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2.
Am J Orthod Dentofacial Orthop ; 159(4): e301-e310, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33541787

RESUMO

INTRODUCTION: The objective of this research was to observe changes in aerodynamics and anatomic characteristics of the upper airway after mini-implants assisted rapid maxillary expansion and to evaluate the correlation between the 2 changes of the upper airway in young adults. METHODS: Thirty consecutive patients (mean age, 23.82 ± 3.90 years; median, 24.5 years; 9 males, 21 females) were involved. Cone-beam computed tomography was taken before activation and over 3 months. Three-dimensional models of the upper airway were reconstructed on the basis of cone-beam computed tomography. The anatomic characteristics of the upper airway, including volume, area, transverse, and sagittal diameter, were measured. The aerodynamic characteristics of the upper airway were calculated on the basis of 3-dimensional models using computational fluid dynamics. The correlation between the changes in aerodynamics and anatomic characteristics of the upper airway was explored. RESULTS: The enlargements of the volume of the total pharynx, nasopharynx, and oropharynx were found (9.99%, 20.7%, and 8.84%, respectively). The minimum cross-sectional area increased significantly (13.6%). The airway resistance (R) and maximum velocity (Vmax) decreased significantly in both the inspiration and expiration phase (inspiration: R, -26.8%, Vmax, -15.7%; expiration: R, -24.7%, Vmax, -16.5%). The minimum wall shear stress reduced significantly only in the inspiration phase (-26.3%). The correlations between decreased R and increased volume and minimum cross-sectional area were observed. CONCLUSIONS: Mini-implants assisted rapid maxillary expansion is an effective device for improving anatomic characteristics represented by the total volume of the upper airway and minimum cross-sectional area, which contributed to the respiratory function depending on the favorable changes of aerodynamic characteristics including resistance, velocity, and minimum wall shear stress.


Assuntos
Implantes Dentários , Técnica de Expansão Palatina , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Imageamento Tridimensional , Masculino , Maxila/diagnóstico por imagem , Nariz , Orofaringe/diagnóstico por imagem , Faringe/diagnóstico por imagem , Adulto Jovem
3.
Am J Orthod Dentofacial Orthop ; 159(4): e377-e388, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33583695

RESUMO

INTRODUCTION: The purpose of this cross-sectional retrospective study was to evaluate the patterns of pharyngeal airway volume change determined by cervical vertebral maturation (CVM) stage and compare it with that which was characterized by chronological age. Correlations between hyoid bone positions and airway volumes were also examined. METHODS: CVM staging was determined from cone-beam computed tomography scans of 420 white patients aged 9-15 years. Patients were stratified on the basis of sex and skeletal pattern to establish pharyngeal airway volume clusters for each CVM stage. The horizontal and vertical positions of hyoid bones were measured using Hyoidius and Sella. RESULTS: Males had larger pharyngeal airway volumes compared with females. In males, the largest increases in pharyngeal airway volumes occurred at an earlier CVM stage than females. No statistically significant differences in pharyngeal airway volumes were noted in subjects with skeletal Class I, II, and III malocclusion. The hyoid bone in males was more anteriorly and inferiorly positioned compared with females. The Class III group had a further forward position of the hyoid bone than the Class I and II groups. CONCLUSIONS: The patterns of pharyngeal airway change obtained using CVM staging did not correlate well with traditional maturational models for skeletal growth. It implies that chronologic age could be a relatively reliable indicator for the assessment of pharyngeal airway volumes in adolescents, as outlined in part 1 of the present study. Subjects with anteriorly and superiorly positioned hyoid bones exhibited smaller pharyngeal airway volumes, which highlights the role of soft tissue and its influence on airway patency.


