Comparing results of three measurement techniques used to determine the size of oropharyngeal airway in adults.

INTRODUCTION AND OBJECTIVE: The oropharyngeal airway, also known as the Guedel airway, is a crucial medical device used for over a century as a basic way to maintain a patient's airway open and secure. Although it is easy to use, this can be misleading as incorrect sizing can lead to injuries, bleeding, laryngospasm, and potentially fatal complications. This study aims to compare three techniques for selecting the appropriate oropharyngeal airway size using craniofacial anatomical landmarks. MATERIAL AND METHODS: Three facial distances were measured, each one according to the techniques described in the scientific sources. For greater reliability of the test, measurements were made sequentially with two different methods. RESULTS: The study included over 500 participants. Depending on the measurement technique used, different results of average lengths and thus approximate sizes of oropharyngeal airway were obtained. This indicated that depending on which technique is used for measuring purposes, differences in the size of the oropharyngeal airway can be up to 2-3 cm, with a high degree of statistical significance. CONCLUSIONS: Using different craniofacial anatomical landmarks to select the size of the oropharyngeal airway can yield significantly varied results for the same adult patient, thus posing a potentially fatal threat. To ensure effective and safe airway management, proper ventilation and oxygenation, it is recommended to follow the ISA (Initial Size Approximation) approach when choosing the oropharyngeal airway size in medical education, training, and clinical settings. Further research is needed to explore this matter, also in different populations.

Anatomical oropharyngeal cavity specialisations in the cutlassfish (Trichiurus lepturus, Linnaeus, 1758).

Trichiurus lepturus is a carnivorous fish, and most of the previous anatomical research has focused on computed tomography imaging and histology of their teeth and fangs, while the remaining structures of pharyngeal cavity remain unexplored. The present research is the first to use anatomical examinations alongside scanning electron microscopy to investigate the T. lepturus oral cavity. The oropharyngeal roof included teeth, upper lip, rostral and caudal velum and the palate. The middle of the palate showed a median groove flanked by two folds, followed by a median band flanked by micro-folds, thereafter the palate became crescent shaped. The lateral regions of the palate exhibited longitudinal folds that extended rostrally towards the fangs. The oropharyngeal floor had two cavities which acted as a scabbard for the premaxillary fangs and upper velum, while the caudal sublingual cavity contained two oyster-shaped structures on the outer surface plus sublingual ridges and sublingual clefts. The tongue apex exhibited a spoon-like shape, its body demonstrated a median elevation and the root with two lateral branches contained only dome-shaped papillae. Taste buds were located on the upper velum, lower lip and the caudal part of the interbranchial septum. Images and descriptions of T. lepturus tooth structure are also provided. The present research, using anatomical dissection and morphological observation using scanning electron microscopy, has identified the structures of the dentition system, a variety in shapes of the folds and microridges, and identified the taste buds and mucous pores in the T. lepturus oropharyngeal cavity.

Evaluation of the influence of hyoid bone position, volume, and types on pharyngeal airway volume and cephalometric measurements.

OBJECTIVES: We aimed to explore the position, morphological, and morphometric properties of the hyoid bone (HB) and to investigate the effect of HB on the pharyngeal airway (PA) volume and cephalometric measurements. METHODS: A total of 305 patients with CT images were included in the study. DICOM images were transferred to the InVivoDental three-dimensional imaging software. The position of the HB was determined based on the cervical vertebra level and in volume render tab, the bone was classified into six types after all structures around the HB were removed. Also, final bone volume was recorded. In the same tab, the pharyngeal airway volume was divided and measured in three groups (nasopharynx-oropharynx-hypopharynx). The linear and angular measurements were performed on the 3D cephalometric analysis tab. RESULTS: HB was most commonly located in C3 vertebra level (80.3%). While B-type was found to be the most frequent (34%), V-type was the least frequent (8%). The volume of the HB was found to be significantly higher in male (3205 mm3) than female (2606 mm3) patients. Also, it was significantly higher in the C4 vertebra group. The vertical height of the face was positively correlated with the HB volume, C4 level position, and increased oro-nasopharyngeal airway volume. CONCLUSION: The volume of the HB is found to differ significantly between genders and can potentially serve as a valuable diagnostic tool for understanding respiratory disorders. Its morphometric features are associated with increased face height and airway volume; however, are not related with the skeletal malocclusion classes.

