Made available in DSpace on 2014-06-11T19:35:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-08Bitstream added on 2014-06-13T20:06:19Z : No. of bitstreams: 1 cerqueira_bgp_dr_botfm.pdf: 295769 bytes, checksum: 065bbe9eb894a3eade5a04fd50f245b4 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A dificuldade de intubação traqueal é causa de mortalidade em anestesiologia e pode estar relacionada à obesidade. Reconhecer o paciente com intubação difícil antes da indução anestésica contribui para o sucesso na abordagem da via aérea. Os parâmetros preditores da mesma não estão bem estabelecidos, sendo a classificação de Mallampati um dos testes mais aplicados pelos anestesiologistas. Estudos da sua acurácia em populações específicas e comparações das variações no modo como o teste é realizado ainda são escassos. Assim, o objetivo desta pesquisa foi quantificar as alterações que a fonação exerce sobre a classificação de Mallampati, comparar a acurácia da classificação de Mallampati sem e com fonação no diagnóstico dos graus 3 e 4 da escala de Cormack e Lehane como estimativa de laringoscopia difícil e avaliar a incidência de laringoscopia difícil na população obesa submetida a anestesia geral. O índice massa corpórea, a classificação de Mallampati sem e com fonação, a circunferência do pescoço, a distância interincisivos, a distância tireomentoniana e o grau da síndrome da apneia obstrutiva do sono de 156 pacientes obesos de ambos os sexos foram avaliados no período pré-operatório. Após a monitorização, o posicionamento adequado e a indução anestésica os pacientes foram submetidos à laringoscopia direta, sendo avaliado o grau da escala de Cormack e Lehane. Utilizou-se o programa estatístico Statistical Package for the Social Science (SPSS) versão 9.0, Chicago, IL, 1999, para comparar os parâmetros estudados, sendo considerado estatisticamente significativo o valor de p < 0,05. Foi calculada a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo da classificação de Mallampati sem e com fonação em predizer os graus 3 e 4 da escala de Cormack... / Difficult tracheal intubation is a cause of mortality in anesthesiology and can be associated with obesity. The ability to recognize a patient with difficult tracheal intubation before anesthetic induction may add to the success of the airway approach. Parameters used to predict difficult intubations are not well established being Mallampati classification one of the most used tests by the anesthesiologists. Accuracy studies of this test in specific populations and comparison of the different ways to performing it are still rare. Thus the goals of the present study is to quantify the influence of phonation on Mallampati classification, to compare Mallampati classification accuracy with and without phonation for the detection of Cormack and Lehane scale grades 3 and 4 as a estimative of difficult laryngoscopy and establish the incidence of difficult laryngoscopy in obese patients submitted to general anesthesia. Body mass index, Mallampati classification with and without phonation, neck circumference, interincisor gap, thyromental distance and the level of obstructive sleep apnea were assessed in 156 obese patients from both genders in the preoperative time. After monitoring, proper positioning and anesthetic induction, the patients were submitted to direct laryngoscopy. Their classification according to Cormack and Lehane scale were assessed and the parameters compared. The statistical analysis of the studied parameters was conducted using the Statistical Package for the Social Sciences (SPSS) 9.0 (Chicago, IL, 1999) and statistical significance was determined when p < 0.05. Mallampati classification with and without phonation sensitivity, specificity, positive predictive value and negative predictive value for the detection of Cormack and Lehane scale grades 3 and 4 were calculated with confidence... (Complete abstract click electronic access below)

Orientador: Eliana Marisa Ganem / Banca: Guilherme Antonio Moreira de Barros / Banca: Norma Sueli Pinheiro Módolo / Banca: Antonio Argôlo Sampaio Filho / Banca: Angélica de Fátima Assunção Braga / Resumo: A dificuldade de intubação traqueal é causa de mortalidade em anestesiologia e pode estar relacionada à obesidade. Reconhecer o paciente com intubação difícil antes da indução anestésica contribui para o sucesso na abordagem da via aérea. Os parâmetros preditores da mesma não estão bem estabelecidos, sendo a classificação de Mallampati um dos testes mais aplicados pelos anestesiologistas. Estudos da sua acurácia em populações específicas e comparações das variações no modo como o teste é realizado ainda são escassos. Assim, o objetivo desta pesquisa foi quantificar as alterações que a fonação exerce sobre a classificação de Mallampati, comparar a acurácia da classificação de Mallampati sem e com fonação no diagnóstico dos graus 3 e 4 da escala de Cormack e Lehane como estimativa de laringoscopia difícil e avaliar a incidência de laringoscopia difícil na população obesa submetida a anestesia geral. O índice massa corpórea, a classificação de Mallampati sem e com fonação, a circunferência do pescoço, a distância interincisivos, a distância tireomentoniana e o grau da síndrome da apneia obstrutiva do sono de 156 pacientes obesos de ambos os sexos foram avaliados no período pré-operatório. Após a monitorização, o posicionamento adequado e a indução anestésica os pacientes foram submetidos à laringoscopia direta, sendo avaliado o grau da escala de Cormack e Lehane. Utilizou-se o programa estatístico Statistical Package for the Social Science (SPSS) versão 9.0, Chicago, IL, 1999, para comparar os parâmetros estudados, sendo considerado estatisticamente significativo o valor de p < 0,05. Foi calculada a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo da classificação de Mallampati sem e com fonação em predizer os graus 3 e 4 da escala de Cormack... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Difficult tracheal intubation is a cause of mortality in anesthesiology and can be associated with obesity. The ability to recognize a patient with difficult tracheal intubation before anesthetic induction may add to the success of the airway approach. Parameters used to predict difficult intubations are not well established being Mallampati classification one of the most used tests by the anesthesiologists. Accuracy studies of this test in specific populations and comparison of the different ways to performing it are still rare. Thus the goals of the present study is to quantify the influence of phonation on Mallampati classification, to compare Mallampati classification accuracy with and without phonation for the detection of Cormack and Lehane scale grades 3 and 4 as a estimative of difficult laryngoscopy and establish the incidence of difficult laryngoscopy in obese patients submitted to general anesthesia. Body mass index, Mallampati classification with and without phonation, neck circumference, interincisor gap, thyromental distance and the level of obstructive sleep apnea were assessed in 156 obese patients from both genders in the preoperative time. After monitoring, proper positioning and anesthetic induction, the patients were submitted to direct laryngoscopy. Their classification according to Cormack and Lehane scale were assessed and the parameters compared. The statistical analysis of the studied parameters was conducted using the Statistical Package for the Social Sciences (SPSS) 9.0 (Chicago, IL, 1999) and statistical significance was determined when p < 0.05. Mallampati classification with and without phonation sensitivity, specificity, positive predictive value and negative predictive value for the detection of Cormack and Lehane scale grades 3 and 4 were calculated with confidence... (Complete abstract click electronic access below) / Doutor

Introduction: The Modified Mallampati Tongue Score (MMT) is commonly used in anesthesiology for the pre-anesthetic assessment of the airway in patients. This score roughly estimates the size and position of the tongue relative to the oral cavity, with higher scores associated with difficult intubation and increased incidence of breathing interferences, such as obstructive sleep apnea. The distance from the tongue base to roof of the mouth decreases from MMT-I to MMT-IV. The tongue shape and position impact the airway patency in the hypopharynx, contributing to changes in craniofacial head posture followed by changes in craniofacial morphology. This present study examines the pattern of associations between the Modified Mallampati Tongue Score positions and 1) the postural relationship of the cranium, hyoid bone, cervical column, and tongue 2) size, shape, and position of the craniofacial components, as depicted in a lateral cephalogram. Methods: This retrospective study was performed on 200 subjects (145 female, 55 male) prior to starting orthodontic treatment. MMT was assessed from one photograph of maximum mouth opening and tongue protrusion. Pretreatment cephalograms were analyzed to evaluate craniocervical posture, resting tongue position, hyoid bone position, or sagittal and vertical skeletal relationships. MMT (I-IV) was also compared to basic demographics (age, gender, race/ethnicity). One-way ANOVA, Chi-square test, and correlation analysis were used for statistical analysis. Probability values <0.05 were accepted as significant. Results: A total of 200 patients (72.5% Female, 27.5% Male, 54% African American), with a mean age of 20 (Range 7-73), were included for the study. MMT-III was most prevalent (34%). MMT was not associated with age, gender, or race/ethnicity. Mean cephalometric measurements of hyoid position (p=0.06-0.03), mandibular position (p=0.006), ANB (p=0.009), and SNB (p=0.023, were shown to have significant differences with MMT. MMT positively correlated with the ANB (p=0.001), Wits (p=0.016), vertical position of the hyoid bone to neck (p=0.004) and mandible (p=0.048); and inversely correlated with the SNB (p=0.003) and Pog:Na-Perp (p=0.045). Conclusion: A higher MMT correlates to a Class II skeletal morphology and extended craniofacial posture. Preliminary results suggest high tongue position influences Class II craniofacial morphology, enhancing maxillary prognathic growth and mandibular deficiency. This indicates that MMT can be a potential predictor of craniofacial growth patterns, strengthening the prognosis and long-term stability of orthodontic treatment. / Oral Biology