Assuntos
Osso Hioide , Má Oclusão de Angle Classe III , Adolescente , Cefalometria , Criança , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Feminino , Humanos , Osso Hioide/diagnóstico por imagem , Masculino , Mandíbula , Faringe/diagnóstico por imagem , Estudos Retrospectivos
4.
Am J Orthod Dentofacial Orthop ; 159(2): 148-157, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33388197

RESUMO

INTRODUCTION: This study aimed to compare cephalometrically the pharyngeal airway, hyoid bone, and soft palate (SP) changes after Class II malocclusion treatments using Twin-block (TWB) and Forsus Fatigue Resistant Device (FFRD) (3M Unitek Corp, 3M Dental Products, Monrovia, Calif) during the postpeak growth period. METHODS: Forty-two patients with Class II malocclusion treated during the postpeak growth period were randomly and retrospectively included in this study. These patients were divided into 2 treatment groups: TWB and FFRD. The skeletal, dental, pharyngeal airway, hyoid bone position, and SP measurements were obtained from the lateral cephalometric radiographs taken at the beginning and at the end of the treatment. Paired-samples and independent-samples t tests were used for the intragroup and intergroup comparisons, respectively. RESULTS: In the TWB group, the SNB (°), Md1-NB (mm), Md1-NB (°), and McNamara upper and lower pharyngeal airway dimensions significantly increased, whereas the ANB (°), AD1-Ba (mm), AD2-H (mm), adenoidal nasopharyngeal area, and SP angle decreased (P < 0.05). In the FFRD group, the SNB (°), Md1-NB (mm), Md1-NB (°), Ptm-Ba (mm), and McNamara upper airway dimensions significantly increased, whereas the ANB (°), AD2-H (mm), and interincisor angle decreased (P < 0.05). Moreover, there were statistically significant differences in the Md1-NB angles and SP thicknesses between the 2 groups (P < 0.05). CONCLUSIONS: The effects of TWB and FFRD treatment on the airway during the postpeak growth period were similar. However, the FFRD caused a greater mandibular incisor protrusion.


Assuntos
Má Oclusão de Angle Classe II , Aparelhos Ortodônticos Funcionais , Cefalometria , Humanos , Osso Hioide/diagnóstico por imagem , Má Oclusão de Angle Classe II/diagnóstico por imagem , Má Oclusão de Angle Classe II/terapia , Mandíbula/diagnóstico por imagem , Palato Mole/diagnóstico por imagem , Faringe/diagnóstico por imagem , Estudos Retrospectivos
5.
J Craniomaxillofac Surg ; 49(2): 146-153, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33423893

RESUMO

The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p<0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.


Assuntos
Má Oclusão de Angle Classe III , Procedimentos Cirúrgicos Ortognáticos , Cefalometria , Tomografia Computadorizada de Feixe Cônico , Humanos , Má Oclusão de Angle Classe III/cirurgia , Osteotomia de Le Fort , Osteotomia Sagital do Ramo Mandibular , Faringe/diagnóstico por imagem
6.
Ann Emerg Med ; 77(3): 285-295, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33455839

RESUMO

STUDY OBJECTIVE: Extraglottic airway devices are frequently used during cardiac arrest resuscitations and for failed intubation attempts. Recent literature suggests that many extraglottic airway devices are misplaced. The aim of this study is to create a classification system for extraglottic airway device misplacement and describe its frequency in a cohort of decedents who died with an extraglottic airway device in situ. METHODS: We assembled a cohort of all decedents who died with an extraglottic airway device in situ and underwent postmortem computed tomographic (CT) imaging at the state medical examiner's office during a 6-year period, using retrospective data. An expert panel developed a novel extraglottic airway device misplacement classification system. We then applied the schema in reviewing postmortem CT for extraglottic airway device position and potential complications. RESULTS: We identified 341 eligible decedents. The median age was 47.0 years (interquartile range 32 to 59 years). Out-of-hospital personnel placed extraglottic airway devices in 265 patients (77.7%) who subsequently died out of hospital; the remainder died inhospital. The classification system consisted of 6 components: depth, size, rotation, device kinking, mechanical blockage of ventilation opening, and injury. Under the system, extraglottic airway devices were found to be misplaced in 49 cases (14.4%), including 5 (1.5%) that resulted in severe injuries. CONCLUSION: We created a novel extraglottic airway device misplacement classification system. Misplacement occurred in greater than 14% of cases. Severe traumatic complications occurred rarely. Quality improvement activities should include review of extraglottic airway device placement when CT images are available and use the classification system to describe misplacements.


