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Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

dom, 07/14/2019 - 09:46

Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

J Craniofac Surg. 2019 Jul;30(5):e420-e424

Authors: Sirin Y, Yildirimturk S, Horasan S, Guven K

Abstract
The aim of the present study is to assess the reliability and accuracy of different 3-dimensional (3D) reconstruction algorithms in detecting undisplaced condylar, zygomatic arc, and orbital rim fractures based on cone-beam computed tomography data set. Twenty sheep heads were used in the present study. Sixty fractured and 60 nonfractured (control) zones were randomly allocated. Three groups consisting of nondisplaced fractures of condyle (CF, n = 20), orbital (OF, n = 20), and zygomatic arc (ZF, n = 20) were created by using a diamond cutting disc. Soft tissues were only dissected and no fractures were generated in the control group (n = 60). The 3D reconstructions were created by using multiplanar reconstruction (MPR), surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) algorithms. Final 3D models were examined in Osirix software (Pixmeo SARL, Bernex, Switzerland) by 6 observers. Diagnostic accuracies of each algorithm were statistically compared by receiver operating characteristics (ROC) and area under the ROC curves (AUCs). For the detection of CF, AUC for VR algorithm was found to be statistically larger than that of MIP while AUCs for VR and MIP were larger than those of MPR and SR for OF detection. For the detection of ZF, AUCs for MPR and VR were significantly larger than those of MIP and SR (P < 0.05 for each). Within the limitations of this experimental study, it can be concluded that for maxillofacial surgeons, it is more likely to detect condylar, orbital, and zygomatic fractures by using VR algorithm in 3D reconstruction.

PMID: 31299800 [PubMed - in process]

Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology?

dom, 07/07/2019 - 08:43
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Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology?

Neurourol Urodyn. 2019 Jul 06;:

Authors: Mukhtar BMB, Solomon E, Naaseri S, Aughwane P, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ

Abstract
AIMS: Functional obstruction secondary to a high-tone nonrelaxing sphincter (HTNRS) may lead to the formation of a proximal-to-mid-urethral diverticulum (pmUD) in patients without a history of anatomical obstruction, vaginal delivery, vaginal and/or urethral surgery, or periurethral gland infection, that is, a functional pmUD (fpmUD). We used measurements of the urethra-sphincter complex volume (USCv) as a proxy for the maximal urethral closure pressure to evaluate this potential etiological factor.
METHODS: We compared 17 consecutive women with fpmUD (mean age ± SD of 49.4 ± 13.2 years) with a control group consisting of 24 age-matched women (mean age: 50.8 ± 11.2 years) with no previous urological symptoms having MRI for posthysterectomy vesicovaginal fistula, and in all 71 women (mean age: 48.1 ± 11.6 years) with classical urethral diverticulum (cpmUD) referred in the same time period. The urethra-sphincter complex was measured using T2-weighted MRI and OsiriX© was then used to determine the USCv.
RESULTS: The mean USCv of the fpmUD group was 10.01 ± 6.97 cm3 . The mean USCv of the cpmUD was 5.19 ± 1.19 cm 3 and for the control group was 3.92 ± 1.60 cm 3 . There was a high statistically significant (P = .01) difference between the USCv in the fpmUD group and the USCv of both the cpmUD and the control groups.
CONCLUSIONS: Women with fpmUD demonstrated USCv that were significantly higher than those in women with cpmUD and the control group. These findings suggest that high pressure in the proximal urethra during voiding secondary to a HTNRS may contribute to the formation of urethral diverticula.

PMID: 31278796 [PubMed - as supplied by publisher]

Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable?

ter, 07/02/2019 - 07:51

Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable?

