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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. [ABSTRACT FROM AUTHOR]

The study aimed to: (1) compare the occurrence of postoperative respiratory difficulties (PRD) following primary cleft palate repair (CPR) in infants with an isolated cleft palate (iCP) and infants with Robin sequence (RS), and (2) describe the possible benefit of preoperative analysis with palatal plate in infants with RS. All consecutive infants with an iCP and infants with RS who underwent CPR between January 2009 and June 2022 in the Wilhelmina Children's Hospital were retrospectively reviewed. A total of 127 infants were included of which 74 infants with an iCP and 53 infants with RS. The group of infants with RS consisted of 35 infants with non-isolated RS (niRS) and 18 infants with isolated RS (iRS). Significant more PRD were seen in infants with RS compared to infants with an iCP (14/53 versus 9/74; p = 0.04). Especially infants with niRS have a significant higher risk of developing PRD in comparison with infants with an iCP (OR = 4.16, 95% CI [1.17–15.99], p = 0.031). The preoperative palatal plate screening in infants with RS (n = 25) did not show abnormalities and had no effect on the perioperative policy. Within the limitations of this study it seems that infants with niRS are more prone to develop PRD following primary CPR when compared to infants with iRS or an iCP. No clear benefit was found in postponing surgery until 12 months or later in infants with RS to avoid PRD. The preoperative palatal plate screening did not demonstrate signs of UAO in infants with RS that developed PRD. These findings suggest that preoperative analysis with palatal plate has a low predictive value. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The aim of the study was to provide insight into the influence of the COVID-19 on the frequency and characteristics of urgent and emergent tracheostomies (TS), comparing data collected both before and during the pandemic. Our two hypotheses were that during COVID-19, more TS were performed in the emergent setting and that during COVID-19 more TS were performed under general anaesthesia. The research was retrospective. The study period included the two years before and after the COVID-19 outbreak in Slovenia. Forty-one patients in each period met the inclusion criteria. Their medical charts were reviewed. The anamnestic, clinical, surgical and anaesthesiological data were collected. The two groups of patients from corresponding time periods were statistically compared. Predominantly men required the surgical resolution of acute upper airway obstruction (76% of patients). The causes for acute respiratory distress included head and neck cancer (62%), infections (20%), vocal cord paralysis (16%), and stenosis (2%). There were no statistically significant differences either in the (emergent/urgent) setting of TS or in the type of anaesthesia used. Both hypotheses were rejected. A statistically significant rise in use of the C-MAC laryngoscope during COVID-19 (from 3% to 15%) was reported. The outbreak of COVID-19 did not have a statistically significant effect on the frequency of performing emergent and urgent tracheostomies nor on the use of general or local anaesthesia. It did, however, require a change of intubation technique. Consequently, a significant rise in the use of the C-MAC laryngoscope was noted. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) and airway compromise are common in infants with Pierre Robin syndrome (PRS) due to tongue-based airway obstruction. Tongue-lip adhesion (TLA) is an effective procedure that can alleviate the symptoms of OSA by preventing posterior prolapse of the tongue. Although OSA consistently improved following TLA, it did not fully resolve. Ongoing management of OSA was required in all patients. These results identify the need for OSA to be reevaluated and managed for several years in PRS patients who have had a TLA.

Objective: Heliox, a mixture of helium and oxygen, has been shown to improve laminar airflow and decrease airway resistance in children. This study aims to describe the outcomes of heliox use in children with respiratory compromise and to identify variables associated with a need for airway surgical intervention. Methods: A retrospective cohort study of patients who received heliox between 2012 and 2022 at a tertiary care children's hospital. Results: A hundred and thirty‐eight heliox treatments were recorded in 119 children. Twelve patients were excluded. Most (n = 100, 84%) patients had significant comorbidities. On average, patients spent a cumulative mean of 94 ± 187 h on heliox therapy per hospital admission. Patients with croup or asthma without known airway pathology presented at an older age than patients with other indications for heliox therapy (4.0 ± 4.7 vs. 2.2 ± 3.6 years, p = 0.04) and were significantly less likely to have background diseases (n = 14, 52% vs. n = 74, 93%, p < 0.0001). Overall, 51 (47.7%) patients were recommended tracheostomy placement, airway reconstruction, or palliative care. Cumulative use of heliox for more than 47 h was associated with an increased risk of needing tracheostomy or airway reconstruction (odds ratio 6.2, 95% confidence intervals 2.56–14.13, p < 0.0001). In multivariable regression analysis, neuromuscular disease, intracranial neuropathology, and cumulative time of heliox were associated with a need for definitive airway intervention. Conclusions: Heliox may be used as a temporizing agent in children with upper airway obstruction. The effectiveness of heliox use for more than 47 h in children, especially in the presence of neuromuscular disease and intracranial neuropathology should be reconsidered. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Acquired hemophilia A can upshot in a life‐threatening hemorrhage and airway obstruction. Airway bleeding is a weighty emergency in hemophilia care, necessitating the immediate start of effective hemostatic therapy (porcine factor VIII, the factor eight inhibitor bypassing activity and recombinant factor VIIa) and the decision to undertake proper airway control, such as tracheal intubation and tracheostomy. However, due to the dearth deficiency of effective hemostatic measures we relied upon the use of fresh frozen plasma and cryoprecipitate to gain control of the bleeding despite the precarious threat of infectious disease transmission associated with their use. [ABSTRACT FROM AUTHOR]

