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Lee HL, Chung CH, Hsu YT, Chung KH, Chien WC, Chiu HC. Influence of Obstructive Sleep Apnea on the Risk of Dental Caries: Insights from a 13-Year Population-Based Retrospective Study. JDR Clin Trans Res 2024:23800844241246198. [PMID: 38733110 DOI: 10.1177/23800844241246198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT Obstructive sleep apnea has been proven to have a great negative impact on patients, and the relationship between sleep apnea and dental caries is still inconclusive. Our study shows that patients with sleep apnea and those older than 45 y have a significant risk of dental caries.
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Affiliation(s)
- H L Lee
- Department of Oral and Maxillofacial Prosthodontics, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
- Department of Oral Health Science, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - C H Chung
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Y T Hsu
- Department of Oral Health Science, School of Dentistry, University of Washington, Seattle, Washington, USA
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - K H Chung
- Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, Washington, USA
| | - W C Chien
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - H C Chiu
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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2
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Bradshaw B, Jaffal H, Wysocki CA, Grover LA, Mitchell RB, Ulualp S, Shah GB, Chorney SR. Chronic Granulomatous Disease of the Upper Airway. Ear Nose Throat J 2024; 103:289-292. [PMID: 34670444 DOI: 10.1177/01455613211054635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Brad Bradshaw
- Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hussein Jaffal
- Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian A Wysocki
- Departments of Internal Medicine and Pediatrics, Division of Allergy/Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lyndsey A Grover
- Division of Pediatric Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatric Anesthesiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Seckin Ulualp
- Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Gopi B Shah
- Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA
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Grobman M, Reinero C, Lee‐Fowler T, Lever TE. Incidence and characterization of aerophagia in dogs using videofluoroscopic swallow studies. J Vet Intern Med 2024; 38:1449-1457. [PMID: 38561963 PMCID: PMC11099788 DOI: 10.1111/jvim.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Aerophagia (ingestion of air), is a functional aerodigestive disorder in people. Criteria for diagnosis of aerophagia in dogs are >1/3 of bolus volume containing air or ingested air resulting in gastric distention (>1/3 of end gastric volume). Aerophagia is highlighted during eating and drinking. Videofluoroscopic swallow studies (VFSS) document aerophagia in dogs, but the incidence, clinical signs (CS), and associated disorders are unknown. OBJECTIVES Identify the incidence of aerophagia, compare CS between dogs with and without aerophagia, and identify associated and predisposing disorders using VFSS. ANIMALS A total of 120 client-owned dogs. METHODS Sequential VFSS and associated medical records from dogs presenting to veterinary teaching hospitals at Auburn University and the University of Missouri were retrospectively reviewed. Statistical comparisons were made using Mann-Whitney and chi-squared tests, odds ratios (OR), and multiple logistic regression (P < .05). RESULTS The incidence (95% confidence interval [CI]) of aerophagia was 40% (31.7-48.9). Dogs with mixed CS (gastrointestinal [GI] and respiratory; P < .001, 58.3%) were more likely to have aerophagia than dogs with exclusively respiratory CS (25%). Aerophagia was significantly more common in brachycephalic dogs (P = .01; 45.8% vs 13.8%), dogs with nonbrachycephalic upper airway obstruction (P < .001; 33.3% vs 4.1%), pathologic penetration and aspiration (P-A) scores (P = .04; 41.6% vs 23.6%), and gagging (P < .001; 25% vs 11.7%). Mixed CS (P = .01), brachycephaly (P < .001), and upper airway obstruction (P < .001) were independent predictors of aerophagia. CONCLUSIONS AND CLINICAL IMPORTANCE Aerophagia was common, particularly in dogs with mixed CS. Brachycephalic dogs and dogs with upper airway obstruction are predisposed. Aspiration risk was high, emphasizing overlapping upper aerodigestive pathways.
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Affiliation(s)
- Megan Grobman
- Department of Clinical SciencesAuburn University College of Veterinary MedicineAuburnAlabamaUSA
- Department of Veterinary Medicine & SurgeryUniversity of Missouri Veterinary Health CenterColumbiaMissouriUSA
| | - Carol Reinero
- Department of Veterinary Medicine & SurgeryUniversity of Missouri Veterinary Health CenterColumbiaMissouriUSA
| | - Tekla Lee‐Fowler
- Department of Clinical SciencesAuburn University College of Veterinary MedicineAuburnAlabamaUSA
| | - Teresa E. Lever
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Missouri School of MedicineColumbiaMissouriUSA
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Chatwin M, Sancho J, Lujan M, Andersen T, Winck JC. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J Clin Med 2024; 13:2643. [PMID: 38731172 PMCID: PMC11084470 DOI: 10.3390/jcm13092643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters.
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Affiliation(s)
- Michelle Chatwin
- Neuromuscular Complex Care Centre, The National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, London WC1N 3BG, UK;
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, Part of Guys and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Jesus Sancho
- Respiratory Medicine Department, Hospital Clínico Universitario, 46010 Valencia, Spain;
- Institute of Health Research INCLIVA, 46010 Valencia, Spain
| | - Manel Lujan
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
- Centro de Investigación Biomédica en Red (CIBERES), 28029 Madrid, Spain
| | - Tiina Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, 5021 Bergen, Norway;
- The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Joao-Carlos Winck
- Cardiovascular R&D Centre (UniC), Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
- Pulmonology Unit, Instituto CUF, 4460-188 Porto, Portugal
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Sutthipongkiat E, Chumpathong S, Boonmak L, Panyamee S, Vorasanon K, Mangmeesri P. Emergency Tracheostomy: Complications, Anesthetic Techniques, and Outcomes. Ear Nose Throat J 2024:1455613241238620. [PMID: 38462908 DOI: 10.1177/01455613241238620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Objectives: Acute upper airway obstruction is a critical medical condition that presents considerable challenges to anesthesiologists. This study aims to provide a formal report on the incidence and outcomes of perioperative complications, as well as the factors that influence unstable intraoperative hemodynamics. Methods: This retrospective study reviewed patients aged 18 years and older who underwent emergency tracheostomy between January 2013 and October 2021. Data on perioperative complications and outcomes within the first 24 hours and 7 days after surgery were subjected to analysis. Descriptive and multivariate analyses were used to examine the results. Results: A total of 253 patients were included in the study. The mean age was 61.5 ± 12.9 years. Malignancy was detected in 78.3% of the patients. General anesthesia was administered to 43.9% of the patients. The incidence of intraoperative complications was 51.8%, with hypotension and hypertension occurring in 30.4% and 22.5% of the cases, respectively. Desaturation and cardiac arrest were observed in 4.7% and 0.8% of the patients, respectively. The mortality rate at 7 days after surgery was 1.6%. Multivariate analysis revealed that monitored anesthesia care [adjusted odds ratio (OR) = 1.80; 95% confidence interval (CI): 1.08-3.00] and hypertensive patients (adjusted OR = 1.70, 95% CI: 1.01-2.86) were associated with unstable intraoperative hemodynamics. Conclusions: Cardiovascular instability represented the majority of the complications observed. Monitoring anesthesia care and hypertension were significant prognostic factors for unstable intraoperative hemodynamics. We recommend extensive communication between ear, nose, and throat surgeons and anesthesiologists to determine the appropriate choice of anesthesia.
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Affiliation(s)
- Ekanong Sutthipongkiat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowapark Chumpathong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lapatrada Boonmak
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sriwimon Panyamee
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khanittha Vorasanon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerachatra Mangmeesri
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ojha S, Poonia A, Sharma M, Bansal R, Gupta S. Nasal Pyriform Aperture Stenosis in a Newborn: When to Operate. Cureus 2024; 16:e56017. [PMID: 38606260 PMCID: PMC11008318 DOI: 10.7759/cureus.56017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is a very rare cause of neonatal respiratory distress and is often missed because of its rarity. It arises from the overgrowth of the nasal process of the maxilla. Maxillofacial CT scan findings of pyriform aperture width <11 mm in a full-term baby, median central incisor, triangular-shaped palate, and median palatal ridge confirm the diagnosis. We describe here a case of CNPAS admitted with respiratory distress that increased further on feeding. An infant feeding tube of size 6 was not negotiable through the nostrils. Resistance was appreciated at the inlet of the nostril. Maxillofacial CT showed pyriform aperture stenosis of 3.4 mm, suggesting CNPAS. The child could not be weaned off a high-flow nasal cannula despite conservative management with decongestants, steroids spray, dilatation, and stenting for 20 days. Subsequently, surgical widening of the nasal aperture by a sublabial approach was done. The child was discharged on the 10th postoperative day on full oral feeds. It is important to suspect CNPAS in neonates with respiratory distress where other common causes have been ruled out, as it can be treated by surgery in cases refractory to conservative management.
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Affiliation(s)
- Sunita Ojha
- Department of Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Anil Poonia
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Maya Sharma
- Department of Otorhinolaryngology, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Rajiv Bansal
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Supriya Gupta
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
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Bai X, Liu R, Feng S, Pu J, Gu Q. [Characterization of otorhinolaryngologic manifestations in children with mucopolysaccharide storage disease typeⅠand type Ⅱ]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:221-224;229. [PMID: 38433691 DOI: 10.13201/j.issn.2096-7993.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Indexed: 03/05/2024]
Abstract
Objective:To analyze the characteristics of otorhinolaryngological clinical manifestations in children with Mucopolysaccharide(MPS) type Ⅰ and type II in order to improve the knowledge of otorhinolaryngologists about this disease. Methods:Clinical data related to 55 children with MPS type Ⅰ and type II were retrospectively analyzed to investigate the clinical manifestations of MPS in ENT. Results:All 40 patients(72.72%) with MPS had at least one ENT symptom during the course of the disease, with 95% of them having an ENT symptom prior to the diagnosis of MPS; upper airway obstruction was the most common ENT symptom(34, 85.00%), followed by recurrent upper respiratory tract infections(23, 57.50%), and lastly, hearing loss(11, 27.50%); all 26 patients had undergone at least one surgical procedure, of which 15(57.69%) had undergone ENT surgery, and all of these patients underwent ENT surgery before diagnosis. The most common ENT surgery was adenoidectomy. Conclusion:Early clinical manifestations of MPS patients are atypical, but the early and prevalent appearance of otolaryngologic symptoms and increased awareness of the disease among otolaryngologists has a positive impact on the prognosis of MPS.
