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ObjectiveDrug induced sleep endoscopy (DISE) is often performed for pediatric obstructive sleep apnea (OSA) when initial diagnostic studies do not provide adequate information for therapy. However, DISE scoring is subjective and with limitations. This proof-of-concept study demonstrates the use of a novel long-range optical coherence tomography (LR-OCT) system during DISE of two pediatric patients.MethodsLR-OCT was used to visualize the airway of pediatric patients during DISE. At the conclusion of DISE, the OCT probe was guided in the airway under endoscopic visual guidance, and cross-sectional images were acquired at the four VOTE locations. Data processing involved image resizing and alignment, followed by rendering of three-dimensional (3D) volumetric models of the airways.ResultsTwo patients were included in this study. Patient one had 18.4%, 20.9%, 72.3%, and 97.3% maximal obstruction at velum, oropharynx, tongue base, and epiglottis, while patient two had 40.2%, 41.4%, 8.0%, and 17.5% maximal obstruction at these regions, respectively. Three-dimensional reconstructions of patients' airways were also constructed from the OCT images.ConclusionThis proof-of-concept study demonstrates the successful evaluation of pediatric airway during DISE using LR-OCT, which accurately identified sites and degrees of obstruction with respective 3D airway reconstruction.

Background: Recently, the development of advanced, noninvasive methods has allowed the study of respiratory function even in uncooperative infants. To date, there is still little data on the application of this technique in infants with suspected airway obstruction. The aims of our study were: - To evaluate the role of respiratory function testing (PFR) in the diagnosis and follow-up of infants with stridor - To evaluate the differences between patients with inspiratory stridor and expiratory stridor. - To evaluate the concordance between PFR and endoscopy. Methods: We enrolled infants aged < 1 year with a diagnosis of inspiratory and/or expiratory chronic stridor and a group of healthy controls. For each patient we performed PFR at diagnosis (T0) and for cases at follow-up, at 3 months (T1), 6 months (T2), 12 months (T3). At T0, all patients were classified according to a clinical score, and at follow-up, stature-ponderal growth was assessed. When clinically indicated, patients underwent bronchoscopy. Results: We enrolled 48 cases (42 diagnosed with inspiratory stridor and 6 expiratory stridor) and 26 healthy controls. At T0, patients with stridor had increased inspiratory time (p < 0.0001) and expiratory time (p < 0.001) than healthy controls and abnormal curve morphology depending on the type of stridor. At T0, patients with expiratory stridor had a reduced Peak expiratory flow (p < 0.023) and a longer expiratory time (p < 0.004) than patients with inspiratory stridor. We showed an excellent concordance between PFR and endoscopic examination (k = 0.885, p < 0.0001). At follow-up, we showed a progressive increase of the respiratory parameters in line with the growth. Conclusions: PFR could help improve the management of these patients through rapid and noninvasive diagnosis, careful monitoring, and early detection of those most at risk. [ABSTRACT FROM AUTHOR]

Introduction Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment. Materials and Methods This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist. Results There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38–31.07 seconds; 6 months: median 36.33, interquartile range 31.59–55.22 seconds; 12 months: median 49.50, interquartile range 41.75–60.75 seconds; 24 months: median 38.79, interquartile range 30.20–53.08 seconds; P  < .0001, P  < .0001, P  = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50–10.00; 6 months: median 8.00/10, interquartile range 6.75–9.00; 12 months: median 8.00/10, interquartile range 6.75–9.25; P  < .0001, P  < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50–10.00; 24 months: 10.00/10, interquartile range 9.00–10.00; P =.125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria. Conclusions This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency. [ABSTRACT FROM AUTHOR]

