A midline nasopharyngeal heterotopic neuroglial tissue

Glial heterotopia is a rare disorder. However, it must be considered in the differential diagnosis of airway obstruction in the newborn. Differentiation of this lesion from nasal glioma and encephalocele is important. In this paper we report a midline glial heterotopia, which presented with upper airway obstruction in a newborn. The origin of a glial heterotopia from the midline of the nasopharynx has not been reported before. We present a review of the literature and discuss the clinical, radiological and pathological features of nasopharyngeal brain heterotopia in an infant.     

Nasopharyngeal brain heterotopia--a cause of upper airway obstruction in infancy

The finding of mature neuroglial tissue in a mass from the head and neck region of a child raises four differential diagnostic possibilities: teratoma, encephalocele, glioma, and heterotopic brain tissue. We present a review of the literature and discuss the clinical, radiographical, and pathological features of a rare nasopharyngeal brain heterotopia in an infant causing upper airway obstruction.     

Management of airway obstruction in the Pierre Robin sequence

A 10-year retrospective study of the management of airway obstruction in 26 infants with Pierre Robin sequence was made. It was not possible when the infant was first seen to assess the future severity of the airway obstruction but later 3 distinct groups could be identified according to the airway management which had become necessary. The deaths from respiratory obstruction indicate the prime importance of airway management. Laryngoscopy for intubation or endoscopic evaluation was often difficult and sometimes could not be achieved. 'Awake intubation' without general anesthesia has proved to be safer and less difficult using a special purpose slotted laryngoscope. Airway management should be individualized following the progressive sequence of posturing in the prone position, nasopharyngeal tube, endotracheal intubation and tracheotomy until successful control is achieved as indicated by the clinical features and pulse oximetry.     

鼻咽和口咽通气道在阻塞性睡眠呼吸暂停低通气综合征多平面手术围手术期中的应用研究

目的:对比研究鼻咽及口咽通气道对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者多平面术后缓解上气道阻塞的作用,观察患者的生命指征,探讨鼻咽及口咽通气道的临床应用价值及可靠性。方法:鼻咽通气道组为56例经PSG确诊为重度OSAHS的患者,术后置鼻咽通气道。口咽通气道组为45例经PSG确诊为重度的OSAHS患者,术后置口咽通气道,其余治疗2组相同。2组患者术后行心电、血氧饱和度和血流动力学监测。比较2组患者术后24h内的呼吸困难、最低血氧饱和度、血流动力学、咽部疼痛不适情况。结果:多平面术后24h内,鼻咽通气道组患者血流动力学指标HR(82.3±2.65)次/min、SBP(124.5±13.95)mmHg、DBP(76.2±8.1)mmHg、RPP(10 282.0±1 481.7),口咽通气道组患者血流动力学指标HR(93.4±2.89)次/min、SBP(135.1±16.5)mmHg、DBP(92.25±11.25)mmHg、RPP(12 664.4±1 936.3),两者差异有统计学意义(P<0.05);咽部疼痛鼻咽通气道组(1.71±0.45)分,口咽通气道组(3±0)分,两者差异有统计学意义(P<...     

Stenting the nasopharyngeal isthmus by nasopharyngeal airway after correction of acquired total nasopharyngeal obstruction: surgical procedure and results

The objective of this study is to describe a simple surgical procedure for management of acquired total nasopharyngeal obstruction in adults. Five patients were diagnosed as having complete nasopharyngeal obstruction over a 3-year period. Three patients previously underwent uvulopalatoplasty, while for the remaining two it was due to pharyngoscleroma. In all the patients, nasopharyngeal obstruction was at the level of the inferior edge of the soft palate. Two of the post-uvulopalatoplasty patients had recurrent obstruction after scar excision and topical application of mitomycin-C without stenting. All the patients were treated surgically by creation of a new anatomical nasopharyngeal isthmus and stenting it by nasopharyngeal airway for 6?months. All the patients experienced satisfactory results and good tolerability to airway placement. The nasopharyngeal airway can counteract the inevitable scar contraction of the new nasopharyngeal isthmus after surgical correction and maintain its patency.     