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Affiliation(s)
- Xinru Bai
- Graduate School of Peking Union Medical College,Beijing,100730,Chian
- Children's Hospital Affiliated to the Capital Institute of Pediatrics
| | - Rong Liu
- Children's Hospital Affiliated to the Capital Institute of Pediatrics
| | - Shunqiao Feng
- Children's Hospital Affiliated to the Capital Institute of Pediatrics
| | - Jian Pu
- Children's Hospital Affiliated to the Capital Institute of Pediatrics
| | - Qinglong Gu
- Graduate School of Peking Union Medical College,Beijing,100730,Chian
- Children's Hospital Affiliated to the Capital Institute of Pediatrics
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Choo H, Davis AS, Bain LC, Ahn H. Weight Gain of Infants with Robin Sequence Treated Nonsurgically Using the Stanford Orthodontic Airway Plate (SOAP): 1-Year Follow-Up. Cleft Palate Craniofac J 2024:10556656241233239. [PMID: 38373407 DOI: 10.1177/10556656241233239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To identify weight gain trends of infants with Robin sequence (RS) treated by the Stanford Orthodontic Airway Plate treatment (SOAP). DESIGN Retrospective longitudinal cohort study. SETTING Single tertiary referral hospital. PATIENTS Eleven infants with RS treated with SOAP. INTERVENTIONS Nonsurgical SOAP. MAIN OUTCOME MEASURES Body weight, Weight-for-age (WFA) Z-scores, and WFA percentiles at birth (T0), SOAP delivery (T1), SOAP graduation (T2), and 12-months old (T3). RESULTS Between T0 and T1, the weight increased but the WFA percentile decreased from 36.5% to 15.1%, and the Z-score worsened from -0.43 to -1.44. From T1 to T2, the percentile improved to 22.55% and the Z-score to -0.94. From T2 to T3, the percentile and the Z-scores further improved to 36.59% and -0.48, respectively. CONCLUSIONS SOAP provided infants experiencing severe respiratory distress and oral feeding difficulty with an opportunity to gain weight commensurate with the WHO healthy norms without surgical intervention.
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Affiliation(s)
- HyeRan Choo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Alexis S Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Lisa C Bain
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - HyoWon Ahn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
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Resnick CM, Katz E, Varidel A. Application of the MicroNAPS Classification for Robin Sequence. Cleft Palate Craniofac J 2024:10556656241229892. [PMID: 38303142 DOI: 10.1177/10556656241229892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE The only findings consistent among infants with Robin sequence (RS) are the presence of micrognathia, glossoptosis, and upper airway obstruction (UAO). Feeding and growth dysfunction are typical. The etiopathogenesis of these findings, however, is highly variable, ranging from sporadic to syndromic causes, with widely disparate levels of severity. This heterogeneity has created inconsistency within RS literature and debate about appropriate workup and treatment. Despite several attempts at stratification, no system has been broadly adopted. DESIGN We recently presented a novel classification that is summarized by the acronym MicroNAPS. Each of 5 elements is scored: Micrognathia, Nutrition, Airway, Palate, Syndrome/comorbidities, and element scores are summarized into a "stage". RESULTS Testing of this system in a sample of 100 infants from our center found it to be clinically relevant and to predict important management decisions and outcomes. CONCLUSIONS We herein present an interactive website (www.prscalculator.com) and printable reference card for simple application of MicroNAPS, and we advocate for this classification system to be adopted for clinical care and research.
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Affiliation(s)
- Cory M Resnick
- Associate Professor of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Eliot Katz
- Assistant Professor of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Pulmonary-Sleep Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Alistair Varidel
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Fellow in Pediatric Craniofacial Surgery, Boston Children's Hospital, Boston, MA, USA
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Weitzman RE, Shah HP, Modi VK, Maurrasse SE. Type 3 Laryngeal Clefts Presenting with Upper Airway Obstruction without Aspiration. Laryngoscope 2024; 134:977-980. [PMID: 37436152 DOI: 10.1002/lary.30849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/07/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
Traditionally, otolaryngologists are taught that the defining clinical feature of a laryngeal cleft is aspiration. However, in a small subset of patients-even those with extensive clefts-the sole presenting feature may be airway obstruction. Here, we report two cases of type III laryngeal clefts that presented with upper airway obstruction without aspiration. The first patient was a 6-month-old male with history of tracheoesophageal fistula (TEF) who presented with noisy breathing, initially thought to be related to tracheomalacia. Polysomnogram (PSG) demonstrated moderate OSA and modified barium swallow (MBS) was negative for aspiration. In-office laryngoscopy was notable for a mismatch of tissue in the interarytenoid region. A type III laryngeal cleft was identified on bronchoscopy, and airway symptoms resolved after endoscopic repair. The second patient was a 4-year-old male with a diagnosis of asthma who presented with progressive exercise-induced stridor and airway obstruction. In-office flexible laryngoscopy revealed redundant tissue in the posterior glottis and MBS was negative for aspiration. He was found to have a type III laryngeal cleft on bronchoscopy and his stridor and upper airway obstruction resolved after endoscopic repair. While aspiration is the most common presenting symptom of a laryngeal cleft, it is important to consider that patients can have a cleft in the absence of dysphagia. Laryngeal cleft should be included in the differential diagnosis for patients with obstructive symptoms not explained by other etiologies and in those with suspicious features on flexible laryngoscopy. Laryngeal cleft repair is recommended to restore normal anatomy and relieve obstructive symptoms. Laryngoscope, 134:977-980, 2024.
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Affiliation(s)
- Rachel E Weitzman
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York City, New York, USA
| | - Hemali P Shah
- Department of Surgery, Section of Pediatric Otolaryngology-Head & Neck Surgery, Yale School of Medicine, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | - Vikash K Modi
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York City, New York, USA
| | - Sarah E Maurrasse
- Department of Surgery, Section of Pediatric Otolaryngology-Head & Neck Surgery, Yale School of Medicine, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
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11
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McGrath JL, Mantilla-Rivas E, Aivaz M, Manrique M, Rana MS, Crowder HR, Oh NS, Rogers GF, Oh AK. Predicting Failure of Conservative Airway Management in Infants with Robin Sequence: The EARN Factors. Cleft Palate Craniofac J 2024:10556656231224194. [PMID: 38166451 DOI: 10.1177/10556656231224194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVE Evaluate infants with Robin Sequence (RS) who were successfully treated with conservative airway measures alone vs. those who failed and eventually underwent surgical airway intervention after a protracted course of conservative management. DESIGN Retrospective review of prospectively gathered database. SETTING Large tertiary care institution. PATIENTS Infants diagnosed with RS (n = 122) who underwent primary airway management at a single institution from 1994-2020. MAIN OUTCOME MEASURE Patient demographics, nutritional and respiratory status, laboratory values, and polysomnographic results were compared between patients who were discharged after successful conservative airway management (Group 1, n = 61) and patients that underwent surgical airway intervention after failing a prolonged course of conservative management (Group 2, n = 61). Receiver operating characteristic (ROC) curve analysis was done to assess continuous variables that may predict failure of conservative airway management. RESULTS 122 infants with RS were investigated. While several variables were significantly different between groups, the following polysomnographic EARN factors, with cut points, were identified as most predictive of failed conservative airway management: ETCO2 (max) > 49 mmHg, AHI > 16.9 events/hour, OAHI REM >25.9 events/hour, OAHI Non-REM > 23.6 events/hour. CONCLUSIONS We identified factors in infants with RS that were associated with severe UAO that failed to improve despite weeks of conservative airway management. Our results may expedite earlier definitive treatment of these critical patients and reduce risks for known complications of prolonged UAO.
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Affiliation(s)
- Jennifer L McGrath
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Marudeen Aivaz
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Monica Manrique
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Hannah R Crowder
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Nathanael S Oh
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Gary F Rogers
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Albert K Oh
- From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
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12
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Ben-David Y, Bentur L, Gur M, Ilivitzki A, Toukan Y, Nir V, Shallufi G, Dabbah H, Bar-Yoseph R. Pediatric negative pressure pulmonary edema: Case series and review of the literature. Pediatr Pulmonol 2023; 58:3596-3599. [PMID: 37737464 DOI: 10.1002/ppul.26700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Negative pressure pulmonary edema (NPPE) is a potentially life-threatening complication that develops rapidly following acute upper airway obstruction. The condition is rare, dramatic but resolves quickly. Prompt recognition and appropriate supportive treatment may prevent unnecessary investigations and iatrogenic complications. METHODS We describe a spectrum of etiologies and clinical manifestation of pediatric NPPE in our center and review of previous publications. CONCLUSION The etiology for the development of NPPE in children has shifted over the years. Although dramatic in presentation, this type of pulmonary edema often resolves quickly with minimal support.
