• Sleep Medicine and Psychophysiology
• /
• v.11 no.1
• /
• pp.5-9
• /
• 2004

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent cessation of breathing due to complete or partial upper airway occlusion during sleep. The incompetent tone of palatal, pharngeal, and glossal muscles which fail to maintain airway patency during sleep causes narrowing of the airway dimension and increased resistance of breathing. The identification of the sites of upper airway obstruction in patients with OSA is important in understanding the pathogenesis and deciding the treatment modality of snoring and/or OSA. Various upper airway imaging modalities have been used to assess upper airway size and precise localization of the sites of upper airway obstruction during sleep. Dynamic imaging modalities enabled assessment of dimensional changes in the upper airway during respiration and sleep. This article focused on reviews of various upper airway imaging modalities, especially dynamic upper airway imaging studies providing important information on the pathogenesis of OSA.

• Tuberculosis and Respiratory Diseases
• /
• v.70 no.1
• /
• pp.63-68
• /
• 2011

Multiple symmetrical lipomatosis (MSL), also called Madelung's disease, is a rare disorder of unknown etiology and characterized by abnormal accumulation of large subcutaneous fatty masses in neck, shoulder, and upper trunk. MSL has known to predominantly affect middle-aged men with a history of alcoholism. Although the clinical course of MSL is considered to be slowly progressive, in advanced stage, fatty masses in the neck may compress the upper aerodigestive tract, resulting in dyspnea and dysphagia. The treatment of MSL is surgical resection, but radical excision is very difficult and recurrence after surgery is frequent. We report the case of 55-year-old man with long lasting MSL, which caused severe airway obstruction. This patient was admitted with progressive dyspnea and massive accumulation of fat around the vocal cord that was detected on a neck CT scan. This abnormal fatty infiltration in supraglottic region caused upper airway obstruction.

• Sleep Medicine and Psychophysiology
• /
• v.12 no.2
• /
• pp.93-97
• /
• 2005

Nasal obstruction may cause or aggravate sleep disordered breathing but exact pathogenesis is not clear. The possible mechanism could be combination of alteration in upper airway aerodynaimcs, loss of nasal reflex or sensation, effect of mouth opening, and a genetic predisposition. Anatomical narrowing of nasal airway cause more rapid airflow and induce more negative inspiratory air pressure. So, it increases collapsibility of pharyngeal airway. Loss of nasal sensation to airflow block nasal reflex. Mouth opening decreases the activity of pharyngeal airway dilator muscles and narrowing the pharyngeal airway may occur. The treatment of nasal obstruction should be done according to the cause. The causes of nasal obstruction are various from problems of external nasal opening to nasopharynx. Relief of nasal obstruction may not cure sleep disordered breathing always. In some mild obstructive sleep apnea patients, treatment of nasal obstruction only may cure sleep disordered breathing. In some severe sleep apnea patients, treatment of nasal obstruction may increase compliance of continous nasal positive airway pressure.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.3
• /
• pp.449-454
• /
• 1996

Functional upper airway obstruction due to vocal cord dysfunction is being increasingly recognized and has been variously described as "Munchausen's stridor", "Emotional laryngeal wheezing", "Nervous asthma". It's features are symptoms of acute reversible recurrent dyspnea associated with an inspiratory stridor, normal anatomy of the upper airway, demonstration of variable severe exthrathoracic upper airways obstruction with pathologic adduction of the vocal cord at bronchoscopy. The patients with this condition are frequently misdiagnosed as asthma and the diagnosis is often delayed. So they can present a serious medical problem and are exposed to the complication of treatment and investigation. We report a case of functional upper airway obstruction due to vocal cord dysfunction who showed paradoxical vocal cord motion at bronchoscopy and typical features of variable exthrathoracic obstruction on Flow-volume loop during a symptomatic period.