Effects of vertical control on anatomic and aerodynamic characteristics of the oropharyngeal airway during premolar extraction treatment of Class II hyperdivergent nonsevere crowding malocclusion.

INTRODUCTION: This study aimed to analyze the effects of premolar extraction treatment with vertical control on changes in the anatomy and aerodynamics of the oropharynx in Class II hyperdivergent malocclusion with nonsevere crowding. METHODS: Thirty-nine patients with Class II hyperdivergent malocclusion were enrolled consecutively. All the participants underwent 4 premolar extractions. The high-pull J-hook and mini-implants were used to provide vertical control. Cone-beam computed tomography was performed before and after treatment. The participants were divided into a decreased lower vertical facial height group (n = 23) and an increased lower vertical facial height group (n = 16) on the basis of superimposition. The aerodynamic characteristics, including airway resistance (inspiration, Rin; expiration, Rex) and maximum velocity (inspiration, Vmaxin; expiration, Vmaxex) at inspiration and expiration, were calculated using computational fluid dynamics. Anatomic characteristics, including volume and cross-sectional area (CSAmin), were measured using the Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif). RESULTS: After treatment, the median volume and CSAmin increased by 2357 mm3 and 43 mm2, respectively, and median Rin and Vmaxex decreased by 0.15 Pa/L/min and 0.24 m×s-1, respectively, in decreased lower vertical facial height group. In contrast, the median CSAmin decreased by 9.5 mm2 in the increased lower vertical facial height group. All the changes were statistically significant (all P <0.05). Significant differences in volume, CSAmin, Rin, and Vmaxex were observed between the 2 groups. CONCLUSIONS: Vertical control might improve the anatomic and aerodynamic characteristics of the oropharyngeal airway during premolar extraction treatment of Class II hyperdivergent malocclusion with nonsevere crowding.

Complex enameloid microstructure of †Ischyrhiza mira rostral denticles.

Serving in a foraging or self-defense capacity, pristiophorids, pristids, and the extinct sclerorhynchoids independently evolved an elongated rostrum lined with modified dermal denticles called rostral denticles. Isolated rostral denticles of the sclerorhynchoid Ischyrhiza mira are commonly recovered from Late Cretaceous North American marine deposits. Although the external morphology has been thoroughly presented in the literature, very little is known about the histological composition and organization of these curious structures. Using acid-etching techniques and scanning electron microscopy, we show that the microstructure of I. mira rostral denticles are considerably more complex than that of previously described dermal denticles situated elsewhere on the body. The apical cap consists of outer single crystallite enameloid (SCE) and inner bundled crystallite enameloid (BCE) overlying a region of orthodentine. The BCE has distinct parallel bundled enameloid (PBE), tangled bundled enameloid (TBE), and radial bundled enameloid (RBE) components. Additionally, the cutting edge of the rostral denticle is produced by a superficial layer of SCE and a deeper ridges/cutting edge layer (RCEL) of the BCE. The highly organized enameloid observed in the rostral denticles of this batomorph resembles that of the multifaceted tissue architecture observed in the oral teeth of selachimorphs and demonstrates that dermal scales have the capacity to evolve histologically similar complex tooth-like structures both inside and outside the oropharyngeal cavity.

Ultrastructural adaptation of the oropharyngeal cavity of the Eurasian common moorhen (Gallinula chloropus chloropus): Specific adaptive dietary implications.