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Affiliation(s)
- Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Anat Ilivitzki
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Husein Dabbah
- Pediatric Pulmonary Service, Baruch Padeh Medical Center, Poriya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Zefat, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Fleurance A, Leunen D, Végas N, Soupre V, Griffon L, Adnot P, Malecot G, Luscan R, Amiel J, Fauroux B, Abadie V. Developmental outcome of children with Robin sequence treated with the current Paris protocol. Acta Paediatr 2023; 112:2601-2610. [PMID: 37786287 DOI: 10.1111/apa.16979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
AIM We aimed to investigate the developmental outcome of children with Robin sequence (RS) for whom continuous positive airway pressure was the main strategy to release upper airway obstruction. METHODS We included children with isolated RS or RS associated with Stickler syndrome who were aged 15 months to 6 years. We used the French version of the Child Development Inventory and calculated the developmental quotient (DQ) for eight different domains and the global DQ (DQ-global). We searched for determinants of risk of delay. RESULTS Of the 87 children, for 71%, the developmental evolution was within the norm (DQ-global ≥86 or ≥-1 SD), 29% were at high risk of delay (DQ-global <86 or <-1 SD), and only 3% were at very high risk of delay (DQ-global <70 or <-2 SD). The DQs for expressive language and language comprehension were lower in our study population than the general population, but an improvement was noticed with the children's growth. CONCLUSION Risk of a developmental delay was not greater for children with the most severe respiratory phenotype than the others. Children whose mothers had low education levels were more at risk than the others.
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Affiliation(s)
- Alix Fleurance
- General Paediatrics Unit, Necker University Hospital, Paris, France
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
| | - Dorothée Leunen
- Pedopsychiatric Unit, Necker University Hospital, Paris, France
| | - Nancy Végas
- General Paediatrics Unit, Necker University Hospital, Paris, France
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Malformation and Embryology Lab, IMAGINE Institute, Paris, France
- Paris Cité University, Paris, France
| | - Véronique Soupre
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Maxillo-Facial and Plastic Surgery Unit, Necker University Hospital, Paris, France
| | - Lucie Griffon
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Sleep and Non-Invasive Ventilation Unit, Paris, France
| | - Pauline Adnot
- General Paediatrics Unit, Necker University Hospital, Paris, France
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Paris Cité University, Paris, France
| | - Gaelle Malecot
- General Paediatrics Unit, Necker University Hospital, Paris, France
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
| | - Romain Luscan
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Ear Nose and Throat Unit, Paris, France
| | - Jeanne Amiel
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Malformation and Embryology Lab, IMAGINE Institute, Paris, France
- Paris Cité University, Paris, France
- Medical Genetics Department, Necker University Hospital, Paris, France
| | - Brigitte Fauroux
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Paris Cité University, Paris, France
- Sleep and Non-Invasive Ventilation Unit, Paris, France
| | - Véronique Abadie
- General Paediatrics Unit, Necker University Hospital, Paris, France
- Reference Centre for Rare Disease-Centre de Référence Maladies Rares «Syndromes de Pierre Robin et troubles de succion-déglutition congénitaux», Paris, France
- Paris Cité University, Paris, France
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Özdemir G, Ozturk Z. An exceptional cause of acute respiratory failure in an infant: negative pressure pulmonary edema. Malawi Med J 2023; 35:234-235. [PMID: 38362569 PMCID: PMC10865057 DOI: 10.4314/mmj.v35i4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Acute respiratory failure is an important reason for pediatric intensive care admissions. Lung parenchymal disease, airway obstruction, or neuromuscular dysfunction are the most common causes. Negative pressure pulmonary edema, characterized by pulmonary edema associated with upper airway obstruction, can rarely cause sudden onset respiratory failure. Herein, we describe an infant who suffered sudden onset respiratory failure and pulmonary hemorrhage while being held facedown for a bath, was admitted to the pediatric intensive care unit, intubated and mechanically ventilated for three days, and was diagnosed with negative pressure pulmonary edema, and discharged without any sequelae. Negative pressure pulmonary edema is a rare entity. Its true frequency is not known due to the lack of awareness. This report aimed to increase clinician familiarity with negative pressure pulmonary edema in patients with sudden onset respiratory failure and/or pulmonary hemorrhage.
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Affiliation(s)
- Göktuğ Özdemir
- Department of Pediatric Intensive Care, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Zeynelabidin Ozturk
- Department of Pediatric Intensive Care, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
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15
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Demissie Z, Zemedkun N, Demile A, Nega B, Bekuretsion Y, Getachew B, Berhanu B. Primary Tracheobronchial Amyloidosis Presenting with an Upper Airway Obstruction. Int Med Case Rep J 2023; 16:757-761. [PMID: 38020579 PMCID: PMC10661957 DOI: 10.2147/imcrj.s438379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
This is a case of localized primary tracheobronchial amyloidosis in a patient who presented with upper airway obstruction. Tracheobronchial amyloidosis is a type of localized bronchopulmonary amyloidosis that is frequently overlooked. It involves the deposition of amyloid protein on the tracheal and bronchial tissue, leading to progressive tracheal stenosis and airway obstruction that can be seen on imaging as a tracheal mass. Because of its significant diagnostic difficulty and therapeutic conundrum, it ought to be considered in the differential diagnosis of upper airway symptoms with an unknown etiology.
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Affiliation(s)
- Zekewos Demissie
- Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia
| | - Nahom Zemedkun
- Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia
| | - Abraham Demile
- Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia
| | - Berhanu Nega
- Department of Surgery, Division of Cardiothoracic Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Bekuretsion
- Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bisrat Getachew
- Department of Otolaryngology, Head and Neck Surgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Bethelhem Berhanu
- Department of Radiology, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
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16
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Chebil A, Hasnaoui M, Masmoudi M, Ben Fatma A, Jerbi S, Mighri K. Cervical Aggressive Fibromatosis Causing Airway Obstruction. Ear Nose Throat J 2023:1455613231210392. [PMID: 37949917 DOI: 10.1177/01455613231210392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Fibromatosis or desmoid tumors are rare benign fibroblastic lesions that are rarely present in the head and neck regions. When they do occur in these regions, however, they tend to be aggressive toward the surrounding tissue and be associated with heavy morbidity and mortality. We report the case of a 26-year-old Tunisian female who presented with acute obstructive dyspnea and a 3-week history of cervical swelling. The swelling was initially only located in the left submandibular area, it then gradually extended to all the anterior cervical supra- and infrahyoid regions causing a clinical presentation resembling that of obstructive dyspnea, the patient was admitted, and an emergency tracheotomy was performed. Tissue samples were taken, pathological analysis revealed an aggressive case of fibromatosis. The patient was treated with corticosteroids and antihormonal therapy, the fibrous mass shrunk considerably allowing the removal of the tracheotomy cannula, no tumor recurrence was noted during the observation period. Due to the rarity of this disease, especially in the cervical region, there are no therapeutic guidelines available.
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Affiliation(s)
- Azer Chebil
- Department of Otorhinolaryngology-Head and Neck Surgery, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Mehdi Hasnaoui
- Department of Otorhinolaryngology-Head and Neck Surgery, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Mohamed Masmoudi
- Department of Otorhinolaryngology-Head and Neck Surgery, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Abedrraouf Ben Fatma
- Department of Radiology, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Saida Jerbi
- Department of Radiology, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Khelifa Mighri
- Department of Otorhinolaryngology-Head and Neck Surgery, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
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17
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Kosyk MS, Ruiz RL, Pontell ME, Carlson AR, Villavisanis DF, Zapatero ZD, Kalmar CL, Bartlett SP, Taylor JA, Swanson JW. Pharyngeal Airway Changes Following Mandibular Distraction Osteogenesis as Evaluated with Laryngoscopy. Cleft Palate Craniofac J 2023:10556656231204517. [PMID: 37915226 DOI: 10.1177/10556656231204517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
PURPOSE Mandibular distraction osteogenesis (MDO) may improve airway grade in patients with Robin Sequence (RS), but little is known about the response of the oropharyngeal airway to the distraction process in cases of tongue base obstruction (TBAO). This study used drug-induced sleep endoscopy (DISE) to evaluate the impact of MDO on the oropharynx. METHODS RS patients with severe obstructive sleep apnea (OSA) were prospectively enrolled, and underwent DISE prior to MDO, and at the time of distractor removal. Laryngoscopy views, glossoptosis degree, polysomnography (PSG) results, oxygen saturations and airway measurements were compared pre- and post-MDO. RESULTS Twenty patients met inclusion criteria. At the time of distractor placement, a grade II laryngoscopic view was most frequently observed (63%), and one patient (5%) had a grade I view. Median obstructive apnea hypopnea index (OAHI) improved after MDO (49.1 [30.2-74.0] to 9.1, [3.9-18.0], p ≤ .001). Median oxygen saturation nadir also improved (preoperative 69% [60-76] to 85% [82-91], p ≤ .001). At distractor removal, mean laryngoscopic view improved (p ≤ .002) with no views that were grade 3 or higher. Median intraoperative oropharyngeal width improved, (3.1 mm [2.8-4.4] to 6.0 mm [4.4-6.8], p ≤ .021), as did median cephalometric anteroposterior oropharyngeal width (3.5 mm [2.7-4.1] to 6.3 mm [5.6-8.2], p ≤ .002). CONCLUSION Following MDO, RS patients with TBAO have an approximate doubling of oropharyngeal width and an improvement in laryngoscopic grade. These findings likely contribute to improved oxygenation, OAHI and ease of intubation.