Objective: To compare patterns of obstruction in infants and toddlers with obstructive sleep apnea (OSA) by analyzing drug‐induced sleep endoscopy (DISE) examinations. Study Design: Retrospective chart review. Setting: An academic tertiary care pediatric hospital at a single institution. Methods: Children aged ≤3 years who underwent DISE with propofol titration from 2020 to 2022 were included in the study. Data extracted included age, body mass index, comorbidities, and polysomnography parameters. The sites of anatomic obstruction during DISE were recorded using a validated 10‐site scoring system. Results: A total of 86 children underwent DISE, including 15 infants (<1 year) and 71 toddlers (>1≤3 years). Sixty‐two percent were male and 37% were female. The mean age of the infant group was 9.6 months (95% confidence interval [CI]: 7.92, 11.28 months), and the mean age of the toddler group was 2.3 years (95% CI: 2.06, 2.50 years). The mean total number of sites of obstruction was not significantly different between infants (N = 2.5) and toddlers (N = 3.2, P =.086). The most common subsite of significant obstruction in both infants and toddlers was the aryepiglottic folds (46.7% and 36.8%, respectively; P =.578). The sites of obstruction and frequency of their occurrence were not significantly different between the 2 groups. Conclusion: Multisite airway obstruction is common among children with OSA, especially at the epiglottis, aryepiglottic folds, and tongue base. There is no difference in sites of obstruction and their frequency between toddlers and infants. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) in children under 15 years often results in airway compression, with bronchus intermedius (BI) being the most common site. Endoscopic enucleations can be used to remove lymph nodes and establish an airway in severe cases. Both rigid and flexible bronchoscopy are suitable, with alligator forceps being preferred for its ability to extract tissue. Recent studies have also explored cryoprobe enucleation. Case Presentation: An HIV-positive boy with persistent symptoms after 9 months of TB treatment was diagnosed based on his mother's and sister's Xpert MTB/RIF positive status. He was started on 4-drug TB treatment, but the child remained clinically symptomatic with abnormal chest X-ray and unconfirmed TB. Bronchoscopy was performed, revealing complete obstruction of BI due to caseating granulomas causing collapse of the right middle and lower lobes. Cryotherapy was used to recanalize the airway, and follow-up bronchoscopy confirmed patent BI. Conclusion: While cryotherapy was effective in the restoration of airway patency in this case, there is a lack of knowledge about its use in children. [ABSTRACT FROM AUTHOR]

• Only the minimum cross-sectional area found a significant relationship and a difference between the upper airway morphology and OSA severity. • No significant correlation was found between upper airway volume and OSA severity. Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep. However, little evidence is available on the differences between the sub-regions of the upper airway morphology and OSA severity. Since orthodontists frequently perform cone beam computed tomography (CBCT) in the neck area, we aimed to investigate the relationship and the differences between upper airway morphology and OSA severity using CBCT. The medical records, CBCT imaging of 21 OSA patients diagnosed by polysomnography, and the apnea-hypopnea index (AHI) results were included to classify OSA severity as mild, moderate, or severe. The minimum cross-sectional areas (MCA) and volumes of the upper pharyngeal airway boundaries in four sub-regions: nasopharynx, retropalatal, retroglossal, and hypopharynx were measured. Dolphin Imaging software was used for upper airway segmentation. The correlation coefficient (r), one-way ANOVA, and the least significant difference post hoc multiple comparison test were applied to fulfill the objectives. A statistically significant relationship was found between the MCA of the nasopharynx and the AHI (r = −0.473, P < 0.05). Furthermore, a difference was found between mild and moderate and moderate and severe OSA severity in the MCA results of the retroglossal region (P < 0.05). However, no relationship was found between the upper airway volume and OSA severity. MCA was moderately negatively correlated to AHI only in the nasopharynx subregion. Moderate OSA presented significantly less MCA than mild and severe OSA only in the oropharynx and retroglossal subregions. [ABSTRACT FROM AUTHOR]

