Radiological analysis of oropharyngeal airway space after posterior internal fixation for the atlantoaxial dislocation

doi:10.3969/j.issn.2095-4344.1450

Abstract

Abstract:

BACKGROUND: The posterior atlantoaxial internal fixation may also cause dysphagia, dyspnea and even airway obstruction, but there is no clear factor affecting the stenosis of oropharyngeal airway.

OBJECTIVE: To investigate the effect of posterior internal fixation surgery for atlantoaxial dislocation on the oropharyngeal airway space.

METHODS: Forty patients with atlantoaxial dislocation under posterior internal fixation surgery were retrospectively included. All patients signed informed consent. This study was approved by the Hospital Ethics Committee. The narrowest oropharyngeal airway space, atlantodental interval, occipito-C₂ angle, prevertebral soft tissue thickness and C₂–C₆ angle were measured in lateral cervical plain radiographs of neutral position before and after operation. The changes of postoperative data and their effects on the narrowest oropharyngeal airway space were analyzed.

RESULTS AND CONCLUSION: (1) Except C₂–C₆ angle and prevertebral soft tissue thickness, other data were significantly different after operation compared with those before operation (P < 0.01). Among them, the narrowest oropharyngeal airway space and atlantodental interval were reduced; and occipito-C₂ angle was increased. (2) The atlantodental interval (β=0.524) and occipito-C₂ angle (β=0.477) had the greatest effect on the narrowest oropharyngeal airway space. (3) Results suggested that posterior reduction and internal fixation of atlantoaxial dislocation patients may lead to oropharyngeal airway stenosis. Especially for patients with obvious atlantoaxial dislocation before operation, intensive monitoring is needed to prevent dyspnea and dysphagia.

Key words: atlantoaxial dislocation, posterior internal fixation, oropharyngeal airway space, occipito-C2 angle, atlantodental interval, prevertebral soft tissue thickness

CLC Number:

R459.9|R445.4|R318

Chen Xingjie, Yi Honglei, Chen Xuqiong, Wu Zenghui, Ma Xiangyang, Ai Fuzhi, Wang Jianhua, Zhang Kai, Xia Hong. Radiological analysis of oropharyngeal airway space after posterior internal fixation for the atlantoaxial dislocation[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(36): 5856-5860.

Figures/Tables 4

References

[1]Xu J, Yin Q, Xia H, et al. New clinical classification system for atlantoaxial dislocation. Orthopedics. 2013; 36(1): e95-e100.

[2]Izeki M, Neo M, Ito H, et al. Reduction of atlantoaxial subluxation causes airway stenosis. Spine(Phila Pa 1976).2013;38(9):E513-E520.

[3]Battagel JM, Johal A, L'Estrange PR, et al. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod. 1999;21(4):363-376.

[4]Furuya J, Tamada Y, Suzuki T. Effect of mandibular position on three-dimensional shape of the oropharynx in seated posture. J Oral Rehabil. 2012;39(4): 277-284.

[5]Miyata M, Neo M, Fujibayashi S, et al. O-C2 angle as a predictor of dyspnea and/or dysphagia after occipitocervical fusion. Spine (Phila Pa 1976). 2009; 34(2): 184-188.

[6]Isono S, Tanaka A, Ishikawa T, et al. Sniffing position improves pharyngeal airway patency in anesthetized patients with obstructive sleep apnea. Anesthesiology. 2005;103(3):489-494.

[7]Muto T, Takeda S, Kanazawa M, et al. The effect of head posture on the pharyngeal airway space (PAS). Int J Oral Maxillofac Surg. 2002; 31(6): 579-583.

[8]Hasebe D, Kobayashi T, Hasegawa M, et al. Changes in oropharyngeal airway and respiratory function during sleep after orthognathic surgery in patients with mandibular prognathism. Int J Oral Maxillofac Surg. 2011;40(6):584-592.

[9]Riley RW, Powell NB, Guilleminault C, et al. Obstructive sleep apnea syndrome following surgery for mandibular prognathism. J Oral Maxillofac Surg. 1987;45(5):450-452.

[10]Kawamata A, Fujishita M, Ariji Y, et al. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(3):278-287.

[11]Izeki M, Neo M, Takemoto M, et al. The O-C2 angle established at occipito-cervical fusion dictates the patient’s destiny in terms of postoperative dyspnea and/or dysphagia. Eur Spine J. 2014;23(2): 328-336.

[12]Ota M, Neo M, Aoyama T, et al. Impact of the O-C2 angle on the oropharyngeal space in normal patients. Spine (Phila Pa 1976). 2011; 36(11): E720-E726.

[13]Tagawa T, Akeda K, Asanuma Y, et al. Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion. J Anesth.2011;25(1):120-122.

[14]Hong J, Lim S. Dysphagia after Occipitocervical Fusion. N Engl J Med. 2017;376(22):e46.

[15]Izeki M, Neo M, Takemoto M, et al. The O-C2 angle established at occipito-cervical fusion dictates the patient's destiny in terms of postoperative dyspnea and/or dysphagia. Eur Spine J. 2014;23(2): 328-336.

[16]Meng Y, Wu T, Liu Z, et al. The impact of the difference in O-C2 angle in the development of dysphagia after occipitocervical fusion: a simulation study in normal volunteers combined with a case-control study. Spine J. 2018.

[17]Kaneyama S, Sumi M, Kasahara K, et al. Dysphagia After Occipitothoracic Fusion is Caused by Direct Compression of Oropharyngeal Space Due to Anterior Protrusion of Mid-cervical Spine. Clin Spine Surg. 2017;30(7):314-320.

[18]Morizane K, Takemoto M, Neo M, et al. Occipital and external acoustic meatus to axis angle as a predictor of the oropharyngeal space in healthy volunteers: a novel parameter for craniocervical junction alignment. Spine J. 2018;18(5):811-817.

[19]Shoda N, Takeshita K, Seichi A, et al. Measurement of occipitocervical angle. Spine (Phila Pa 1976). 2004;29(10):E204-E208.

[20]Guo Q, Ni B, Yang J, et al. Relation between alignments of upper and subaxial cervical spine: a radiological study. Arch Orthop Trauma Surg. 2011;131(6): 857-862.

[21]Yoshida M, Neo M, Fujibayashi S, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine. 2007; 32(8): E267-E270.

[22]Redlund-Johnell I. Upper airway obstruction in patients with rheumatoid arthritis and temporomandibular joint destruction. Scand J Rheumatol. 1988;17(4): 273-279.