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Affiliation(s)
- Mychajlo S Kosyk
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ryan L Ruiz
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Matthew E Pontell
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Anna R Carlson
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Dillan F Villavisanis
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Zachary D Zapatero
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Christopher L Kalmar
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, USA
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18
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Fageeh YA. Clinical Impact of Preoperative Tonsil and Adenoid Size on Symptomatic Outcomes Following Adenotonsillectomy in Pediatric Patients. Cureus 2023; 15:e47093. [PMID: 38021551 PMCID: PMC10646436 DOI: 10.7759/cureus.47093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Adenotonsillar hypertrophy is a common clinical problem in pediatric patients. Adenotonsillectomy is a surgical intervention to remove airway obstruction and alleviate symptoms. However, some children continue to experience persistent symptoms after surgery. Objective This study aimed to investigate the relationship between preoperative tonsils and adenoid size and the persistence of symptoms, including snoring, mouth breathing, noisy breathing, and sleep apnea, after adenotonsillectomy in pediatric patients. Method This study was conducted in Taif, Saudi Arabia, and included 109 pediatric patients aged three to 14 years who underwent adenotonsillectomy. Data on preoperative and postoperative symptoms were collected through patient records and follow-up surveys. Tonsil and adenoid size were assessed using the Brodsky scale and endoscopic grading scales, respectively. Statistical analysis was performed using SPSS Version 26 (IBM Corp., Armonk, NY). Results The most prevalent presenting symptoms were snoring, mouth breathing, and noisy breathing. Tonsil size grades 3+ and 4+ were significantly more prevalent than the other grades (p<0.05). Adenoid size grades 3 and 4 were also significantly more prevalent than the other grades (p<0.05). Significant associations were observed between tonsil and adenoid size grades and specific presenting symptoms, such as snoring, mouth breathing, and noisy breathing. No significant correlations were found between preoperative tonsil or adenoid size and postoperative persistent symptoms. Conclusion While tonsil and adenoid size are essential factors in determining the need for surgery, they may not predict postoperative resolution of symptoms. A comprehensive evaluation of various clinical factors is necessary to understand the persistence of symptoms after surgery. Although adenotonsillectomy is an effective treatment for upper airway obstruction in pediatric patients, some individuals may experience residual symptoms.
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Affiliation(s)
- Yahya A Fageeh
- Otolaryngology - Head and Neck Surgery, College of Medicine, Taif University, Taif, SAU
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19
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Knechtel P, Weismann C, Poets CF. Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice. Children (Basel) 2023; 10:1628. [PMID: 37892291 PMCID: PMC10605622 DOI: 10.3390/children10101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
The Tübingen Palatal Plate (TPP) is a minimally invasive yet highly effective functional orthodontic treatment for upper airway obstruction in infants with Robin Sequence (RS). It consists of a palatal plate to cover the cleft and a velar extension that shifts the root of the tongue forward. We review our practical experience with this approach. First, upon admission, our local orthodontists perform an (3-D) intraoral scan of the maxilla. Based on the scan data, the TPP is manufactured in a semi-digital workflow. The length and angulation of its extension is checked via awake laryngoscopy and the effectiveness confirmed by a sleep study. Plates are kept in place by adhesive cream. When inserting the TPP, the tip of the tongue must be visible. Next, metal fixation bows should be secured to the forehead using tape and elastic bands. Plates are removed daily for cleaning, and the oral mucosa is then checked for pressure marks. Feeding training (initially only via finger feeding) may even start before plate insertion. Breathing often normalizes immediately once the plate is inserted. For isolated RS, we have never had to perform a tracheostomy. This has largely been possible through our highly dedicated and competent team, particularly the nursing staff, and the early involvement of parents.
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Affiliation(s)
- Petra Knechtel
- Department of Neonatology, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Christina Weismann
- Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, 72076 Tübingen, Germany
- Department of Orthodontics, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Christian F. Poets
- Department of Neonatology, Tübingen University Hospital, 72076 Tübingen, Germany
- Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, 72076 Tübingen, Germany
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van der Plas PPJM, van Heesch GGM, Koudstaal MJ, Pullens B, Mathijssen IMJ, Bernard SE, Wolvius EB, Joosten KFM. Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study. Cleft Palate Craniofac J 2023:10556656231199840. [PMID: 37728101 DOI: 10.1177/10556656231199840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. DESIGN Prospective study. SETTING Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS/ PARTICIPANTS 36 patients with Robin Sequence who were treated between 2011 and 2021. INTERVENTIONS Positional therapy and respiratory support. MAIN OUTCOME MEASURE(S) Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). RESULTS Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from -0.40 to -0.33 to -1.03, respectively. CONCLUSIONS Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.
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Affiliation(s)
- Pleun P J M van der Plas
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gwen G M van Heesch
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas Pullens
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Hand Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen F M Joosten
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
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Rappold T, Nishisaki A. Anticipating Pediatric Post-Extubation Risk: Calling All (North) Stars. Pediatr Crit Care Med 2023; 24:787-789. [PMID: 37668502 PMCID: PMC10491419 DOI: 10.1097/pcc.0000000000003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Thomas Rappold
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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22
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Andiné A, Tarnow P, Boivie P. Cleft Palate in Apert Syndrome: A Descriptive Study of Incidence and Surgical Outcome. Cleft Palate Craniofac J 2023:10556656231194445. [PMID: 37563888 DOI: 10.1177/10556656231194445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE Apert syndrome (AS) is a rare congenital craniofacial disorder that requires a multidisciplinary approach to treatment and multiple surgeries. Given that cleft palate (CP) is presented in some of these cases, this poses an additional risk of aggravating obstructed airways after closure. The timing and outcome of CP repair in these patients remains disputed and requires additional attention. DESIGN This retrospective analysis included patients diagnosed with CP and AS, born between 1950 and 2020, and treated at our institution. Data were collected from medical records and evaluated using descriptive statistics. SETTING Data analyses were conducted at Sahlgrenska University Hospital in Gothenburg, Sweden. PATIENTS/PARTICIPANTS A registry of 83 patients with AS resulted in a cohort of 26 patients also presenting with CP. MAIN OUTCOME MEASURES Postoperative complications, requirement for intensive care, and reoperations following CP repair. RESULTS CP incidence among all registered patients was 31%. Patients undergoing CP repair at low age (mean: 22.5 months) tended to experience more frequent postoperative complications and requirements for intensive care. Among the evaluated cohort with medical records describing CP repair (n = 14), 29% experienced postoperative complications, all of which involved aggravation of obstructed airways. CONCLUSIONS This study highlights the importance of airway assessment before and after CP repair in AS. The findings suggest that surgical outcomes might benefit from postponing CP repair, avoiding combined surgeries, and operating in two stages when indicated. However, additional and larger studies are required.
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Affiliation(s)
- Alicia Andiné
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Patrik Boivie
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
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23
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Yagiz Agayarov O, Arslan IB, Gumussoy M, Guclu G, Cukurova I. The Impact of the COVID-19 Pandemic on Urgent Awake Tracheotomies in Adults. Cureus 2023; 15:e44015. [PMID: 37753000 PMCID: PMC10519441 DOI: 10.7759/cureus.44015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Objective This study aims to investigate the impact of the COVID-19 pandemic on urgent awake tracheotomies (UATs) in adults in a reference center. Methodology During the pandemic (between March 2020 and May 2022) and before the pandemic (between January 2018 and March 2020), medical charts of patients who underwent UATs were reviewed. The analysis focused on demographic characteristics, indications, COVID-19 positivity status, surgical procedures, and complications. Results During the pandemic, 67 UATs (age 62.04 ± 11.9 years) were performed. Of the indications, 56 (83.5%) were malignancy. Before the pandemic, 22 UATs (age 63.86 ± 15.1 years) were performed, of which 14 UATs (63.6%) were due to malignancy. There was a significant increase in UATs and their indications in patients with head and neck malignancies (P < 0.05). Stay suture (65, 97%) and suture ligation of the thyroidal isthmus (61, 91%) were significantly performed during the pandemic (P < 0.05). Conclusions A significant increase in UAT was detected, especially in patients with advanced head and neck cancer. Pandemic conditions and the risk of viral transmission have led to more conservative UAT techniques.
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Affiliation(s)
- Ozlem Yagiz Agayarov
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Ilker Burak Arslan
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Murat Gumussoy
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Gulay Guclu
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Ibrahim Cukurova
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
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24
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Rudman L, Chambi-Torres JB, Chohan F, Aftab M, Cao X, Michel G. A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature. Cureus 2023; 15:e42152. [PMID: 37602134 PMCID: PMC10438953 DOI: 10.7759/cureus.42152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Negative-pressure pulmonary edema (NPPE) is an uncommon diagnosis that requires a high clinical suspicion to recognize and manage and has high morbidity and mortality. It usually results secondary to markedly negative intrapleural pressure due to the forceful inspiration against the obstructed airway from upper airway infection, tumor, or laryngospasm. We present a case of a 27-year-old female with morbid obesity who underwent sleeve gastrectomy and developed NPPE upon emergence from anesthesia. The focus of supportive care should be on addressing the obstruction in the upper airway through either endotracheal intubation or cricothyroidotomy. Additionally, it is important to initiate lung-protective positive-pressure ventilation and promote diuresis, unless the patient is in a state of shock. The resolution of pulmonary edema is typically swift, partially due to the preservation of alveolar fluid clearance mechanisms. In the literature review, we delve into the clinical presentation, pathophysiology, and management of NPPE or post-obstructive pulmonary edema.
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Affiliation(s)
- Larri Rudman
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | | | - Farah Chohan
- Research and Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - Mohammad Aftab
- Pulmonary and Critical Care, Larkin Community Hospital, South Miami, USA
| | - Xinyu Cao
- Pulmonary and Critical Care Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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25
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Alzahrani HA, Alkhaldi RO, Alsufyani DH, Alghamdi SA, Althobity TA, Fageeh YA. Adenoid Hypertrophy and Orthodontic Complications: An Assessment of Parental Knowledge in Saudi Arabia. Cureus 2023; 15:e41692. [PMID: 37575783 PMCID: PMC10413793 DOI: 10.7759/cureus.41692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background Adenoid hypertrophy is a common condition that can cause upper airway obstruction in children and adolescents, leading to various complications, including dental and maxillofacial abnormalities. However, parents may have limited knowledge of the orthodontic complications associated with this condition. Objective This study aimed to assess the knowledge and attitude of parents toward the orthodontic complications of untreated adenoid hypertrophy and to promote their awareness about this problem. Method This descriptive cross-sectional study involved 824 parents from all regions of Saudi Arabia. An online questionnaire was used to collect data on parents' demographics, their children's information, and their general knowledge about adenoid hypertrophy, including its symptoms, complications, and treatment. Results The study included 824 parents with a mean age of 36.78 ± 10.87 years, 73.2% of whom were women. Overall, only 6.2% (51.1 parents) had a good level of knowledge about adenoid hypertrophy. Conclusion The study highlights the importance of promoting awareness and educating parents about the orthodontic complications associated with adenoid hypertrophy. Greater awareness and understanding can help parents make better decisions for their children's health and well-being.