Upper airway obstruction can occur suddenly and result in a patient's rapid deterioration. In this article we provide a structured approach to identifying those patients with acute airway compromise and stratifying them according to clinical urgency. This includes ways of distinguishing both the level of obstruction and its severity, based on the clinical signs and symptoms, and the role and timing of investigations. We describe the key aspects of emergency management, including temporizing measures and airway adjuncts. Management of rare, but important, situations are discussed such as post-thyroidectomy haematoma, occlusion of tracheostomy and laryngectomy stomas, and post-obstruction pulmonary oedema (POPE) is discussed. We describe the situation when an emergency surgical airway should be considered, along with our technique of performing one. [ABSTRACT FROM AUTHOR]

Robin Sequence (RS) is a collection of distinct morphologic features involving the face and upper airway that results from the abnormal development of the neonatal mandible. Typically described as the triad of micrognathia, glossoptosis, and upper airway obstruction, it is frequently associated with a cleft palate and can be found in isolation or as part of a syndromic presentation. Owing to the intimate relationship between the mandible and its soft tissue attachments, micrognathia manifests clinically with respiratory and feeding difficulties. There is significant heterogeneity in both the degree of anatomic aberration and the associated physiological compromise, which dictates the medical and surgical treatment plan. In severe cases requiring surgical intervention, mandibular distraction osteogenesis (MDO) has been shown to be successful in relieving airway obstruction by correcting the morphologic deficiency of the mandible. However, controversy persists regarding the best treatment method as the exact relationship between the anatomic changes affected by MDO and the physiologic improvement remains poorly understood. This controversy is fueled by differing opinions about the natural growth potential of the abnormal mandible in patients with RS and the lack of long-term data on the maxillomandibular relationship at skeletal maturity of patients who underwent MDO in infancy. The objective of this systematic review is to provide a comprehensive summary of the morphologic changes to the mandible, upper airway, and hyoid bone affected by MDO and the impact of these changes on physiologic improvement and long-term growth. [ABSTRACT FROM AUTHOR]

Objectives: (1) To investigate the prevalence and severity of drooling among healthy young children referred for adenotonsillectomy; (2) to evaluate the effect of adenotonsillectomy on drooling. Study Design: Prospective study. Setting: Tertiary referral center. Methods: Healthy typically developed children aged 18 to 48 months referred to adenotonsillectomy for upper airway obstruction (UAO) were recruited. Age‐matched children recruited from the community served as controls. Drooling frequency and severity were assessed at baseline and 2 months following surgery based on 2 subjective scales: the Drooling Infants and Preschoolers Scale (DRIPS) and Thomas‐Stonell and Greenberg Saliva Severity Scale (TSGS). Results: Eighty‐seven children aged 18 to 48 months were included in the study. Forty‐three children referred to adenotonsillectomy (study group) and 44 age‐matched controls. There were significant differences in almost all of the DRIPS items between children in the presurgery group compared to controls. Drooling severity and frequency were greater in the former compared to the latter (TGF‐s severity: 1.4 ± 1.0 vs 0.6 ± 0.8, P =.001; TGF frequency: 1.3 ± 0.9 vs 0.5 ± 0.6, P <.001). After surgery, the scores for all DRIPS and TSGS items decreased significantly and were comparable to the control group. Conclusions: The frequency and severity of drooling among otherwise young children referred for adenotonsillectomy were greater than those for healthy controls. Following surgery, both the frequency and severity significantly improved and became comparable to those of controls. These findings suggest that a major improvement in drooling is one of the benefits of a surgical intervention in a child with UAO. [ABSTRACT FROM AUTHOR]