J Laparoendosc Adv Surg Tech A. 2019 Jun 28;:

Authors: van den Bos J, Schols RM, van Kuijk SMJ, Wieringa FP, Stassen LPS

Abstract
Aims: To investigate whether different calculation methods to express fluorescence intensity (FI) as target-to-background (BG) ratio are comparable and which method(s) match with human perception. Materials and Methods: Comparison of three calculation methods from current literature (OsiriX®, ImageJ®, and Photoshop®) to objectify FI during laparoscopic cholecystectomy measured at the exact same locations within recorded images of two categories: ex vivo and in vivo. Currently applied formulas to present FI in relation to the BG signal are compared with the subjective assessment by the human observers. These three formulas are Signal contrast = (FI in fluorescence regions-FI in BG)/255; Target-to-background ratio = (FI of target-FI of BG)/FI of BG; Signal-to-background ratio = FI of cystic duct/FI of liver and Target-to-background ratio = (FI of target-noise)/(FI of BG-noise). Results: In our evaluation OsiriX and ImageJ provided similar results, whereas OsiriX values were structurally slightly lower compared with ImageJ. Values obtained through Photoshop were less evidently related to those obtained with OsiriX and ImageJ. The formula Target-to-background ratio = (FI of target-noise)/(FI of BG-noise) was less corresponding with human perception compared with the other used formulas. Conclusions: FI results based on measurements using the programs OsiriX and ImageJ are similar, allowing for comparison of results between these programs. Results using Photoshop differ significantly, making direct comparison impossible. This is an important finding when interpreting study results. We propose to report both target and BG FI in articles, so that proper interpretation between articles can be made.

PMID: 31259650 [PubMed - as supplied by publisher]

Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging.

qui, 06/27/2019 - 10:02
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Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging.

Spinal Cord Ser Cases. 2019;5:20

Authors: Cummins DP, Connor JR, Heller KA, Hubert JS, Kates MJ, Wisniewski KR, Berliner JC, O'Dell DR, Elliott JM, Weber KA, Smith AC

Abstract
Study design: Retrospective study.
Objectives: To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI.
Setting: Academic university setting.
Methods: Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience.
Results: High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively.
Conclusions: Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.

PMID: 31240117 [PubMed - in process]

Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study.

sex, 05/31/2019 - 14:23
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Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study.

J Neurol Surg B Skull Base. 2019 Jun;80(3):295-305

Authors: Laleva L, Spiriev T, Dallan I, Prats-Galino A, Catapano G, Nakov V, de Notaris M

Abstract
Objective  The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods  Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results  The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion  The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.

PMID: 31143574 [PubMed]

S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection.

qui, 05/30/2019 - 08:09
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S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection.

Surg Endosc. 2019 May 28;:

Authors: Kim HJ, Choi GS, Park JS, Park SY, Cho SH, Seo AN, Yoon GS

Abstract
BACKGROUND: Lateral pelvic lymph node dissection (LPND) is a technically demanding procedure. Consequently, there is a possibility of incomplete dissection of lateral pelvic lymph nodes (LPNs). We aimed to identify metastatic LPNs intraoperatively in real-time under dual guidance of fluorescence imaging and 3D lymphovascular reconstruction, and then to remove them completely.
METHODS: Rectal cancer patients who were scheduled to undergo LPND after preoperative chemoradiotherapy (CRT) were prospectively enrolled. We traced changes in suspected metastatic LPNs during preoperative CRT and defined them as index LPNs on post-CRT imaging studies. For fluorescence imaging, indocyanine green (ICG) at a dose of 2.5 mg was injected transanally around the tumor before the operation. For 3D reconstruction images, each patient underwent preoperative axial CT scan with contrast (0.6 mm slice thickness). These images were then manipulated with OsiriX. Index LPNs and essential structures in the pelvic sidewall, such as the obturator nerve, were reconstructed with abdominal arteries from 3D volume rendering. All surgical procedures were performed via laparoscopic or robotic approach.
RESULTS: From March to July 2017, ten rectal cancer patients underwent total mesorectal excision with LPND after preoperative CRT under dual image guidance. Bilateral LPND was performed in five patients. All index LPNs among ICG-bearing lymph nodes were clearly identified intraoperatively by matching with their corresponding 3D images. Pathologic LPN metastasis was confirmed in four patients (40.0%) and in five of the 15 dissected pelvic sidewalls (33.0%). All metastatic LPNs were identified among index LPNs. Four (80.0%) of the five metastatic LPNs were located in the internal iliac area.
CONCLUSION: Index LPNs among ICG-bearing lymph nodes in pelvic sidewall were clearly identified and completely removed by matching with their corresponding 3D reconstruction images. Further studies and long-term oncologic outcomes are required to determine the real impact of dual image guidance in LPND.