Assuntos
Competência Clínica/estatística & dados numéricos , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas/efeitos adversos , Erros Médicos/classificação , Faringe/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Masculino , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Faringe/diagnóstico por imagem , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
7.
Angle Orthod ; 90(3): 425-431, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378426

RESUMO

OBJECTIVE: To evaluate pharyngeal airway and maxillary sinus volumes following symmetric rapid maxillary expansion (RME) and asymmetric rapid maxillary expansion (ARME) treatment using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The study consisted of 60 patients presenting to the orthodontics clinic with an indication that they required symmetric or asymmetric rapid maxillary expansion treatment. Individuals were included if they were aged 12-15 years and had symmetric (RME group; 14 girls, 16 boys) or asymmetric (ARME group; 16 girls, 14 boys) maxillary deficiency. Maxillary sinus volume (mm3) and pharyngeal airway volume (upper, lower, and total; mm3) were evaluated using CBCT records. The parameters were compared before treatment (T1) and after 3 months in retention (T2). RESULTS: All measurements at T2 were increased significantly compared with T1 in the RME group (P < .05). In the ARME group, changes in the lower pharyngeal airway and the nonaffected maxillary sinus volumes (non-affected side of maxillary sinus volumes) were not significant; however, the other measurements increased significantly from T1 to T2 (P < .05). Intergroup comparisons revealed that total pharyngeal airway volume and total maxillary sinus volume changes were significantly greater in the RME group. CONCLUSIONS: Pharyngeal airway and maxillary sinus volumes increased with both RME and ARME treatment. Both were found to be effective for treating transverse maxillary deficiency.


Assuntos
Maxila , Técnica de Expansão Palatina , Adolescente , Criança , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Maxila/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Faringe/diagnóstico por imagem
8.
Angle Orthod ; 90(5): 715-722, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378484

RESUMO

OBJECTIVES: To assess changes in the maxillary sinus (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT scans of 48 patients were divided into two groups: group 1: maxillary advancement and mandibular setback (n = 24); group 2: maxillomandibular advancement (n = 24). The CBCTs were acquired 1 to 2 months preoperatively and 6 to 8 months postoperatively. A kappa test was used to determine intra- and interexaminer agreement. Area, volume, and linear measurements of MSs and PASs obtained before and after surgery were compared using a mixed model (P < .05). RESULTS: All variables of the MS showed significant postsurgical reductions in both groups, except the MS length, which showed a significant increase in group 2. Volume and minimum axial area of PAS showed statistically significant postsurgical increases in both groups (P < .05). CONCLUSIONS: Despite the reduction in the MS and the increase in the PAS, results indicated that the airway was not negatively affected after maxillomandibular advancement and maxillary advancement with mandibular setback.


Assuntos
Má Oclusão de Angle Classe III , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cefalometria , Tomografia Computadorizada de Feixe Cônico , Humanos , Má Oclusão de Angle Classe III/diagnóstico por imagem , Má Oclusão de Angle Classe III/cirurgia , Mandíbula , Seio Maxilar , Faringe/diagnóstico por imagem
9.
Orthod Fr ; 91(3): 239-248, 2020 10 01.
Artigo em Francês | MEDLINE | ID: mdl-33146618

RESUMO

The aim of our study was to evaluate the effect of treatment with a maxillary protraction appliance on the development of the craniofacial structures and to describe the correlation between the skeletal changes and the sagittal airway dimension associated with tongue, soft palate, and hyoid bone position in skeletal Class III children. A total of 40 patients with Class III malocclusions were evaluated by the use of lateral cephalograms. Pretreatment and posttreatment cephalometric radiographs were analyzed; linear and angular measurements were performed by the same orthodontist. The effect of treatment with a maxillary protraction appliance on the development of the craniofacial structures were evaluated by Student's T test and the correlation between treatment changes in craniofacial morphology and those in upper airway, tongue, soft palate, and hyoid position was evaluated by Pearson's correlation test. A significant increase in maxillary forward growth, inhibition of mandibular forward growth, and clockwise rotation of the mandible were observed. The statistical analysis revealed that maxillary growth had a significant positive effect on the superior upper airway sagittal dimension. The nasopharyngeal airway dimensions can be improved in the short term with maxillary protraction in skeletal Class III children.