Shota Abe,1 Akira Furuyama,2 Kenji Ohsuga,2 Shinya Yamazaki,1 Hiroyoshi Kawaai1,2 1Department of Dental Anesthesiology, Ohu University, School of Dentistry, Koriyama City, Fukushima Prefecture, Japan; 2Department of Oral Physiology and Biochemistry, Ohu University, School of Dentistry, Koriyama City, Fukushima Prefecture, JapanCorrespondence: Hiroyoshi Kawaai, Department of Dental Anesthesiology, Ohu University School of Dentistry, 31-1 Misumido, Tomita, Koriyama City, Fukushima, 963-8611, Japan, Tel +81-24-932-9337, Email h-kawai@den.ohu-u.au.jpPurpose: Intravenous sedation (IVS) with propofol (PPF) is commonly performed in dental treatment, particular in patients with dentophobia, with gag reflex, or undergoing implant surgeries, as PPF has the advantages of rapid induction and recovery. However, PPF and other intravenous sedatives may cause respiratory depression. Thus, IVS with PPF requires oxygen administration. But airway burn may occur when high-concentration oxygen is stored in the oral cavity and catches fire. For these reasons, the present study aimed to elucidate the changes in oxygen concentration (OC) under IVS with PPF and oxygen administration.Patients and methods: Nineteen healthy male volunteers participated in the study. None of them had missing teeth, nasal congestion, or temporomandibular joint dysfunction. They were sedated with a continuous PPF infusion dose of 6 mg/kg/hr for 25 min, followed by administration of 3 L/min oxygen via a nasal cannula. The OC was measured at two sites, namely, the median maxillary anterior teeth (MMAT) and median maxillary soft palate (MMSP), before PPF infusion (baseline) and 14, 15– 18 (Term 1), 19, and 20– 23 (Term 2) min after the start of infusion.Results: Compared with the values at baseline, the OC in the MMSP significantly increased at each time point, whereas the OC in the MMAT significantly increased at Term 2. Furthermore, in the comparison of the OC before and after the use of a mouth prop, the OC exhibited an upward trend, but no statistically significant differences were observed between the two time points in the MMAT and MMSP. In IVS with PPF and oxygen administration, the OC in the pharynx increases as the sedative level deepens.Conclusion: Oxygen administration should be temporarily discontinued, and suction should be performed to decrease the OC in the oral cavity when sparking procedures during IVS with PPF and oxygen administration are performed.Keywords: nasal cannula, propofol, mouth prop, airway fire, upper airway obstruction

Abstract Background Tracheal necrosis post endotracheal intubation is a rare life-threatening disease that can compromise airway patency. We demonstrated a novel usage of upper airway ultrasonography (USG) to diagnose tracheal necrosis. Case presentation A middle-aged smoking male presented with productive cough, noisy breathing and exertional dyspnea for 2 weeks. He was intubated one month prior due to a traumatic brain injury. Upper airway USG findings showed irregular air-mucosal interface (AMI) and comet tail artefacts over the 1st and 2nd tracheal ring. A direct laryngoscopy in the operating room showed thick mucopus inferior to the vocal cords, with necrotic tracheal cartilages and debris obstructing the airway. He was successfully treated with parenteral antibiotics, wound debridement and tracheostomy. Conclusion Our case highlights the first documented USG findings of tracheal necrosis. Upper airway USG serves as a potential diagnostic modality in managing the condition.