Introduction: The Modified Mallampati Tongue score is a quick and reliable method commonly used in anesthesiology to assess airway patency and predict the ease of intubation. Modified Mallampati Tongue scores range from I – IV with higher Mallampati scores being associated with more difficult intubations as well as increased sleep-disordered breathing, such as obstructive sleep apnea. The Mallampati Tongue score is determined by visibility of the oropharynx when the mouth is opened as wide as possible with the tongue maximally protruded and is directly affected by the position of the tongue. The tongue is an influential muscle to the craniofacial complex; it plays an essential role in the development of the dentoalveolar structures, and its position affects airway volume which influences natural head posture, which influences craniofacial growth. Objective: The primary aims of this study were to identify if any associations exist between Modified Mallampati Tongue scores (I-IV) and 1) craniofacial sagittal and vertical relationships of the jaws and 2) craniofacial head posture (including the postural relationships of the cervical vertebrae, hyoid bone, cranium, and tongue). A secondary aim was to identify if any associations exist between Modified Mallampati Tongue score and age, sex, or race/ethnicity. Methods: This retrospective study included 400 subjects from the Temple University Kornberg School of Dentistry Department of orthodontics who had pre-orthodontic treatment diagnostic records obtained from June 1st 2020 through September 1st 2021. Each patient’s Modified Mallampati Tongue score (I-IV) was recorded in an intraoral photograph of maximum mouth opening with tongue protrusion. All lateral cephalograms were traced in Dolphin Imaging and Amira Morphometrics Software by two examiners tracing 200 subjects each. The craniofacial morphological features were analyzed through the Steiner, Wits, and McNamara analyses for assessment of the sagittal relationships of the maxilla and mandible and by the Jarabak analysis for assessment of the vertical relationships and divergence. Craniofacial head posture was assessed through an analysis that represents the postural relationships of the cervical vertebrae, cranium, length/height of the tongue, and position of the hyoid bone. For statistical analysis, One-way ANOVA, Pearson’s correlation, and Chi-square tests were conducted. Probability values of <0.05 were considered significant. Results: Overall, this study included 400 subjects with ages ranging from 7-73 years old (mean age of 17.99 years), of which there were 288 females (72%) and 112 males (28%). Of the 400 subjects, 60% (241) were African American, 32% (127) Hispanic, 7% (26) Caucasian, and 2% (6) Asian. The most prevalent Modified Mallampati Tongue Score was III (142 subjects, 36%). Out of all of the craniofacial morphology and head posture variables compared against Modified Mallampati Tongue scores (I-IV), significant findings from the one-way ANOVA tests included vertical position of the hyoid bone to the neck, vertical position of the hyoid bone to the mandible, ANB, and Wits values. Higher Mallampati Tongue scores were associated with higher ANB and higher Wits values. Greater Mallampati scores were associated with increased vertical distance of the hyoid bone to the mandible and to the neck, meaning a lower position of the hyoid bone. In addition, correlations that were statistically significant given a 95% confidence interval, included significant positive correlations between Mallampati Tongue score and increased ANB, Wits, and distance of the hyoid to the mandible and to the neck. Pearson’s Correlation Index also showed a significant negative correlation between Mallampati Tongue scores and craniofacial morphology values for SNB and pogonion to nasion-perpendicular, showing that increased Modified Mallampati Tongue scores correlate with more retrognathic mandibles. When evaluating the results of the Chi-Square analyses, there were no significant differences between Modified Mallampati Tongue score and race/ethnicity or age, but there was a significant difference between genders showing that women were more likely to have lower Mallampati Tongue scores than men. Inter-examiner and intra-examiner reliability for the craniofacial head posture measurements, craniofacial morphology measurements, and Modified Mallampati Tongue scores were excellent (correlation coefficients: 0.84 – 0.99). Conclusions: This study reveals that a higher Modified Mallampati Tongue score correlates with higher ANB and Wits values, meaning that higher Modified Mallampati Tongue scores are associated with a Skeletal Class II relationship of the jaws, which could be due to retrognathic mandibular growth. In addition, a higher Modified Mallampati Tongue score is significantly associated with increased distance of the hyoid bone to the mandible and to the neck. This study also found women more likely to have lower Modified Mallampati Tongue scores than men. The results of this study allude to the potential for Mallampati Tongue scores to be used as predictors of Class II skeletal sagittal growth which would ultimately help with orthodontic treatment planning decisions and enhance overall treatment outcomes. / Oral Biology