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Affiliation(s)
- Huda A Alzahrani
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | - Raghad O Alkhaldi
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | - Demah H Alsufyani
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | - Shatha A Alghamdi
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | | | - Yahya A Fageeh
- Otolaryngology, Head and Neck Surgery, College of Medicine, Taif University, Taif, SAU
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26
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Hasegawa A, Niimi N, Mitaka C, Hayashida M. Negative pressure pulmonary edema due to upper airway obstruction after general anesthesia in a patient with Parkinson's disease: A case report. Clin Case Rep 2023; 11:e7444. [PMID: 37266349 PMCID: PMC10229746 DOI: 10.1002/ccr3.7444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/29/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Abstract
In a patient with Parkinson's disease (PD) who underwent spine surgery 13 h after the last anti-Parkinson medications, negative pressure pulmonary edema from upper airway obstruction developed immediately after extubation. Although oxygenation improved with high-flow nasal cannula therapy, such complications might develop due to abrupt discontinuation of medication for PD.
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Affiliation(s)
- Ayaka Hasegawa
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
| | - Naoko Niimi
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
| | - Chieko Mitaka
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
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27
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Luján M, Lalmolda C. Ventilators, Settings, Autotitration Algorithms. J Clin Med 2023; 12:jcm12082942. [PMID: 37109277 PMCID: PMC10141077 DOI: 10.3390/jcm12082942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
The choice of a ventilator model for a single patient is usually based on parameters such as size (portability), presence or absence of battery and ventilatory modes. However, there are many details within each ventilator model about triggering, pressurisation or autotitration algorithms that may go unnoticed, but may be important or may justify some drawbacks that may occur during their use in individual patients. This review is intended to emphasize these differences. Guidance is also provided on the operation of autotitration algorithms, in which the ventilator is able to take decisions based on a measured or estimated parameter. It is important to know how they work and their potential sources of error. Current evidence on their use is also provided.
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Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigacion Biomédica en Red (CIBERES), 28029 Madrid, Spain
| | - Cristina Lalmolda
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
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28
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Martin S, Thorburn TG, Swan MC. Reflective Foreign Bodies Mimicking Fistulae of the Hard Palate in the Paediatric Population. Cleft Palate Craniofac J 2023:10556656231162445. [PMID: 36895089 DOI: 10.1177/10556656231162445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Palatal foreign bodies remain relatively rare, consequently, delays in diagnosis and misdiagnosis can occur leading to unnecessary anxiety and invasive investigations. We report three children with a reflective disc from inside a confetti balloon masquerading as a fistula of the hard palate. Awareness of this foreign body phenomenon enabled timely diagnosis in subsequent patients; hence the need to highlight such cases to the global cleft community. Crucially, while the foreign body remains in the oral cavity, there is an ongoing risk of airway aspiration which could be life threatening. Removal can be easily facilitated in the outpatient setting.
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Affiliation(s)
- Serena Martin
- Spires Cleft Centre, 11269John Radcliffe Hospital, Oxford, UK
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29
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Seyoum K, Mesfin T, Dadi S, Atlie G, Haji N. Upper airway obstruction following oropharyngeal bee sting: A case report. Trop Doct 2023; 53:291-292. [PMID: 36872872 DOI: 10.1177/00494755231159579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
There have been several reports globally of insect stings, which typically occur in the limbs, head, and neck. However, stings in the oropharynx and lower throat are rare but may be life-threatening. Clinical response to a sting range from minor local inflammation with or without envenomation to anaphylaxis. We describe a bee-sting occurring in Ethiopia and how this unpleasant and unusual incident was handled.
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Affiliation(s)
- Kenbon Seyoum
- Department of Midwifery, 233750Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Telila Mesfin
- School of Medicine, 233750Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Sisay Dadi
- School of Medicine, 233750Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Gela Atlie
- School of Medicine, 233750Madda Walabu University Goba General Hospital, Goba, Ethiopia
| | - Nuri Haji
- School of Medicine, 233750Madda Walabu University Goba General Hospital, Goba, Ethiopia
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30
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Sarkar M, Sharma SK, Jhobta A, Gulati A. A case report of pulmonary alveolar microlithiasis with pulmonary tuberculosis. Lung India 2023; 40:161-164. [PMID: 37006101 PMCID: PMC10174655 DOI: 10.4103/lungindia.lungindia_276_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/09/2023] [Indexed: 03/05/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterised by the deposition of calcium phosphate microliths in the alveoli. PAM has been reported in all continents and there is often a familial history. There is clinical-radiological dissociation as there is often a paucity of symptoms in contrast to the imaging findings. Patients often remain asymptomatic until the third or fourth decade of life, and dyspnea is the most common symptom. PAM is caused by a mutation within the solute carrier family 34 member 2 gene (the SLC34A2 gene) located on chromosome 4p15.2, which encodes a sodium/phosphate co-transporter. The imaging appearance of the disease is quite pathognomic with the high-resolution computed tomography (HRCT) demonstrating a diffuse micronodular appearance. Transbronchial lung biopsy also confirms the diagnosis. There is no effective therapy at present except lung transplantation. We herein, present a case of PAM along with clinical history, imaging study, histopathological study and genetic study of a 43-year-old female adult patient along with genetic analysis.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sudarshan K. Sharma
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Jhobta
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anchana Gulati
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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31
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Pang SL, Ho CHA, Law CML, Yang Y, Leung YY. Pre-Epiglottic Baton Plate in the Management of Upper Airway Obstruction in an Infant with Femoral Facial Syndrome: A Case Report. Cleft Palate Craniofac J 2023; 60:367-375. [PMID: 34787010 DOI: 10.1177/10556656211059705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Femoral facial syndrome (FFS) is a rare condition which may present with hypoplasia or aplasia of the femora and unusual facies characterized by long philtrum, thin upper lip and micrognathia. We present the case of a ten-month old infant with FFS who had retroglossal obstruction and who was treated with a pre-epiglottic baton plate. The pre-epiglottic baton plate can be a simple, non-invasive and effective tool for the clinical management of syndromic patients with mild-to-moderate upper airway obstruction due to micrognathia.
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Affiliation(s)
- Si Ling Pang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, 25809The University of Hong Kong, Hong Kong
| | - Cheuk Hin Angus Ho
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Chun Man Lorie Law
- Maxillofacial Department, Dental Laboratory, 66392The Prince Philip Dental Hospital, Hong Kong
| | - Yanqi Yang
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, 25809The University of Hong Kong, Hong Kong
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32
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Han SH, Kim M, Ji JY, Kwon SK. Analysis of clinical features and risk factors of subglottic cysts in children: a clinical experience using the spontaneous respiration technique. Clin Exp Otorhinolaryngol 2023; 16:177-183. [PMID: 36822198 DOI: 10.21053/ceo.2023.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Objective Subglottic cyst (SGC) is one of the rare causes of respiratory distress caused by upper airway obstruction in infants and young children. Risk factors other than prematurity with a history of endotracheal intubation have not yet been well elucidated. Therefore, we aimed to describe the clinical features and analyze the risk factors of SGC. Methods A retrospective review of medical records of pediatric patients who underwent marsupialization for SGCs between January 2017 and March 2022 was undertaken. These records were then compared with those of controls with a history of neonatal intubation with a case to control ratio of 1:3. Results Eleven patients (8 males and 3 females) diagnosed with SGCs and 33 control patients (26 males and 7 females) were included. All patients had a history of premature birth and neonatal intubation. Symptoms of SGC appeared at a mean age of 8.2 months (1-14 months) after extubation. The mean duration of intubation was 21.5 days (2-90 days), and the intubation period was longer in patients with SGC than in controls (21.5±24.8 days vs. 5.3±7.1 days; p<0.001). Furthermore, gestational age (28.3±4.2 weeks vs. 33.8±4.4 weeks; p=0.001) and birth weight (1134.1±515.1 g vs. 2178.2±910.1 g; p=0.001) were significantly lower in patients with SGC than in controls. In multivariable analysis, intubation period was identified as an independent risk factor. Conclusion This study showed that gestational age, birth weight, and intubation period were significantly associated with development of SGC. Pediatric patients presenting with progressive dyspnea with the corresponding risk factors should undergo early laryngoscopy for the differential diagnosis of SGC.