Dagmawi Anteneh Teferi,1 Ayto Addisu Negash,2 Daniel Aman,2 Sisay Hailu,2 Taye Nigatu Tola,1 Yared G/Michael Tarekegn,3 Wubhareg Anteneh Teferi4 1Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4School of Medicine and Health Science, Wolkite University, Wolkite, EthiopiaCorrespondence: Dagmawi Anteneh Teferi, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Po.Box: 1271, Addis Ababa, Ethiopia, Email dagmawianteneh16@gmail.comBackground: Thyroid gland abscess is a rare pathology with life-threatening complications when there is a delay in diagnosis. However, physicians should be aware of and consider this differential in patients with anterior neck swelling having acute onset compressive symptoms to ensure early diagnosis and management.Case Presentation: A 62-year-old female patient presenting with worsening of painful anterior neck swelling with associated fever, shortness of breath, and difficulty swallowing. The patient was found to have a thyroid abscess causing upper airway obstruction, against a background of follicular nodular disease found on clinical examination, cytology and fluid analysis from aspirate, biopsy, ultrasonography, and computed tomography. The patient was managed with endotracheal intubation and was subsequently discharged after recovery with antibiotic therapy, incision and drainage, and thyroid lobectomy.Conclusion: Thyroid abscess is an uncommon, critical clinical condition with high morbidity and mortality. Thyroid gland abscess should be considered while evaluating patients presenting with acute onset anterior neck swelling. Satisfactory clinical outcomes could be achieved with early diagnosis and proper management.Keywords: thyroid abscess, thyroid emergency, upper airway obstruction, anterior neck mass, incision and drainage, thyroidectomy

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

Background: Tracheal necrosis post endotracheal intubation is a rare life-threatening disease that can compromise airway patency. We demonstrated a novel usage of upper airway ultrasonography (USG) to diagnose tracheal necrosis. Case presentation: A middle-aged smoking male presented with productive cough, noisy breathing and exertional dyspnea for 2 weeks. He was intubated one month prior due to a traumatic brain injury. Upper airway USG findings showed irregular air-mucosal interface (AMI) and comet tail artefacts over the 1st and 2nd tracheal ring. A direct laryngoscopy in the operating room showed thick mucopus inferior to the vocal cords, with necrotic tracheal cartilages and debris obstructing the airway. He was successfully treated with parenteral antibiotics, wound debridement and tracheostomy. Conclusion: Our case highlights the first documented USG findings of tracheal necrosis. Upper airway USG serves as a potential diagnostic modality in managing the condition. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) and airway compromise are common in infants with Pierre Robin syndrome (PRS) due to tongue-based airway obstruction. Tongue-lip adhesion (TLA) is an effective procedure that can alleviate the symptoms of OSA by preventing posterior prolapse of the tongue. Although OSA consistently improved following TLA, it did not fully resolve. Ongoing management of OSA was required in all patients. These results identify the need for OSA to be reevaluated and managed for several years in PRS patients who have had a TLA. [ABSTRACT FROM AUTHOR]

Tracheostomy is a surgical procedure in an emergency setting to relieve the upper airway obstruction by creating an opening in the anterior part of trachea. It can also be done electively to wean off from a ventilator, during an elective surgery and clearance of pulmonary secretions. This study was a retrospective analysis of microbiological profile, antibiotic sensitivity & resistance pattern in patients with a tracheostomized wound. A retrospective review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between May 2022 and May 2023 at our hospital. Based on the tracheostomy indications, patients were allocated under obstructed and non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter. Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5 ± 16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p = 0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%). The colonization was predominantly by gram negative bacteria Acinetobacter species, P. aeruginosa & Klebsiella pneumoniae and fungal species like Candida albicans followed by Aspergillus niger and non-Albicans candida. [ABSTRACT FROM AUTHOR]

The article presents the case of a 10-year-old child with a history of X-linked chronic granulomatous disease (CGD) who is experiencing non-productive cough, dysphonia and weight loss for 12 months to discuss chronic granulomatous disease of the upper airway. Also cited are the use of airway endoscopy to confirm friable, edematous mucosa of the supraglottic larynx and the possible causes of CGD like defects in nicotinamide adenine dinucleotide phosphate (NAPH) oxidase subunits.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Objective Heliox, a mixture of helium and oxygen, has been shown to improve laminar airflow and decrease airway resistance in children. This study aims to describe the outcomes of heliox use in children with respiratory compromise and to identify variables associated with a need for airway surgical intervention. Methods A retrospective cohort study of patients who received heliox between 2012 and 2022 at a tertiary care children's hospital. Results A hundred and thirty‐eight heliox treatments were recorded in 119 children. Twelve patients were excluded. Most (n = 100, 84%) patients had significant comorbidities. On average, patients spent a cumulative mean of 94 ± 187 h on heliox therapy per hospital admission. Patients with croup or asthma without known airway pathology presented at an older age than patients with other indications for heliox therapy (4.0 ± 4.7 vs. 2.2 ± 3.6 years, p = 0.04) and were significantly less likely to have background diseases (n = 14, 52% vs. n = 74, 93%, p

