t usando un valor de 0,05 para establecer significancia estadística. Se observó que los sujetos de clase II presentaron valores menores a los sujetos clase III en todas las mediciones realizadas; en el área de orofaringe e hipofaringe se observaron las diferencias mas importantes, estadísticamente significativas (p<0,05). Se puede concluir que los sujetos con deformidad facial clase II presentan un espacio de vía aérea faríngea más estrecho y se sugiere que este temática sea resuelta en la etapa de diagnóstico previo a la selección de tratamientos quirúrgicos o no quirúrgicos.

Pharyngeal airway space, hyoid bone position, and head posture after bimaxillary orthognathic surgery in Class III patients: long-term evaluation.

OBJECTIVE: (1) To determine the effect of bimaxillary orthognathic surgery on pharyngeal airway, hyoid bone, and craniocervical posture in Class III bimaxillary surgery patients. (2) To evaluate short-term and long-term results. (3) To compare short- and long-term values. MATERIALS AND METHODS: Twenty-six Class III adult patients treated with bimaxillary surgery were included in the study. Cephalometric records were taken before treatment (T1), before surgery (T2), and 5 months (T3), 1.4 years (T4), 3 years (T5), and 5 years (T6) postsurgery. RESULTS: No significant differences were identified in craniocervical angulation between time intervals. There was a significant superior movement of hyoid bone at postsurgery (T3; P < .05); however, adaptation occurred to the normal position in the long term. A nonsignificant decrease occurred at the oropharyngeal middle pharyngeal distance parameter; however, this was compensated with a significant increase between T5 and T6 (P < .001). A significant decrease was observed in the hypopharyngeal Go-P parameter between T3 and T1 (P < .01), but it recovered with a nonsignificant increase in the long term. A significant increase in nasopharyngeal area was observed between T3 and T1 (P < .05). The hypopharyngeal area significantly increased between T5 and T6, and PNS-R significantly increased between T3 and T1 (P < .05). CONCLUSION: The pharyngeal areas adversely affected after surgery recover at long-term follow-up; thus, adaptation occurs after bimaxillary surgery.