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Background: The slow vital capacity (SVC), forced vital capacity (FVC) difference, and forced expiratory volume in one second (FEV1/SVC ratio are crucial for understanding respiratory health, especially in mild airway obstruction. These parameters are more reliable than traditional measures and are influenced by age and body mass index (BMI). Investigating their relationship can improve diagnostic accuracy and health-care interventions. Aims and Objectives: (i) To record peak expiratory flow rate (PEFR), FVC, FEV1 of expiration, FEV1/FVC ratio, forced expiratory flow rate (FEF25-75%), mean forced expiratory flow rate from 0.2 to 1.2 l of volume expired (FEF.2-12), SVC, and find the difference between SVC and FVC, ratio of FEV1/SVC. (ii) To correlate SVC, SVC-FVC, FEV/SVC, and other pulmonary function tests (PFTs) with age, gender, and BMI emphasizing their importance in detecting airway obstruction. (iii) To assess these known indicators of airflow obstruction in healthy individuals to gain knowledge of changing lung health with respect to advancing age, gender, and BMI. Materials and Methods: The study included 200 individuals, comprising both men and women aged between 18 and 60 years, who were in good health. The sample was divided into five age groups, and participants were classified into categories of underweight, normal weight, overweight, and obese based on their BMI. Standard procedures were employed to record anthropometric measurements. PEFR was measured using Wright's peak flow meter, whereas FVC, FEV1 FEV1/FVC ratio, forced expiratory flow between 25 and 75% of FVC (FEF25-75%), forced expiratory flow at 2-1.2 l (FEF.2-12), and SVC were assessed using an expirograph (Helios 401, RMS, India). Adequate statistical analysis was conducted on the gathered data. Results: There was a highly significant difference in the means of SVC, SVC-FVC, FEV/SVC, and other PFTs (P < 0.000) over the five age groups by ANOVA and a significant difference between younger and older age groups analyzed by post hoc test. It also showed a highly significant difference in the mean values of SVC, FEV/SVC, and other PFTs over the categories of BMI and a significant difference between normal and obese groups by multiple comparisons. A small increase in mean values of SVC-FVC was seen in overweight, obese, and underweight compared to the normal BMI group. Females showed reduced mean values of SVC, FEV/SVC, and other PFTs compared to males. (P < 0.000). The mean value of SVC-FVC in females is greater than in males (P < 0.01), which suggest that the tendency for airway obstruction may be greater in women compared to men due to smaller airway diameter and diffusion surface. PEFR, FVC, FEV1 FEV1/FVC, FEF25-75% FEF 2-12, SVC, and FEV/SVC were negatively correlated with age. SVC-FVC was positively correlated with age (r = 0.338, P < 0.000). There was a negative correlation between PEFR, FVC, FEV1, FEF25-75%, FEF.2-12, SVC, and BMI. Conclusions: PFT serves as a crucial diagnostic tool in assessing respiratory health, with parameters such as FVC and FEV1 commonly utilized. However, SVC is gaining recognition for its nuanced insights into lung function. This article delves into the significance of SVC, highlights the differences between SVC and FVC, and explores the relationship between FEV1/SVC ratio, age, and BMI in healthy individuals. The current research was undertaken due to a scarcity of existing studies and demonstrated that SVC, the ratio of FEV1/SVC, and other PFTs diminish with age progression and increasing BMI. In addition, females exhibited decreased lung function, with a greater disparity between SVC and FVC than males. [ABSTRACT FROM AUTHOR]

Background: Many studies have been reported on tracheostomy to prevent upper airway obstruction after surgery. Among these, the scoring system proposed by Cameron et al. quantifies various factors that influence postoperative respiratory failure. This system provides a basis for surgeons to decide whether to perform an elective tracheostomy. In this study, the authors applied the Cameron scoring system retrospectively to patients undergoing severe oral cancer surgery to reevaluate the indications for elective tracheostomy and to investigate its clinical efficacy in airway management. In this study, a sample of 20 patients who underwent oral cancer surgery was selected and divided into two groups: 10 underwent tracheostomy and 10 did not. The Cameron scoring scores for each patient were extracted, to verify whether elective tracheostomy was performed in accordance with the threshold scores. Differences in scores and significant clinical impact factors between the two groups were analyzed and compared. Result: The 10 patients who underwent tracheostomy had an average Cameron score of 6.4, all scoring above the recommended threshold of 5 for tracheostomy. For the 10 patients who did not undergo tracheostomy, the average score was 2.5, with 8 out of these 10 patients scoring below 5. Significant clinical impact factors observed included the location and size of the tumor, the performance of mandibulectomy and neck dissection, and the type of reconstruction surgery. Conclusion: In planning surgery for oral cancer patients, it is essential to consider the use of elective tracheostomy based on preoperative assessment of the risk of postoperative airway obstruction using tools like the Cameron scoring system, and patients' condition. Research confirms that elective tracheostomy effectively enhances airway management in patients with severe oral cancer. [ABSTRACT FROM AUTHOR]