Key Clinical Message Acquired hemophilia A can upshot in a life‐threatening hemorrhage and airway obstruction. Airway bleeding is a weighty emergency in hemophilia care, necessitating the immediate start of effective hemostatic therapy (porcine factor VIII, the factor eight inhibitor bypassing activity and recombinant factor VIIa) and the decision to undertake proper airway control, such as tracheal intubation and tracheostomy. However, due to the dearth deficiency of effective hemostatic measures we relied upon the use of fresh frozen plasma and cryoprecipitate to gain control of the bleeding despite the precarious threat of infectious disease transmission associated with their use.

Masses on the tongue base are rare and include malignant tumors, benign tumors, cysts, ectopic thyroid glands, and hamartomas. If the masses are enlarged, upper airway obstruction may occur. Hamartomas of the base of the tongue have been rarely reported, and there have been no reports of hamartomas associated with dyspnea beginning in the neonatal period. We present the case of a 14-year-old boy who had a tongue base mass since birth and was managed with a tracheal cannula. An absence of the lingual frenulum and impaired tongue movement were also observed. The mass was behind the base of the tongue and could not be observed intraorally but only on endoscopy. Computed tomography and magnetic resonance imaging showed a 24 × 21 × 32 mm lesion extending from the base of the tongue to the pharynx. Under the diagnosis of a benign tumor at the tongue base, a mass reduction surgery with biopsy was performed at the tongue base under general anesthesia using an intraoral approach. The result of the pathological examination was tongue hamartoma. The postoperative course was uneventful, and the tracheal cannula was removed 4 months after the operation under hospitalization. We also review previous cases of hamartomas of the tongue base with and without complications. [ABSTRACT FROM AUTHOR]

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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 [ABSTRACT FROM AUTHOR]

No abstract available.

Background: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is an incurable condition caused by human papilloma virus (HPV) types 6 and 11, often requiring repeated surgeries and in severe cases, tracheostomy. This imposes a significant socioeconomic burden on patients and families. Gardasil®, a proven prophylactic HPV vaccine, is emerging as a potential adjuvant therapy. We studied its response on JoRRP patients at our center. Methods: We conducted a retrospective review at Red Cross War Memorial Children’s Hospital from January 2015 to June 2022 on histologically confirmed JoRRP cases. Age at diagnosis, baseline and post-dosing Derkay-Coltrera (DC) scores (disease severity measure), inter-surgical intervals and tracheostomy, were collected. Results: Twenty-five of 30 confirmed cases were included. Average age at diagnosis was 60 months (about 5 years old), with HPV Type 6 in 40% and Type 11 in 48% of patients. All patients received at least one Gardasil® dose, 84% received a second dose and 64% a third dose. Total population DC score decreased from an average of 17 (range: 4-34) pre-first dose to 8 (range: 0-16) after three doses, indicating a 50% reduction. Surgical intervals modestly increased. More significant improvements were seen in patients with aggressive forms of the disease. Conclusion: This is the first study in Southern Africa highlighting Gardasil® as adjuvant therapy. Despite our limited sample size, new cases observed a linear reduction in DC scores and tracheostomy rates. Contribution: This suggests that Gardasil® as adjuvant therapy has the potential to reduce disease severity and extend surgical intervals.

Zekewos Demissie,1 Nahom Zemedkun,1 Abraham Demile,1 Berhanu Nega,2 Yonas Bekuretsion,3 Bisrat Getachew,4 Bethelhem Berhanu5 1Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia; 2Department of Surgery, Division of Cardiothoracic Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Otolaryngology, Head and Neck Surgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia; 5Department of Radiology, St. Paul Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Zekewos Demissie, Email zakdem61@gmail.comAbstract: 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.Keywords: tracheobronchial amyloidosis, tracheal mass, upper airway obstruction

