Measurement of Upper Airway Volume in Children with Craniofacial Abnormalities

OBJECTIVE(S)

Previous literature has established a high prevalence of upper airway obstruction in children with craniofacial abnormalities. This study aims to perform quantitative airway volume measurements in patients with craniofacial abnormalities and compare them to age and sex-matched controls.

METHODS

We performed a retrospective review of the records of all children with craniofacial abnormalities who underwent head-and-neck computed tomography (CT) imaging at a single tertiary-care center between 1/1/13 and 12/31/20 using the ICD-10 codes Q75.1, Q75.4, and Q87.0. These patients were then matched by age and sex to patients with isolated craniosynostosis (Q75.0). CT scans were imported into Dolphin Imaging software, and airway volumes were measured for the nasal cavity, nasopharynx, oropharynx, and hypopharynx. The primary outcome was the total airway volume, defined as the sum of these measurements.

RESULTS

Thirty subjects with craniofacial syndromes were matched to 30 patients with isolated craniosynostosis (controls). In both groups, 18 subjects (60%) were male (p = 0.99). The average ages for syndromic patients and controls were 12.1 and 12.9 months, respectively (p = 0.84). On average, the total airway volumes of syndromic patients were 25% lower than those of controls (p = 0.02). Syndromic patients had 39% smaller nasal cavity volumes (p < 0.001) and 32% smaller nasopharyngeal volumes (p < 0.01). Significant volume differences were not observed for the oropharynx or hypopharynx.

CONCLUSION

We present a unique technique to measure airway volumes in patients with craniofacial abnormalities. These findings will help practitioners to further understand the anatomy and pathophysiology of disturbed breathing in children with craniofacial syndromes.

LEVEL OF EVIDENCE

III Laryngoscope, 134:2915-2921, 2024.

Assessment of maximal inspiratory and expiratory pressures in skeletal Class II patients with different growth patterns

OBJECTIVES

To evaluate maximal inspiratory (MIP) and expiratory (MEP) pressures, which are reflective of respiratory muscle strength, in skeletal Class II patients with different growth patterns (horizontal, average, and vertical) and to correlate those with airway dimension.

MATERIALS AND METHODS

Patients with a Class II skeletal base seeking orthodontic treatment were assigned to the following groups: average, horizontal, and vertical growth pattern. The control group (n = 14) comprised patients with a Class I skeletal base and average growth pattern. Airway dimensions were obtained using cone-beam computed tomography scans, and a spirometer with a pressure transducer was used for assessment of MIP and MEP. Routine spirometry for assessment of lung function was also performed.

RESULTS

No significant differences were found in maximal inspiratory and expiratory pressures for the study groups in comparison with the control group. Class I patients had significantly greater oropharyngeal and nasopharyngeal airway volumes compared with the study groups. No significant difference in minimal cross-section area of the airway was observed among groups. A weak positive correlation between maximal inspiratory pressure and airway volume was observed.

CONCLUSIONS

Although Class I patients displayed significantly greater oropharyngeal and nasopharyngeal airway volumes, there was no significant difference in respiratory muscle strength or airway function between Class II patients with different growth patterns and the Class I control group. The findings underscore the significance of exploring factors beyond craniofacial growth patterns that may contribute to sleep-related breathing disorders.

Predictive value of local control by 4'-[methyl-11C]-thiotymidine PET volume parameters in p16-negative oropharyngeal, hypopharyngeal, and supraglottic squamous cell carcinoma

PURPOSE

We investigated the potential of baseline 4'-[methyl- 11 C]-thiothymidine ([ 11 C]4DST) PET for predicting loco-regional control of head and neck squamous cell carcinoma (HNSCC).

METHODS

A retrospective analysis was performed using volumetric parameters, such as SUVmax, proliferative tumor volume (PTV), and total lesion proliferation (TLP), of pretreatment [ 11 C]4DST PET for 91 patients with HNSCC with primary lesions in the oral cavity, hypopharynx, supraglottis, and oropharynx, which included p16-negative patients. PTV and TLP were calculated for primary lesions and metastatic lymph nodes combined. We examined the association among the parameters and relapse-free survival and whether case selection focused on biological characteristics improved the accuracy of prognosis prediction.

RESULTS

The area under the curves (AUCs) using PTV and TLP were high for the oropharyngeal/hypopharyngeal/supraglottis groups (0.91 and 0.87, respectively), whereas that of SUVmax was 0.66 ( P  < 0.01). On the other hand, the oral group had lower AUCs for PTV and TLP (0.72 and 0.77, respectively). When all cases were examined, the AUCs using PTV and TLP were 0.84 and 0.83, respectively.

CONCLUSION

Baseline [ 11 C]4DST PET/CT volume-based parameters can provide important prognostic information with p16-negative oropharyngeal, hypopharyngeal, and supraglottic cancer patients.

Role of the tonsil-oropharynx ratio on lateral cephalograms in assessing tonsillar hypertrophy in children seeking orthodontic treatment

OBJECTIVES

To analyze the diagnostic value of the tonsil-oropharynx (T/O) ratio on lateral cephalograms for evaluating tonsillar hypertrophy (TH).

METHODS

A cross-sectional study was performed on 185 consecutive children (101 males, 84 females; mean age 7.3 ± 1.4 years) seeking orthodontic treatment. The T/O ratios on lateral cephalograms were calculated following Baroni et al.'s method. Tonsil sizes were clinically determined according to the Brodsky grading scale. Spearman correlation coefficients between the T/O ratio and clinical tonsil size were calculated with the total sample and subgroups and then compared between subgroups. Diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values, and accuracy.

RESULTS

There was a strong correlation between the T/O ratio and clinical tonsil size in children (ρ = 0.73; P < 0.001). A significantly higher correlation coefficient was found in the Class III children. The ROC curve revealed an area under the curve of 0.90 (95% CI, 0.86-0.94; P < 0.001). The optimal cutoff value of the T/O ratio for predicting TH was 0.58, with a sensitivity of 98.7% and specificity of 64.2%. Employing the cutoff value of 0.5, the sensitivity was 100% and the specificity was 45.9%.

CONCLUSIONS

Measurement of the T/O ratio on lateral cephalograms may be helpful to initial screening in children for TH. Practitioners may combine the clinical examination of tonsil size with the cephalometric findings for a more comprehensive evaluation.

CBCT Analysis of Oropharynx Airway Volume

OBJECTIVE

The study was performed to analyze the oropharynx airway and examine the influence of age and gender on the oropharynx volume configuration using cone beam computed tomography.