Introduction: Despite the presence of clinical practice guidelines for overnight admission of pediatric patients following adenotonsillectomy, variance in practice patterns exists between pediatric otolaryngologists. The purpose of this study is to examine severity of apnea–hypopnea index (AHI) as an independent predictor of postoperative respiratory complications in children undergoing adenotonsillectomy. Methods: Retrospective chart review of all children undergoing adenotonsillectomy at a large tertiary referral center between January 2015 and December 2019 who underwent preoperative polysomnography and were admitted for overnight observation. Charts were reviewed for total adverse events and respiratory events occurring during admission. Results: Overall, respiratory events were seen in 50.6% of patients with AHI ≥10 and in 39.6% of patients with AHI <10. The overall mean AHI was 19.2, with a mean of 28.1 in the AHI ≥10 subgroup vs 4.6 in the AHI <10 subgroup. There was no statistical correlation or increased risk between an AHI ≥10 and having a pure respiratory event, with a relative risk of 1.19 (.77–1.83, P =.43). There was a statistically significant difference between the mean AHI of those with any adverse event and those without (21.6 vs 13.4, P =.008). There is additionally an increased risk of any event with an AHI over 10, with a relative risk of 1.51 (1.22–1.88, P <.0001). Conclusion: Preoperative AHI of 10 events per hour was not a predictor of postoperative respiratory complications. However, there was a trend for those with a higher AHI requiring additional supportive measures or a prolonged stay. Practitioners should always use their best judgment in deciding whether a child warrants postoperative admission following adenotonsillectomy. [ABSTRACT FROM AUTHOR]

Thermal epiglottitis, a non-infectious cause of epiglottitis, is a rare entity that shares some clinical features with infectious epiglottitis. This study presents 16 years of experience in diagnosing and managing thermal epiglottitis. A retrospective descriptive study in a tertiary center in southern Israel included confirmed cases of thermal epiglottitis in children (0–18 years) between 2004 and 2020 by endoscopy. Of approximately 600,000 pediatric ER admissions between 2004 and 2020, seven children were diagnosed by endoscopy with thermal epiglottitis (mean age 24 months, 71% males). Clinical presentation included stridor, respiratory distress, and drooling. Four children had fever and elevated inflammatory markers at presentation and were treated with systemic antibiotics. All were treated with systemic steroids. The median length of stay in the PICU was five days, and four patients required intubations. All fully recovered without experiencing any sequelae. Conclusion: Thermal epiglottitis stands as a potential contributor to acute upper airway obstruction. Although it's rarity, it should be discussed in any child with acute upper airway obstruction. It is essential to inquire directly about the accidental intake of hot beverages, particularly in cases lacking fever or elevated inflammatory markers. What is Known: • Thermal epiglottitis is a rare, non-infectious condition sharing clinical features with infectious epiglottitis. • Common presentations include stridor, respiratory distress, and drooling. What is New: • Thermal epiglottitis is a potential contributor to acute upper airway obstruction, urging consideration even in the absence of fever or elevated markers. • Direct inquiry about hot beverage intake for diagnosis is essential for diagnosis. [ABSTRACT FROM AUTHOR]

Background: During intraoperative care, ventilatory parameters including peak inflating pressure (PIP) and exhaled tidal volumes are continuously monitored to assess changes in respiratory resistance and compliance. Changes in these parameters, such as an increase in PIP or a decrease in the exhaled tidal volume, may indicate various pathologic processes that may require immediate attention to prevent inadequate ventilation resulting in hypoxemia or hypercarbia. A kinked endotracheal tube (ETT) may mimic other pathologic processes including bronchospasm, mainstem intubation, or ventilator malfunction. As newer ETTs are developed, a key factor in their design should be resistance to kinking or occlusion due to patient positioning. Methods: The current project developed and describes the process for using a repeatable in vitro mechanical test to determine resistance to kinking by an ETT. Results: The mechanical testing procedure can be used to determine the compression force and distance required to kink an ETT under different conditions including temperature. The force required to induce devastating kink failure was lower during heated testing conditions. The addition of airflow through the ETTs during compression testing confirms the occurrence of airway obstruction at approximately the same time a mechanical kink is observed on the force-versus-distance curves. Conclusions: These procedures may be used to characterize and evaluate ETT designs under in vitro conditions mimicking those in the clinical practice. [ABSTRACT FROM AUTHOR]

The authors have conducted a retrospective analysis based on two cases of patients with intra-tracheal pathologies who received treatment from the same surgeon at a tertiary referral center. The effective management of airways in patients with intra-tracheal lesions necessitates close collaboration between surgeons and anesthesiologists. Factors such as the size, location, rigidity of the tumor, and the remaining tracheal lumen space should be carefully considered. In situations where there is near complete obstruction of the trachea and a substantial risk of worsened respiratory function, resorting to cardiopulmonary bypass or extracorporeal membrane oxygenation is advisable. This pilot study aims at devising an algorithm for the airway management of intra-tracheal lesions, although a larger case cohort is needed to assess its applicability and effectiveness. [ABSTRACT FROM AUTHOR]

