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The Cleft Palate-craniofacial Journal :... Mar 2016Objective To gather data from relevant experimental and observational studies to determine the relationship between micrognathia and cleft palate. The goal is to raise... (Review)
Review
Objective To gather data from relevant experimental and observational studies to determine the relationship between micrognathia and cleft palate. The goal is to raise awareness and motivate clinicians to consider the cause and effect relationship when confronted with patients with cleft palate, even if there is no clearly noticeable mandibular abnormality. Design Several electronic databases were systematically examined to find articles for this review, using search terms including "cleft palate," "micrognathia," "tongue," and "airway obstruction." PubMed was the source of all the articles chosen to be included. Exclusion criteria included case reports, articles focused on treatment options, and articles only tangentially related to cleft palate and/or micrognathia. Results A total of 930 articles were screened for relevance, and 82 articles were chosen for further analysis. Evidence gathered in this review includes a variety of etiological factors that are causative or associated with both micrognathia and cleft palate. Observational studies relating the two abnormalities are also included. Much of the included literature recognizes a cause-and-effect relationship between micrognathia and cleft palate. Conclusion On the basis of the published data, we suggest that micrognathia does induce cleft palate in humans and animals. With knowledge of this causative relationship, clinicians should consider the importance of gathering cephalometric data on the mandibles and tongues of patients presenting with isolated cleft palate to determine whether they have micrognathia as well. With more data, patterns may emerge that could give insight into the complex etiology of nonsyndromic cleft palate.
Topics: Animals; Cephalometry; Cleft Palate; Humans; Micrognathism
PubMed: 25658963
DOI: 10.1597/14-238 -
Physical Therapy May 2009BACKGROUND, OBJECTIVES, AND MEASUREMENTS: Patients with chronic airway obstruction (CAO) frequently experience dyspnea and fatigue during activities performed by... (Review)
Review
UNLABELLED
BACKGROUND, OBJECTIVES, AND MEASUREMENTS: Patients with chronic airway obstruction (CAO) frequently experience dyspnea and fatigue during activities performed by accessory muscles of ventilation, which competitively participate in arm elevation. This systematic review of randomized controlled trials (RCTs) concerning patients with CAO addresses the effects of upper-extremity exercise training (UEET), added to lower-extremity training or comprehensive pulmonary rehabilitation, on the following patient-centered outcomes: exercise capacity, symptoms, ability to perform daily activities, and health-related quality of life.
METHODS
Studies were retrieved using comprehensive database and hand-search strategies. Two independent reviewers determined study eligibility based on inclusion criteria. A detailed description of treatments was mandatory. Reviewers rated study quality and extracted information on study methods, design, intervention, and results.
RESULTS
Forty publications were evaluated. Four RCTs met the inclusion criteria but had serious methodological limitations, which introduce possible biases that reduce their internal validity. The outcomes measured were heterogeneous, and the results were inconsistent regarding maximal exercise capacity, dyspnea, and health-related quality of life. No effect of UEET was demonstrated for measures of arm fatigue.
LIMITATIONS AND CONCLUSIONS
The limited methodological quality of the studies retrieved prevented us from performing a meta-analysis, the results of which could be misleading. This systematic review shows that there is limited evidence examining UEET and that the evidence available is of poor quality. Therefore, a recommendation for the inclusion or exclusion of UEET in pulmonary rehabilitation programs for individuals with CAO is not possible. Further research is needed to definitively ascertain the effects of this training modality on patient-centered outcomes.
Topics: Exercise Therapy; Exercise Tolerance; Humans; Patient Compliance; Pulmonary Disease, Chronic Obstructive; Quality of Life; Randomized Controlled Trials as Topic; Self Care; Severity of Illness Index; Treatment Outcome; Upper Extremity
PubMed: 19282362
DOI: 10.2522/ptj.20070368 -
European Journal of Orthodontics Aug 2021Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects.
OBJECTIVE
The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs.
SEARCH METHODS
Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020.
SELECTION CRITERIA
Studies were selected after the application of predetermined eligibility criteria.
DATA COLLECTION AND ANALYSIS
Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented.
RESULTS
Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37-2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments.