Assuntos
Aparelhos de Tração Extrabucal , Má Oclusão de Angle Classe III , Cefalometria , Criança , Humanos , Má Oclusão de Angle Classe III/diagnóstico por imagem , Má Oclusão de Angle Classe III/terapia , Mandíbula , Maxila/diagnóstico por imagem , Faringe/diagnóstico por imagem
10.
Artigo em Chinês | MEDLINE | ID: mdl-33040506

RESUMO

Objective:To investigate the pathogenesis of OSA-related through 128-slice spiral CT measurements of adult male patients with moderate to severe OSA at different respiratory phases, and to optimize treatment options for patients with OSA. Method:128-slice spiral CT was used to scan the upper airway in 52 adult male patients with moderate to severe OSA and 20 normal controls under two different breathing states: calm breathing and Müller maneuver. The plane diameter and length of each area of the upper airway were measured. Area size, soft palate length, thickness, airway volume, airway length, total thickness of the pharyngeal wall, and calculate the compliance of the pharyngeal cavity, including the compliance of the pharyngeal wall, the compliance of the anterior and posterior pharyngeal wall, and the total pharyngeal compliance. Comparison of measurement results and correlation analysis with related parameters.Result: In the OSA group, the length and area of the smallest plane of each airway area(except the posterior epiglottic area) during calm breathing are greater than Müller's movement, and the difference was statistically significant(P<0.05). The soft palate length and thickness of the OSA group during calm breathing were significantly larger than those of the normal group, and the difference was statistically significant(P<0.01), In the OSA group, the total thickness of the soft palate region and the posterior lingual area of the pharyngeal wall in the Müller group was significantly greater than the calm breathing state, and the difference was statistically significant(P<0.01). The volume of the nasopharynx, posterior epiglottic area and airway length in the OSA group during calm breathing were significantly larger than those in the normal group, and the difference was statistically significant(P<0.01). The compliance of the pharyngeal cavity in the OSA group was greater than that in the normal group, and the difference was statistically significant(P<0.05). In the OSA group, the volume of the posterior soft palate, posterior tongue, and total airway volume during Müller movement were significantly smaller than those of calm breathing, and the differences were statistically significant(P<0.01). In the OSA group, the compliance of the pharyngeal wall in the posterior region of the soft palate was greater than the compliance of the anterior and posterior wall of the pharynx, while the compliance of the posterior region of the pharynx in the posterior region of the pharynx was greater than the compliance of the pharynx. There was a significant positive correlation between BMI and AHI in OSA patients(P<0.05), which was statistically significant. Conclusion:Through MSCT measurement of the upper airways of adult male patients with moderate to severe OSA, the morphological structure and compliance of the upper airways can be observed intuitively, and the degree and location of upper airway stenosis can be accurately assessed, and the measurement indicators and related parameters can be combined. The correlation can optimize the clinical treatment options for adult male patients with OSA.


Assuntos
Laringe , Apneia Obstrutiva do Sono , Adulto , Humanos , Masculino , Nasofaringe , Palato Mole/diagnóstico por imagem , Faringe/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico por imagem
11.
Swiss Dent J ; 130(10): 768-784, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33021766