MATERIALS AND METHODS

This study examined the cone beam computed tomographic images of 51 patients 25 male and 26 females, group matched for age and gender. The oropharynx airway volume and area between the posterior nasal spine and top of the epiglottis were measured and compared.

RESULTS

The statistical measurements of 51 cone beam computed tomography images showed a nonsignificant difference found between male and female regarding the age (the mean age for female 40.15 y. and for male32.72 y). Male subjects had greater oropharynx volume, a high significant difference ( P =0.005) in oropharynx volume between the 3 age groups. A significant difference was found between the smallest age group with the larger age groups.

CONCLUSION

The study data revealed that the changes in measurements of oropharynx airway are age-dependent in addition to gender effect.

Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders

BACKGROUND

This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion.

METHODS

Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME.

RESULTS

This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2).

CONCLUSIONS

A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.

[Morphological changes of upper airway in patients with skeletal Class Ⅲ malocclusion after bimaxillary surgery and correlation analysis]

PURPOSE

To analyze the morphological changes of the upper airway and related influencing factors in patients with skeletal Class Ⅲ malocclusion after bimaxillary surgery.

METHODS

Twenty skeletal Class Ⅲ patients who underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy(BSSRO) for maxillary advancement and mandibular setback were selected. The patients received CT scans before(T0) and 3-6 months after surgery, and the images were reconstructed three-dimensionally with Dolphin Imaging 11.9 software. Changes in the volume, cross-sectional area, and landmarks of each soft and hard tissue of the airway were measured. Statistical analysis of the data was performed using SPSS 25.0 software package.

RESULTS

The volume of nasopharyngeal airway increased after operation (P＜0.05), and the volume of oropharyngeal airway decreased significantly(P＜0.01). The cross-sectional area of the airway at the plane of the second cervical vertebra was significantly decreased (P＜0.01), and the coronal and sagittal diameters were decreased(P＜0.05). The change of nasopharyngeal airway volume was moderately positively correlated with the sagittal change of the posterior nasal spine (r=0.460, P＜0.05), and the change of oropharynx and laryngopharyngeal airway volume was positively correlated with the vertical change of the midpoint of the soft palate(r=0.496, 0.696, P＜0.05). The airway cross-sectional area in the second and third cervical vertebra planes and the sagittal diameter of the airway in the third cervical vertebra plane were positively correlated with the vertical changes of the midpoint of the soft palate(r=0.474, 0.629, 0.547, P＜0.05). The change of airway cross-sectional area at the third cervical vertebra plane was moderately negatively correlated with the change of mandibular plane angle(r=-0.536, P＜0.05).

CONCLUSIONS

The volume and cross-sectional area of oropharyngeal airway in skeletal Class Ⅲ patients after bimaxillary surgery will decrease. However, the total upper airway volume doesn't change significantly. The changes in the upper airway are correlated with the changes in some soft and hard tissue landmarks.

Multi-stage Unet segmentation and automatic measurement of pharyngeal airway based on lateral cephalograms

OBJECTIVES

Orthodontic treatment profoundly impact the pharyngeal airway (PA) of patients. Airway examination is an integral part of daily orthodontic diagnosis, and lateral cephalograms (LC) are reliable to reveal PA structures. This study attempted to develop a simple method to help clinicians make a preliminary judgement of patients' PA conditions and assess the impact of orthodontic treatment on their airways.

METHODS

LCs of 764 patients were used to train a multistage unit segmentation model. Another 130 images were used to validate the model and more 130 images were used to test the model.

RESULTS

Unet was used as the backbone, with a mean dice value of 0.8180, precision of 0.8393, and recall of 0.8188. Furthermore, we identified seven key points and measured related indices. The length of the line separating the nasopharynx and oropharynx and the line separating the oropharynx and hypopharynx were manually measured thrice and the average values was compared. The intraclass correlation coefficient (ICC) for the two lines was 0.599 and 0.855. Then, we performed a single linear regression analysis, which indicated a strong correlation between the predictions and measurements for the two lines.

CONCLUSIONS

This method is reliable for segmenting three regions (nasopharynx, oropharynx, and hypopharynx) of the PA and calculating related indices. However, the predictions obtained from this model still have errors, and it is necessary for clinical practitioners to assess and adjust the predictions.

CLINICAL SIGNIFICANCE

Our model can help orthodontists formulate personalised treatment plans and evaluate the risk of airway stenosis during orthodontic treatment. This method may mark the beginning of a new and simpler approach for PA obstruction detection, specifically tailored to orthodontic patients.

Temporal measures of oropharyngeal swallowing events identified using ultrasound imaging in healthy young adults

Swallowing is a complex process that involves precise coordination among oral and pharyngeal structures, which is essential to smooth transition of bolus and adequate airway protection. Tongue base retraction and hyolaryngeal excursion are two significant swallowing movements, and their related events can be examined using ultrasound imaging, which is physically and radioactively non-invasive. The present study aimed to 1) establish the temporal sequences and timing of swallowing events identified using ultrasound imaging, and 2) investigate the variability of the above temporal sequences and 3) investigate the effect of bolus type on the variability of temporal sequences in non-dysphagic individuals. Forty-one non-dysphagic young adults of both genders (19 males and 22 females) participated in the study. Ultrasound images were acquired mid-saggitally at their submental region during swallowing of boluses with different volume (i.e. 5mL or 10mL) and consistencies (i.e. IDDSI Levels 0 and 4). Timing and sequence of six events 1) displacement onset (TBOn), 2) maximum displacement (TBMax) and 3) displacement offset of tongue base retraction (TBOff); and, 4) displacement onset (HBOn), 5) maximum displacement (HBMax) and 6) displacement offset of the hyoid bone excursion (HBOff) were extracted from the ultrasound images. Out of the 161 swallows, 85.7% follow a general sequence of HBOn < TBOn < HBMax < TBMax < HBOff < TBOff. Percentage adherence to six anticipated paired-event sequences was studied. Results suggested the presence of individual variability as adherence ranged from 75.8% to 98.1% in four of the anticipated sequences, leaving only two sequences (HBOn < TBMax and TBMax < HBOff) obligatory (i.e. 100% adherence). For non-obligatory sequences, it was found that bolus type may have an effect on the level of adherence. Findings of the present study lay the groundwork for future studies on swallowing using ultrasound imaging and also the clinical application of ultrasonography.

Imaging of the upper airway: which method is best for orthodontic assessment?