CONCLUSIONS
Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Pharynx; Sleep Apnea, Obstructive
PubMed: 32524148
DOI: 10.1093/ejo/cjaa035 -
Respiratory Care Sep 2016Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the... (Review)
Review
Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the PubMed and EmBase databases for all the cases describing OFTP. The systematic search yielded 28 citations describing 53 subjects with OFTP. The study population (61.1% females) comprised of both adults and pediatric subjects with a median (IQR) age of 40.5 (14.8-60.5) years. The median (IQR) size of endotracheal tube was 7.5 (6-9.3) mm with a median (IQR) duration of intubation of 36 (14-96) hours. The median (IQR) time to onset of symptoms after extubation was 24 (6-96) hours. Stridor was the most common symptom. The average delay in correctly identifying the OFTP was 26 hours. The diagnosis of tracheal pseudomembrane was confirmed by flexible bronchoscopy in 38 (70.4%) instances while rigid bronchoscopy was used in 46.3% subjects for removing the pseudomembrane. There were two deaths, one each in an adult and a pediatric subject. OFTP is a complication of tracheal intubation and presents with respiratory failure. The diagnosis can be confirmed by flexible bronchoscopy. Treatment involves removal of the obstructing membrane with either flexible or rigid bronchoscopy.
Topics: Airway Extubation; Airway Obstruction; Bronchoscopy; Humans; Intubation, Intratracheal; Respiratory Sounds; Tracheal Diseases
PubMed: 27247431
DOI: 10.4187/respcare.04662 -
Thyroid : Official Journal of the... Nov 2016Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying... (Review)
Review
BACKGROUND
Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency.
METHODS
PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with the following study eligibility criteria: English-language publications; adult subclinical or overt hypothyroid patients; intervention, observational, or retrospective studies; and respiratory manifestations. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was followed, and Cochrane's risk of bias tool was used.
RESULTS
A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full-text analyses, of which 22 were included in the review. Possible mechanisms explaining respiratory problems at multiple physiological levels were identified, such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above-mentioned areas was only dealt with in a limited number of studies. Therefore, it is not possible to draw any strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due for example to small numbers of patients, lack of control groups, randomization and blinding, and differences in body mass index, sex, and age between subjects and controls.
CONCLUSION
Mechanistic data linking hypothyroidism and respiratory function are at best limited. This area of research is therefore open for retesting hypotheses, using appropriate study designs and methods.
Topics: Airway Obstruction; Animals; Comorbidity; Disease Models, Animal; Evidence-Based Medicine; Goiter; Humans; Hypothyroidism; Prevalence; Pulmonary Ventilation; Reproducibility of Results; Respiratory Insufficiency; Respiratory System; Selection Bias; Sleep Apnea, Obstructive
PubMed: 27673426
DOI: 10.1089/thy.2015.0642 -
Journal of Cardiothoracic Surgery Apr 2023Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following... (Review)
Review
OBJECTIVES
Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability.
METHODS
A systematic review was performed up to and including February 2022 based on the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study.
RESULTS
A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%).
CONCLUSION
Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning.
Topics: Humans; Pneumonectomy; Mediastinum; Thorax; Prostheses and Implants; Prosthesis Implantation; Syndrome
PubMed: 37038182
DOI: 10.1186/s13019-023-02278-2 -
The British Journal of Oral &... Apr 2024The purpose of this systematic review and meta-analysis was to determine the most effective and least morbid surgical technique for relieving retroglossal airway... (Review)
Review
The purpose of this systematic review and meta-analysis was to determine the most effective and least morbid surgical technique for relieving retroglossal airway obstruction in infants with Robin sequence (RS). The study adhered to PRISMA guidelines and included 25 studies (24 cohorts and one case series) that investigated interventions for airway improvement, including conservative measures, tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and tracheostomy. The primary outcome variable was complication rate, while predictor variable was the use of interventions for airway improvement. Results showed that conservative measures were the preferred initial management strategy in most studies, while TLA was recommended for infants with mild obstruction, and MDO or tracheostomy was reserved for severe cases. Only complications could be analysed via meta-analysis due to data heterogeneity, revealing that tracheostomy had a summary odds ratio of 5.39 in favour of TLA, while MDO had a ratio of 2.8 over TLA, and the complication rates were similar between MDO and tracheostomy. If conservative measures fail, the study recommends mandibular distraction as the preferable technique for stable airway improvement. If the infant is unsuitable for distraction, tongue-lip adhesion may serve as an alternative, while tracheostomy should be reserved for cases of severe multi-level obstruction. The authors propose that large-scale, multicentre trials comparing long-term outcomes are required to establish definitive guidelines.