PMID: 31139999 [PubMed - as supplied by publisher]

A Computed Tomographic (CT) and Pathological Study of Equine Cheek Teeth Infundibulae Extracted From Asymptomatic Horses. Part 1: Prevalence, Type and Location of Infundibular Lesions on CT Imaging.

ter, 05/21/2019 - 09:46
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A Computed Tomographic (CT) and Pathological Study of Equine Cheek Teeth Infundibulae Extracted From Asymptomatic Horses. Part 1: Prevalence, Type and Location of Infundibular Lesions on CT Imaging.

Front Vet Sci. 2019;6:124

Authors: Horbal A, Smith S, Dixon PM

Abstract
Background: Equine maxillary cheek teeth infundibulae are frequently affected by developmental and acquired disorders, but the computed tomographic (CT) imaging features of normal and abnormal infundibulae remain incompletely understood. Objective: To examine infundibulae with various grades of occlusal caries and control teeth by standard CT in order to assess the prevalence, type and location of subocclusal infundibular lesions present. Study design: Ex vivo original study. Methods: One hundred maxillary cheek teeth, including 82 with, and 18 without infundibular occlusal caries, were extracted from horses of different ages and imaged by standard CT; 8 teeth were also imaged by MicroCT. Images were later assessed by Osirix® and the prevalence, characteristics and sites of infundibular lesions were assessed. Results: Teeth with shorter infundibulae (i.e., Triadan 09 position and older teeth) were more likely to have occlusal caries, as were the rostral infundibulae. Subocclusal developmental infundibular lesions, including cemental hypoplasia and caries, were present in 72% of infundibulae without occlusal caries. CT imaging confirmed two main patterns of developmental cemental hypoplasia, i.e., apical cemental hypoplasia usually involving the full width of the apical aspect of the infundibulum and central linear hypoplasia involving the central aspect of the infundibulum over most of its length, and combinations of these types. These developmental lesions could later be affected by (acquired) infundibular caries once occlusally exposed due to normal wear. Some "normal-sized" (i.e., circa 1 mm diameter) occlusal central vascular channels expanded subocclusally to the dimensions of central linear defects. Main Limitations: No clinical histories or accurate ages were available for these teeth. Conclusions: Hypoplastic cemental lesions, including at central linear, and apical sites, are common even in clinically normal maxillary cheek teeth infundibulae and caries can occur when these lesions contact the occlusal surface. Central linear defects are not always clearly distinguishable from "normal" central vascular channels.

PMID: 31106213 [PubMed]

The Nasopharyngeal Airway: Estimation of the nares-to-mandible and nares-to-tragus distance in young children to assess current clinical practice.

qua, 05/08/2019 - 07:23

The Nasopharyngeal Airway: Estimation of the nares-to-mandible and nares-to-tragus distance in young children to assess current clinical practice.

Resuscitation. 2019 May 04;:

Authors: Johnson M, Miskovic A, Ray S, Chong K, Hickson M, Bingham B, Skellett S

Abstract
BACKGROUND: Nasopharygeal airways are used in urgent situations to alleviate airway obstruction. Guidelines for measuring the length of the NPA differ between national and international guidelines, and the evidence base for these measurements is lacking. The purpose of this study was to measure the nares-epiglottis and nares-vocal cord distances in young children (neonates to 12 years) on 3D reconstructed Magnetic Resonance Imaging (MRI) brain volume scans, and to examine the relationship of these distances with the nares-tragus and nares-mandible distances.
METHOD: One-hundred and seventy-six scans were reviewed. All patients had undergone MRI 3D brain volume imaging. The Anatomical landmarks were identified and the nares-tragus, nares-mandible distances measured and compared to nares-epiglottis and nares-vocal cord distance using Osirix.
RESULTS: The nares-epiglottis and nares-vocal cords distances significantly correlated (p-value <0.05). The nares-tragus distance showed strong correlation with the nares-epiglottis and nares-vocal cord distance compared to the nares-mandible distance (p-value<0.05).
CONCLUSION: In conclusion, the length of a nasopharyngeal airway in children under the age of twelve years can be predicted using the nares-tragus external anatomical distance minus 10 mm.

PMID: 31063843 [PubMed - as supplied by publisher]

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

seg, 05/06/2019 - 13:02

Differential growth patterns of the abdominal aorta and vertebrae during childhood.