鼻咽通气管单夜治疗阻塞性睡眠呼吸暂停低通气综合征初步观察

目的 探讨用鼻咽通气管实验治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效及可行性.方法 符合OSAHS诊断标准的32例患者,采用Somte多道睡眠仪行第一夜即治疗前多道睡眠图(PSG)检查,第二夜整夜佩戴硅胶的鼻咽通气管实验治疗,同时行PSG监测.比较两夜的PSG监测指标,数据符合正态分布以x-±s表示,差异比较采用配对t检验.结果 佩戴鼻咽通气管单夜的耐受率为90.6%(29/32).29例采用鼻咽通气管实验治疗时的呼吸暂停低通气指数(AHI)由(44.7±16.0)次/h降至(14.6 4±10.0)次/h;最长呼吸暂停时间由(44.3 4±11.5)s降至(30.1±13.2)s;最低动脉血氧饱和度由(0.722±0.080)提高到(0.861±0.070);动脉血氧饱和度低于0.90时间在睡眠总时间中的构成比由(19.2±18.O)%降至(1.5±4.0)%,7项指标均较治疗前有明显改善(配对t检验,P值均<0.001).29例治疗当夜和次日,OSAHS主观症状明显改善,以AHI<20次/h且降低幅度≥50%作为成功的标准,鼻咽通气管单夜治疗成功率为65.5%(19/29).6例无效的患者,可能与舌后区阻塞所占比例较大有关.结论 单夜初步实验显示,鼻咽通气管对改善OSAHS腭后区阻塞有较好效果,为探索OSAHS新治疗技术提供参考.此外,鼻咽通气管实验治疗效果在判断阻塞平面方面也可能有应用前景,有待深入研究.     

Inter-observer variability in the clinical and radiological assessment of adenoid size,and the correlation with adenoid volume

Forty-six children were independently assessed with respect to size of adenoids and other clinical features by 3 observers of differing experience. Similar assessment was made of adenoid area and post-nasal-space airway from lateral cephalometric X-rays. The inter-observer agreement for these findings has been calculated. Absolute agreement between observers for the assessments is poor and in some instances this is related to clinical experience. In relative terms the agreement is more satisfactory. A nasal obstruction score due to adenoid enlargement has been derived from assessment of mouth breathing and speech hyponasality and this is shown to correlate with the nasopharyngeal radiology score derived from visual assessment of the radiological adenoid area and post-nasal-space airway. The radiology score correlates well with measurements of the nasopharyngeal area made by planimetry. Both the radiology score and the nasal obstruction score correlate with the volume of adenoid tissue removed at adenoidectomy. This study provides the basis for a scoring system for the clinical and radiological assessment of adenoids in order to detect preoperatively those children most likely to benefit from adenoidectomy.     

阻塞性睡眠呼吸暂停低通气综合征患者上气道极速CT测量

目的：通过极速CT测量阻塞性睡眠呼吸暂停低通气综合征（0SAHS）患者上气道,利用上气道各分区的测量值及顺应性来评估OSAHS患者气道阻塞平面,以期为临床诊治提供帮助。方法：随机选取82例OSAHS患者（OSAHS组）,无打鼾的健康人45例作为正常对照组,应用PHILIPS256层螺旋CT（极速CT）对其进行平静呼吸状态（吸气末）测量,及Mailer动作下鼻咽区、腭后区、舌后区、会厌后区各区最窄平面各径线及各区气道容积的测量。结果：①OSAHS组行平静呼吸与MUller动作时CT扫描,2种状态下鼻咽区左右径、会厌后区前后径及横截面积差异无统计学意义,其余各组参数间有差异,其中腭后区体积、舌后区前后径、舌后区体积有显著性差异。②Mailer动作时,2组会厌后区体积比较差异无统计学意义,鼻咽区左右径、鼻咽区体积、腭后区横截面积、舌后区前后径有差异,其余各组参数间有显著性差异。③2组的气道顺应性（Mailer相）比较,各组参数间均有差异,其中鼻咽区前后径、腭后区体积有显著性差异。同时,同一平面内,OSAHS组与正常对照组的左右径均大于前后径。④对阻塞平面的预测,咽腔容积测量与纤维内镜检查结果基本相符。结论：用极速CT测量OSAHS患者上气道,阻塞平面多位于腭后区及舌后区。上气道容积的CT测量可用于OSAHS患者上气道阻塞平面的评估。     

Nasopharyngeal actinomycosis: a rare cause of nasal airway obstruction

Nasopharyngeal actinomycosis is a rare clinical disease. It can occur after nasal trauma or surgical manipulation. It is also reported to occur without prior trauma, making diagnosis difficult. We report a case of nasopharyngeal actinomycosis that presented as nasal airway obstruction causing snoring and mimicking nasopharyngeal carcinoma. To our knowledge, only a few other cases of nasopharyngeal actinomycosis have previously been published, most coming after mucosal trauma. Diagnosis is made by observing the bacteria or its associated sulfur granules in the biopsy specimen. This anaerobic organism is difficult to culture. Treatment consists of wide debridement and prolonged antibiotic therapy, with good prognosis.     

