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Children with Special Needs
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
This is characterised by mandibular hypoplasia, cleft palate and micrognathia. Glossoptosis – a tendency of the tongue to prolapse back into the airway – contributes to airway obstruction. Feeding problems are common and these babies are best nursed prone in contrast with the usual advice to put babies on their backs – ‘back to sleep’. They may need a nasopharyngeal airway but the airway improves as the baby develops and the mandible grows. Nowadays, tracheostomy is very rarely needed.
Upper airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Anita Deshpande, Cherie A. Torres-Silva, Catherine K. Hart
When evaluating the posterior oral cavity and oropharynx, the endoscopist should take care to identify the palatine tonsils and their size and contribution to oropharyngeal collapse (Figure 4.3). Glossoptosis and lingual tonsillar hypertrophy (Figure 4.4) are also important in the evaluation of obstructive sleep apnea. With the flexible endoscope in place just inferior to the soft palate, a jaw thrust maneuver should be performed to assist in differentiation between these two conditions, as jaw thrust should improve an obstruction caused by glossoptosis (Figure 4.5). Symmetry of the vallecula should also be assessed. Masses located at the base of the tongue can include a lingual thyroglossal duct cyst (Figure 4.6) or a lingual thyroid, either of which can cause potential airway displacement and subsequent respiratory distress.9
Effect of sleep-disturbed breathing on maxillofacial growth and development in school-aged children
Published in Orthodontic Waves, 2021
Ayano Murakami, Hitoshi Kawanabe, Hisashi Hosoya, Kazunori Fukui
About 90% of the patients diagnosed with OSAS who scored 15 or higher on the apnoea-hypopnoea index (AHI) reportedly snored, while other reports state that 80% of children with an AHI score of 5 or higher were observed to snore [3]. Consequently, snoring is seen as a primary symptom of OSAS. Paediatric OSAS is defined as an illness in which partial or total blockage of the upper respiratory tract occurs during sleep [3]. The main causes of paediatric OSAS are enlargement of tonsillar tissues, such as the pharyngeal tonsil (adenoid) or palatine tonsil. In contrast, micrognathia and glossoptosis are the main causes in obese patients [4]. Furthermore, factors that may worsen symptoms include abnormalities in maxillofacial morphology, including retraction or narrow jawbones, nasal or paranasal sinus illness, and obesity [5].
Effects of unilateral sinonasal surgery on sleep-disordered breathing
Published in Acta Oto-Laryngologica, 2019
Kojiro Ishioka, Hitoshi Okumura, Takanobu Sasaki, Masanao Ikeda, Nao Takahashi, Hironori Baba, Naotaka Aizawa, Arata Horii
Obesity and stenosis of the upper airway at the mesopharynx level are primarily involved in the pathogenesis of OSA (Obstructive Sleep Apnea) [1]. However, nasal obstruction may also have an impact on AHI (apnea hypopnea index) or SDB (sleep-disordered breathing) [2]. The mechanisms underlying nasal obstruction-induced SDB are speculated as follows: when nasal resistance is high, the negative pressure of the downstream mesopharynx may increase (Bernoulli’s principle), causing airway collapse; and nasal obstruction-related mouth breathing may lead to glossoptosis and pharyngeal collapse [3]. Indeed, it is reported that the risk of SDB is higher in patients with nasal obstruction than in those without it [4] and that artificial nasal obstruction induced OSA [5], while opposite results were also reported [6,7].
Paraglossal straight blade intubation in syndromic children
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Michiel A du Toit, Rebecca M Gray
The basis for airway obstruction in Pierre Robin syndrome is micrognathia, retrognathia and glossoptosis. These abnormalities can also be accompanied by a cleft palate in up to 50% of patients. Because of this combination of facial abnormalities, conventional midline laryngoscopy is often unsuccessful and can cause soft tissue trauma. The efficacy of paraglossal straight blade laryngoscopy was shown in a series of neonates with severe Pierre Robin syndrome undergoing elective glossopexy.12 Further case reports have also demonstrated the efficacy of paraglossal laryngoscopy in this subset of patients.13