RESUMO

This review about extraoral anatomy depicted in cone beam computed tomography describes the pharyngocervical region. Large (≥ 8 × 8 cm) field of views of the maxilla and/or mandible will inevita-bly depict the pharyngocervical region that com-prises the posterior upper airway, the pharyngeal part of the digestive tract, as well as the cervical segment of the spine. The latter consists of seven cervical vertebrae (C1-C7) with corresponding distinctive features, i.e., the atlas (C1) and the axis (C2). In addition, cervical vertebrae serve as ref-erences for the vertical position of anatomical structures. For instance, C4 is a typical landmark since it generally denotes the level of the chin, of the body of the hyoid bone, of the base of the epiglottis, and of the bifurcation of the common carotid artery, respectively. The pharynx, which is functionally involved in respiration, deglutition, and vocalization, extends from the lower aspect of the skull base to the esophagus. Anatomically, the pharynx is divided into three segments, i.e. the nasopharynx, the oropharynx, and the laryn-gopharynx. All communicate anteriorly with cor-responding cavities, i.e. the nasal cavities, the oral cavity, and the larynx. Although not directly located within the pharyngocervical region, the hyoid bone and the styloid process are also dis-cussed in this review, since both structures are commonly visible on CBCT images of this region.


Assuntos
Tomografia Computadorizada de Feixe Cônico Espiral , Tomografia Computadorizada de Feixe Cônico , Osso Hioide/diagnóstico por imagem , Mandíbula , Faringe/diagnóstico por imagem
12.
Comput Biol Med ; 125: 103980, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871294

RESUMO

PURPOSE: Severe pharyngitis is frequently associated with inflammations caused by streptococcal pharyngitis, which can cause immune-mediated and post-infectious complications. The recent global pandemic of coronavirus disease (COVID-19) encourages the use of telemedicine for patients with respiratory symptoms. This study, therefore, purposes automated detection of severe pharyngitis using a deep learning framework with self-taken throat images. METHODS: A dataset composed of two classes of 131 throat images with pharyngitis and 208 normal throat images was collected. Before the training classifier, we constructed a cycle consistency generative adversarial network (CycleGAN) to augment the training dataset. The ResNet50, Inception-v3, and MobileNet-v2 architectures were trained with transfer learning and validated using a randomly selected test dataset. The performance of the models was evaluated based on the accuracy and area under the receiver operating characteristic curve (ROC-AUC). RESULTS: The CycleGAN-based synthetic images reflected the pragmatic characteristic features of pharyngitis. Using the synthetic throat images, the deep learning model demonstrated a significant improvement in the accuracy of the pharyngitis diagnosis. ResNet50 with GAN-based augmentation showed the best ROC-AUC of 0.988 for pharyngitis detection in the test dataset. In the 4-fold cross-validation using the ResNet50, the highest detection accuracy and ROC-AUC achieved were 95.3% and 0.992, respectively. CONCLUSION: The deep learning model for smartphone-based pharyngitis screening allows fast identification of severe pharyngitis with a potential of the timely diagnosis of pharyngitis. In the recent pandemic of COVID-19, this framework will help patients with upper respiratory symptoms to improve convenience in diagnosis and reduce transmission.


Assuntos
Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Faringite/diagnóstico por imagem , Smartphone , Telemedicina/métodos , Infecções por Coronavirus , Humanos , Pandemias , Faringe/diagnóstico por imagem , Fotografação , Pneumonia Viral
13.
Am J Orthod Dentofacial Orthop ; 158(4): 527-534, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32807630