The present investigation represents the first morphological description of the oropharyngeal cavity of Eurasian common moorhen. Nine oropharyngeal cavities were examined grossly and by stereomicroscope and scanning electron microscopic (SEM) observations. The tongue had a rounded apex with multiple acicular processes on its rostral and lateral borders. The dorsal lingual surface of the apex and body had a median sulcus. The papillary crest carried four caudally directed triangular conical papillae on its median part and four triangular conical papillae on each lateral part. The filiform papillary system; small papillae on apex and long papillae on the rostral part of the body while broad papillae on the caudal part of the body. The lingual root had a special appearance by presence of three areas: mucosal fossa, two lateral ridges, and rhomboidal elevated central part. The caudal border of the mound carried heart-shaped pharyngeal papillae that possessed three papillary rows. The palate had a median palatine ridge rostrally that surrounded by two lateral palatine ridges. The choanae had two equal parts: rostral tapering and wide caudal. The rostral tapering choanal part was surrounded by two longitudinal rows of caudally directed conical papillae, one on each side. There was a single transverse row of conical papillae on each side of the caudal part of the rostral tapering choanal part. The caudal wide choanal part did not encircle by any papillae. Our conclusion exhibited unique structural and functional specifications of the oropharyngeal cavity with the tongue that evident with nutritional behavior.

Efeitos do posicionamento sagital da mandíbula na morfometria das vias aéreas superiores / Efects of sagital positioning of the mandibule in upper airway morphometry

O objetivo do presente estudo foi analisar as dimensões das vias aéreas superiores (VAS) em indivíduos com diferentes posicionamentos sagitais da mandíbula, bem como a sua relação com o comprimento efetivo mandibular (CoGn). A amostra foi constituída por 63 exames de tomografia computadorizada de feixe cônico (TCFC) de indivíduos com idade entre 13 e 35 anos, alocados em três grupos conforme os valores angulares de SNB: grupo com retrognatismo mandibular (RMand); grupo com posicionamento normal da mandíbula (NMand) e grupo com prognatismo mandibular (PMand). Com o auxílio do programa Dolphin Imaging® (versão 11.95 Premium), as VAS foram subdivididas em Nasofaringe (NF), Orofaringe (OF) e Hipofaringe (HF), e o volume (Vol) e área axial mínima (Axmin) de cada região mensurados, assim como a altura (Alt) da OF e HF. A medida linear CoGn também foi averiguada e sua influência sobre as dimensões das VAS avaliada. MANCOVA foi utilizada para comparar o conjunto de variáveis das VAS entre os grupos de acordo com o padrão mandibular. Além disso, modelos de regressão linear foram implementados para estimar, independentemente, o efeito x do SNB e CoGn nas dimensões das VAS. Indivíduos com prognatismo mandibular apresentaram medidas significativamente maiores para NF-Axmin e OF-Vol, quando comparados aos indivíduos que mostraram normalidade e retrognatismo mandibular (P < 0,05). Não foram observadas diferenças entre os grupos para quaisquer das outras medidas consideradas no estudo. A variável CoGn foi relacionada às medidas de volume de todas as regiões avaliadas das VAS e também à HF-Alt. Concluiu-se que indivíduos com prognatismo mandibular apresentaram, de modo expressivo, maior área axial mínima da Nasofaringe e maior volume da Orofaringe quando comparados àqueles com normalidade e retrognatismo mandibular; destacando-se que o comprimento efetivo mandibular demonstrou ser um preditor mais relevante nas dimensões das VAS em comparação ao SNB. (AU)

