上气道阻塞机制的研究进展

上气道是呼吸气体出入肺的通道,睡眠呼吸障碍性疾患（sleep disordered breathing,SDB）与睡眠时上气道的狭窄和塌陷关系密切。对于上气道阻塞机制的认识有助于诊治睡眠呼吸障碍性疾患,本篇综述回顾了上气道阻塞机制的研究及其最新的进展,从①上气道形态异常;②上气道开放肌功能异常;③呼吸驱动和调控障碍;④觉醒阈异常这四个方面进行阐述,探讨并展望了睡眠呼吸障碍性疾患的治疗前景。     

Lingual cellulitis causing upper airway obstruction

A case is reported in which upper airway obstruction occurred in an immunosuppressed patient due to the presence of lingual cellulitis.     

Three-dimensional study of the upper airway in different skeletal Class II malocclusion patterns

Objectives:To characterize upper airway volume and morphology in patients with different skeletal patterns of Class II malocclusion compared to Class I.Materials and Methods:A total of 197 individuals who had cone-beam computed tomography were allocated into groups according to ANB, SNA, and SNB angles (Class I, Class II maxillary protrusion, Class II mandibular retrusion), each subdivided into hypodivergent, normal, and hyperdivergent. Nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) were assessed with three-dimensional image reconstruction software.Results:Intergroup comparison did not detect significant differences in volume and morphology of NP, OP, and HP. The males displayed larger OP and HP volume than the females. Positive correlations between age and NP, OP, HP volume and between craniocervical angle and OP and HP volume were observed. Linear regression analysis detected a tendency for OP and HP volume to increase as maxillary and mandibular length increased.Conclusions:Upper airway volume and morphology were similar in different skeletal patterns of Class II malocclusion. Actual upper and lower jaw lengths were more closely related to upper airway volume and morphology than the angles that reflected their position relative to the cranial base.     

功能矫形治疗对安氏Ⅱ1类错畸形上气道结构的影响

目的探讨安氏Ⅱ1类错(牙合)畸形儿童功能矫治前后上气道的改变.方法选择腕骨片示生长发育为FG阶段儿童37例,其中安氏Ⅱ1类错(牙合)畸形儿童18例,正常(牙合)19例.安氏Ⅱ1类错(牙合)畸形组选用矫治器为Twin-block功能矫治器,治疗时间平均11.9个月,正常(牙合)观察12个月.分别测量矫治前后及观察前后头颅X线侧位片并进行统计学分析处理.结果安氏Ⅱ1类错(牙合)畸形组功能矫治后上气道PAS显著增加,和正常组无差异;UMPW也有显著增加,但未达到正常;舌骨测量中H-MP显著减小,H-VL显著增加.结论安氏Ⅱ1类错(牙合)畸形组功能矫治可使舌骨前上移位;增加上气道口咽段间隙,特别是舌根后气道间隙.     

Lingual haematoma leading to upper airway obstruction

A case is reported in which upper airway obstruction occurred in a patient following suturing of his lacerated tongue under local anaesthesia and the subsequent development of a large lingual haematoma.     

Oropharyngeal airway appliance for infant with upper airway obstruction: report of a case

A palatal appliance with oropharyngeal tube that reduces the upper airway obstructions of an eleven-month-old male infant with severe cerebral palsy is presented. The palatal appliance was composed of the base plate, the outer guide tube that held the oropharyngeal tube inside it, and the extra outer guide tube for the suction catheter. After the setting of the appliance, respiratory distress was improved without side effects.     

Ethnic differences in craniofacial and upper spine morphology in children with skeletal Class II malocclusion

Objectives:To analyze differences in upper cervical spine and craniofacial morphology, including posterior cranial fossa and growth prediction signs, between Danish and South Korean pre-orthodontic skeletal Class II children and to analyze associations between upper cervical spine morphology and craniofacial characteristics.Materials and Methods:One hundred forty-six skeletal Class II children—93 Danes (54 boys and 39 girls, mean age 12.2 years) and 53 Koreans (27 boys and 26 girls, mean age 10.8 years)—were included. Upper spine morphology, Atlas dimensions, and craniofacial morphology, including posterior cranial fossa and growth prediction signs, were assessed on lateral cephalograms. Differences and associations were analyzed by multiple linear and logistic regression analyses adjusted for age and gender.Results:Significant differences between the ethnic groups were found in the sagittal and vertical craniofacial dimensions (P < .001), mandibular shape (P < .01), dental relationship (P < .01), posterior cranial fossa (P < .05), and growth prediction signs (P < .001). No significant differences were found in upper spine morphology and Atlas dimensions between the groups. Upper spine morphology/dimensions were significantly associated with the cranial base angle (P < .01), sagittal craniofacial dimensions (P < .001), posterior cranial fossa (P < .001), and growth prediction signs (P < .05).Conclusions:Upper spine morphology/dimensions may be valuable as predictive factors in treatment planning for growing Class II children.     