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Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea, Hwaseong, Korea
| | - Minju Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
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33
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Song A, Phillips H, Oliveira CR, McCoy AM. CT volumetric analysis permits comparison of tongue size and tongue fat in different canine brachycephalic and mesaticephalic breeds. Vet Radiol Ultrasound 2023. [PMID: 36787184 DOI: 10.1111/vru.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023] Open
Abstract
While macroglossia is a newly accepted component of brachycephalic obstructive airway syndrome (BOAS) in dogs, macroglossia with increased tongue fat is a well-known cause for obstructive sleep apnea (OSA) in people, and targeted reduction procedures such as midline glossectomy are used to treat people with OSA. While midline glossectomy has been described in dogs, tissue contributions to macroglossia have not been characterized. The purpose of this retrospective, descriptive, case-control study was to describe and compare volumetric dimensions of the tongue and tongue fat in brachycephalic (BC) and mesaticephalic (MC) dogs using CT images. Data collected included head and neck CT images from 17 BC and 18 control MC dogs. Multiplanar reformatted and 3D reconstructed images were created using image segmentation and specialized visualization software to calculate volumetric dimensions of the total tongue, tongue fat, and tongue muscle. Rostral and caudal topographical distributions of fat were compared. Total tongue and tongue muscle volume (P < 0.0001) and tongue fat volume (P = 0.01) normalized to body weight (BW) were greater in BC dogs. More fat was localized in the caudal tongue in both groups (P < 0.04). In regression analysis, BC conformation and increased weight were significant predictors of increased tongue fat volume. As in people, increased tongue fat may contribute to macroglossia and sleep-disordered breathing in BC dogs. Use of CT volumetry to identify tongue fat deposits may permit targeted surgical reduction of tongue volume in BC dogs and contribute substantially to treatment of BOAS.
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Affiliation(s)
- Ava Song
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Cintia R Oliveira
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
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34
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Constantin BN, Marina TC, Eugen SH, Ileana E, Adrian G. Tongue Base Ectopic Thyroid Tissue-Is It a Rare Encounter? Medicina (Kaunas) 2023; 59. [PMID: 36837515 DOI: 10.3390/medicina59020313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam revealed a tongue base, spherical, well-defined tumour covered by normal mucosa. Further assessments established the diagnosis of the tongue base ectopic thyroid tissue. Due to the patient's symptoms, a transhyoid tongue base tumour removal was performed. The selected patient gave consent for participation and inclusion in this paper, in compliance with the 1964 Helsinki declaration.
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35
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Effert J, Uhlig S, Wiechers C, Quante M, Poets CF, Schulz MC, Reinert S, Krimmel M, Koos B, Weise C. Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy. J Clin Med 2023; 12:jcm12020448. [PMID: 36675376 PMCID: PMC9864988 DOI: 10.3390/jcm12020448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To assess the long-term functional orthodontic outcome of the Tübingen palatal plate (TPP) in children with Robin sequence (RS) in comparison to age- and sex-matched healthy controls. METHODS Between 09/2019 and 10/2020, we performed orthodontic assessments in 41 children at our Department of Orthodontics. Included were patients with RS (17 non-syndromic; four syndromic) and healthy controls (n = 22, average age in both groups 9.9 y). Facial analyses of 2D images, digital study casts and cephalometric measurements were made. RESULTS The orthodontic examinations showed no statistically significant group differences regarding functional extraoral, intraoral and pharyngeal parameters, or in skeletal patterns. The relationship between the upper and lower incisors was significantly increased (overjet 4 (2-10) vs. 3 (0-9) mm; p = 0.01) with a significant deficit in the lower face proportions (Jaw Index 4.15 (1.9-9.6) vs. 2.98 (0-9); p = 0.02; Facial convexity angle 157 (149-173) vs. 159 (149-170); p = 0.01). CONCLUSION Children with RS treated with the TPP showed normal long-term functional orthodontic outcomes, thanks to the functional adaption of the stomatognathic system. However, soft tissue growth did not completely match skeletal growth, resulting in a more convex facial profile.
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Affiliation(s)
- Josephine Effert
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Simone Uhlig
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Cornelia Wiechers
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Mirja Quante
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Christian F. Poets
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Michael Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-7071-29-62581
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Iyer NP, López-Fernández YM, González-Dambrauskas S, Baranwal AK, Hotz JC, Zhu M, Zhang Y, Craven HJ, Whipple EC, Abu-Sultaneh S, Khemani RG. A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children. Ann Am Thorac Soc 2023; 20:118-30. [PMID: 35976878 DOI: 10.1513/AnnalsATS.202203-212OC] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Rationale: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. Objectives: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. Methods: MEDLINE, CINAHL, and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 h before extubation) and the dose (high dose: ⩾0.5 mg/kg/dose). We performed Bayesian network meta-analysis with studies grouped into four regimens: high dose, early use (HE); low dose, early use (LE); high dose, late use (HL); and low dose, late use. Results: Eight trials (n = 903) were included in the analysis. For preventing UAO (odds ratio; 95% credible interval), HE (0.13; 0.04-0.36), HL (0.39; 0.19-0.74), and LE (0.15; 0.04-0.58) regimens appear to be more effective than no dexamethasone (low certainty). HE and LE had the highest probability of being the top-ranked regimens for preventing UAO (surface under the cumulative ranking curve 0.901 and 0.808, respectively). For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared with no dexamethasone (very low certainty). HE and LE were the top-ranked regimens (surface under the cumulative ranking curve 0.803 and 0.720, respectively) for preventing reintubation. Sensitivity analysis showed that regimens that started >12 hours before extubation were likely more effective than regimens started >6 hours before extubation. Conclusions: Periextubation dexamethasone can prevent postextubation UAO in children, but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 h before extubation) appears to be more important than the dose of dexamethasone. Ultimately, the specific steroid strategy should be personalized, considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation.
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Wiechers C, Uhlig S, Poets A, Weise C, Naros A, Krimmel M, Koos B, Poets CF, Quante M. Sleep and neurocognitive outcomes in primary school children with Robin Sequence. Sleep 2022; 46:6960708. [PMID: 36566505 DOI: 10.1093/sleep/zsac317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/16/2022] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES To investigate neurocognitive and behavioral outcomes at primary school age in relation to obstructive sleep apnea (OSA) in children with Robin sequence (RS) treated with the Tuebingen palatal plate in infancy and to assess the impact of OSA in these patients. METHODS Forty-two primary school-aged children (n=21 with Robin Sequence, n=21 age and sex-matched controls) underwent polysomnography, intelligence testing ("Wechsler Intelligence Scale for Children - Fifth Edition" [WISC-V]) and anthropometrics. Families completed a 7-day sleep diary and questionnaires on sleep and behavior (Children's Sleep Habits Questionnaire [CSHQ] and the Child Behavior Checklist [CBCL]). RESULTS In children with RS (17 non-syndromic, 4 syndromic; median age 9.7 (8.5-10.8) years), the obstructive apnea-hypopnea index (OAHI) was significantly higher than in controls (1.3 [0.4 - 2.7]/h vs. 0.4 [0.1-0.6]/h). Two syndromic children with RS were already on nocturnal respiratory support for OSA prior to our study, and one non-syndromic child was diagnosed with severe OSA (OAHI 57/h) despite an unremarkable medical history and questionnaire. The overall intelligence quotient in children with RS was within the normal range and did not differ between children with RS and healthy peers (102 vs. 108, p=0.05). However, children with RS had values in the at-risk clinical range for externalizing behavior. CONCLUSIONS These children with RS showed an increased risk of OSA and behavioral problems, suggesting regular screening for OSA throughout childhood. Neurocognitive scores in children with RS were within the normal range after adequate treatment of OSA during infancy.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Simone Uhlig
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
| | - Anette Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
| | - Christina Weise
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany
| | - Andreas Naros
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital
| | - Michael Krimmel
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Mirja Quante
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
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Muacevic A, Adler JR, Fujisaki N. Potential Fatal Complication of Neurofibromatosis Type 1: Acute Upper Airway Obstruction Due to Ruptured Transverse Cervical Artery Aneurysm. Cureus 2022; 14:e32910. [PMID: 36699773 PMCID: PMC9871536 DOI: 10.7759/cureus.32910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) can cause vascular complications even in undiagnosed NF1 patients. A ruptured aneurysm of the branches of the subclavian artery is a rare but life-threatening event, and the hemorrhage can cause upper airway obstruction. We present a case of NF1 patient with a ruptured transverse cervical artery aneurysm, which led to a nearly obstructed airway. A 52-year-old man who was not previously diagnosed with NF1 presented with sudden pain from the left shoulder to the neck. Since childhood, he has had multiple cutaneous neurofibromas and café-au-lait macules, and freckling in the bilateral axillae. His swollen left side of the neck and left shoulder suggested a hematoma, which compressed the upper airway. Contrast-enhanced computed tomography revealed a cervical hematoma caused by a ruptured aneurysm of the transverse cervical artery. We performed awake fiberoptic intubation because a difficult airway was predicted and surgical airway management may have been impossible due to the anterior cervical hematoma. His airway was secured, and his aneurysm was successfully treated by coil embolization. Based on his cutaneous findings, he was finally diagnosed with NF1. Those who have café-au-lait macules and cutaneous neurofibromas may present with acute cervical hematoma, and it is important to consider the possibility of ruptured aneurysms in the neck region. When patients develop an acute cervical hematoma that causes an acute upper airway obstruction, emergency physicians should consider awake fiberoptic intubation to secure the airway.
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Poets CF, Wiechers C, Koos B, Muzaffar AR, Gozal D. Pierre Robin and breathing: What to do and when? Pediatr Pulmonol 2022; 57:1887-1896. [PMID: 33580741 DOI: 10.1002/ppul.25317] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
Robin sequence is characterized by mandibular retrognathia, airway obstruction, and glossoptosis; 80%-90% also have a cleft palate. Various treatment approaches exist, and although controlled studies are rare, objective assessment of treatment outcomes that address the leading clinical issues, namely obstructive sleep apnea and failure to thrive, are essential. Sleep-disordered breathing may be detected using cardiorespiratory polygraphy or polysomnography. Pulse oximetry alone may miss infants with frequent obstructive apneas, yet no intermittent hypoxia. Among conservative treatment options, the Tubingen Palatal Plate with a velar extension shifting the tongue base forward is the only approach that corrects the underlying anatomy and that has undergone appropriate evaluation. Of the surgical treatment options, which are not necessarily the first line of therapy, mandibular distraction osteogenesis (MDO) is effective and has been most extensively adopted. Notwithstanding, it is puzzling that MDO is frequently used in some countries, yet hardly ever in others, despite similar tracheostomy rates. Thus, prospective multicenter studies with side-by-side comparisons aimed at identifying an optimal treatment paradigm for this potentially life-threatening condition are urgently needed.
