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Postoperative Skeletal Stability and Pharyngeal Airway: Counterclockwise versus Clockwise Rotation during Mandibular Setback Surgery.

To compare the effects of counterclockwise rotation (CCR) and clockwise rotation (CR) of the mandible on the pharyngeal airway during mandibular setback surgery. . Serial cephalograms of 40 patients with mandibular prognathism, including 20 who underwent CCR and 20 who underwent CR, were taken at the following time intervals: preoperatively (T1), immediately postoperatively (T2), >1 year after surgery (T3), final surgical changes (T31), postoperative stability (T32), and immediate surgical change (T21). Changes in menton (Me) and hyoid (H) positions, soft palate width, soft palate length, soft palate angle and craniovertebral angle (C2C4-SN), and pharyngeal airway spaces (nasal pharyngeal airway (NOP), uvula pharyngeal airway (UOP), tongue pharyngeal airway (TOP), and epiglottis pharyngeal airway (EOP)) were evaluated.

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Endotracheal Metastasis Causing Airway Obstruction.

Endotracheal metastasis, a critical complication of primary lung cancer, is an extremely rare lesion. A 73-year-old woman who had previously received treatment for lung cancer presented to our emergency department with dyspnea. A chest computed tomography and nasopharyngolaryngoscopy showed an endotracheal mass below the epiglottis, obstructing the trachea almost completely. The patient had an emergency tracheostomy, and then the mass was removed via median laryngotomy. This lesion was proven to be a recurrent metastasis of lung cancer. Clinicians should recognize endotracheal metastasis as an important differential diagnosis in cancer patients presenting with respiratory symptoms.

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Jaw Thrust Versus the Use of a Boil-And-Bite Mandibular Advancement Device as a Screening Tool During Drug-Induced Sleep Endoscopy.

1) to analyse agreement in degree of obstruction and configuration of the upper airway (UA) between jaw thrust and an oral device in situ during drug-induced sleep endoscopy (DISE) 2) to evaluate clinical decision making using jaw thrust or a boil-and-bite MAD, the MyTAP.

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Automatic registration of 2D MR cine images for swallowing motion estimation.

To automate the estimation of swallowing motion from 2D MR cine images using deformable registration for future applications of personalized margin reduction in head and neck radiotherapy and outcome assessment of radiation-associated dysphagia.

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Test-retest reliability of drug-induced sleep endoscopy using midazolam.

Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable method for determining the obstruction patterns causing sleep-disordered breathing. However, since DISE is not performed throughout the duration of sleep but for less than an hour, the reproducibility and reliability of DISE are questionable. Therefore, we aimed to determine the test-retest reliability of DISE using midazolam.

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Ultrasonography for predicting a difficult laryngoscopy. Getting closer.

Our objective was to evaluate the usefulness of five ultrasound measurements to predict a difficult laryngoscopy (DL). Prospective observational study. 50 patients underwent scheduled surgery under general anesthesia with orotracheal intubation with classical laryngoscopy at the University Hospital of Jaén (Spain). Sociodemographic variables, classic preintubation screening tests and ultrasound measurements of the neck soft tissue from skin to hyoid (DSH), epiglottis (DSE) and glottis (DSG) were obtained, as well as two measurements derived from the above: DSH + DSE and DSE - DSG. The relationship between a DL and ultrasound measurements was evaluated using t student test. The ROC Curve was used to establish the diagnostic accuracy of ultrasound measurements to discriminate a DL and logistic regression was used to establish a cut-off point. Multivariate analysis was performed to assess the impact of these measures in clinical practice. Patients with DL showed greater thickness of DSE (2.9 ± 0.46 cm vs 2.32 ± 0.54 cm; p = 0.001), DSH + DSE (4.25 ± 0.45 cm vs 3.62 ± 0.77 cm; p = 0.001) and DSE - DSG (1.83 ± 0.54 cm vs 1.24 ± 0.46 cm; p = 0.001) than those with an easy laryngoscopy. DSE and DSE - DSG had the highest diagnostic accuracy for DL with an area under the ROC curve of 0.79 [95%IC 0.66-0.92] and 0.82 [95%IC 0.68-0.96], respectively. It was established that DSE ≥ 3 cm, could predict a DL with a positive predictive value (PPV) of 69.23% [95%CI 40.3-98.2], and DSE - DSG ≥ 1.9 cm would do so with a PPV of 78.57% [95%CI 53.31-100%]. The multivariate analysis endorsed that DSE and DSE - DSG combined with classic tests (the Modified Mallampati score, the thyromental distance and the upper lip bite test) improved the preoperative detection of a DL. The inclusion of DSE and DSE - DSG in a multivariate model with classic parameters may offer the anesthesiologist better information for detecting a DL preoperatively.

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Migration of an Ingested Fish Bone to the Submandibular Gland: A Case Report and Literature Review.

Fish bone is one of the most common foreign bodies that gets lodged in the upper digestive tract, often located in the tonsil, epiglottis, pear-shaped fossa, and esophagus, where it may be easily located on routine inspection and removed. The forcible swallowing of food such as rice balls after ingesting fish bones by mistake may lead to the migration of the fish bone from the pharynx, throat, or esophagus to the surrounding tissues. Migration most commonly occurs to the soft tissues of the neck, even to the thyroid gland, but migration to the submandibular gland has rarely been reported.

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Molecular epidemiology and evolution of Haemophilus influenzae.

Haemophilus influenzae remains a common cause of illness in children worldwide. H. influenzae type b is the leading cause of bacterial meningitis in children before introduction of vaccination and is a common cause of pneumonia, epiglottis and septic arthritis. Since the implementation of the Hib conjugate vaccine, the non-typeable H. influenzae has rapidly decreased in respiratory and invasive infections in children and adults. However, the rate of antibiotic resistance of H. influenzae varies with region and period and is usually on the rise. In this review, typing of H. influenzae, virulence factors and resistance will be dissertated.

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Tonsillar hypertrophy and prolapse in a child - is epiglottitis a predisposing factor for sudden unexpected death?

Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis.

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Preoperative Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.

Hypoglossal nerve stimulation (HGNS) is an effective treatment for patients with obstructive sleep apnea (OSA) who fail continuous positive airway pressure (CPAP). We assessed the relationship between patient characteristics and response to HGNS.

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