The objectives of the present study were to compare measurements of pharyngeal airway subregions on lateral cephalometric (LC) and cone beam computed tomographic (CBCT) images in relation to skeletal classes and discuss the advantages and disadvantages of these imaging formats for this type of assessment. The CBCT images were assessed via both multiplanar reconstruction (MPR) and 3-dimensional (3D) reconstruction. The LC and CBCT images from 107 patients were classified according to skeletal class: I, n = 35; II, n = 35; and III, n = 37. Linear measurements of the subdivisions of the upper airway were performed on the LC, MPR, and 3D images. In addition, area and volumetric measurements were performed on the MPR images. The relationships among imaging methods, skeletal class, and pharyngeal thirds were assessed by means of a 1-way analysis of variance (α = 0.05). No statistically significant differences in the linear, area, or volumetric measurements of the upper airway subregions were found among the skeletal classes (P > 0.05). For the linear measurements in the oropharynx and hypopharynx, greater values were observed for the LC images than for the MPR and 3D images (P ≤ 0.05). Based on the study findings, MPR images should be preferred for visualization of the pharyngeal airway subregions. However, LC imaging is preferable to 3D reconstruction.

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.

Comparing different software packages for measuring the oropharynx and minimum cross-sectional area

INTRODUCTION

Several imaging software packages report the ability to measure the oropharynx and minimum cross-sectional area (MCA). This study aimed to compare 4 imaging software packages for measuring the oropharynx volume and MCA.

METHODS

Twenty-eight randomly selected cone-beam computed tomography scans had oropharynx volume and MCA calculated by 2 experienced operators using 4 different programs: Dolphin 3D (version 11.95.8.64; Dolphin Imaging & Management Solutions and Management Solutions, Chatsworth, Calif), InVivo Dental (version 6; Anatomage Inc, San Jose, Calif), OnDemand3D (version 1.0.10.7510; CyberMed, Seoul, South Korea), and ITK-SNAP (version 3.8.0; www.itksnap.org). The measurements were repeated after 2 weeks, and intraclass correlation coefficients were used for the reliability tests. Analysis of variance with the Tukey post-hoc test was used to compare the measurements of oropharynx and MCA with different software programs. Paired t tests were used to compare measurements of both investigators and software programs. Bland-Altman analysis was used to assess interexaminer reliability and agreement between the software programs.

RESULTS

The intraclass correlation coefficients revealed excellent repeatability for the 4 programs for both investigators. Analysis of variance showed no statistically significant difference between programs when comparing the oropharynx and MCA. There were no significant differences in software programs when measuring the airway. Bland-Altman showed the maximum difference as 4.1 cm³ for volume and 35 mm² for MCA. Those differences were below the standard deviations of 5.33 cm³ for volume and 73.75 mm² for MCA.

CONCLUSIONS

The use of 4 different software packages to measure the airway for oropharynx volume and MCA showed high intraoperator and interoperator reliability, no statistically significant difference when using analysis of variance, Tukey post-hoc, paired t tests, and variations within one standard deviation when using Bland-Altman.

Zero-TE MRI: Potential Applications in the Oral Cavity and Oropharynx

ABSTRACT

Zero-echo time (ZTE) magnetic resonance imaging (MRI) is the newest in a family of MRI pulse sequences that involve ultrafast sequence readouts, permitting visualization of short-T2 tissues such as cortical bone. Inherent sequence properties enable rapid, high-resolution, quiet, and artifact-resistant imaging. ZTE can be performed as part of a "one-stop-shop" MRI examination for comprehensive evaluation of head and neck pathology. As a potential alternative to computed tomography for bone imaging, this approach could help reduce patient exposure to ionizing radiation and improve radiology resource utilization. Because ZTE is not yet widely used clinically, it is important to understand the technical limitations and pitfalls for diagnosis. Imaging cases are presented to demonstrate potential applications of ZTE for imaging of oral cavity, oropharynx, and jaw anatomy and pathology in adult and pediatric patients. Emerging studies indicate promise for future clinical implementation based on synthetic computed tomography image generation, 3D printing, and interventional applications.

Comprehensive assessments of the open mouth dynamic maneuver and metal artifact reduction algorithm on computed tomography images of the oral cavity and oropharynx

Objectives

To determine the optimal utility of the open mouth maneuver and Metal Artifact Reduction for the Orthopedic Implants (O-MAR) technique for CT of the oral cavity and oropharynx.

Methods

Between July 2017 and May 2019, 59 subjects who underwent both conventional and open mouth head and neck CT scans were included in this retrospective study. All images were reconstructed using the O-MAR algorithm. With conventional CT with/without the O-MAR (CTc_O/CTc) and open mouth CT with/without O-MAR (CTo_O/CTo), one reader measured the noise level in multiple anatomic regions of the oral cavity and oropharynx. Visual scores for the streak artifact and overall subjective image quality were assessed by two independent readers.

Results

For the mobile tongue, retromolar trigone, and palatine tonsil, the mean noise was significantly lower, and the mean visual scores were significantly higher, with CTo than with CTc or CTc_O (all, P < 0.001). The mean visual scores were higher with CTo_O than with CTo for the mobile tongue and palatine tonsil (all, P < 0.001). Contrarily, for the mouth floor and tongue base, the mean noise was significantly higher with CTo_O than with CTc or CTc_O, and the mean visual scores were significantly higher with CTc than with CTo or CTo_O (all, P < 0.001).

Conclusions

The open mouth maneuver and O-MAR technique can have different influences on the CT image quality according to the anatomical subsites of the oral cavity and oropharynx.

Squamous Cell Carcinoma and Lymphoma of the Oropharynx: Differentiation Using a Radiomics Approach

The purpose of this study was to evaluate the diagnostic performance of magnetic resonance (MR) radiomics-based machine learning algorithms in differentiating squamous cell carcinoma (SCC) from lymphoma in the oropharynx. MR images from 87 patients with oropharyngeal SCC (n=68) and lymphoma (n=19) were reviewed retrospectively. Tumors were semi-automatically segmented on contrast-enhanced T1-weighted images registered to T2-weighted images, and radiomic features (n=202) were extracted from contrast-enhanced T1- and T2-weighted images. The radiomics classifier was built using elastic-net regularized generalized linear model analyses with nested five-fold cross-validation. The diagnostic abilities of the radiomics classifier and visual assessment by two head and neck radiologists were evaluated using receiver operating characteristic (ROC) analyses for distinguishing SCC from lymphoma. Nineteen radiomics features were selected at least twice during the five-fold cross-validation. The mean area under the ROC curve (AUC) of the radiomics classifier was 0.750 [95% confidence interval (CI), 0.613-0.887], with a sensitivity of 84.2%, specificity of 60.3%, and an accuracy of 65.5%. Two human readers yielded AUCs of 0.613 (95% CI, 0.467-0.759) and 0.663 (95% CI, 0.531-0.795), respectively. The radiomics-based machine learning model can be useful for differentiating SCC from lymphoma of the oropharynx.