RESUMO

INTRODUCTION: This study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA). METHODS: A total of 25 patients (mean age 37.1 ± 17.3 years) were included in the study. Cone-beam computed tomography scans were taken before treatment; after presurgical orthodontic treatment; immediately after MMA procedure; and follow-up visit. All Digital Imaging and Communications in Medicine files were analyzed using the Dolphin 3D Imaging software program (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to determine the total airway volume (TAV), airway area (AA), and minimal cross-sectional area (MCA). Dolphin 3D voxel-based superimposition was used to determine the amount of skeletal advancement with MMA and changes after surgery. RESULTS: Significant increase in TAV, AA, and MCA was found with MMA treatment (40.6%, 28.8%, and 56.4%, respectively, P <0.0001). Smaller but significant decrease in TAV, AA, and MCA was found during a follow-up visit (20.0%, 9.7%, and 26.8%, respectively, P <0.0001) giving a net increase of TAV, AA and MCA (35.8%, 27.1%, and 45.9%, respectively). No significant differences were found in any of the airway measurements with or without the GTA procedure. The average forward movements of the maxilla, mandible, and chin were 6.6 mm, 8.2 mm, and 11.4 mm, respectively. A relapse of less than 1 mm was found in each of the variables during the follow-up period. No correlation was found between the magnitudes of skeletal advancement and the change in oropharyngeal airway space (OPAS). CONCLUSIONS: Significant increase in OPAS can be expected with MMA surgery with or without GTA procedure in patients diagnosed with obstructive sleep apnea. A partial loss in OPAS was found during the follow-up visit. The surgical movements were found to be stable, with less than 1 mm of relapse during the follow-up period, which was not clinically significant.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/terapia , Adulto , Cefalometria , Seguimentos , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Osteotomia de Le Fort , Faringe/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
14.
J Oral Rehabil ; 47(12): 1489-1495, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32813891

RESUMO

BACKGROUND: Dysphagia is a growing health problem in aging societies. An observational cohort study targeting community-dwelling populations revealed that 16% of elderly subjects present with dysphagia. There is a need in elderly communities for systematic dysphagia assessment. OBJECTIVE: This study aimed to verify whether laryngeal elevation in the pharyngeal phase could be measured from the body surface using thin and flexible stretch sensors. METHODS: Thirty-two elderly subjects (17 males, 15 females; mean age ± SD: 89.2 ± 6.2 years) with suspected dysphagia underwent a swallowing contrast examination in which seven stretch sensors were attached to the front of the neck. The elongation of the sensors was measured and compared to the laryngeal elevation time values obtained using videofluorography. The sensor signal detected the laryngeal elevation start time, conclusion of the descent of the larynx, and the laryngeal elevation time. The respective laryngeal elevation times obtained using videofluorography and using the sensor were compared using the Bland-Altman method. RESULTS: The laryngeal elevation time was 1.34 ± 0.46 s with the stretch sensor and 1.49 ± 0.56 s with videofluorography. There was a significant positive correlation between the duration obtained by both methods (r = .69, P < .0001). A negative additional significant bias of -0.15 s (95% confidence interval -0.30 to -0.03, P = .046) was noted in the laryngeal elevation time from the videofluorography measurement. CONCLUSION: Laryngeal elevation time can be measured non-invasively from the neck surface using stretch sensors.


Assuntos
Transtornos de Deglutição , Laringe , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Humanos , Laringe/diagnóstico por imagem , Masculino , Faringe/diagnóstico por imagem
15.
Am J Orthod Dentofacial Orthop ; 158(5): 710-721, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32828607

RESUMO

INTRODUCTION: This study investigated correlations between airway size and age, sex, and skeletal patterns; identified airway change trends; and measured volumetric norms in children via cone-beam computed tomography. METHODS: Four hundred twenty nontreated white patients were stratified by age, sex, and anteroposterior skeletal pattern. The nasopharyngeal airway (NPA), oropharyngeal airway (OPA), and total pharyngeal airway (TPA) volumes were delineated on 3-dimensional digital cephalograms. SPSS (SPSS, Chicago, Ill) was used to run an analysis of variance and post-hoc analyses. RESULTS: The Class III group had significantly larger OPA volumes than Class I and II groups. Male subjects had considerably larger NPA volumes than female subjects. Age was significantly associated with all 3 airway volumes (P <0.05). The young cohort (ages, 9-10 years) had a mean TPA of 11,435.34 ± 484.45 mm3, the middle cohort (ages, 11-13 years) had a mean TPA of 14,152.07 ± 395.46 mm3, and the older cohort (ages, 14-15 years) had a mean TPA of 18,057.99 ± 484.25 mm3. CONCLUSIONS: An effect of skeletal classification on OPA and a sex effect on NPA were observed. The annual change in the mean of TPA volume decreased in subjects aged 10-12 years, then rebounded until 14 years. TPA change peaked in female subjects 1 year before male subjects.


