• 수면정신생리
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• 제18권2호
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• pp.63-66
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• 2011

It has been controversial whether upper airway resistance syndrome (UARS) is a distinct syndrome or not since it was reported in 1993. The International Classification of Sleep Disorders classified UARS under obstructive sleep apnea syndrome (OSAS) in 2005. UARS can be diagnosed when the apnea-hypopnea index (AHI) is fewer than 5 events per hour, the simultaneously calculated respiratory disturbance index (RDI) is more than 5 events per hour due to abnormal non-apneic non-hypopneic respiratory events accompanying respiratory effort related arousals (RERAs), and oxygen saturation is greater than 92% at termination of an abnormal breathing event. Although esophageal pressure measurement remains the gold standard for detecting subtle breathing abnormality other than hypopnea and apnea, nasal pressure transducer has been most commonly used. RERAs include phase A2 of cyclical alternating patterns (CAPs) associated with EEG changes. Symptoms of OSAS can overlap with UARS, but chronic insomnia tends to be more common in UARS than in OSAS and clinical symptoms similar with functional somatic syndrome are also more common in UARS. In this journal, diagnostic and clinical differences between UARS and OSAS are reviewed.

• 대한한방내과학회지
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• 제40권3호
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• pp.557-565
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• 2019

Objectives: This study investigated the effect of local acupuncture point stimulation and the application of a topical herbal mixed heating cream in a chronic cough patient who had not responded to various medications for more than a few months. Methods: An 81 year-old female patient who was suspected to be suffered from Upper Airway Cough Syndrome (UACS) was examined. The patient was treated with local acupuncture point stimulation and the application of a topical herbal mixed heating cream. We used the Leicester Cough Questionnaire, Cough-Specific Quality-of-Life Questionnaire, and Verbal Numerical Rating Scale to assess the patient's respiratory symptoms. Results: Local acupuncture point stimulation and the application of a topical herbal mixed heating cream resulted in the improvement of cough symptoms. The quality of life due to the alleviation of symptoms also significantly improved. Adverse effects were not observed. Conclusions: This study suggests that local acupuncture point stimulation and the application of a topical herbal mixed heating cream may be an effective therapy for the treatment of chronic cough in patients with UACS.

• 대한치과교정학회지
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• 제40권3호
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• pp.145-155
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• 2010

악교정 수술은 안면골격형태 뿐만 아니라 상기도 공간에도 영향을 준다. 본 연구는 골격성 III급 부정교합자 중 하악골 후퇴술을 시행 받은 환자를 대상으로 상기도 공간의 부피변화를 관찰하기 위하여 시행되었다. 기존의 연구들이 측모두부방사선사진을 중심으로 시행하였으나 본 연구에서는 3차원 cone-beam computed tomography (CBCT)를 이용하여 영상을 재구성한 뒤 분석하였다. 연구 대상은 하악골 후퇴술을 시행 받은 20명(남성 12, 여성 8)이었으며, 수술 전 평균 1.8주(Baseline), 술 후 평균 2.3개월(T1) 그리고 술 후 평균 1년(T2) 시기에 CBCT를 촬영하였다. 상기도공간은 기준평면에 따라 비인두, 구인두, 하인두로 나누어 계측하고 Baseline, T1, T2를 각각 비교하였다. 결과로 수술 후 2.3개월(T1)시기에 상기도 공간은 상당히 감소하였으며 (p < 0.001), 술 후 1년 후(T2)에도 감소된 양은 증가하지 않았다. 구인두는 상기도 공간 중 가장 많은 감소폭을 보였다. 이러한 결과로 하악골후퇴술은 상기도 공간을 장 단기간동안 감소하는 것으로 나타났다.

• 대한장애인치과학회지
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• 제4권2호
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• pp.88-91
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• 2008

A female patient (14 years-old) with mental retardation was scheduled for ambulatory general anesthesia to treat peri-apical abscess and multiple dental caries. She had got cleft palate plasty at 5 years, but there was no past history of difficulty airway during general anesthesia or airway obstruction. Following induction of anesthesia using an inhalational anesthetic technique, conventional naso-tracheal intubation was tried. However, with conventional intubation technique we could not insert tube. And following several trial of intubation with laryngoscope, she developed an upper airway obstruction. Her lungs could not be ventilated using a facial mask and oxygen saturation was decreased. A #3 laryngeal mask airway (LMA) was inserted immediately, which allowed us to ventilate her lungs and restore the oxygen saturation. And dental treatment was carried out under LMA insertion successfully.