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. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to compare clinical features and outcomes of tracheotomies performed in our clinic before and during the COVID-19 pandemic, with a special focus on coronavirus disease 2019 (COVID-19) positive cases. Methods: The adult tracheotomy procedures performed in our clinic between 2018 and 2021 were retrospectively included in the study. Demographic data, indications, intubation periods, complications, and survival data were retrospectively analyzed and compared for the periods before and during the pandemic, as well as between patients with and without COVID-19. Results: In the years considered, 84 (58.7%) male and 59 (41.3%) female patients underwent tracheotomies performed by our surgical team, for a total of 143 patients. The mean age of these patients was 60.9 ± 17.2 years. The indications for tracheotomy were chronic illness requiring long-term intubation in 80 (55.9%) cases and prevention or treatment of upper airway obstruction in 63 (44.1%) cases. Four (2.8%) patients developed pneumothorax after the operation. While 86 patients were operated on during the COVID-19 pandemic (2020-2021), only 9 (10.5%) of them were polymerase chain reaction (PCR)-positive for COVID-19. No significant differences were seen between the periods before and during the pandemic regarding age, gender, indications, intubation period, complications, or survival data of the patients (P > .05). Likewise, no increased risk of complications or decreased survival was observed for patients with COVID-19 (P > .05). Conclusion: According to our findings, the COVID-19 pandemic did not significantly affect the indications, complications, or survival rates of tracheotomies performed in our clinic. Tracheotomies may be performed safely even for patients with COVID-19 after taking the necessary precautions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Negative-pressure pulmonary edema (NPPE) is a rare respiratory complication due to acute upper airway obstruction occurring shortly after extubation. We report a case of NPPE in young adult patient who underwent an eventful general anesthesia. The patient presented laryngospasm followed by acute respiratory distress with pink frothy sputum. The NPPE was initially misdiagnosed, and a preventable tracheostomy was performed. NPPE was managed with mechanical ventilation and diuretics, and the patient had full recovery. Every anesthesiologist should be aware of the diagnosis of NPPE. Early recognition and management are essential to prevent the morbidity associated with NPPE in young healthy patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Adenotonsillar hypertrophy (AH) is a prevalent condition in children that can cause significant complications if left untreated. In this study, we investigated the impact of adenoidectomy on pulmonary function tests (PFTs) and explored the relationship between spirometric parameters in affected children. By evaluating these factors, we can better understand the post-surgical outcomes and the potential benefits of surgical intervention. Methods: The present study utilized a prospective controlled design to conduct a before and after clinical trial involving 23 children diagnosed with upper airway obstruction resulting from AH. Five specific spirometric parameters were selected to evaluate pulmonary function before and 1-3 months following the adenoidectomy procedure. Additionally, adenoid grade scores and gender differences were recorded for each patient to assess their effect on the lung. Results: Peak expiratory flow (PEF) (p = 0.002), the first second of expiration (FEV1) (p < 0.001), and the ratio of FEV1/FVC (p = 0.001) significantly increased postoperatively. However, no significant correlations were found between the forced vital capacity (FVC) (p = 0.39) and mid-expiratory forced expiratory flow (FEF25-75) (p = 0.2). Rising of the FVC, PEF, FEV1, and FEV1/FVC was observed in AH grade III patients compared to AH grade IV patients following the surgical intervention, in comparison to the preoperative baseline, especially statistical significance was FEV (p = 0.047), indicating a noteworthy change in lung function. Conclusions: These findings emphasize the beneficial effects of adenoidectomy on PFTs and highlight that adenoidectomy positively affects the upper and lower airways. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnoea (OSA) is identified as repetitive and intermittent upper airway collapse or narrowing during sleep. Skeletal advancement through maxillomandibular surgery remains the most effective surgical treatment for OSA but is radical with certain relapse rate. Distraction Osteogenesis of mandible is a single-jaw surgical treatment alternative to bi-jaw surgeries having lesser complications. This case report describes successful management of a 46-year-old patient who reported with a chief complain of obstruction in breathing while sleeping since one year. Obstructive Sleep Apnoea (OSA) secondary to a retrognathic mandible was the final diagnosis, which was successfully treated by Distraction Osteogenesis (DO) of the mandible. The case showed enhancement in airway by 13mm and marked forward movement of Point-B (SNB increased by 6 degrees). The Epworth Sleepiness Scale value decreased from 19mm to 8 mm indicating substantial increase in the airway with stable results after 18 months of follow-up (elimination of symptoms and subsequent sound sleep). Distraction osteogenesis is an effective and reliable method to treat obstructive sleep apnoea secondary to retrognathic mandible. [ABSTRACT FROM AUTHOR]