Sonographic Assessment of Oropharynx Movement During Deep Breathing

To investigate the feasibility of ultrasonography in detecting the oropharynx movement during deep breathing and to quantitatively analyze oropharynx airway lumen changes during deep breathing. The motions of oropharynx were monitored, and sonographic measurements of airway lumen were obtained during deep breathing in 448 healthy volunteers. Adequate visualization of oropharynx movement was obtained on all healthy volunteers. The anterior-posterior (AP) diameters and AP/transverse (T) diameter ratios were greater at the end of deep inspiration than that at the end of deep expiration for each sex (p < 0.01). The anterior-posterior dimensional changes were greater than lateral airway dimensional changes each sex (p < 0.05). Ultrasonography could provide realistic impression of the process on the oropharynx movement during deep breathing and perform the quantitative analysis of the oropharynx airway lumen changes during deep breathing. The results were encouraging and supported the utility of ultrasonography in future studies.

Evaluation of changes in the upper airway after Twin Block treatment in patients with Class II malocclusion

The purpose of this prospective case control study is to describe in growing patients with mandibular hypoplasia, treatment outcomes following functional therapy in terms of volumetric changes in nasopharynx and oropharynx, that is, upper and lower pharynx. We recruited 60 study participants aged between 8 and 12 years having mandibular Class II malocclusion and a reduced upper airway (UA) size, as determined by McNamara cephalometric analyses. Forty patients received Twin Block treatment, whereas the remaining 20 patients did not receive treatment, thus constituting the control group. The control group included patients who did not start treatment after their first visit but returned for a consultation one or 2 years later. All patients underwent an initial teleradiography examination of the skull and a final teleradiography examination to measure changes using McNamara cephalometric analysis of the UA. Pretreatment and posttreatment changes were assessed using Student's t test for independent samples with a significance level of 0.05. Both anatomical structures analyzed-the upper pharynx (nasopharynx) and lower pharynx (oropharynx)-showed significant increases after treatment regardless of whether the patients were boys or girls. The controls showed a decrease in UA size on average after approximately 2 years of growth. A clear relationship exists between the mandibular advancement achieved with TB treatment and an increased UA size. Therefore, the appliance is considered suitable for improving the respiratory quality of growing patients with a decreased UA size.

Three-dimensional evaluation of changes in upper airway volume in growing skeletal Class II patients following mandibular advancement treatment with functional orthopedic appliances

OBJECTIVES

The aim of this study was to assess three-dimensionally the upper airway changes following functional appliance treatment in growing Class II patients.

MATERIALS AND METHODS

Pre-and post-treatment Cone beam computed tomography scans of 20 patients (age range: 9 to 12; mean: 11.4 ± 1.0 years) were retrieved from the list of patients previously treated with functional appliances in the Postgraduate Clinic at the Section of Orthodontics, Aarhus University, Denmark. Total and partial volumes of the upper airway (ie, lower nasopharynx, velopharynx, and oropharynx) were calculated. To rule out the effect of growth, the changes in the functional appliance group were compared to an age-matched Class I group of 18 patients (age range: 8 to 14; mean: 11.8 ± 1.4 years).

RESULTS

In the functional appliance group, all the partial and total volumes were significantly larger at the end of treatment when compared to the start of treatment ( P < .003). On the other hand, when comparing the changes for the total and partial volumes of the upper airway in the functional appliance group with the Class I group, a statistical difference was seen only for the oropharynx ( P = .022) and total volume ( P = .025), with the functional appliance group showing a larger volume increment.

CONCLUSIONS

An increase in the upper airway volume was found after treatment with functional appliances. This difference was mainly related to the changes at the oropharynx level, which differed significantly from what was observed in the Class I group.

Perinatal diagnosis and management of oropharyngeal fetus in fetu: A case report

Fetus in fetu is an extremely rare congenital anomaly. We describe the perinatal diagnosis and management of a fetus with oropharyngeal and cervical fetus in fetu. High-resolution ultrasonography with 3-dimensional rendering can identify increased risks of airway obstruction in utero. Early identification allows a multidisciplinary team to be assembled for a scheduled ex utero intrapartum treatment procedure.

An unusual case of oropharyngeal chordoma: A case report and literature review

RATIONALE

Chordomas are rare malignant neoplasms derived from incomplete regression of notochordal tissue along the cranio-coccygeal axis. Chordomas that develop in an atypical position are called ectopic chordomas, such as oropharyngeal chordomas (OCs). OCs are exceedingly rare; only 11 cases have been reported to date. Preoperative diagnosis is challenging, and an accurate diagnosis thus is based on postoperative pathologic examination findings and immunohistochemistry. Although surgical therapy and radiotherapy is performed in some patients, the 5-year survival rate is low. Increasingly more studies of chordomas have been based on molecular biology to increase the survival rate, and targeted therapy could be a new therapy in the future.

PATIENT CONCERNS

The patient presented with a left oropharyngeal mass that had begun slowly enlarging 1 year previously. He reported a foreign body sensation and dysphonia during this time period.

DIAGNOSES

The patient was initially diagnosed with a neurogenic tumor. Routine postoperative pathology showed that the mass was consistent with a chordoma.

INTERVENTION

Mass resection was performed.

OUTCOME

One year after the initial surgery, magnetic resonance imaging revealed block signal images at the left retropharyngeal space and clivus. The patient developed recurrence of the OC.

LESSONS

Surgical resection is the mainstay of treatment for OC, and postoperative adjuvant radiotherapy is also important. An understanding of the unusual case described in this report may be helpful in diagnosing OC, and development of targeted therapy may help clinicians to provide novel treatment for patients with OC.

Anatomical relation between nasal septum deviation and oropharynx volume in different facial patterns evaluated through cone beam computed tomography

INTRODUCTION

The objective of this study was to establish the anatomical relation between nasal septum deviation (NSD) and oropharynx volume in different facial patterns using cone beam computed tomography (CBCT).

METHODS

Ninety CBCT examinations were analyzed. InVivoDental software was used to evaluate cephalometric image reconstructions in terms of facial type, determined from cephalometric measurements indicative of growth direction; the presence of NSD was also evaluated. ITK-SNAP software was employed for delimitation of the oropharynx. Intra-examiner error methods were recorded. The results were subjected to parametric and non-parametric tests using Bioestat 5.0.

