Cartilago Epiglottica Morfometrisinin Manyetik Rezonans Görüntüleme ile Değerlendirilmesi

Year 2023, Volume: 12 Issue: 1, 46 - 51, 15.03.2023

Esma Derinöz , Alper Vatansever , Bahar Yanık , Emrah Özcan , İlter Kuş

https://doi.org/10.53424/balikesirsbd.1180892

Abstract

ÖZ
Amaç: Cartilago epiglottica (CE), elastik kıkırdak yapısına sahip olan önemli bir larynx kıkırdağıdır. Fonksiyonel olarak larynx ve pharynx arasında bir kapı görevi gören bu yapı, endotrakeal tüpün ilerletilmesi sırasında zor entübasyon sebebiyle zarar görebilmektedir. Bu çalışmanın amacı; CE’nın çevre anatomik yapılar ile arasındaki morfometrik ilişkisinin incelenerek, elde edilen veriler doğrultusunda klinik uygulamalarda meydana gelen komplikasyonların en aza indirgenebilmesini sağlamaktır. Gereç ve Yöntem: Çalışmada, 20 yaş ve üzerindeki 79 kadın ve 53 erkek bireyin servikal MR serileri Balıkesir Üniversitesi PACS sistemi arşivinden temin edilerek retrospektif olarak incelendi. Elde edilen görüntülerin morfometrik analizi Radiant DICOM Viewer yazılımına aktarılarak gerçekleştirildi. Çalışmada, CE’nın çevre anatomik yapılara olan mesafesi, petiolus epiglottidis (PE) ile cartilago thyroidea (CTh) arasındaki visseral bölge açısı ve cartilago epiglottica’nın fikse (CEF) ve serbest (CES) kısmının uzunlukları değerlendirildi. Çalışmada değerlendirilen veriler SPSS yazılımı kullanılarak istatistiksel olarak analiz edildi. Bulgular: Çalışmada istatistiksel olarak analiz edilen uzunluk değerleri, erkek bireylerde kadın bireylere oranla fazla olma eğilimindeydi. Ancak; PE ile CTh arasındaki visseral bölge açısının, kadın bireylerde erkek bireylere oranla fazla olma eğiliminde olduğu görüldü. Yaş ile larynx uzunluğu (LU), CEA kısmının radix linguae’ya (RL) olan mesafesi ve CES kısmının uzunluğu pozitif yönlü korelasyon gösterdi. Belirlenen referans noktalarına göre LU, ort. 2.45±0.53 cm idi. Sonuç: Klinisyenler ulaşılan değerler sonucunda, endotrakeal entübasyondan hemen önce LU’nu palpasyonla ölçerek CEA kısmının RL’ya olan uzaklığı hakkında bir fikir sahibi olabileceklerdir. Buna istinaden zor entübasyonun öngörülmesiyle olası CE yaralanmalarının önüne geçilebileceği düşünülmektedir.

Keywords

Cartilago Epiglottica, Endotrakeal Entübasyon, Larynx, Morfometri, MRG.

Evaluation of Epiglottic Cartilage Morphometry Using Magnetic Resonance Imaging

Abstract

Objective: Epiglottic cartilage (EC) is an important larynx cartilage with elastic cartilage structure. Functionally, this structure, which acts as a gate between the larynx and the pharynx, can be damaged due to difficult intubation during the advancement of the endotracheal tube. The aim of this study; EC’s morphometric relationship with the surrounding anatomical structures is to be examined and to minimize the complications that occur in clinical applications in line with the data obtained. Materials and Methods: In the study, cervical MRI series of 79 females and 53 males aged 20 years and older were obtained from Balikesir University PACS system archive and analysed retrospectively. The morphometric analysis of the obtained images was carried out by transferring them to the Radiant DICOM Viewer software. In the study, the distance of EC to the surrounding anatomical structures, the angle of the visceral region between the stalk of epiglottis (SE) and the thyroid cartilage (ThC), and the lengths of the fixed and free part of EC were evaluated. The data evaluated in the study were statistically analysed using SPSS software. Results: The length values analysed statistically in the study tended to be higher in male individuals than in female individuals. However, It was observed that the visceral region angle between SE and (ThC) tended to be higher in female individuals than in male individuals. Age and larynx length (LL), the distance of apex part of epiglottic cartilage (AEC) to root of tongue (RT), and the length of the free part of epiglottic cartilage (FEC) showed a positive correlation. The mean length of larynx was 2.45±0.53 cm according to the determined reference points. Conclusion: As a result of the values reached, clinicians will be able to have an idea about the distance of AEC to RT by measuring the LL with palpation just before endotracheal intubation. Based on this, it is thought that possible EC injuries can be prevented by predicting difficult intubation.