Clin Anat. 2019 May 06;:

Authors: Gregory LS, McGifford OJ, Jones LV

Abstract
INTRODUCTION: The adult vertebral level of the splanchnic branches of the abdominal aorta relies on a complex series of fusion and regression steps during embryological development, such that variation is common. Little is known however regarding the anatomy of the abdominal aorta in children. This study aimed to investigate the spatial relationship between the abdominal aorta and vertebral column during childhood development to inform clinical management of pediatric patients.
MATERIALS AND METHODS: Retrospective multi-slice computed tomography abdominopelvic angiograms of children aged neonate to 19 years (n=232), were used to examine vertebral levels of the celiac trunk (CoT), superior (SMA) and inferior mesenteric (IMA) arteries, and aortic bifurcation (AB) using multiplanar formatting views in OsiriXTM . The abdominal aorta length, AB angle, and displacement of the aorta from the midline were quantified with the effect of age and sex analyzed using multinomial logistic regression and general linear models.
RESULTS: The most frequent origins of CoT, SMA, IMA and AB were T12, L1, L3 and L4, respectively, with significant variation in vertebral level for each vessel. SMA level was significantly more proximal with age, and CoT and AB demonstrated marked sex differences in vertebral level. As the age of the child increased AB angle decreased, aortic displacement increased, and the length of the abdominal aorta increased at a slower velocity to the vertebral column (p<0.001).
CONCLUSIONS: Our study highlights the variation of the location and geometry of the abdominal aorta in children; this knowledge will positively impact pediatric surgical approaches and endovascular procedures. This article is protected by copyright. All rights reserved.

PMID: 31056783 [PubMed - as supplied by publisher]

Safety and Feasibility Assessment of the O-arm as an Intraoperative Angiography Device in Aneurysm Surgery: Technical Note.

qui, 04/18/2019 - 07:09

Safety and Feasibility Assessment of the O-arm as an Intraoperative Angiography Device in Aneurysm Surgery: Technical Note.

World Neurosurg. 2019 Apr 14;:

Authors: Torné R, García S, Sanroman L, Rodríguez-Hernández A, Reyes L, Tercero J, Enseñat J

Abstract
OBJECTIVE: To describe the technique and initial experience using a rotational 3D fluoroscopy system (O-arm, Medtronic) as intraoperative angiography (IA) in the surgery of cerebral aneurysms.
METHODS: The 3D IA with O-arm (IAWOA) was performed in a consecutive cohort of patients with unruptured intracranial aneurysms. Conventional microsurgical clipping was performed with the assistance of indocyanine green videoangiography (ICGVA). Then the O-arm chasis was brought in, ipsilateral internal carotid artery was catheterized and contrasted images acquired. Resulting data sets were exported in DICOM and processed using the Osirix software in an accessory computer. The 3D image reconstruction was evaluated intraoperatively to confirm aneurysm occlusion and parent vessels patency. Afterwards, agreement among IAWOA, ICGVA and standard postoperative angiography were analyzed.
RESULTS: The initial pilot study was performed in six patients with seven unruptured aneurysms. Aneurysms occlusion rate was 100%. The concordance of the IAWOA and the standard postoperative angiography was complete, both in terms of occlusion and parent vessels patency. No complications derived from the IAWOA were observed except in one patient, who presented a retroperitoneal hematoma without clinical consequences.
CONCLUSION: The 3D rotational fluoroscopy (O-arm) device could be safely and effectively used as an IA system in selected patients. To the best of our knowledge this is the first study reporting its use as an IA device. This technique seems to offer excellent image quality that could compare to that of the gold standard 3D digital subtraction angiography but with a lower cost and versatility of use for other subspecialties.

PMID: 30995551 [PubMed - as supplied by publisher]

Variations in Cochlear Size of Cochlear Implant Candidates.

ter, 04/09/2019 - 08:25
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Variations in Cochlear Size of Cochlear Implant Candidates.