RESULTS

A comparison of facial types revealed a significantly lower prevalence of NSD in the dolichofacial group compared with the brachyfacial and mesofacial groups (P = 0.0101 and 0.0149, respectively). In the total sample, there was a very strong positive relation between the presence of NSD and oropharynx space volume (P = 0.0162). The oropharynx volume was larger in all facial patterns in the presence of NSD.

CONCLUSION

The presence of NSD was not associated with facial type, although the oropharynx volume in patients with NSD increased. Therefore, deviation of the septum influences oropharynx volume.

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.

Effect of orthodontic treatment on the upper airway volume in adults

INTRODUCTION

The aim of this study was to examine the effects of orthodontic treatment with and without extractions on the anatomic characteristics of the upper airway in adults.

METHODS

For this retrospective study, the pretreatment and posttreatment cone-beam computed tomography scans of 74 adult patients meeting defined eligibility criteria were analyzed. Imaging software was used to segment and measure upper airway regions including the nasopharynx, the retropalatal, and retroglossal areas of the oropharynx, as well as the total airway. The Wilcoxon signed rank test was used to compare volumetric and minimal cross-sectional area changes from pretreatment to posttreatment.

RESULTS

The reliability values were high for all measurements, with intraclass correlation coefficients of 0.82 or greater. The volumetric treatment changes for the extraction and nonextraction groups were as follows: total airway, 1039.6 ± 3674.3 mm³ vs 1719.2 ± 4979.2 mm³; nasopharynx, 136.1 ± 1379.3 mm³ vs -36.5 ± 1139.8 mm³; retropalatal, 412.7 ± 3042.5 mm³ vs 399.3 ± 3294.6 mm³; and retroglossal, 412.5 ± 1503.2 mm³ vs 1109.3 ± 2328.6 mm³. The treatment changes in volume or minimal cross-sectional area for all airway regions examined were not significantly (P >0.05) different between the extraction and nonextraction groups.

CONCLUSIONS

Orthodontic treatment in adults does not cause clinically significant changes to the volume or the minimally constricted area of the upper airway. These results suggest that dental extractions in conjunction with orthodontic treatment have a negligible effect on the upper airway in adults.

Evaluation of the oropharynx in class I and II skeletal patterns by CBCT

PURPOSE

This study aimed to evaluate the dimensions of the oropharynx and its shape in the minimum cross-sectional area, in individuals with Class I and Class II skeletal patterns, using three-dimensional CBCT images.

METHODS

Forty-two cone-beam computed tomography images of grown individuals were evaluated. The images were divided according to the patient's skeletal patterns. The dimensions of the oropharyngeal airway space were determined using the Dolphin Imaging software.

RESULTS

The volume and the minimum cross-sectional area were greater in patients with a Class I skeletal pattern, with a median difference of 5379 mm³ and 86.8 mm², respectively. The anteroposterior and lateral diameters in the minimum cross-sectional area were also higher in Class I individuals (2.3 and 6.0 mm, respectively), but the ratio between them was not different.

CONCLUSIONS

The volume and the minimum cross-sectional area of the oropharynx, as well as the anteroposterior and lateral diameters, are lower in individuals with a class II skeletal pattern than in individuals with a class I skeletal pattern. There was no difference in the shape of the oropharynx in healthy individuals with different skeletal patterns.

Is Ultrasound a Valid and Reliable Imaging Modality for Airway Evaluation?: An Observational Computed Tomographic Validation Study Using Submandibular Scanning of the Mouth and Oropharynx

OBJECTIVES

Ultrasound (US) imaging of the airway may be useful in predicting difficulty of airway management (DAM); but its use is limited by lack of proof of its validity and reliability. We sought to validate US imaging of the airway by comparison to CT-scan, and to assess its inter- and intra-observer reliability. We used submandibular sonographic imaging of the mouth and oropharynx to examine how well the ratio of tongue thickness to oral cavity height correlates with the ratio of tongue volume to oral cavity volume, an established tomographic measure of DAM.

METHODS

A cohort of 34 patients undergoing CT-scan was recruited. Study standardized assessments included CT-measured ratios of tongue volume to oropharyngeal cavity volume; tongue thickness to oral cavity height; and US-measured ratio of tongue thickness to oral cavity height. Two sonographers independently performed US imaging of the airway before and after CT-scan.

RESULTS

Our findings indicate that the US-measured ratio of tongue thickness to oral cavity height highly correlates with the CT-measured ratio of tongue volume to oral cavity volume. US measurements also demonstrated strong inter- and intra-observer reliability.

CONCLUSIONS

This study suggests that US is a valid and reliable tool for imaging the oral and oropharyngeal parts of the airway, as well as for measuring the volumetric relationship between the tongue and oral cavity, and may therefore be a useful predictor of DAM.

Volumetric MRI Evaluation of Airway, Tongue, and Mandible in Different Skeletal Patterns: Does a Link to Obstructive Sleep Apnea Exist (OSA)?

Backgroun/Objectives: Craniofacial disharmony has been long debated as an important predisposing factor in the development and progression ofsleep-disordered breathing and OSA. The present study was aimed to determine and compare whether a direct correlation occurs between the airway volume, mandibular dimension, and tongue volume in different craniofacial growth patterns. The objectives were the 3D MR[ assessment and comparison ofairway volume, mandibular dimensions, and tongue volume in Class I normodivergent, Class II hyperdivergent, and OSA group.

MATERIALS/METHODS

Study population included 45 patients (12-18 years). Soft tissue volume estimation for airway [oropharyngeal (OP), nasopharyngeal (NP)] and tongue was carried out using MRI and DICOM image processing software(Osirix@ v5.6).Mandibular dimensions were characterized on MR, and derivations were made using the Pythagoras theorem. Subsequently, 3D reconstructions were carried out. The mean and standard deviation were obtained. Kruskal-Wallis and Wilcoxon rank sum test were used. Multiple regression analysis was performed for OP and NP volumes using BMI, mandibular area, and tongue volume as predictors for the complete sample.

RESULTS

It was found that in overall sample, mandibular length showed a positive correlation with OR NP and tongue volumes. For both OP and NP glossomandibular area, and tongue volume were found to be statistically significant predictors.

CONCLUSIONS/IMPLICATIONS

A direct correlation was confirmed between the airway volume, mandibular dimensions, and tongue volume in different craniofacial growth patterns. The present knowledge can be utilized on patients for treatment of reduced airway space using the derived formula for mandibular dimensions, and the regression equations can be used as a diagnostic aid in determining the OP and NP volume for any individual using 2D radiofraphs in orthodontics.