Invasive mechanical ventilation is prevalent and associated with considerable morbidity. Pediatric critical care teams must identify the best timing and approach to liberating (extubating) children from this supportive care modality. Unsurprisingly, practice variation varies widely. As a first step to minimizing that variation, the first evidence-based pediatric ventilator liberation guidelines were published in 2023 and included 15 recommendations. Unfortunately, there is often a substantial delay before clinical guidelines reach widespread clinical practice. As such, it is important to consider bar- riers and facilitators using a systematic approach during implementation planning and design. In this narrative review, we will (1) summarize guideline recommendations, (2) discuss recent evidence and identify practice gaps relating to those recommendations, and (3) hypothesize about potential barriers and facilitators to their implementation in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). Design: This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. Results: Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability (r >.86, P <.001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% (P =.043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 (P =.044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant (P >.05), but an increase in the mean values were observed. Conclusion: Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD. [ABSTRACT FROM AUTHOR]

Background: Adverse airway events (AAEs) are rare but devastating complications following palatoplasty. The purpose of this study is to evaluate patient risk factors for their effect on these complications. We hypothesize that prolonged operative time and the presence of multiple medical comorbidities are risk factors for AAEs. Design: Retrospective cohort study. Setting: Participant hospitals in the Pediatric American College of Surgeons National Surgical Quality Improvement Program year 2016–2019. Patients: Cases of palatoplasty in children under 3 years of age. Outcomes: Adverse airway events including postoperative reintubation or any requirement of postoperative mechanical ventilation. Results: A total of 6668 patients met inclusion criteria. The median operative time was 126 min (IQR 82). AAEs were identified in 107 (1.6%) patients. The incidence of risk factors was found to increase with age and AAEs were more prevalent in younger and older patients. Although patients in the older age groups had significantly higher burden of comorbidities, differences in age were not independently associated with AAEs. Following multivariable logistic regressions, operative times greater than 2 h, ASA class ≥3, >3 medical comorbidities, and black race were found to be significant independent risk factors. Conclusions: In this large, retrospective database study in palatoplasty, increased operative time, ASA classification ≥3, multiple comorbidities, and black race were independently associated with AAEs. [ABSTRACT FROM AUTHOR]

Dynamic lower airway obstruction is the primary component of canine bronchomalacia, but the ventilatory function remains underinvestigated. This prospective study analyzed tidal breathing characteristics in 28 dogs, comprising 14 with severe bronchomalacia diagnosed by bronchoscopy versus 14 without respiratory disease. Spirometry was conducted in all dogs. Bronchoscopy with bronchoalveolar lavage or brush under anesthesia was performed in 14 dogs with cough and expiratory effort. Severe bronchomalacia was defined by the severity of collapse and total number of bronchi affected. Ventilatory characteristics were compared between groups. Results revealed that dogs with severe bronchomalacia had lower minute volume (218 vs 338 mL/kg, p = .039) and greater expiratory-to-inspiratory time ratio (1.55 vs 1.35, p = .01) compared to control dogs. The tidal breathing pattern of dogs with bronchomalacia was different from that of normal dogs, and the pattern differed from the concave or flat expiratory curves typical of lower airway obstruction. Compared to control dogs, dogs with severe bronchomalacia had a significantly prolonged low-flow expiratory phase (p < .001) on the flow-time plot and a more exponential shape of the expiratory curve (p < .001) on the volume-time plot. Flow-time index ExpLF/Te (>0.14) and volume-time index Vt-AUCexp (≤31%) had a high ROC-AUC (1.00, 95% confidence interval 0.88 to 1.00) in predicting severe bronchomalacia. In conclusion, the tidal breathing pattern identified here indicates abnormal and complicated ventilatory mechanics in dogs with severe bronchomalacia. The role of this pulmonary functional phenotype should be investigated for disease progression and therapeutic monitoring in canine bronchomalacia.