Int Arch Otorhinolaryngol. 2019 Apr;23(2):184-190

Authors: Zahara D, Dewi RD, Aboet A, Putranto FM, Lubis ND, Ashar T

Abstract
Introduction  The cochlear anatomy varies in each individual, and that has an impact on decisions regarding the insertion of electrodes. The measurement of the cochlear size is the routine examination required to choose the proper cochlear implant (CI) electrodes. Objective  To acquire normative data on the size of the cochlea (length, width, height, scala timpani [ST] height, cochlear duct length [CDL]) of CI candidates in Medan, Indonesia. Methods  This descriptive study was conducted based on high-resolution computed tomography (HRCT) temporal bone data and on HRCT temporal data manipulated to reconstruct three-dimensional (3D) multiplanar images with OsiriX MD DICOM Viewer version 9.5.1 (Pixmeo SARL, Bernex, Geneva, Switzerland) viewer of 18 patients (36 ears) who were CI candidates in Medan, Indonesia, in order to determine cochlear length (A), cochlear width, cochlear height, ST height and CDL, calculated through a simple mathematical function. Results  The average cochlear length (A) was 8.75 mm (standard deviation [SD] = 0.31 mm); the average cochlear width was 6.53 mm (SD = 0.35 mm); the average cochlear height was 3.26 mm (SD = 0.24 mm) and the average ST height at the basal cochlea was 1.00 mm (SD = 0.1 mm); and 0.71 mm (SD = 0.1 mm) at the half turn of cochlea. The average total CDL was 32.45 mm (SD = 1.31 mm; range: 30.01-34.83 mm). Conclusion  The cochlear size varies in each individual; therefore, the temporal bone measurement of CI candidates using HRCT is essential: for the selection of suitable implant electrodes; to minimize cochlear damages at the insertion of the electrode arrays; and to maximize the hearing improvements.

PMID: 30956703 [PubMed]

Imaging in the Mobile Domain.

dom, 04/07/2019 - 08:00
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Imaging in the Mobile Domain.

Rheum Dis Clin North Am. 2019 May;45(2):291-302

Authors: Bird P

Abstract
This article outlines the current state of imaging software with an emphasis on mobile sharing of images and mobile sharing of imaged data. The second portion focuses on the mobility of imaging design devices, highlighting the accessibility and the wider application of mobile devices.

PMID: 30952399 [PubMed - in process]

Multislice Computed Tomography Assessment of Airway Patency Changes Associated with Mandibular Advancement Appliance Therapy in Supine Patients with Obstructive Sleep Apnea.

qui, 04/04/2019 - 07:28
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Multislice Computed Tomography Assessment of Airway Patency Changes Associated with Mandibular Advancement Appliance Therapy in Supine Patients with Obstructive Sleep Apnea.

Sleep Disord. 2019;2019:8509820

Authors: Matsumura Y, Ueda H, Nagasaki T, Medina CC, Iwai K, Tanimoto K

Abstract
The purpose of the present study was to measure the regional effects of the mandibular advancement appliance (MAA) on the upper airway of supine subjects with obstructive sleep apnea (OSA) using multislice computed tomography (MSCT). The subjects included 8 males and 5 females who were diagnosed with mild to moderate OSA and were referred to the Orthodontic Clinic of Hiroshima University Hospital, where they underwent MAA therapy. Using a CT scanner, baseline MSCT images were obtained from the subjects without the MAA for morphological analysis, and then the experimental images were obtained while wearing the MAA. To measure the anteroposterior diameter, width, and cross-sectional area of the oropharynx region of interest (ROI), five distance variables were first defined on each multiplanar reconstruction (MPR) image using OsiriX. Additionally, the volumes of the upper airway, bony hard tissue, and soft tissue (soft palate and tongue) in the oro-hypopharyngeal region were measured. In most of the assessed airway size variables, significant increases in the anteroposterior diameter and width were observed after MAA therapy. Regarding the upper airway cross-sectional area, all the upper airway size variables exhibited significant increases. In the volumetric analysis, a significant increase was observed in airway volume, whereas the soft tissue volume in the oro-hypopharyngeal region did not show the significant decrease after MMA therapy. However, from a different point of view, the volumes of the upper airway and soft tissue significantly increased and decreased, respectively, as demonstrated by the calculated ratio for the oro-hypopharyngeal region. We demonstrated that the proportional size of the soft tissue volume, i.e., the soft palate and tongue in the oro-hypopharyngeal region, significantly decreased during use of an MAA. This forward displacement of the soft tissue thereby increases the retroglossal airway space (except the nasopharynx) three-dimensionally.

PMID: 30941225 [PubMed]