Are three-dimensional airway evaluations obtained through computed and cone-beam computed tomography scans predictable from lateral cephalograms? A systematic review of evidence

OBJECTIVE

To systematically review the literature correlating upper airway parameters between lateral cephalograms (LC) and cone-beam computed tomography (CBCT) or computed tomography (CT) scans to determine the utility of using LC to predict three-dimensional airway parameters.

MATERIALS AND METHODS

Both electronic and manual searches of the included studies were performed by two reviewers, and the quality of the studies that met selection criteria were assessed.

RESULTS

A total of 11 studies from the literature met the selection criteria. Assessed outcome variables showed correlation r < .7 between the LC and CT scans. The correlation between the LC and CBCT ranged from weak to strong with -.78 ≤ r and r ≤ .93 reported in the nasopharyngeal segment. In the oropharyngeal segment, a weak to strong correlation was reported with a range of -37 ≤ r and r ≤ .83 between the CBCT and LC. All associations in the hypopharyngeal segment showed a weak correlation. Four of studies were of weak quality, five were of moderate quality, and two were rated to be of strong quality.

CONCLUSION

No strong correlations were reported between the LC and CT scans. However, the LC-derived adenoid-nasopharyngeal ratio and the linear measurement (posterior nasal spine, PNS, to posterior pharyngeal wall) had a strong correlation with upright nasopharyngeal area and volume in the CBCTs. The area measurement in conventional LC can be also used as an initial screening tool to predict the upright three-dimensional oropharyngeal volumetric data. The variability of the hypopharyngeal segment cannot be predicted by LCs. However, more well-designed studies are needed to determine the clinical utility of using LC to predict airway size.

[Caustics injuries in the upper gastrointestinal tract: clinical and endoscopic features]

OBJECTIVE

To describe the clinical and endoscopic features of caustics injuries in the upper gastrointestinal tract in patients of the National Hospital Daniel Alcides Carrión.

MATERIALS AND METHODS

A descriptive study was conducted; the study populations were patients diagnosed with caustic ingestion who were admitted into the Gastroenterology service of the HNDAC to perform an upper endoscopy during the period of January 2009 to December 2012. We documented the type of caustic substance ingested, cause of intake, amount ingested, intake mode, signs or symptoms present, endoscopic findings as classified by Zargar, presence of complications and treatment performed. Analysis was performed comparing them based on the ingested caustic type: acid or alkali.

RESULTS

We obtained 91 patients; the average age was 30.6±16.3 years. Caustic substances ingested were: bleach (sodium hypochlorite) in 71 (78%) patients, muriatic acid (hydrochloric acid) in 18 (20%) patients, caustic soda in 2 (2%) patients. The average intake was 136ml (30-500 ml). The most frequent signs and symptoms were vomiting, abdominal pain, nausea and sore throat. The 46% of patients had injuries. 100% of patients who ingested acid and 33% who ingested alkali had lesions. Five (5%) patients had oropharyngeal lesions, 24 (26%) in the esophagus, 36 (40%) in the stomach and 12 (13%) in the duodenum. Grade I lesions were found in 10 (11%) patients, 16 (18%) patients with grade II lesions and 15 (16%) of patients with grade III, 12 patients who toke acid had lesions of grade III. Esophageal stricture was found in 2 (2%) patients, gastric stenosis in 7 (8%) patients and esophageal and gastric stenosis in 3 (3%) patients. Two patients required pneumatic dilation and 10 surgical treatments.

CONCLUSION

Most injuries were found in the stomach. Acidic injuries occur more frequently and with greater severity than alkaline. Acidic substances produce esophageal or gastric stenosis more frequently than alkaline.

[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.

Gender-related difference in the upper airway dimensions and hyoid bone position in Chinese Han children and adolescents aged 6-18 years using cone beam computed tomography

OBJECTIVE

To investigate the gender-related differences in upper airway dimensions and hyoid bone position in Chinese Han children and adolescents (6-18 years) using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT-scans of 119 boys and 135 girls were selected and divided into four groups (group 1: 6-9 years; group 2: 10-12 years; group 3: 13-15 years; group 4: 16-18 years). The airway dimensions including the cross-sectional area (CSA), anteroposterior (AP) and lateral (LAT) width, length (L), mean CSA and volume (VOL) of upper airway segmentations and hyoid bone position including 11 linear and three angular measurements were investigated using Materialism's interactive medical image control system (MIMICS) 16.01 software. Gender-related differences were analyzed by two independent sample t-tests.

RESULTS

No gender-related difference was found in values of the facial morphology, airway dimensions and hyoid bone position for group 1 (p > 0.05). The children and adolescents in groups 2, 3 and 4 showed significant gender-related differences in the measurement results of facial morphology, airway dimensions and hyoid bone positions (p < 0.05). What's more, the measurement values of boys were obviously larger than those of girls except some measurements in group 2.

CONCLUSIONS

The measurements of airway dimensions and hyoid bone positions have gender-related differences in children and adolescents aged 10-18 years. These results could be taken into consideration during orthodontic diagnosis and treatment.

Carotid stent extrusion following carotid blowout

OBJECTIVE

We describe an unusual foreign body, a carotid stent extruded into the upper airway, and discuss the predisposing factors.

METHODS

This is a single patient case report with review of the literature.

RESULTS

Our patient is a 59 year old female treated for T3N2aM0 (stage IVa) left tonsil squamous cell carcinoma who experienced a carotid blowout treated by carotid stent placement with subsequent carotid coiling and vessel takedown. Approximately ten months later, she coughed and expelled approximately 3cm of tubular stent-appearing material into her airway causing acute stridor and dysphagia. CT angiography (CTA) showed the distal and proximal stent in proper position without evidence of extravasation. The stent was extracted transorally showing the distal end of the carotid to be patent and covered by fibrin within its lumen. Review of the literature shows that such stent extrusions, although rare, do occur.

CONCLUSION

Carotid stents are a valuable tool in cases of carotid blowout. However, long-term data on patient prognosis is lacking. The foreign body response triggered by stent placement can cause dislodgement. The potential for stent extrusion is greatest in patients who have preexisting ulceration or who have undergone radiation, both common in head and neck cancer patients.

Comparison of pharyngeal airway volume among different vertical skeletal patterns: a cone-beam computed tomography study

OBJECTIVE

To test the null hypothesis that there are no significant differences in pharyngeal airway volumes among adult patients with different vertical skeletal patterns and a clinically normal sagittal skeletal pattern using cone-beam computed tomography (CBCT).