Oropharyngeal foreign body after attempted nasal intubation: a case of traumatic middle turbinectomy

A nasopharyngeal airway, or nasal trumpet, is an adjunctive airway device used to bypass upper airway obstruction at the level of the oral cavity or oropharynx. Although nasal trumpet placement on an awake patient may be uncomfortable, there are no reports of significant trauma from insertion. We present an unusual case of middle turbinate avulsion presenting as a foreign body in the oropharynx after several attempts at placement of a nasopharyngeal airway in an unconscious patient. We hope to raise awareness that nasal intubation in patients with altered consciousness can result in significant nasal trauma, especially after multiple attempts have failed.     

Nasopharyngeal teratoma as a respiratory emergency in the neonate

We report a congenital nasopharyngeal teratoma which presented as acute neonatal airway obstruction. After immediate orotracheal intubation, a pedunculated mass, which filled the nasopharyngeal and oropharyngeal cavities, was completely removed. Histological examination of the specimen revealed as a mature teratoma, composed of all three germ layers with recognizable early organ differentiation.     

鼻咽通气道在鼻源性OSAHS患者术后应用评估

目的：探讨鼻咽通气道（NPA）在鼻源性阻塞性睡眠呼吸暂停低通气综合征（0sAHs）患者术后的应用,观察患者生命体征,评估其临床应用价值。方法：以216例鼻源性0sAHS患者为研究对象,按照术后鼻腔是否放置NPA随机分为2组：实验组（112例）放置NPA,对照组（104例）未放置NPA。2组患者术后行24h心电、血氧饱和度和血流动力学监测,比较2组患者术后不适感和LSaO2、血流动力学等指标。患者术后主观评价采用视觉模拟量表评分。结果：实验组在鼻阻塞感、鼻疼痛感、头痛感、咽干感、失眠、抽出填塞物（换药）时疼痛感均较对照组明显降低,差异有统计学意义（P〈O．01）。实验组LSaO2（P〈O．05）、心率（P〈0．01）、收缩压（P〈0．05）、舒张压（P〈O．01）、平均动脉压（P〈O．01）及率压积（P〈0．01）各指标均较对照组明显降低,差异有统计学意义。结论：NPA在鼻源性OSAHS患者的术后应用,可保持鼻腔通畅,避免了上呼吸道阻塞,具有良好的安全性和依从性,既减轻了患者痛苦,又可以改善低氧血症,保证了血液动力学的稳定性。     

成人阻塞性睡眠呼吸暂停低通气综合征的上气道多平面外科治疗

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠时频繁发生低氧及高碳酸血症,最终导致全身多系统、多器官渐进性损害。目前除了非手术的经鼻持续正压通气治疗(nCPAP)外,手术仍是主要的治疗措施。OSAHS上气道阻塞部位包括鼻腔、鼻咽、口咽与下咽,可单一或多部位阻塞,根据上气道的阻塞平面及范围,从而进行有针对性的手术是提高疗效的关键。文章就OSAHS外科治疗的历史、基于阻塞部位的临床分型及不同阻塞部位外科术式的选择、疗效评价等做了综述。     

Newborn and infant nasal dyspnea

OBJECTIVE: The aim of this study is to report our experience of causes of newborn and infant nasal obstruction. METHODS: Four cases (3 newborns, 1 infant) of nasal dyspnea are reported. For each of them, background circumstances, diagnostic and therapeutic methods and outcomes are reported. Based on a review of the literature, the main causes of nasal obstruction and their treatments are discussed. RESULTS: In all cases, the diagnosis was made by the rhinoscopy with an endoscope and CT-Scan. Choanal atresia, infectious rhinitis, bilateral lacrymo-nasal cyst and nasopharyngeal hamartoma were diagnosed, and associated with respiratory distresses or difficulties in feeding. The treatment consisted of simple removal of the nasopharyngeal hamartoma, marsupialization for the lacrymo-nasal cysts, antibiotherapy and stenting for a few weeks for the infectious rhinitis and permeabilization by puncture and stenting for the choanal atresia. The outcome was successful in all cases. CONCLUSION: Newborn and infant nasal dyspnea is a serious disease. This study underlines the importance of efficient and rapid management. Knowledge of the possible causes grouped in three categories--malformative, tumoral and infectious--is mandatory to make the appropriate choice.     