The coronavirus disease-19 (COVID-19) pandemic has prompted new interest among anesthesiologists and intensivists in controlling coughing and expectoration of potentially infectious aerosolized secretions during intubation and extubation. However, the fear of provoking laryngospasm may cause avoidance of deep or sedated extubation techniques which could reduce coughing and infection risk. This fear may be alleviated with clear understanding of the mechanisms and effective management of post-extubation airway obstruction including laryngospasm. We review the dynamic function of the larynx from the vantage point of head-and-neck surgery, highlighting two key concepts: 1. The larynx is a complex organ that may occlude reflexively at levels other than the true vocal folds; 2. The widely held belief that positive-pressure ventilation by mask can "break" laryngospasm is not supported by the otorhinolaryngology literature. We review the differential diagnosis of acute airway obstruction after extubation, discuss techniques for achieving smooth extubation with avoidance of coughing and expectoration of secretions, and recommend, on the basis of this review, a clinical pathway for optimal management of upper airway obstruction including laryngospasm to avoid adverse outcomes.

Nasogastric tube syndrome (NGTS) induced by a nasointestinal ileus tube is an uncommon but potentially life-threatening complication. NGTS often becomes serious and progresses to acute upper airway obstruction caused by bilateral vocal cord paralysis or laryngeal infection. Early detection and proper treatment of NGTS are necessary. We describe the case of a 78-year-old patient with this syndrome induced by a nasointestinal ileus tube. At administration, ileus was suspected based on physical examination and thoracoabdominal X-ray findings. A nasointestinal ileus tube was placed through the left nasal cavity. Three days after tube placement, hoarseness and wheezing were found during nutrition support team rounds. Upper airway obstruction was suspected and evaluated immediately with flexible laryngoscopy by an otolaryngologist. The nasointestinal ileus tube was removed. The symptoms decreased with prompt proper management. Immediate removal of the tube and early recognition of symptoms are the first steps in the treatment for this syndrome, in addition to the initiation of steroid, proton pump inhibitor, and antibiotic therapy. The cause of NGTS is thought to be continuous pressure on the hypopharynx and cervical esophagus. NGTS should be considered in patients with either nasogastric or nasointestinal ileus tubes. Early diagnosis and proper management of NGTS are important.

Upper airway obstructions represent a huge burden to the health care system due to its high morbidity and cost to the economic systems. Therefore, it is important to understand the physiological parameters used in diagnosis and prognosis of these diseases. Various physiological lung parameters should be examined simultaneously to make the precise diagnosis of upper airway obstruction. Relying on only one parameter and neglecting others might lead to misdiagnosis and subsequent mismanagement. The shape of the flow-volume loop, Forced Expiratory Flow at 50% of vital capacity/Forced Inspiratory Flow at 50% of vital capacity ratio (FEF-50%/FIF-50%), Forced Expiratory Volume in 1 second /Forced Expiratory Volume after 0.5 seconds (FEV1/FEV0.5), Empey index, and the refined version of the Expiratory Disproportion Index (EDI) are of great value in the diagnosis of different types of upper airway obstructions. The shape of the flow-volume loop changes earlier than other spirometrical parameters and is very useful in detecting early changes in upper airway diseases. This review was aimed to explain and simplify the role of pulmonary function tests and flow volume curve not only for pulmonologists, but also for surgeons, anesthesiologists, and ENT specialists who can utilize and implement usefully these tests in their clinical practice.

Background: Peritonsillar abscess is a collection of pus between the tonsillar fibrous capsule and the pharyngeal constrictor muscle. Unilateral peritonsillar abscess is a common complication of acute tonsillitis, whereas bilateral peritonsillar abscess is rare. The incidence of bilateral peritonsillar abscess remains unknown but is estimated to be 4.9% of all peritonsillar abscess cases. Case report: A 20-year-old man came to the emergency room with bilateral peritonsillar abscess and complained of shortness of breath for two weeks. Physical examination showed muffled voice, 82% oxygen saturation, and inspiratory stridor. The isthmus faucium was narrow, with approximately 30% remaining. Peritonsillar puncture revealed pus mixed with blood. The treatment for this patient included bilateral peritonsillar incision and drainage and intravenous antibiotics of levofloxacin and metronidazole. The patient came to the Ear, Nose, Throat, Head, and Neck (ENTHN) Outpatient Unit eight days after the procedure for a control checkup and was in good condition. Conclusion: We have reported a bilateral peritonsillar abscess with complications of upper airway obstruction, in which we performed incision and drainage. Prompt and appropriate management is needed to avoid unwanted morbidity and mortality.

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.