The aim of the present study was to analyze the dimensions of the upper airways (UA) in individuals with different sagittal positioning of the mandible, as well as its relationship with the effective mandibular length (CoGn). The sample consisted of 63 cone beam computed tomography (CBCT) scans of individuals aged between 13 and 35 years, allocated into three groups according to the angular values of SNB: Group with Mandibular Retrognathism (RMand); Group with Normal Jaw and Group with Mandibular Prognathism (PMand). Using Dolphin Imaging® program (version 11.95 Premium), the UA were subdivided into Nasopharynx (NP), Oropharynx (OP) and Hypopharynx (HP), and the volume (Vol) and minimum axial area (Axmin) of each region measured, as well as the total height (Ht) of the OP and HP. The linear measure CoGn was also investigated and its influence on the dimensions of the VAS evaluated. MANCOVA was used to compare the set of VAS variables between the groups according to the mandibular pattern. In addition, linear regression models were implemented to independently estimate the effect of SNB and CoGn on UA xii dimensions. Individuals with mandibular prognathism had significantly higher measurements for NP-Axmin and OP-Vol, when compared to individuals with harmony and mandibular retrognathism (P < 0.05). No differences were observed between groups for any of the other measures considered in the study. The CoGn variable was related to the volume measurements of all the evaluated regions of the UA and also to the HP-Ht. It was concluded that individuals with mandibular prognathism significantly presented a greater minimum axial area of the Nasopharynx and greater volume of the Oropharynx when compared to those with harmony and mandibular retrognathism; highlighting that the effective mandibular length proved to be a more relevant predictor in the dimensions of the UA compared to the SNB. (AU)

Three-dimensional evaluation of upper airway changes following rapid maxillary expansion: A retrospective comparison with propensity score matched controls.

BACKGROUND: The aim of this study is to evaluate upper airway changes three-dimensionally following rapid maxillary expansion (RME) and compare the changes with matched controls. MATERIALS AND METHODS: Seventeen patients (mean age 12.6 ± 1.8 years) with maxillary transverse deficiency were treated with RME. Using the propensity score matching method, 17 patients (mean age 12.3 ± 1.5 years) were selected from a non-RME control group of 33. Case-control matching was performed based on 5 covariates: age, gender, CBCT scan interval, sagittal skeletal pattern, and tongue posture. Airway volumes of nasopharynx and oropharynx and minimum cross-sectional areas (MCA) of oropharynx were measured and compared between the case and control groups in CBCT scan images. RESULTS: In the case group, significant increases from before to after RME were found in all measurements except MCA of the retroglossal segment of oropharynx. Before treatment, there were no significant differences between case group and control group. While comparing the case group with the control group after treatment showed overall greater increases in the case group. In particular, MCA of retropalatal segment showed statistically significant differences. CONCLUSION: The results of this study indicate that RME causes an increase in upper airway dimensions.

Importance in the Occurrence Distribution of Minimum Oropharyngeal Cross-Sectional Area in the Different Skeletal Patterns Using Cone-Beam Computed Tomography.

PURPOSE: Obstructive sleep apnea is a condition involving repetitive partial or complete collapse of the pharyngeal airway, especially in patient with mandibular hypoplasia. The present study investigated the differences between the volume of the oropharyngeal airway and the minimum axial area in three skeletal patterns through the use of cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans of 147 patients were collected to measure the upper oropharyngeal airway volume (UOV), lower oropharyngeal airway volume (LOV), upper oropharyngeal airway area (UOA), minimum upper oropharyngeal airway area (MUOA), lower oropharyngeal airway area (LOA), minimum lower oropharyngeal airway area (MLOA), anatomical structures (orbitale, Or; porion, Po; pogonion, Pog; hyoid, H; second cervical vertebra, C2; fourth cervical vertebra, C4), and relevant angles. Statistical analysis was performed using analysis of variance and Pearson's test. RESULTS: Compared with patients in Class II, those in Class III and Class I exhibited a significantly anterior position of H and Pog. The vertical positions of H and Pog revealed no significant difference between the three skeletal patterns. Patients in skeletal Class III exhibited significantly larger oropharyngeal area (UOA, MUOA, LOA, MLOA) and oropharyngeal airway (UOV and LOV) than those in skeletal Class II did. The horizontal position of Pog had a moderately significant correlation with UOA (r = 0.471) and MUOA (r = 0.455). CONCLUSION: Patients in skeletal Class II had significantly smaller oropharyngeal airway areas and volumes than those in Class III did. The minimum oropharyngeal cross-sectional area had a 67% probability of occurrence in the upper oropharyngeal airway among patients in Class I and Class II and a 50% probability of occurrence among patients in Class III.