Congenital salivary gland anlage tumor: a case series and review of the literature

OBJECTIVE: To understand the clinical presentation and management of salivary gland anlage tumor (SGAT). DESIGN AND METHODS: This case series includes a report of a newborn male who presented with acute airway obstruction secondary to a nasopharyngeal mass which was discovered in the course of the clinical evaluation. Six additional cases of SGAT from the pathology consultation files of one of the authors (LPD) presenting in similar fashion are also included. The relevant literature from 1966 to the present has been reviewed through a Medline keyword search utilizing terms "salivary gland anlage tumor", "neonatal", and "nasopharynx." RESULTS: Endoscopic evaluation identified a nasopharyngeal mass tethered to the posterior septum. Although CT and MRI were helpful in identifying the mass and excluding involvement of the surrounding structures, the imaging characteristics of the mass itself were nonspecific. The patient was taken to the operating room and the polypoid mass was removed transorally after lysis of its septal attachment. Pathologic examination revealed a SGAT, a recently described entity in neonates and young infants, who present with early onset respiratory distress. Since the initial report of nine cases by one of the co-authors (LPD), seven additional cases including the present one have been seen in consultation. CONCLUSIONS: Salivary gland anlage tumor of the nasopharynx is a rare cause of neonatal airway obstruction. Endoscopic evaluation and imaging studies are helpful in the exclusion of other etiologies, some of which may have intracranial extension. Simple excision has been curative to date. There have been no reported recurrences in any of the previously studied cases with clinical follow-up dating more than 5 years.     

Tracheomalacia and bronchopulmonary dysplasia

Wheezing in the infant with bronchopulmonary dysplasia results from various pathophysiologic mechanisms, including upper or central airway obstruction. We report an infant with bronchopulmonary dysplasia who presented with episodic wheezing associated with hypoxia and bradycardia without evidence of stridor. Bronchoscopy revealed the presence of tracheomalacia. Upper or central airway obstruction, if undiagnosed, may be life-threatening. We suggest that wheezing with hypoxia and bradycardia in neonates should alert the physician to the possibility of tracheomalacia, even in the absence of audible stridor. Infants presenting with these symptoms should undergo bronchoscopy to confirm the diagnosis.     

Reoperation on patients with obstructive sleep apnea–hypopnea syndrome after failed uvulopalatopharyngoplasty

The goals of this study were to explore the reasons after failed uvulopalatopharyngoplasty (UPPP) in some patients with obstructive sleep apnea–hypopnea syndrome (OSAHS), and to observe the efficacy of the second surgery. Twenty-three OSAHS patients with failed UPPP were included in the study. Routine physical exams, electronic endoscopy, computed tomography scan and polysomnography after nasopharyngeal tube insertion were performed to assess the site of upper airway obstruction, and corresponding appropriate surgical treatment was carried out based on the diagnosis. Comprehensive evaluation of the 23 patients revealed that the sites of obstruction after failed UPPP were as follows: 7 cases predominantly in the oropharyngeal area, 2 cases in the nasal, nasopharyngeal and oropharyngeal area, 5 cases predominantly in the glossopharyngeal area and 9 cases in the oropharyngeal and glossopharyngeal areas. Correspondingly, 7 cases underwent improved UPPP alone, 2 cases underwent adenoidectomy or nasal expansion and improved UPPP, 5 cases underwent glossopharyngeal surgery alone and 9 cases underwent improved UPPP and glossopharyngeal surgery. Follow-up for more than 12 months showed that there were four cured cases, 12 cases with marked improvement, and 7 cases with treatment failure. The success rate was 69.6 %. After undergoing UPPP, OSAHS patients may still have oropharyngeal airway obstruction. By performing a detailed preoperative assessment on the patient’s airway condition and clarifying the site of obstruction, performing the second surgical treatment can still achieve a relatively satisfactory treatment outcome.     

重度阻塞性睡眠呼吸暂停低通气综合征的多平面外科治疗

目的：探讨联合应用多个平面手术的方法治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效及临床意义。方法：28例重度OSAHS患者，术前进行明确的阻塞平面定位，根据阻塞平面的不同采取相应的手术方法进行治疗。全部患者在术前、术后6个月及术后1年进行临床随访和PSG监测。结果：手术均未出现严重并发症，术后6个月有效率为100％，1年有效率为89．29％。术后PSG监测示AHI和LSaO2均较术前有明显变化（均P〈0．01）。结论：重度OSAHS患者大多存在上气道多平面解剖结构的阻塞，鼻腔、鼻咽部、腭-咽平面及舌-咽平面阻塞者常见。根据阻塞平面进行多平面手术治疗可提高疗效。手术方案应根据患者上气道阻塞情况和接受程度等具体制定。     

A nasopharyngeal dermoid causing neonatal airway obstruction

A case of neonatal respiratory distress due to a pedunculated nasopharyngeal dermoid is presented with its MRI assessment. The dermoid was removed without complications. Nasopharyngeal teratomas are uncommon, consisting of tissues from all three germ layers with varying degrees of differentiation. Symptoms arise during the neonatal period and are associated with airway obstruction. MRI can be performed for contemporary assessment. The first goal of management is to establish a safe and protected airway using complete surgical excision.