Assuntos
Má Oclusão de Angle Classe III , Mandíbula , Adolescente , Cefalometria , Criança , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Feminino , Humanos , Imageamento Tridimensional , Masculino , Faringe/diagnóstico por imagem , Estudos Retrospectivos
16.
J Craniofac Surg ; 31(4): 1098-1100, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487834

RESUMO

BACKGROUND: Orthodontists and surgeons have been looking for more accurate methods to predict surgical outcomes in patients with skeletal discrepancies. METHODS: The sample consisted of 20 patients from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bilateral sagittal split osteotomy, with or without genioplasty. All patients had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin 3-dimensional (3D) software. The 3D voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft-tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The upper airway was segmented and exported as stereolithography surface files in both T1 and Tp. The measurements of the 3D volume of the airway were calculated and compared among T1 and Tp by using surface superimposition technique. Mean and standard deviations of upper airway volume were compared and correlated using paired t-test. RESULTS: There was no statistically significant difference between the upper airway volume of T1 and Tp. CONCLUSION: Dolphin 3D delivers accurate airway prediction which is an important step in 3D virtual planning.


Assuntos
Imageamento Tridimensional , Nariz/diagnóstico por imagem , Procedimentos Cirúrgicos Ortognáticos , Faringe/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Software
17.
PLoS One ; 15(6): e0233983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484841

RESUMO

BACKGROUND: Anatomical feline models can aid in understanding the relationships between clinical findings and anatomical features and the course of foreign bodies passing through the oesophagus. This study has two goals 1) to assess feline oesophageal foreign bodies in feline patients using physical, radiologic and endoscopic examination and, how their location influences treatment plans and complications. 2) How the anatomical sharp angle of the oesophagus contribute to foreign body lodgement. Thirty-five cats were enrolled in this study; 30 of them were clinically ill, and five cats were used for anatomical study. RESULTS: Cats with clinical signs underwent complete clinical and radiologic examination. Endoscopy was performed in only five cases. The site with the highest occurrence of foreign body lodgement was the oesophageal entrance, caudal to the pharynx (63.3%), followed by the thoracic inlet (26.7%) and the mid-cervical region of the oesophagus (10%). Two types of foreign bodies were identified: sewing needles (25/30) and bone (5/30). Radiography was able to identify the location and nature of the foreign body in all 30 affected cats. Therapeutic regimens were applied according to the nature and location of the foreign body and any associated complications. Removal of the foreign body was achieved using Rochester pean artery forceps in 17/30 cases, using full surgical intervention in 8/30 cases, and during endoscopy in 5/30 cases. CONCLUSION: The results suggest that the location of the foreign body is strongly related to combination of consumed foreign body type and anatomic features of the cat oesophagus. The feline oesophagus has a variety of sharp angles that facilitate the entrapment of rigid linear and angular foreign bodies. Radiographic imaging remains the most frequently used diagnostic modality for determining the lodgement site and nature of radiopaque foreign bodies. Over all complication rate was low (6/30).


Assuntos
Esôfago/anatomia & histologia , Corpos Estranhos/diagnóstico por imagem , Faringe/anatomia & histologia , Animais , Gatos , Esofagoscopia , Esôfago/diagnóstico por imagem , Faringe/diagnóstico por imagem
18.
J Oral Maxillofac Surg ; 78(9): 1629.e1-1629.e9, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32417317