Glossopexy for upper airway obstruction in Robin sequence.

A modified glossopexy is described with results of the operation in 24 patients who were specifically selected based on nasopharyngoscopic examination of the upper airway. Only patients with documented glossoptosis on endoscopy were selected for glossopexy. The procedure is designed to use two points of attachment for the tongue, one at the mandibular alveolus and the other at the lower lip. The genioglossus is also released to lengthen the tongue. All patients had resolution of their upper airway obstruction. There was only one partial dehiscence. The glossopexies were all released at the time of palate repair, usually before the first birthday.     

Functional outcomes in patients with facial dysostosis and severe upper airway obstruction

An increased risk of upper airway obstruction (UAO) is seen in up to 95% of patients with facial dysostosis. Secondary to respiratory problems are feeding difficulties and increased nutritional requirements. Little has been described regarding these outcomes in this patient population. Hence, a retrospective cohort study was performed to gather data on functional outcomes. Eighteen patients with facial dysostosis and severe UAO were included. The median follow-up time was 3.42 years. A tracheostomy tube was placed in 13 patients, of whom 10 subsequently underwent mandibular distraction. Three of the five patients without a tracheostomy underwent mandibular distraction as the primary surgical treatment; the remaining two patients were treated conservatively with oxygen supplementation. At presentation, 13 patients had feeding difficulties. Overall malnutrition was present in 16 patients during follow-up. At the end of follow-up, severe UAO was present in 12 patients, feeding difficulties in seven patients, and malnutrition in four patients, while two patients died. In conclusion, patients with facial dysostosis have a high prevalence of severe UAO, feeding difficulties, and malnutrition. Importantly, mandibular distraction has limited success in treating severe UAO in these patients. Close follow-up by a specialized craniofacial team is of paramount importance to manage the long-term consequences.     

正常儿童上气道及周围结构X线头影测量研究

目的本研究旨在建立上海地区正常儿童上气道其周围结构的Ｘ线头影测量的正常值。方法运用计算机辅助Ｘ线头影测量技术，对１１６例替牙期和恒牙早期的正常儿童的Ｘ线头颅侧位定位片进行研究。结果随着儿童年龄的增长，舌体、软腭和口腔容积逐渐增大，舌骨位置逐渐下降。咽部的形态结构存在明显的性别差异。结论替牙列期和恒牙早期的儿童都应按性别分别建立上气道及期周围结构的正常值范围。     

Management of upper airway obstruction in the Pierre Robin syndrome

Eight patients with Pierre Robin syndrome (PRS), were treated according to our management protocol. All our patients initially were given a trial of conservative, positional treatment, with high caloric gavage feeding. In five patients this therapeutic approach resulted in a good weight gain, with no significant respiratory distress. The remaining three patients showed no improvement, failed to thrive and therefore underwent the tongue to lip adhesion (TLA) procedure. Two patients then improved dramatically; whereas one continued with respiratory distress and failure to thrive and required tracheostomy. We conclude that when symptoms of respiratory distress and failure to thrive coexist in patients with PRS despite conservative management, surgical intervention to the airway is mandatory. TLA should be the first surgical procedure considered and if the ultimate goals of weight gain and respiratory comfort are still not achieved then tracheostomy seems inevitable.     

Correction of upper airway obstruction in the newborn with internal mandibular distraction osteogenesis

Tracheostomy for management of neonatal airway obstruction may be life saving but is associated with complications and developmental problems. As an alternative, the effectiveness of internal mandibular distraction osteogenesis was investigated in select neonatal patients with micrognathia and upper airway obstruction. Preoperative tests (sleep study, direct laryngobronchoscopy, and "milk scan" for GI reflux) were used to select appropriate candidates for the procedure. Excluded were patients with 1) central apnea, 2) severe reflux, 3) other airway lesions, and 4) mild to moderate obstruction controlled by positioning. Of 44 newborns (aged <3 weeks) with upper airway obstruction and micrognathia seen in the neonatal intensive care unit, 19 underwent tracheostomy, 10 were discharged with home monitoring and positional instructions, and 15 underwent bilateral mandibular lengthening with microdistractors. Of those who underwent mandibular distraction, a tracheostomy was avoided in 14 of 15 patients. Relative improvement in the posterior airway space was seen on 3D CT scans, cephalograms, and laryngobronchoscopies obtained preoperatively, postoperatively, and during follow-up evaluation. One of these 15 patients required a tracheostomy for postoperative central apnea. In an average of just 4.5 days following completion of distraction, patients were discharged home with improved oral feeding and no feeding tube. This study suggests that for selected newborns, the use of internal microdistractors allows for avoidance of a tracheostomy and improved oral feeding.     