• Journal of Yeungnam Medical Science
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• 제20권2호
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• pp.217-222
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• 2003

Subcutaneous emphysema defines collection of air in subcutaneous spaces of body. It is usually originated from air in upper airway and lower respiratory tract such as larynx, trachea, bronchus and lungs. Air in subcutaneous spaces derives from leakage of air due to tearing or ruptures of airway structures, and also accompanies pneumothorax or pneumomediastinum and/or rib or sternal fractures or other major airway injuries. We experienced a case of subcutaneous emphysema caused by laryngeal injury without any associated airway injuries at neck from motorcycle accident, so we would report a case with the review of literatures.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권4호
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• pp.235-238
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• 2019

Corticobasal degeneration (CBD) is a rare neurodegenerative disease characterized by dystonia, cognitive deficits, and an asymmetric akinetic-rigid syndrome. Little information is available regarding anesthetic management for CBD patients. Our patient was a 55-year-old man with CBD complicated by central sleep apnea (CSA). Due to the risk of perioperative breathing instability associated with anesthetic use, a laryngeal mask airway was used during anesthesia with propofol. Spontaneous respiration was stable under general anesthesia. However, respiratory depression occurred following surgery, necessitating insertion of a nasopharyngeal airway. Since no respiratory depression had occurred during maintenance of the airway using the laryngeal mask, we suspected an upper airway obstruction caused by displacement of the tongue due to residual propofol. Residual anesthetics may cause postoperative respiratory depression in patients with CBD. Therefore, continuous postoperative monitoring of $SpO_2$ and preparations to support postoperative ventilation are necessary.

• 대한구순구개열학회지
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• 제8권2호
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• pp.81-86
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• 2005

Cleft palate patients with congenital anomalies have an increased risk of airway problems following palatoplasty. Factors that were related included presence of associated congenital anomalies, duration of surgery, age at time of surgery, history of previous airway problem, and excessive pressure exerted on the base of the tongue by Dingman retractor. This report described a complication of post-operative Pneumonia after palatoplasty (Furlow technique), which resulted in a life-threatening acute airway obstruction in an infant with cleft palate. Patient has a history of previous mild airway problems. In addition to this problem, we speculate that Furlow technique involves more extensive surgical dissection than other techniques may increase risk for upper airway obstruction. Awareness of this risk permits identifying those patients prior to surgery so that they can be monitored and managed properly, minimizing the likelihood of major complications or possibility of death.

• Journal of Oral Medicine and Pain
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• 제22권2호
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• pp.383-394
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• 1997

The purpose of this study was to examine the anatomic changes in the upper airway with a dental orthosis. the effectiveness and side effects of orthosis in the treatment of snoring and obstructive sleep apnea. To meet this puppose a dental orthosis, designed to increase the size of the upper airway by advancing the mandible, was used in 42 patients (30 M, 12 F), aged 29 - 69 years, to treat snoring and varying decrees of obstructive sleep apnea. Cephalometric study of anatomic featured was made with and without a dental orthosis, and the evaluation of the effectiveness and side effects of orthosis was done by questionnaires. The obtained results were as follows : 1. All subjects were habitual snorers and 32 patients comp1ained the loudness of snoring as severe as be heard outside of the patient's room. 2. According to the degree of respiratory distirbance index(RDI) and aprea index(Al) from the polysomnograph in 34 patient, mild obstructive sleep apnea patients were 5, moderate 6 and severe 16. 3. Various anatomic changes in the upper airway with denta1 orthosis were as follows : (1) More superioly positioned hyoid bone ( p<0.001) (2) Enlarged oropharyngeal (superior p<0.01, middle p<0.01. inferior p<0.01) and hypopharyngeal (P<0.05) airway space. 4. According to the results of the changes of clinical syptoms after the usage of the dental orthosis acquired from questionnaires, there was significant improvement in the frequently, the loudness and the severity of snoring, cessation of breathing and awakening from the difficulty of breathing during sleep. 5. The effectiveness and side effects of dental orthosis by questionnaires were as follows ; (1) Dental orthosis satisfied almost all the patients (68±20%). (2) Snoring was improved in all the patients (73±19%). (3) Obstructive sleep aphea was improved in all the patients (61 ± 37%) (4) Sleepiness in the daytime was significantly improved (61 ±37%). (5) The sleep quality was significantly improved (61±37%). (6) The discomfort of the dental orthosis was minor (33±18%) and no serious complications were observed. 6. The dental orthosis is an effective treatment for the symptom of snoring, and it can also effectively treat varying degrees of obstructive sleep apnea.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.33.1-33.11
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• 2018

Background: Bimaxillary orthognathic surgery with maxillomandibular setback is often accompanied by changes in airway space. We analyzed the changes in airway space before and after surgery and assessed their association with obstructive sleep apnea. Methods: This study is based on the cohort of 13 adult patients (9 males, 4 females, average age 23.85 years) who underwent bimaxillary orthognathic surgery with maxillomandibular setback. We performed computed tomography and portable polysomnography before and after the surgery to assess changes in airway space and Apnea-Hypopnea Index (AHI) values (total, supine, non-supine). Results: The oropharyngeal airway volume decreased by 29% after the surgery, which was statistically significant (p < .05). The upper airway volume and hypopharyngeal airway volume were decreased, but not significantly (4 and 19%, respectively). The changes in airway surface area were statistically significant at all levels examined (p < .05). Changes in the maximum anteroposterior width of the airway were also significant at all levels (p < .05). However, the changes in maximum lateral width were only statistically significant at C2 level (p < .05). AHI values were increased after the surgery but not significantly at any position. Conclusions: Although bimaxillary surgery with maxillomandibular setback significantly reduces the airway space, it does not affect AHI values or induce obstructive sleep apnea.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.181-184
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• 2015

Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.