Abstract Background Recently, the development of advanced, noninvasive methods has allowed the study of respiratory function even in uncooperative infants. To date, there is still little data on the application of this technique in infants with suspected airway obstruction. The aims of our study were: - To evaluate the role of respiratory function testing (PFR) in the diagnosis and follow-up of infants with stridor - To evaluate the differences between patients with inspiratory stridor and expiratory stridor. - To evaluate the concordance between PFR and endoscopy. Methods We enrolled infants aged

Abstract Background Many studies have been reported on tracheostomy to prevent upper airway obstruction after surgery. Among these, the scoring system proposed by Cameron et al. quantifies various factors that influence postoperative respiratory failure. This system provides a basis for surgeons to decide whether to perform an elective tracheostomy. In this study, the authors applied the Cameron scoring system retrospectively to patients undergoing severe oral cancer surgery to reevaluate the indications for elective tracheostomy and to investigate its clinical efficacy in airway management. In this study, a sample of 20 patients who underwent oral cancer surgery was selected and divided into two groups: 10 underwent tracheostomy and 10 did not. The Cameron scoring scores for each patient were extracted, to verify whether elective tracheostomy was performed in accordance with the threshold scores. Differences in scores and significant clinical impact factors between the two groups were analyzed and compared. Result The 10 patients who underwent tracheostomy had an average Cameron score of 6.4, all scoring above the recommended threshold of 5 for tracheostomy. For the 10 patients who did not undergo tracheostomy, the average score was 2.5, with 8 out of these 10 patients scoring below 5. Significant clinical impact factors observed included the location and size of the tumor, the performance of mandibulectomy and neck dissection, and the type of reconstruction surgery. Conclusion In planning surgery for oral cancer patients, it is essential to consider the use of elective tracheostomy based on preoperative assessment of the risk of postoperative airway obstruction using tools like the Cameron scoring system, and patients’ condition. Research confirms that elective tracheostomy effectively enhances airway management in patients with severe oral cancer.

To outline the effect of a Le Fort 1-type advancement osteotomy or Le Fort 1 level distraction osteogenesis (DO) procedure with anterior repositioning on speech, respiration and dimensions of the pharyngeal airway in patients with cleft lip and/or palate. This systematic review was conducted by following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). For studies published until October 2023, an electronic search was conducted, and those were included in which the impact of Le Fort 1 maxillary advancement (I) on the speech, breathing, and pharyngeal airway dimensions (O) compared to pre-operative situation (C) in the patients with non -syndromic cleft lip/palate (P) were assessed. A meta-analysis was done to assess the difference in the amount of pharyngeal depth. From 892 studies, 19 studies were included in the analysis. All studies reported an increase of airway dimensions that were evaluated with 3D-imaging, velar length and improvement in breathing after the intervention. Meta-analysis of the six studies revealed the significant increase of the following variables: nasopharyngeal depth (NPD) immediately after the Le Fort 1 osteotomy, NPD and middle pharyngeal depth immediately and 12 months after Le Fort 1 DO. In patients with cleft lip and/or palate, maxillary advancement using Le Fort 1 osteotomy and Le Fort 1 DO can significantly increase the dimensions of the airway in the nasopharynx. However, the changes in speech and breathing parameters were not significant in the scrutinized literature. Impact of Le Fort maxillary advancement on patients' speech remains controversial. [ABSTRACT FROM AUTHOR]

Predicting postoperative airway obstruction during oral cancer surgery is difficult. We aimed to investigate the relationship between postoperative airway obstruction and surgery in patients. Patients (n = 100, men: 72, women: 28) with oral malignancies who underwent surgery between January 2020 and December 2022 were included. The outcome was postoperative airway obstruction. Age, sex, alcohol, smoking history, BMI, tumor site, T and N classification, stage, surgical method, lymphatic invasion, vascular invasion, perineural invasion, DOI, airway management, occurrence and duration of postoperative airway obstruction were investigated. We defined airway obstruction as confirmed symptoms such as dyspnoea and wheezing, drop in SpO2 below 90 %, stridor auscultation and pharyngeal stenosis by endoscope. The relationship between airway obstruction and patient characteristics was analyzed using Fisher's exact test. The Kaplan–Meier method was used to assess onset of airway obstruction, and the time to onset of airway obstruction was compared using the log-rank test. Airway obstruction and surgery-related factors were evaluated using Cox regression models. Airway obstruction occurred in 6 patients within 12 h. Multivariate analysis revealed that age > 65 years, lymphatic invasion and DOI (cut-off value: 7.00 mm) were independent risk factors for occurrence of airway obstruction. Local resection of tumors ≥ 7 mm in DOI is associated with airway obstruction owing to factors such as swelling associated with deep resection. Age, lymphatic invasion are also associated with airway obstruction, requiring ward management according to the protocols of each institution with attention to postoperative hematoma and edema that may cause airway obstruction. [ABSTRACT FROM AUTHOR]