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Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Arshad R Muzaffar
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, Missouri, USA
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Sakaguchi Y, Nozaki-Taguchi N, Hasegawa M, Ishibashi K, Sato Y, Isono S. Combination therapy of high-flow nasal cannula and upper body elevation for postoperative sleep disordered breathing; randomized cross-over trial. Anesthesiology 2022. [PMID: 35471655 DOI: 10.1097/ALN.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. We considered whether the combination of high-flow nasal cannula and upper body elevation could improve postoperative OSA. METHODS This non-blinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 liter.minute-1 with 40% oxygen concentration) with and without upper body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants. RESULTS Twenty-two out of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean±SD: 59.6 ± 12.0 events.hour-1, n=19) was reduced by 14.7 (95% CI: 5.5 to 30.0) events.hour-1 with head-of-bed elevation alone (p=0.002), 10.9 (1.2 to 20.6) events.hour-1 with high-flow nasal cannula alone (p=0.028), and 22.5 (13.1 to 31.9) events.hour-1 with combined head-of-bed elevation and high-flow nasal cannula (p<0.001). Compared to sole high-flow nasal cannula, additional intervention with head-of-bed elevation significantly decreased flow-based apnea hypopnea index by 11.5 events.hour-1 (1.7 to 21.4) (p=0.022). High-flow nasal cannula, alone or in combination with head-of-bed elevation also improved overnight oxygenation. No harmful events were observed. CONCLUSION The combination of high-flow nasal cannula and upper body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy.
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Chandrasekar I, Tablizo MA, Witmans M, Cruz JM, Cummins M, Estrellado-Cruz W. Obstructive Sleep Apnea in Neonates. Children (Basel) 2022; 9:children9030419. [PMID: 35327791 PMCID: PMC8947507 DOI: 10.3390/children9030419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/03/2022]
Abstract
Neonates have distinctive anatomic and physiologic features that predispose them to obstructive sleep apnea (OSA). The overall prevalence of neonatal OSA is unknown, although an increase in prevalence has been reported in neonates with craniofacial malformations, neurological disorders, and airway malformations. If remained unrecognized and untreated, neonatal OSA can lead to impaired growth and development, cardiovascular morbidity, and can even be life threatening. Polysomnography and direct visualization of the airway are essential diagnostic modalities in neonatal OSA. Treatment of neonatal OSA is based on the severity of OSA and associated co-morbidities. This may include medical and surgical interventions individualized for the affected neonate. Based on this, it is expected that infants with OSA have more significant healthcare utilization.
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Affiliation(s)
- Indira Chandrasekar
- Division of Neonatology, Department of Pediatrics, Valley Children’s Hospital, Madera, CA 94305, USA
- Correspondence: (I.C.); (W.E.-C.)
| | - Mary Anne Tablizo
- Division of Pulmonary and Sleep Medicine, Valley Children’s Hospital, Madera, CA 94305, USA; or
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Jose Maria Cruz
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
| | - Marcus Cummins
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA;
| | - Wendy Estrellado-Cruz
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
- Correspondence: (I.C.); (W.E.-C.)
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Rhame C, Verster J, Dempers J, Goussard P. Obstructive fibrinous tracheal pseudomembrane: Sudden child death following laser removal of papillomata. Clin Case Rep 2022; 10:e05346. [PMID: 35154714 PMCID: PMC8829670 DOI: 10.1002/ccr3.5346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare complication usually following endotracheal intubation, occurring when a collection of inflammatory exudate coalesces at the site of damaged epithelium within the trachea and along the tracheal mucosa, creating a luminal narrowing and subsequent airway obstruction.
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Affiliation(s)
- Caroline Rhame
- Division of Forensic Medicine Department of Pathology Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - Janette Verster
- Division of Forensic Medicine Department of Pathology Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - Johan Dempers
- Division of Forensic Medicine Department of Pathology Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital Cape Town South Africa
| | - Pierre Goussard
- Department of Paediatrics and Child Health Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital Cape Town South Africa
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Loewen JM, Bach JF. Performing an upper airway examination in dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:16-21. [PMID: 35044069 DOI: 10.1111/vec.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increased airway resistance due to upper airway obstruction is a common cause of respiratory distress. An upper airway exam is an inexpensive and quick diagnostic procedure that can serve to localize a disease process, confirm a definitive diagnosis, and offer therapeutic benefits. DESCRIPTION The upper airway examination consists of an external evaluation of the head and neck as well as a sedated examination of the oral cavity, the pharyngeal cavity, larynx, and nasal passages. SUMMARY An upper airway examination should be performed in patients with increased inspiratory effort or increased upper respiratory noise (eg, stertor or stridor). A complete, sedated upper airway examination should be considered for patients with clinical signs of upper airway disease for which a cause is not obvious from the physical examination. KEY POINTS Indications for an upper airway examination include sneezing, nasal discharge or epistaxis, reduced or absent nasal airflow, change in phonation, inspiratory difficulty, and audible respiratory sounds. Upper airway examination helps localize pathological processes and allows the clinician to confirm or exclude several differential diagnoses. Pre-oxygenation of the patient for 3-5 minutes prior to sedation will help increase the amount of time available before hypoxemia occurs, should complications arise. Upon completion of the upper airway examination, it is important to monitor the patient carefully and ensure a safe recovery. Careful planning to ensure the availability of necessary equipment and preparation of the team to react during and after the airway examination will minimize the risks of examination to patients with upper airway disease.
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Affiliation(s)
- Jennifer M Loewen
- School of Veterinary Medicine, Department of Medical Sciences, University of Wisconsin, Madison, Madison, Wisconsin, USA
| | - Jonathan F Bach
- School of Veterinary Medicine, Department of Medical Sciences, University of Wisconsin, Madison, Madison, Wisconsin, USA
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Van den Bossche K, Van de Perck E, Wellman A, Kazemeini E, Willemen M, Verbraecken J, Vanderveken OM, Vena D, Op de Beeck S. Comparison of Drug-Induced Sleep Endoscopy and Natural Sleep Endoscopy in the Assessment of Upper Airway Pathophysiology During Sleep: Protocol and Study Design. Front Neurol 2021; 12:768973. [PMID: 34950101 PMCID: PMC8690862 DOI: 10.3389/fneur.2021.768973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Study Objectives: Obstructive sleep apnea (OSA) is increasingly recognized as a complex and heterogenous disorder. As a result, a "one-size-fits-all" management approach should be avoided. Therefore, evaluation of pathophysiological endotyping in OSA patients is emphasized, with upper airway collapse during sleep as one of the main features. To assess the site(s) and pattern(s) of upper airway collapse, natural sleep endoscopy (NSE) is defined as the gold standard. As NSE is labor-intensive and time-consuming, it is not feasible in routine practice. Instead, drug-induced sleep endoscopy (DISE) is the most frequently used technique and can be considered as the clinical standard. Flow shape and snoring analysis are non-invasive measurement techniques, yet are still evolving. Although DISE is used as the clinical alternative to assess upper airway collapse, associations between DISE and NSE observations, and associated flow and snoring signals, have not been quantified satisfactorily. In the current project we aim to compare upper airway collapse identified in patients with OSA using endoscopic techniques as well as flow shape analysis and analysis of tracheal snoring sounds between natural and drug-induced sleep. Methods: This study is a blinded prospective comparative multicenter cohort study. The study population will consist of adult patients with a recent diagnosis of OSA. Eligible patients will undergo a polysomnography (PSG) with NSE overnight and a DISE within 3 months. During DISE the upper airway is assessed under sedation by an experienced ear, nose, throat (ENT) surgeon using a flexible fiberoptic endoscope in the operating theater. In contrast to DISE, NSE is performed during natural sleep using a pediatric bronchoscope. During research DISE and NSE, the standard set-up is expanded with additional PSG measurements, including gold standard flow and analysis of tracheal snoring sounds. Conclusions: This project will be one of the first studies to formally compare collapse patterns during natural and drug-induced sleep. Moreover, this will be, to the authors' best knowledge, the first comparative research in airflow shape and tracheal snoring sounds analysis between DISE and NSE. These novel and non-invasive diagnostic methods studying upper airway mechanics during sleep will be simultaneously validated against DISE and NSE. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04729478.
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Affiliation(s)
- Karlien Van den Bossche
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Eli Van de Perck
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Elahe Kazemeini
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Op de Beeck
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
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Green J, Ross PA, Newth CJ, Khemani RG. Subglottic Post-Extubation Upper Airway Obstruction Is Associated With Long-Term Airway Morbidity in Children. Pediatr Crit Care Med 2021; 22:e502-e512. [PMID: 33833205 PMCID: PMC8490268 DOI: 10.1097/pcc.0000000000002724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Post-extubation upper airway obstruction is the most common cause of extubation failure in children, but there are few data regarding long-term morbidity. We aim to describe the frequency of long-term airway sequelae in intubated children and determine the association with post-extubation upper airway obstruction. DESIGN Retrospective, post hoc analysis of previously identified prospective cohort of children in the pediatric/cardiothoracic ICU at Children's Hospital Los Angeles from July 2012 to April 2015. A single provider blinded to the upper airway obstruction classification reviewed the electronic medical records of all patients in the parent study, before and after the index extubation (extubation during parent study), to identify pre-index and post-index upper airway disease. Primary outcomes were prevalence of newly diagnosed airway anomalies following index extubation. SETTING Single center, tertiary, 391-bed children's hospital. PATIENTS From the parent study, 327 children younger than 18 years (intubated for at least 12 hr) were included if they received subsequent care (regardless of specialty) after the index extubation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS New airway anomalies were identified in 40 of 327 children (12.2%). Patients labeled with subglottic upper airway obstruction at the index extubation were more likely to be diagnosed with new airway anomalies on subsequent follow-up, receive long-term Otolaryngology follow-up, or receive airway surgery (all p ≤ 0.006). In multivariable modeling, upper airway obstruction as the primary reason for initial intubation (odds ratio, 3.71; CI, 1.50-9.19), reintubation during the index ICU admission (odds ratio, 4.44; CI, 1.67-11.80), pre-index airway anomaly (odds ratio, 3.31; CI, 1.36-8.01), and post-extubation subglottic upper airway obstruction (odds ratio, 3.50; CI, 1.46-8.34) remained independently associated with the diagnosis of new airway anomalies. CONCLUSIONS Post-extubation subglottic upper airway obstruction is associated with a three-fold greater odds of long-term airway morbidity. These patients may represent an at-risk population that should be monitored closely after leaving the ICU.