MATERIAL AND METHODS

The study sample consisted of 100 adult patients (45 men and 55 women; mean age  =  24.0 ± 5.3 years) with a normal sagittal skeletal pattern divided into three groups according to the vertical skeletal patterns: high angle (32 patients: 15 women and 17 men), low angle (34 patients: 14 women and 20 men), and normal angle (34 patients: 16 women and 18 men) groups. Nasopharyngeal, oropharyngeal, and total airway volumes of patients in all vertical groups were calculated. Group differences were analyzed using one-way analysis of variance and post hoc Tukey tests.

RESULTS

Nasopharyngeal airway volume in the high-angle group (mean  =  6067.9 ± 1693.9 mm(3)) was significantly lower than that of the low- and normal-angle groups (P < .01). Oropharyngeal airway volume was highest in the low-angle group (mean  =  15,957.6 ± 6817.2 mm(3)) and significantly decreased in the control (mean  =  11,826.1 ± 4831.9 mm(3); P  =  .008) and high angle (mean  =  10,869.1 ± 4084.1 mm(3); P  =  .001) groups. Total airway volume was highest in the low-angle group (mean  =  24,261.6 ± 8470.1 mm(3)) and lowest in the high-angle group (mean  =  16,937.0 ± 5027.4 mm(3); P < .001).

CONCLUSION

The null hypothesis was rejected. Significant differences were found in pharyngeal airway volumes among different skeletal vertical patterns.

Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography

OBJECTIVE

To determine the treatment effects of the Xbow appliance on the upper airway dimensions and volume using cone-beam computed tomography (CBCT); to evaluate the cephalometric changes in the skeletal and dental structures of the skeletal Class II patients.

MATERIALS AND METHODS

The sample consisted of 25 Class II patients (11 male, 14 female) with a mean age of 11.1 ± 1.1 years. CBCT images were obtained at the beginning of the treatment (T0) and after the debonding of the Xbow (T1).

RESULTS

Changes in superior, middle, and inferior parts of the oropharynx in the retroglossal region and changes in the oropharyngeal airway volume were statistically significant (P < .05, P < .01). The differences favoring the Xbow for the changes in the direction of Class II correction included SNA, SNB, ANB, maxillary depth angles, and point A-NPg and Co-B distances. Data of the dental parameters showed palatal tipping and extrusion of the maxillary incisors, labial tipping of the mandibular incisors, and mesial movement and extrusion of the mandibular molars.

CONCLUSIONS

Treatment with the Xbow appliance in Class II patients resulted in favorable increase in the oropharyngeal airway dimensions and volume. Further studies with larger study samples and with control groups are needed.

The relationship of vertical skeletofacial morphology to oropharyngeal airway shape using cone beam computed tomography: possible implications for airway restriction

OBJECTIVE

To determine if the shape of the oropharyngeal airway is related to the vertical morphology of the skeletofacial complex, including the hyoid bone.

MATERIALS AND METHODS

Cone beam computed tomography scans from 50 pretreatment adult orthodontic records were used to obtain skeletal and airway measurements. Linear regression statistics were used to compare soft tissue variables to hard tissue predictor variables.

RESULTS

Transverse airway widening was significantly increased when the distance between the hyoid and vertebrae was reduced; when the three-dimensional (3D) facial axis angle decreased (became more vertical); when the 3D mandibular plane angle increased; when the width of the hyoid increased, or when the calculated length of the geniohyoid decreased.

CONCLUSIONS

A laterally elliptical airway-found when the face is more vertical and when the hyoid is closer to the cervical vertebrae-is hypothetically more resistant to collapse. Patients with a retrognathic, skeletal deep bite and a rounded oropharynx should be identified and corrected early to prevent potential airway problems.

Effects of fixed functional therapy on tongue and hyoid positions and posterior airway

OBJECTIVE

To evaluate how therapy with a fixed functional appliance affects airway dimensions, dentoalveolar changes, and tongue and hyoid positions.

MATERIALS AND METHODS

A retrospective study was carried out on 46 pre- and posttreatment lateral cephalometric radiographs of 23 post-peak Class II patients (12 girls, 11 boys) treated with a Forsus Fatigue Resistant Device (FRD) appliance. The radiographies were taken at the start and at the end of Forsus FRD appliance therapy when a Class I or overcorrected Class I canine and molar relationship was achieved. The process took an average of 5 months 13 days ± 1 month 4 days. Skeletal and dental parameters were measured using Dolphin software, and the sagittal airway area was measured by AutoCAD software.

RESULTS

Analyses of the pre- and posttreatment means revealed that there was no statistically significant skeletal correction of the sagittal malocclusion; increase of lower incisor inclination, decrease of upper incisor inclination, decrease of interincisal angle, and rotation of occlusal plane all contributed to the reduction of overjet. The tongue area and intermaxillary space area increased in response to these dentoalveolar changes; however, there was no statistically significant change in the hyoid position or the oropharyngeal area between the two time points.

CONCLUSIONS

The dentoalveolar changes produced by Forsus FRD appliance did not cause any significant posterior airway changes in young adult patients.

Unusual presentations of choanal polyps: report of 3 cases

Most choanal polyps arise from the maxillary sinus, and they are called antrochoanal polyps. Their typical endoscopic and radiologic appearance makes them easy to diagnose. However, some choanal polyps originate in unusual sites in the paranasal sinuses and nose, such as the sphenoid sinus and the lateral wall of the nose. These polyps usually present unilaterally, although bilateral presentations are possible. We describe 3 cases of atypical choanal polyps: a sphenochoanal polyp, bilateral antrochoanal polyps, and a giant antrochoanal polyp. In each case, nasal endoscopy and computed tomography clinched the diagnosis, and endoscopic surgery was performed to successfully remove the polyp. We discuss the clinical characteristics of these 3 cases.

[Possibilities of ultrasound diagnosis of esophageal cancer]

The investigation was undertaken to estimate the possibilities of the current ultrasound study (USS) in patients with esophageal cancer for its specifying diagnosis and the evaluation of the efficiency of performed treatment. The paper gives data on the current possibilities of ultrasound diagnosis in patients with esophageal cancer, which, during one study, makes it possible to visualize the tumor, to characterize its sizes and structure, to reveal enlarged regional lymph nodes, and to evaluate the oropharynx and abdominal organs. A definite USS program was used to examine 54 patients with verified esophageal cancer (42 (77.8%) men and 12 (22%) women aged 53 to 76 years). The patients' mean age was 65.3 +/- 4.8 years. The upper, middle, and lower esophagus was involved in 7 (13%), 41 (76%), and 6 (11%) patients, respectively. Most examinees had stages III and IV, received combined chemoradiation therapy. There was satisfactory and good visualization of middle esophageal tumor in 88% of the patients. USS identified enlarged paraesophageal lymph nodes in 22%. Enlarged nodes in the neck and supra- and subclavicular areas were detected in 16 (30%) patients, including 10 patients with stage IVa.