PubMed: 38845304
DOI: 10.1016/j.bjoms.2024.04.003 -
The Journal of Craniofacial Surgery May 2017The aim of this study was to perform a systematic review of the treatment of nasal bone fractures. The search terms ("nasal bone fracture" AND complication) and ("nasal... (Review)
Review
The aim of this study was to perform a systematic review of the treatment of nasal bone fractures. The search terms ("nasal bone fracture" AND complication) and ("nasal bone fracture" AND [anosmia OR olfaction OR olfactory nerve OR smell]) and (anosmia AND ["nasal preparation" OR "nasal antiseptics"]) were used to search PubMed and SCOPUS. Of the 500 titles, 40 full papers were reviewed. One paper was excluded, and 3 mined papers were added. Ultimately, 12 papers were analyzed. The overall deformity rate was 10.4% ± 4.8%. No significant differences were found between patients who underwent closed reduction (14.7% ± 7.3%) and those who underwent open reduction (9.4% ± 4.4%), between those who underwent local anesthesia (5.8% ± 4.5%), and those who underwent general anesthesia (8.8% ± 3.8%), or between those who received timely treatment (5.7%) and those whose treatment was delayed (9.0%). Septal deviation occurred in 10.0% of patients as a sequela of nasal bone fracture. The nasal obstruction rate was 10.5% ± 5.3%. Fewer patients of nasal obstruction occurred in the open reduction patients (6.9% ± 4.4%) than in the closed reduction patients (15.2%). One patient of epiphora and 1 patient of diplopia were reportedAmong the 77 patients with nasal bone fractures, 29 (37.7% ± 11.3%) complained of olfactory disturbances. No significant associations were found between the type of fracture and the presence of olfactory disturbances. It is recommended for providers to explain to patients that approximately one-tenth of nasal bone fractures exhibit deformity, septal deviation, or nasal obstruction after surgery. Surgeons should take considerable care to avoid the olfactory mucosa during reduction surgery.
Topics: Humans; Nasal Bone; Nasal Obstruction; Nose Deformities, Acquired; Olfaction Disorders; Open Fracture Reduction; Skull Fractures; Tomography, X-Ray Computed
PubMed: 28468171
DOI: 10.1097/SCS.0000000000003482 -
World Neurosurgery Jun 2021Sialadenitis is a rare complication of skull base neurosurgery, in which the submandibular gland undergoes acute inflammation with edema after surgery. Although... (Review)
Review
BACKGROUND
Sialadenitis is a rare complication of skull base neurosurgery, in which the submandibular gland undergoes acute inflammation with edema after surgery. Although attributable to transient obstruction or manual compression, presentation may be rapidly life-threatening as a result of airway obstruction. Understanding risk factors is limited at present, and no practical management guidelines have been reported. Our objective was to survey the literature and to characterize the associated risk factors, treatment considerations, and overall trends in outcomes for patients experiencing post skull base neurosurgery sialadenitis.
METHODS
A search of the Ovid EMBASE, SCOPUS, and PubMed databases from inception through August 2020 was performed via Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Systematic review identified 13 publications describing 18 cases of acute sialadenitis after skull base surgery. We describe the 19th reported case. Commonalities include the need for aggressive respiratory support as intubation or emergent tracheostomy is almost universally required. Risk factors are poorly understood but may include extreme flexion and/or rotation of the head and neck. Outcomes are favorable overall, although secondary complications have been described.
CONCLUSIONS
Sialadenitis is a rare but potentially life-threatening complication of skull base neurosurgery, owing to acute loss of airway and the potential for a diverse array of secondary complications.
Topics: Humans; Neurosurgical Procedures; Postoperative Complications; Risk Factors; Sialadenitis; Skull Base; Treatment Outcome
PubMed: 33684589
DOI: 10.1016/j.wneu.2021.02.124 -
Children (Basel, Switzerland) Nov 2020Oral breathing, nasal obstruction and airway space reduction are usually reported as associated to allergic rhinitis. They have been linked to altered facial patterns... (Review)
Review
BACKGROUND
Oral breathing, nasal obstruction and airway space reduction are usually reported as associated to allergic rhinitis. They have been linked to altered facial patterns and dento-skeletal changes. However, no firm correlation based on the evidence has been established. This systematic review has been undertaken to evaluate the available evidence between malocclusion and allergic rhinitis in pediatric patients.
METHODS
The research refers to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines, databases (Medline, Cochrane Library, Pubmed, Embase and Google Scholar) were screened, the quality was evaluated through Quality Assessment of Diagnosfic Accuracy Studies (QUADAS-2).
RESULTS
The articles selected (6 out of initial 1782) were divided on the basis of the study design: two observational randomized study, three case-control study, one descriptive cross-sectional study, and one longitudinal study. A total of 2188 patients were considered. Different results were reported as related to allergic rhinitis ranging from a higher incidence of dental malocclusion, to an increase of palatal depth, and in posterior cross-bite about anterior open-bite and to longer faces and shorter maxillas.
CONCLUSIONS
Most of the studies selected found a rise in the prevalence of both malocclusion and allergic rhinitis in children. However, the level of bias is high, impaired by a poor design and no conclusive evidence can be drawn.
PubMed: 33261020
DOI: 10.3390/children7120260