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Affiliation(s)
- Jack Green
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Patrick A. Ross
- Department of Anesthesiology Critical Care Medicine, Keck School of Medicine of University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California
| | - Christopher J.L. Newth
- Department of Anesthesiology Critical Care Medicine, Keck School of Medicine of University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California
| | - Robinder G. Khemani
- Department of Anesthesiology Critical Care Medicine, Keck School of Medicine of University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California
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Li Q, Zhou L. A rare case of type II negative pressure pulmonary edema following extraction of inhaled peanuts in a 21-month-old boy. J Int Med Res 2021; 49:3000605211047779. [PMID: 34586944 PMCID: PMC8485296 DOI: 10.1177/03000605211047779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To date, only one case of pediatric type II negative pressure pulmonary edema (NPPE) caused by removal of an endobronchial foreign body has been documented. We report another case of type II NPPE that developed after extraction of inhaled peanuts. A 21-month-old boy who presented with wheezing and intermittent cough for 1 month after eating peanuts was admitted to our department. A chest computed tomographic scan showed foreign bodies lodged in the right main bronchus. Fiberoptic bronchoscopy was performed, and three pieces of peanuts were removed. Fifteen minutes after this procedure, the child grew restless and started coughing with frothy pink sputum. Tachypnea and rales were observed. A chest radiograph showed patchy opacification in both lungs, especially in the right lower zone, leading to the diagnosis of type II NPPE. Intravenous furosemide and dexamethasone were immediately administered, followed by non-invasive continuous positive airway pressure ventilation. Twelve hours later, the patient recovered uneventfully and was discharged home the following day. In conclusion, pediatric type II NPPE rapidly occurs following the relief of upper airway obstruction. Clinicians need to be aware of the acuteness and manifestations of type II NPPE to make an early diagnosis and initiate prompt treatment.
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Affiliation(s)
- Qin Li
- Department of Respirology, Children's Hospital of Hebei Province, Shijiazhuang City, Hebei Province, China
| | - Liang Zhou
- Department of Respirology, Children's Hospital of Hebei Province, Shijiazhuang City, Hebei Province, China
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Bhatt NK, Huang VP, Bertelsen C, Gao WZ, Reder LS, Johns MM, O'Dell K. Pulmonary Function Tests May Better Predict Dyspnea-Severity in Patients with Subglottic Stenosis Compared to Clinician-Reported Stenosis. Ann Otol Rhinol Laryngol 2021; 131:791-796. [PMID: 34496642 DOI: 10.1177/00034894211045266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with subglottic stenosis (SGS) present with varied degree of breathing complaints. The dyspnea index (DI) is a 10-question patient-reported outcome measure designed to measure the severity of upper airway obstruction. We set out to determine whether pulmonary function tests or clinician-reported degree of stenosis best predicted DI scores. METHODS Thirty patients with SGS were retrospectively reviewed over a 6-year period. One visit from each patient was included. Data including peak expiratory flow rate (PEFR), body-mass index (BMI), clinician-reported degree of stenosis, and DI scores were reviewed. Multiple linear regression was performed to determine how degree of stenosis and PEFR % predicted the variation in DI score. RESULTS PEFR % better predicted DI scores compared to degree of stenosis (partial correlation -0.32 vs 0.17). After stepwise elimination, PEFR % remained in the regression and was significantly associated with DI scores (F[1, 29] = 9.38, P = .005). BMI did not demonstrate a linear relationship with DI scores and was not included in the regression (r = -.02). The PEFR % unstandardized coefficient was -0.25 (95% CI: -0.42 to -0.08, P = .005). The model predicts that a 4% increase in the PEFR % results in a 1-point decrease in the DI score (95% CI: -1.68 to -0.32). CONCLUSION This study suggests that pulmonary function tests may be a better in-office measure to substantiate the severity of symptoms in patients with SGS.
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Affiliation(s)
- Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, St Louis, MO, USA
| | - Valerie P Huang
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Lindsay S Reder
- Southern California Permanente Medical Group, Kaiser Permanente Baldwin Park, Baldwin Park, CA, USA
| | - Michael M Johns
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Karla O'Dell
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
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Blanc F, Harrewijn I, Duflos C, Maggiulli F, Captier G. Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases. Cleft Palate Craniofac J 2021; 59:891-898. [PMID: 34313144 DOI: 10.1177/10556656211031105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. DESIGN A retrospective single-center study of 150 children with PRS. SETTING Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. PATIENTS A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. MAIN OUTCOME MEASURES Evolution and results of the initial treatment of PRS. RESULTS Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 (P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. CONCLUSIONS Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.
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Affiliation(s)
- Fabian Blanc
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Inge Harrewijn
- Neonatal Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Claire Duflos
- Department of Medical Information, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Frederica Maggiulli
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Guillaume Captier
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France.,School of Medicine, University of Montpellier, Montpellier, France
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49
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Lam AS, Bindschadler MD, Evans KN, Friedman SD, Blessing MS, Bly R, Cunningham ML, Egbert MA, Ettinger RE, Gallagher ER, Hopper RA, Johnson K, Perkins JA, Romberg EK, Sie KCY, Susarla SM, Zdanski CJ, Wang X, Otjen JP, Perez FA, Dahl JP. Accuracy and Reliability of 4D-CT and Flexible Laryngoscopy in Upper Airway Evaluation in Robin Sequence. Otolaryngol Head Neck Surg 2021; 166:760-767. [PMID: 34253111 DOI: 10.1177/01945998211027353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the performance of 4-dimensional computed tomography (4D-CT) in assessing upper airway obstruction (UAO) in patients with Robin sequence (RS) and compare the accuracy and reliability of 4D-CT and flexible fiber-optic laryngoscopy (FFL). STUDY DESIGN Prospective survey of retrospective clinical data. SETTING Single, tertiary care pediatric hospital. METHODS At initial and 30-day time points, a multidisciplinary group of 11 clinicians who treat RS rated UAO severity in 32 sets of 4D-CT visualizations and FFL videos (dynamic modalities) and static CT images. Raters assessed UAO at the velopharynx and oropharynx (1 = none to 5 = complete) and noted confidence levels of each rating. Intraclass correlation and Krippendorff alpha were used to assess intra- and interrater reliability, respectively. Accuracy was assessed by comparing clinician ratings with quantitative percentage constriction (QPC) ratings, calculated based on 4D-CT airway cross-sectional area. Results were compared using Wilcoxon rank-sum and signed-rank tests. RESULTS There was similar intrarater agreement (moderate to substantial) with 4D-CT and FFL, and both demonstrated fair interrater agreement. Both modalities underestimated UAO severity, although 4D-CT ratings were significantly more accurate, as determined by QPC similarity, than FFL (-1.06 and -1.46 vs QPC ratings, P = .004). Overall confidence levels were similar for 4D-CT and FFL, but other specialists were significantly less confident in FFL ratings than were otolaryngologists (2.25 and 3.92, P < .0001). CONCLUSION Although 4D-CT may be more accurate in assessing the degree of UAO in patients with RS, 4D-CT and FFL assessments demonstrate similar reliability. Additionally, 4D-CT may be interpreted with greater confidence by nonotolaryngologists who care for these patients.
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Affiliation(s)
- Austin S Lam
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Michael D Bindschadler
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kelly N Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Seth D Friedman
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew S Blessing
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Randall Bly
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Michael L Cunningham
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark A Egbert
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Oral and Maxillofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington, USA
| | - Russell E Ettinger
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Emily R Gallagher
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Richard A Hopper
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan A Perkins
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Erin K Romberg
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen C Y Sie
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Oral and Maxillofacial Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Carlton J Zdanski
- Department of Otolaryngology/Head & Neck Surgery and Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Xing Wang
- Biostatistics, Epidemiology and Analytics in Research (BEAR) Core, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Francisco A Perez
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
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Tsuboi K, Tsuboi N, Sakamoto K, Takebayashi A, Tomizawa D, Nishimura N, Nakagawa S. Life-threatening oral mucositis following chemotherapy in a pediatric patient. Clin Case Rep 2021; 9:e04356. [PMID: 34136255 PMCID: PMC8190677 DOI: 10.1002/ccr3.4356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
Severe oral mucositis as a complication of chemotherapy may lead to airway obstruction and require prolonged intubation. As its course is consistent with the course of neutropenia, airway management strategies should be determined individually.
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Affiliation(s)
- Kaoru Tsuboi
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Norihiko Tsuboi
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Kenichi Sakamoto
- Children’s Cancer CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Akira Takebayashi
- Children’s Cancer CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Daisuke Tomizawa
- Children’s Cancer CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Nao Nishimura
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Satoshi Nakagawa
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
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