Keywords

Epiglottic cartilage, Endotracheal intubation, Larynx, Morphometry, MRI.

References

• Ajmani, ML. (1990). A metrical study of the laryngeal skeleton in adult Nigerians. Journal of Anatomy, 171, 187-191.
• Baba, A., Okuyama, Y., Yamauchi, H., Ogino, N., Dorgu, M., Kobashi, Y. et al. (2019). Evaluation of normal epiglottis on computed tomography with special attention to thickness. The Bulletin of Tokyo Dental College, 60(1), 11-16. https://doi.org/10.2209/tdcpublication.2017-0046
• Catalfumo, FJ., Golz, A., Westerman, ST., Gilbert, LM., Joachims, HZ. and Goldenberg, D. (1998). The epiglottis and obstructive sleep apnoea syndrome. The Journal of Laryngology and Otology, 112(10), 940-943. https://doi.org/10.1017/s0022211500142136
• Delakorda, M. and Ovşenik, N. (2019). Epiglottis shape as a predictor of obstruction level in patients with sleep apnea. Sleep & Breathing, 23(1), 311-317. https://doi.org/10.1007/s11325-018-1763-y
• Gazayerli, M., Bleibel, W., Elhorr, A., Maxwell, D. and Seifeldin, R. (2006). A correlation between the shape of the epiglottis and obstructive sleep apnea. Surgical Endoscopy, 20(5), 836-837. https://doi.org/10.1007/s00464-005-0641-4
• Hatzakorzian, R., Shan, WLP. and Backman, SB. (2006). Epiglottic hematoma: a rare occurrence after tracheal intubation. Canadian Journal of Anaesthesia, 53(5), 526-527. https://doi.org/10.1007/BF03022630
• Hayran, M. ve Hayran, M. Sağlık araştırmaları için temel istatistik. Ankara: Omega Araştırma Organizasyon Eğitim Danışmanlık Ltd. Şirketi, 2011.
• Joshi, MM., Joshi, SS. and Joshi, SD. (2011). The morphological study of adult human larynx in a Western Indian population. Journal of Laryngology and Voice, 1(2), 50-54. https://doi.org/10.4103/2230-9748.85062
• Li, S., Wu, D., Jie, Q., Bao’nun, J. and Shi, HJ. (2014). Lingua–epiglottis position predicts glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome. European Archives of Oto-Rhino-Laryngology, 271(10), 2737-2743. https://doi.org/10.1007/s00405-014-3033-3
• Lin, TS., Chen, CH. and Yang, MW. (2004). Folding of the epiglottis - an unusual complication to be recognized after laryngoscopic endotracheal intubation. Journal of Clinical Anesthesia, 16(6), 469-471. https://doi.org/10.1016/j.jclinane.2003.11.006
• Mohammadi, SS., Tavakkoli, AB. and Maraşi, M. (2020). Correlation between ultrasound measured distance from skin to epiglottis and epiglottis to mid-vocal cord with Cormack-Lehane classification for predicting difficult intubation. Archives of Anesthesiology and Critical Care, 6(1), 23-26. https://doi.org/10.18502/aacc.v6i1.2045
• Poornima, GC. and Dakshayini, KR. (2017). A study of morphometry of adult human larynx and its importance in clinical applications. International Journal of Anatomy and Research, 5(2.1), 3713-3717. https://doi.org/10.16965/IJAR.2017.155
• Sprinzl, GM., Eckel, HE., Sitte, C., Pototschnig, C. and Koebke, J. (1999). Morphometric measurements of the cartilaginous larynx: An anatomic correlate of laryngeal surgery. Head and Neck, 21(8), 743-750.
• Torre, C., Camacho, M., Liu, SYC., Huon, LK. and Capasso, R. (2016). Epiglottis collapse in adult obstructive sleep apnea: A systematic review. The Laryngoscope, 126(2), 515-523. https://doi.org/10.1002/lary.25589
• Van Zundert, AAJ. and Wyssusek, KH. (2018). Epiglottis folding double with supraglottic airway devices. British Journal of Anaesthesia, 120(4), 884-885. https://doi.org/10.1016/j.bja.2018.01.015