• Tuberculosis and Respiratory Diseases
• /
• v.51 no.3
• /
• pp.270-274
• /
• 2001

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve ; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.30 no.3
• /
• pp.237-245
• /
• 2004

The deformities of micrognathia and glossoptosis in the newborn are frequently associated with a cleft palate, which is known as Pierre Robin sequence. Upper airway obstruction is the most serious problem in these patients. Treatment of Pierre Robin sequence includes either positional or surgical intervention. Mild cases are often managed in the prone position. However, when the patient fails to thrive due to chronic upper airway obstruction, or severe respiratory distress ensures despite positional treatment, surgical intervention is mandatory to relieve the obstruction. We experienced three infants with Pierre Robin sequence who showed a symptom triad of micrognathia, glossoptosis, and cleft palate. Intermittent cyanosis, depression of the chest, respiratory difficulty and feeding problems were also observed. To relieve severe upper airway obstruction caused by micrognathia and glossoptosis, we simultaneously performed modified tongue lip adhesion (TLA) and a subperiosteal release of the floor of the mouth (SRFM). Respiratory and feeding difficulties were relieved, the tongue positioned anteriorly, body weight increased, and mandibular growth improved. Simultaneous TLA and SRFM may constitute a simple and reliable method for surgical treatment of airway obstruction in patients with Pierre Robin sequence.

• Journal of Genetic Medicine
• /
• v.15 no.1
• /
• pp.34-37
• /
• 2018

A 1q21.1 microdeletion is an extremely rare chromosomal abnormality that results in phenotypic diversity and incomplete penetrance. Patients with a 1q21.1 microdeletion exhibit neurological-psychiatric problems, microcephaly, epilepsy, facial dysmorphism, cataract, and thrombocytopenia absent radius syndrome. We reported a neonate with confirmed intrauterine growth restriction (IUGR), micrognathia, glossoptosis, upper airway obstruction, facial dysmorphism, and eye abnormality at birth as well as developmental delay at the age of 1 year. These clinical manifestations, except for the IUGR and upper airway obstruction, in the neonate indicated a 1q21.1 microdeletion. Here, we report a rare case of a 1q21.1 microdeletion obtained via paternal inheritance in a newborn with upper airway obstruction caused by glossoptosis and tracheal stenosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.34 no.4
• /
• pp.460-467
• /
• 2008

Pierre Robin sequence as a symptom triad of micrognathia, glossoptosis, and cleft palate results in upper airway obstruction and feeding problems. If mild, it is often managed in the prone position. When positional treatment fails, however, surgical intervention such as tongue-lip adhesion, tracheostomy, and mandibular distraction osteogenesis is mandatory to relieve airway obstruction. There has been growing interest in the application of distraction osteogenesis for the management of craniofacial abnormalities. The mandibular distraction osteogenesis to newborns may prevent the airway obstruction, decrease the potential tracheostomy, and reduce the likehood of orthognathic surgery after growth. We experienced an infant with Pierre Robin sequence who showed mandibular hypoplasia, glossoptosis, incomplete cleft palate, intermittent cyanos is, depression of the chest, and respiratory difficulty associated with airway obstruction. We treated the airway obstruction by tongue-lip adhesion at 2 weeks of age, and treated the mandibular retrognathism and depression of the chest byusing internal mandibular distraction osteogenesis at 7 month of age. The mandible moved forwardly, the upper airway space was enlarged, and the antero-posterior distance of the mandible was elongated after the mandibular distraction. Mandibular distraction osteogenesis may be a promising technique to avoid the need of tracheostomy and orthognathic surgery, and to correct airway obstruction in infants with congenital craniofacial malformation.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.23 no.4
• /
• pp.179-192
• /
• 2023

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.22 no.6
• /
• pp.457-464
• /
• 2022

Tracheostomy is a surgical procedure that is commonly used to treat upper airway obstruction. In particular, patients with head and neck cancer may require elective or emergency tracheostomy because of airway obstruction due to massive bleeding of the intraoral tumor mass and rapid growth of the tumor mass in the neck area. Here, we report four cases of tracheostomy in patients with head and neck cancer with narrowed airway space and difficulty in breathing. Based on these cases and a literature review, we recommend that oral and maxillofacial surgeons and dental anesthesiologists should cooperate closely and determine the appropriate timing to perform definitive airway management for such patients during palliative treatment, along with continuous evaluation of tumor location, risk of recurrence, and airway involvement.