Gross morphological, histological and scanning electron specifications of the oropharyngeal cavity of the hooded crow (Corvus cornix pallescens).

The present study was carried out on the oropharyngeal cavity of the hooded crow to investigate the gross and microscopic structures via gross anatomy, light microscopy and scanning electron microscopy (SEM). The gross anatomy clarified the elongated triangular shape of the oropharyngeal cavity with a non-protruding tongue with a bifid apex. The lingual body contained median groove rostrally and separated caudally from the root by a transverse papillary crest. The laryngeal mound located posterior to the lingual root, contained midline laryngeal cleft and bounded caudally by a transverse row of pharyngeal papillae. The palate contained choanal cleft rostrally and infundibular slit caudally in addition to five palatine ridges. By light microscopy, the dorsal lingual epithelium was highly keratinised stratified squamous with a lingual nail in the most rostral part of the apex. Then, the thickness of the keratin layer decreased caudally, while in the ventral surface, the lining epithelium became non-keratinised. The entoglossum supported the lingual body and root, but not extended to the apex. The lining epithelium of the palate was also keratinised stratified squamous and became none-keratinised at the oral side of the choanal cleft. There were numerous lobules of polystomatic salivary glands in the lingual root and the palate. SEM revealed the arrangement of different types of papillae covering both the floor and the roof of the oropharynx besides numerous openings of salivary glands in the lingual root, laryngeal mound and the palate. These findings reflect the functional relationship of the oropharyngeal cavity of the hooded crow during feeding.

Hidden Anatomy of Opera Singers.

The history of research on the voice of opera soloists shows that there are certain functional features of the cranial nerves and cortical nerve centers. In this chapter, we review the most important findings in the field of canto voice neuroanatomy, which we corroborate with the results of our team research and experience. Our study focuses on the nerve structures involved in phonation at each level of the vocal formants: infraglottic, glottic, and oropharyngeal. We consider this research to have direct applicability in the fields of neurolaryngology, neuroscience, phoniatry, but also in the academic teaching. At the same time, the present study is a starting point for future research works on the anatomical and functional particularities of the structures involved during the act of phonation in canto soloists.

Evaluating interactions of airway changes during growth with orthodontic treatment.

OBJECTIVE: The aim of this study was to longitudinally evaluate changes in the pharyngeal airway volume in adolescents treated with fixed orthodontic appliances compared to matched untreated adolescents and to assess its impact on airflow resistance. MATERIALS AND METHODS: The sample consisted of 16 adolescents (mean start age of 11 years 3 months) who had started and completed treatment at the orthodontic department of the University of Detroit Mercy School of Dental Medicine. This group was compared to a control that consisted of 16 adolescents (mean start age 12 years) who had two CBCTs with no treatment in between for the purpose of regular orthodontic evaluation. Differences in airway volume, length, minimum cross-sectional area, and the average cross-sectional area were calculated. RESULTS: The results indicated that the airway volume increased by 39% and was a statistically significant change (P<0.05). Regarding the influence on airflow resistance, the change in cross sectional area was significant in the group treated with fixed orthodontic appliances (P<0.03). CONCLUSION: Adolescents treated with fixed orthodontic appliances do experience an increase in airway volume, as well as a decrease in airway resistance to airflow compared to that in normal growth.

Oropharyngeal morphology related to filtration mechanisms in suspension-feeding American shad (Clupeidae).

