Letter to editor on "Efficiency of bimaxillary advancement surgery in increasing the volume of the upper airways: a systematic review of observational studies and meta-analysis"

Influence of tongue volume, oral cavity volume and their ratio on upper airway: A cone beam computed tomography study

Background

Our study aimed to measure the tongue volume (TV), oral cavity volume (OCV), and their ratio (TV/OCV) and correlate with upper airway using cone-beam computed tomography (CBCT).

Method

The volume of oral cavity, tongue and upper airway were obtained by the manual process of segmentation of CBCT data of 15 subjects. The mean age of the sample was 21.86 years (range 15-33 years). Segmentation of the upper airway, tongue and oral cavity was performed manually using Mimics 11.0 (Materialise, Leuven, Belgium) software at different thresholds for air and the tongue. The Hounsfield units (HU) for airway volume of the different facial region ranged from -1024 to -500. For tongue volume, Hounsfield units (HU), ranging from -200 to 200 was calculated.

Results

A significant negative correlation between TV/OCV and oropharynx (r = - 0.51; P = 0.04), TV/OCV and oral cavity airway volume (r = - 0.74; P = 0.002) was found. There was a significant and a positive correlation with TV/OCV and tongue volume (r = 0.65; P = 0.009).

Conclusion

A significant negative correlation established between TV/OCV, oropharynx and oral cavity airway volume. This finding indicates an influence tongue volume, oral cavity volume and their ratio on patency of the oropharynx.

Meta-Analysis of the Effect of the Clinical Pathway Applied to Patients with Endoscopic Sinus Surgery in China

BACKGROUND

Chronic rhinosinusitis (CRS) is one of the most common diseases in China. The incidence of CRS in the Chinese urban population is between 5 and 15%. It is difficult to cure with traditional surgery. Endoscopic sinus surgery is the first choice for the treatment of CRS. Compared with developed countries, the development of the clinical pathway of endoscopic sinus surgery in China is still unclear.

OBJECTIVES

The aim is to explore whether the clinical pathway of endonasal sinus surgery is better than the traditional one in the Chinese population.

METHODS

We searched PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, SinoMed, China National Knowledge Internet, Wanfang database of Chinese Journals, and VIP database of Chinese Journals. The last retrieval date was August 24, 2018. Review Manager 5.3 software was used for comprehensive quantification data analysis.

RESULTS

Fourteen papers involving 1,882 patients were included in this study. The results showed that compared with the traditional pathway, the clinical pathway can effectively shorten the average number of hospitalization days (mean difference, MD = -2.00, 95% CI: -2.50, -1.49). In total, 10 of the 14 papers, with a total of 1,500 patients, proved that the clinical pathway can effectively reduce the hospitalization costs of patients (standard mean difference, SMD = -3.15, 95% CI: -4.20, -2.10); 11 of the 14 papers, with a total of 1,488 patients, proved that the clinical pathway can effectively improve patients' knowledge of health (95% CI:1.03, 1.09); and 7 of the 14 papers, with a total of 810 patients, proved that the clinical pathway can effectively improve patient satisfaction (95% CI:1.10, 1.20).

CONCLUSIONS

Our systematic review and meta-analysis support the use of the clinical pathway in patients with endoscopic sinus surgery in China.