不同治疗对上气道狭窄伴牙颌畸形儿童上气道的影响

目的 比较手术治疗与正畸治疗对上气道狭窄伴牙颌畸形儿童上气道的影响.方法 选取20例上气道狭窄伴牙颌畸形儿童,其中正畸组10例,手术组10例,分别接受上颌扩弓与双牙合垫矫治器的正畸治疗和切除肥大腺样体扁桃体的手术治疗,获取治疗前后的锥形束计算机断层扫描(cone beam computed tomography,CBC...     

Life-threatening upper airway obstruction due to isolated hypermobile tongue

Isolated hypermobile tongue is extremely rare. We present a case of isolated hypermobile tongue that caused several life-threatening airway obstructions during sleep. The tongue could reach to the nasopharynx and clear and moisten the nasopharynx by its movement.     

Home management of upper airway obstruction in Pierre Robin sequence using a nasopharyngeal airway.

OBJECTIVE: This unit has reported management of infants with Pierre Robin Sequence (PRS) and upper airway obstruction using nasopharyngeal airways and nutritional support until enough growth takes place for the infant to thrive. There was a mean hospital stay of 60 days. This long in-patient stay prompted review of our management protocols and consideration of treatment at home. This paper reports our experience of managing infants with PRS at home using a nasopharyngeal airway and nasogastric feeding tube and reviews whether such management reduces in-patient stay while remaining safe and effective. DESIGN: Retrospective review of cases referred over a 3.5-year period. Comparison is made with the unit's previously published results. PATIENTS: Thirteen PRS infants were referred to the West Midlands Regional Cleft service and required transfer to Birmingham Children's Hospital for specialist assessment and airway control. INTERVENTIONS: The parents of 12 infants underwent training to manage the airway and feeding tube. Treatment then continued at home. OUTCOME MEASURES: In-patient episode, rate of weight gain, and complication rate were used. Results: The median hospital stay was 19.5 days compared to 54 days previously. The median rate of weight gain was 34 g/d. There were no complications or readmissions. CONCLUSION: This series demonstrates the revised management protocol followed has reduced in-patient stays and remained effective, with infants continuing to thrive after discharge home, and has a low complication rate.     

External laryngopyocele: a rare cause of upper airway obstruction

Laryngocele is generally defined as abnormal dilatations of the laryngeal saccule. Its etiology is not well known but probably caused by congenital and acquired causes. It is uncommon and usually asymptomatic. It may be seen at any age but is most commonly presented at fifth and sixth decades. They are defined as internal, external, and mixed (combined) types according to their relationship with the thyrohyoid membrane. External laryngocele extends upward and protrudes through the thyrohyoid membrane to the neck. Infection of the laryngocele can cause acute symptoms or worsens existing symptoms. An infected laryngocele is known as laryngopyocele. It is an extremely rare disease and needs urgent diagnosis and treatment. We report a rare case of an external laryngopyocele that presented as upper airway obstruction. We also discussed the effect of needle aspiration in the emergency treatment of external laryngopyocele.     

Midface distraction to alleviate upper airway obstruction in achondroplastic dwarfs.

OBJECTIVE: The use of midface distraction in patients with achondroplasia and upper airway obstruction secondary to midface hypoplasia has not been reported. In this report, we review the treatment of two patients with severe midface hypoplasia and obstructive sleep apnea secondary to achondroplasia using midface distraction osteogenesis. DESIGN, SETTING, AND PATIENTS: Two patients with achondroplastic dwarfism and midface hypoplasia with airway obstruction were treated in a tertiary referral center for craniofacial disorders. RESULTS AND CONCLUSIONS: Both patients had their tracheostomies decannulated after midface distraction of 25 mm. Midface distraction osteogenesis is useful to alleviate upper airway obstruction from midface hypoplasia seen in achondroplasia.     

Internal mandibular distraction to relieve airway obstruction in children with severe micrognathia

Congenital craniofacial malformations such as Pierre Robin sequence or Treacher Collins syndrome are associated with mandibular micrognathia, resulting in obstructive sleep apnea (OSA) due to a decreased pharyngeal airway; in severe cases this leads to tracheostomy dependence. We present a series of 18 patients in whom we performed mandibular lengthening using internal distraction devices to relieve airway obstruction. Seven were tracheostomy-dependent and 11 were respiratory distressed without tracheostomy. The mandible was distracted at a rate of 1 mm per day. Following 3 months of consolidation for bony maturation, the distraction devices were removed. Results demonstrated forward mandibular elongation of a mean 22 mm (range 20–25 mm) and an increase in SNB angle and in pharyngeal airway. All patients with tracheostomies were decannulated, and there was an improved airway with resolution of signs and symptoms of OSA and elimination of oxygen requirement in all patients. We conclude that mandibular distraction using internal devices is a useful and comfortable method for younger children to expand the mandible forward and increase the pharyngeal airway.