To assess potential filtration mechanisms, scanning electron microscopy was used in a comprehensive quantification and analysis of the morphology and surface ultrastructure for all five branchial arches in the ram suspension-feeding fish, American shad (Alosa sapidissima, Clupeidae). The orientation of the branchial arches and the location of mucus cells on the gill rakers were more consistent with mechanisms of crossflow filtration and cross-step filtration rather than conventional dead-end sieving. The long, thin gill rakers could lead to a large area for the exit of water from the oropharyngeal cavity during suspension feeding (high fluid exit ratio). The substantial elongation of gill rakers along the dorsal-ventral axis formed d-type ribs with a groove aspect ratio of 0.5 and a Reynolds number of approximately 500, consistent with the potential operation of cross-step filtration. Mucus cell abundance differed significantly along the length of the raker and the height of the raker. The mucus cell abundance data and the observed sloughing of denticles along the gill raker margins closest to the interior of the oropharyngeal cavity suggest that gill raker growth may occur primarily at the raker tips, the denticle bases, and the internal raker margins along the length of the raker. These findings will be applied in ongoing experiments with 3D-printed physical models of fish oral cavities in flow tanks, and in future ecological studies on the diet and nutrition of suspension-feeding fishes.

Comparative gross and scanning electron microscopical study of the oropharyngeal roof of young and adult domestic pigeons (Columba livia domestica).

The present study aims to compare the morphology of the oropharyngeal roof of young and adult domestic pigeon (Columba livia domestica) by gross observation, morphometric measurements, and scanning electron microscopy (SEM). The oropharyngeal roof was divided into the palate and pharyngeal roof. The palate was narrow triangular in shape and concave along its length. It could be divided into a rostral part contained three longitudinal palatine ridges and a caudal part contained the choanal slit. The choanal slit consisted of narrow rostral and wide caudal parts. The edges of the narrow part were encircled by small caudomedially directed papillae. On the contrary, the edges of the wide part of slit were free from papillae. By SEM, the palatal mucosa in young pigeon showed primordia of small papillae which increased in number and size forming a longitudinal row of papillae parallel to the edges of the rostral narrow part of slit in adult pigeon. The surface of the pharyngeal roof appeared smooth in young pigeon, while in adult pigeon, it showed dome-shaped elevations. The infundibular cleft had smooth edges. The caudal part of the pharyngeal roof formed an elevated transverse mucosal fold on which a transverse row of conical-shaped papillae was present. In conclusion, our results documented the presence of some differences between the oropharyngeal roof of young and adult pigeon, which suggest a high degree of functional adaptation in adult pigeon to their diet compared to young pigeon. Such adaptations might increase the efficiency of food prehension in adult pigeon. The present study compared the morphology of the oropharyngeal roof of young and adult domestic pigeon by gross observation, morphometry, and scanning electron microscopy. The morphometrical data showed higher values in adult pigeon compared to young pigeon. The palatal mucosa and the pharyngeal roof of adult pigeon showed papillae and elevations that were not present in young pigeon. Our results suggest a high degree of functional adaptation in adult pigeon to their diet compared to young pigeon. Such adaptations might increase the efficiency of food prehension in adult pigeon.

The impact of tongue dimension on air volume in brachycephalic dogs.

OBJECTIVE: To compare the dimensions and density of the tongue in brachycephalic and mesaticephalic dog breeds and to document the relative extents of the nasopharyngeal and oropharyngeal airways occupied by the tongue and palatal tissues. STUDY DESIGN: Case control study. ANIMALS: Sixteen brachycephalic dogs and 12 mesaticephalic dogs. METHODS: The volume of the tongue was measured with computed tomography in all dogs. Cross-sectional areas of tongue, oropharynx, nasopharynx, and palatal soft tissue were evaluated at two levels, the caudal aspect of the hard palate and the level of the hamulae of the pterygoid. Density of the tongue and soft palate were measured. All variables were compared between brachycephalic and mesaticephalic dogs (P ≤ .05). RESULTS: Absolute tongue volumes did not differ between groups, the volume of the tongue was greater in brachycephalic dogs than in mesaticephalic dogs when expressed relative to (a) body weight (median 5650, interquartile range [IQR] 4833-6522 vs median 4454, IQR 4309-4743, respectively), (b) ratio between skull length/width (70 833, IQR 62490-126 209 vs 48 064, IQR 22984-64 279, respectively), and (c) skull length (689.93, IQR 618.55-970.61 vs 460.04, IQR 288.77-561.69, respectively). The proportion of air (oropharyngeal and nasopharyngeal)/soft tissue (tongue and palatal tissue) in brachycephalic dogs was decreased by approximately 60%, and the tongue was approximately 10 times denser in brachycephalic dogs than in mesaticephalic dogs. CONCLUSION: A relative macroglossia was detected in brachycephalic dogs along with reduced air volume in the upper airway. Tongues of brachycephalic dogs were denser than those of mesaticephalic dogs. CLINICAL SIGNIFICANCE: The relative macroglossia in brachycephalic breeds may contribute to upper airway obstruction.