RESUMO

PURPOSE: Ectodermal dysplasias (EDs) are a diverse set of hereditary conditions in which 2 or more ectodermal structures develop abnormally. The purpose of this study was to use cone-beam computed tomography (CBCT) scans to measure the pharyngeal airway volume and minimum cross-sectional area (MC) among patients with ED and compare them with healthy controls. PATIENTS AND METHODS: The pretreatment CBCT scans of 9 individuals with ED and 61 controls were analyzed. Lateral cephalograms were created from the CBCT volumes and then traced and compared between the 2 groups. Airway volumes were evaluated by Dolphin 3D software (Dolphin Imaging, Chatsworth, CA) to compare the total pharyngeal volume, nasopharyngeal volume, oropharyngeal volume, hypopharyngeal volume, and MC. The mean airway volumes of the 2 groups were compared, and the odds ratio and relative risk of having an MC of less than 100 mm2 in the ED group were calculated. RESULTS: Intraclass correlation analysis showed excellent inter-rater reliability. All cephalometric features of controls were within the norms of patients with ideal skeletal-dental relationships. Patients with ED displayed significantly lower values for SNA (angle between sella-nasion and nasion-A point) (P = .018), ANB (angle between nasion-A point and nasion-B point) (P = .002), L1-MP (angle between long axis of mandibular incisor and gonion-menton plane) (P = .013), and L1-NB (distance between mandibular incisor and perpendicular line between nasion and B point) (P < .001). Although the ED group exhibited slightly smaller airway volumes for all subregions, the differences were not statistically significant for total pharyngeal volume, nasopharyngeal volume, oropharyngeal volume, hypopharyngeal volume, or MC (P > .05). The odds of having an MC of less than 100 mm2 were almost 3 times greater among ED patients, and the relative risk of an MC of less than 100 mm2 among ED patients was double that of controls. CONCLUSIONS: Although the craniofacial structures of individuals with ED are characterized by maxillary and midface deficiency, the airway volumes among affected individuals may not be significantly different from those of unaffected controls. However, patients with ED displayed a higher risk of having an MC of less than 100 mm2, which may be of clinical significance and warrants further investigations with larger samples.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Displasia Ectodérmica , Cefalometria , Humanos , Imageamento Tridimensional , Faringe/diagnóstico por imagem , Reprodutibilidade dos Testes
19.
J Laryngol Otol ; 134(4): 354-361, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32284084

RESUMO

OBJECTIVE: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.


Assuntos
Remodelação das Vias Aéreas/fisiologia , Nasofaringe/patologia , Palato Mole/patologia , Faringe/patologia , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , China/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/anatomia & histologia , Nasofaringe/diagnóstico por imagem , Palato Mole/anatomia & histologia , Palato Mole/diagnóstico por imagem , Faringe/anatomia & histologia , Faringe/diagnóstico por imagem , Polissonografia/métodos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
20.
J Craniofac Surg ; 31(5): 1353-1361, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224775

RESUMO

INTRODUCTION: In this study, the authors aimed to perform a novel and extensive analysis, based on the most applicable correlations between the mandibular and upper airway parameters, using cone beam computed tomography across all malocclusion classes. The authors also focused on gender-dependent differences in an Iranian population. MATERIALS AND METHODS: Images were acquired from adult patients using cone beam computed tomography. The patients were classified into three groups of malocclusion classes (class I: 13 males and 27 females, class II: 13 males and 27 females, and class III: 25 males and 15 females). For each patient, 10 parameters for the mandible and 23 parameters for the pharynx, pyriform aperture, and nasal cavity were evaluated in the images. RESULTS: Pearson's correlation coefficient showed significant correlations between the mandibular morphology and upper airway dimensions in each malocclusion class. In females, the menton angle had a significant correlation with pharyngeal dimensions in all malocclusion classes. In males, the bigonial width, bicondylar width, and symphyseal height of the mandible were correlated with pharyngeal dimensions in all classes. The greatest correlation between the mandible and upper airways was observed in class III malocclusions, and the lowest correlation was observed in class I malocclusions. In addition, the mandibular parameters had relationships with the nasal cavity and pyriform aperture. CONCLUSION: It is important to consider the knowledge of the relationship between some characteristics of the mandible and airways in various clinical approaches.


Assuntos
Mandíbula/diagnóstico por imagem , Cavidade Nasal/diagnóstico por imagem , Faringe/diagnóstico por imagem , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Imageamento Tridimensional , Masculino , Má Oclusão de Angle Classe I , Má Oclusão de Angle Classe III
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