[Sonographic examination of the soft palate in dogs]

PURPOSE

The aim of this study was to characterize the normal sonographic anatomy of the soft palate in dogs.

MATERIALS AND METHODS

The study was performed on seven canine heads via a submental and intraoral approach. The detected anatomical structures were then reexamined via a submental approach in a water bath. Each anatomic layer was subsequently dissected starting with the submental layers and working towards the soft palate. After every preparation a sonographic examination was carried out.

RESULTS

Differentiation between the soft palate and the surrounding oropharyngeal tissue can be effectively achieved. Using the submental approach, the transition between hard palate and soft palate as well as the middle section of the soft palate were distinguished from other oropharyngeal structures in all cases. Visualization of the caudal part of the velum and evaluation of the echogenicity of the soft palate were difficult and not always possible. In the two brachycephalic dogs of the study, it was challenging to distinguish the soft palate from the surrounding tissue.

CONCLUSION

The sonographic appearance of the canine soft palate in cadavers was described in this study. The submental approach allows differentiation between intraoral structures. Evaluation of the echogenicity and length of the soft palate is limited.

Teledynamic evaluation of oropharyngeal swallowing

PURPOSE

The objective of the present investigation was to test the feasibility and clinical utility of a real-time Internet-based protocol for remote, telefluoroscopic evaluation of oropharyngeal swallowing.

METHOD

In this prospective cohort study, the authors evaluated 32 patients with a primary diagnosis of stroke or head/neck cancer. All patients participated in 2 separate fluoroscopic swallowing evaluations--one traditional on site and one telefluoroscopic off site--through the use of a telemedicine system. Agreement between sites was tested for 3 categories of variables: (a) overall severity of swallowing difficulty, (b) presence and extent of laryngeal penetration and aspiration as rated by the 8-point Penetration-Aspiration scale, and (c) treatment recommendations.

RESULTS

Results showed overall good agreement in subjective severity ratings (κ = 0.636) and in Penetration-Aspiration scale ratings (mean absolute difference = 1.1 points) between the onsite and offsite clinicians. Agreement in treatment recommendations was moderate to high, ranging from 69.3% to 100%.

CONCLUSIONS

The present study supports the feasibility and clinical utility of a telemedicine system for evaluating oropharyngeal swallowing. Given the difficulty and expertise needed to complete such evaluations, this study offers promising clinical avenues for patients in rural, remote, and underserved communities and countries where expert swallowing specialists are not available.

Developmental sexual dimorphism of the oral and pharyngeal portions of the vocal tract: an imaging study

PURPOSE

The anatomic origin for prepubertal vowel acoustic differences between male and female subjects remains unknown. The purpose of this study is to examine developmental sex differences in vocal tract (VT) length and its oral and pharyngeal portions.

METHOD

Nine VT variables were measured from 605 imaging studies (magnetic resonance imaging and computed tomography) of subjects between birth and age 19 years. Given sex differences in growth rate (Vorperian et al., 2009), assessment of sex differences was done through use of a localized comparison window of 60 months. Analysis entailed applying this comparison window first to 4 discrete age cohorts, followed by a progressive assessment in which this comparison window was moved in 1-month increments from birth across all ages.

RESULTS

Findings document significant postpubertal sex differences in both the oral and pharyngeal portions of the VT. They also document periods of significant prepubertal sex differences in the oral region first, followed by segments in the pharyngeal region.

CONCLUSIONS

Assessment of developmental sex differences using localized age ranges is effective in unveiling sex differences that growth rate differences may conceal. Findings on the presence of prepubertal sex differences in the oral region of the VT may clarify, in part, the anatomic basis of documented prepubertal acoustic differences.

Comparison of pharyngeal airway changes on plain radiography and cone-beam computed tomography after orthognathic surgery

PURPOSE

The purpose of the present prospective study was to develop a 3-dimensional analysis of the airway using cone-beam computed tomography (CBCT) and to determine whether changes in the airway before and after orthognathic surgery correlate on 2-dimensional lateral cephalogram and 3-dimensional CBCT images.

MATERIALS AND METHODS

Patients requiring orthognathic surgery during 2004 to 2005 were recruited for the present study. Lateral cephalograms and CBCT scans were obtained at 3 points: preoperatively, within 1 month postoperatively, and after 6 months postoperatively. The nasopharynx, oropharynx, and hypopharynx were segmented on both the radiograph and the CBCT scan for each patient in a repeatable manner at each point. For the lateral cephalogram, linear measurements in the middle of each of the 3 segments were obtained. For the CBCT, volumetric measurements of each of the 3 segments were obtained. The intrarater variability was assessed, and Pearson's correlation was used to compare the 2 imaging modalities.

RESULTS

A total of 20 patients scheduled for orthognathic surgery were recruited for the present study. Of the 20 patients, 13 were female and 7 were male. The mean age at surgery was 23.85 years (range 14 to 43). Of the 20 patients, 6 underwent maxillary advancement only, 8 underwent mandibular advancement with or without genioplasty, and 6 underwent 2-jaw surgery or mandibular setback. We examined the entire cohort without separation into procedure or examination point and found a weak, but statistically significant, correlation between the linear and volume measurements in the nasopharyngeal and oropharyngeal regions but not in the hypopharyngeal region (r = 0.43, P < .002; r = 0.49, P < .0002; r = 0.16, P = .26, respectively). The maxillary advancement group (n = 6) demonstrated a correlation between the linear and volume measurements in the nasopharyngeal region (r = 0.53, P = .03). The mandibular advancement with or without genioplasty group (n = 8) showed a correlation in the nasopharyngeal and oropharyngeal regions (r = 0.55, P < .02, and r = 0.46, P = .05, respectively). For the combination/setback procedures (n = 6), a correlation was found in the oropharyngeal region (r = 0.64, P < .01). All other comparisons between the linear and volume measurements did not correlate. Additionally, no correlations were found between the linear and volumetric change in airway size between 6 months postoperatively and preoperatively, except for the oropharyngeal region (r = 0.67, P < .01).

CONCLUSION

We present a method of measuring the airway that could be used for both 2-dimensional and 3-dimensional images. It includes segmentation of the pharyngeal airway into its nasopharyngeal, oropharyngeal, and hypopharyngeal components. Correlations were found between the linear and volumetric measurements of the segmented airway in patients who had undergone orthognathic surgery; however, the correlations were generally weak.