A novel technique for repositioning a nasobiliary catheter from the mouth to nostril in endoscopic retrograde cholangiopancreatography.

BACKGROUND: Endoscopic nasobiliary drainage (ENBD) is widely used for biliary decompression in patients with biliary disease. However, it is difficult to reposition a nasobiliary catheter from the mouth to nostril. We developed a new device, which has a curved flexible loop and bar-handle, for repositioning of ENBD catheter. The aim of this study was to evaluate the usefulness of the new loop-device for facilitating the repositioning of an ENBD catheter from the mouth to nostril. METHODS: Between January 2015 and December 2017, a comparative observational study was performed to evaluate the time taken for repositioning a nasobiliary catheter during endoscopic retrograde cholangiopancreatography (ERCP) and compare the results of ENBD procedure between the new loop-device and conventional techniques. In the subgroup analysis, we evaluated the occurrence of oral cavity injury and the time taken to transfer ENBD catheter from the mouth to nostril. RESULTS: In all, 145 ENBD procedures were performed using these two techniques. The procedure time was significantly shorter in the new technique group than in the conventional group. (44 s vs. 194 s, p < 0.001). The total success rate of new device technique was 97.3%. No complication, including oral cavity injury, was observed. CONCLUSIONS: The technique using our new loop-device was useful for repositioning a nasobiliary catheter from the mouth to nostril in ERCP. The new device does not require the removal of the mouthpiece before ENBD positioning, which can help perform the ENBD procedure rapidly and avoid the finger injury of endoscopists.

The phylogenetic significance of the morphology of the syrinx, hyoid and larynx, of the southern cassowary, Casuarius casuarius (Aves, Palaeognathae).

BACKGROUND: Palaeognathae is a basal clade within Aves and include the large and flightless ratites and the smaller, volant tinamous. Although much research has been conducted on various aspects of palaeognath morphology, ecology, and evolutionary history, there are still areas which require investigation. This study aimed to fill gaps in our knowledge of the Southern Cassowary, Casuarius casuarius, for which information on the skeletal systems of the syrinx, hyoid and larynx is lacking - despite these structures having been recognised as performing key functional roles associated with vocalisation, respiration and feeding. Previous research into the syrinx and hyoid have also indicated these structures to be valuable for determining evolutionary relationships among neognath taxa, and thus suggest they would also be informative for palaeognath phylogenetic analyses, which still exhibits strong conflict between morphological and molecular trees. RESULTS: The morphology of the syrinx, hyoid and larynx of C. casuarius is described from CT scans. The syrinx is of the simple tracheo-bronchial syrinx type, lacking specialised elements such as the pessulus; the hyoid is relatively short with longer ceratobranchials compared to epibranchials; and the larynx is comprised of entirely cartilaginous, standard avian anatomical elements including a concave, basin-like cricoid and fused cricoid wings. As in the larynx, both the syrinx and hyoid lack ossification and all three structures were most similar to Dromaius. We documented substantial variation across palaeognaths in the skeletal character states of the syrinx, hyoid, and larynx, using both the literature and novel observations (e.g. of C. casuarius). Notably, new synapomorphies linking Dinornithiformes and Tinamidae are identified, consistent with the molecular evidence for this clade. These shared morphological character traits include the ossification of the cricoid and arytenoid cartilages, and an additional cranial character, the articulation between the maxillary process of the nasal and the maxilla. CONCLUSION: Syrinx, hyoid and larynx characters of palaeognaths display greater concordance with molecular trees than do other morphological traits. These structures might therefore be less prone to homoplasy related to flightlessness and gigantism, compared to typical morphological traits emphasised in previous phylogenetic studies.

Pharyngeal dimensional changes in class II malocclusion treatment when using Forsus® or intermaxillary elastics - An exploratory study.

OBJECTIVE: Pharyngeal airway obstruction can facilitate some forms of sleep disorder breathing (SDB) in susceptible children, especially in those having class II malocclusion. Changes in the anatomic areas surrounding the pharyngeal region during orthodontic treatment could hypothetically impact the pharyngeal airway dimensions. Management of a class II malocclusion on a growing individual with either intermaxillary elastics or different removable or fixed class II appliance designs have been proposed over the last century. The objective of this retrospective exploratory cohort study is to investigate to what extent the class II malocclusion treatment with either intermaxillary elastics (IME) or Forsus® fatigue resistance device (FFRD) leads to changes in oropharyngeal airway dimensions. MATERIALS AND METHODS: Twenty-nine patients diagnosed as class II with an average age of 12.7years were included in this study, (11 males, 18 females). The sample was divided into group 1: IME and group 2: FFRD. CBCT's scans before (T1) and after treatment (T2) were obtained and analysed using Dolphin software. Reliability was obtained using Intraclass Correlation Coefficient (ICC). Descriptive statistics, ANOVA and paired t-test were used for analysis. RESULTS: Intra-rater reliability test was excellent in all measurements for both groups. There were no statistically significant differences in pharyngeal airway dimensions between both groups (P=0.919). A statistically significant correlation was found for sex, where male patients had the highest increase in oro-space area (ORS), and in oropharyngeal volume. Children under 14-year-old in IME group showed statistically negative correlation for sub-mandibular (SM) and for ORS, meaning the younger the greatest increase. Additionally, individuals younger than 14years had a statistically significant increase in the vertical dimension. CONCLUSIONS: Both orthodontic treatment approaches appear to be associated with a similar increase in oropharyngeal airway dimensions. Male patients under 14-year-old had a greater significant increase compared to female patients and older children. Normal pharyngeal dimensions changes were not accounted for.

Comparison of Dimensions of the Nasopharynx and Oropharynx Using Different Anatomical References: Is There Equivalence?

PURPOSE: To evaluate the equivalence of the volumes obtained using different anatomic references to measure the nasopharynx and oropharynx on cone-beam computed tomography (CBCT) scans. We hypothesized that no variations would be found in the nasopharynx and oropharynx dimensions when measured using different measurement methods. MATERIALS AND METHODS: A total of 40 CBCT scans of patients with skeletal Class I (age range, 20 to 50 years) were measured independently by 2 of us. The nasopharynx and oropharynx subregions were volumetrically measured using the adopted limits of 5 different measurement methods (3 for the nasopharynx and 2 for the oropharynx) and InVivoDental software, version 5.4 (Anatomage, San Jose, CA). The minimum area and the minimum area of localization were also evaluated. The intra- and interexaminer concordance for the measurements from the different methods were verified using the interclass correlation coefficient (ICC). The analysis of variance for repeated measures was used to compare the measurements from the 3 nasopharynx methods. The paired t test was used to compare the measurements from the 2 oropharynx methods. The statistical tests were performed at the 5% significance level using SPSS software, version 22.0 (IBM Corp, Armonk, NY). RESULTS: The intra- and interexaminer ICC values were greater than 0.8. We found a statistically significant difference in the volume measurements among the 3 nasopharynx methods (P = .001). However, no differences were found in the minimum area or minimum area of localization comparisons. Statistically significant differences were also observed for the volume, minimum area, and minimum area of localization between the 2 oropharynx methods (P = .001). CONCLUSIONS: Studies that have used different methods of measurement should not be directly compared. The different measurement methods used for nasopharynx and oropharynx evaluations should not be compared.

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.