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J Appl Physiol (March 12, 2004). doi:10.1152/japplphysiol.00907.2003
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Submitted on August 25, 2003
Accepted on March 1, 2004

Influences of head positions and bite opening on collapsibility of the passive pharynx

Shiroh Isono1*, Atsuko Tanaka1, Yugo Tagaito1, Teruhiko Ishikawa1, and Takashi Nishino1

1 Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan

* To whom correspondence should be addressed. E-mail: isonos-chiba{at}umin.ac.jp.

A collapsible tube surrounded by soft material within a rigid box was proposed as a two-dimensional mechanical model for the pharyngeal airway. This model predicts that changes in the box size, (pharyngeal bony enclosure size anatomically defined as cross-sectional area bounded by the inside edge of bony structures such as the mandible, maxilla and spine, and being perpendicular to the airway), influence patency of the tube. We examined whether changes in the bony enclosure size either with head positioning or bite opening influence collapsibility of the pharyngeal airway. Static mechanical properties of the passive pharynx were evaluated in anesthetized, paralyzed patients with sleep disordered breathing before and during neck extension with bite closure (n=11), neck flexion with bite closure (n=9) and neutral neck position with bite opening (n=11). Neck extension significantly increased maximum oropharyngeal airway size and decreased closing pressures of the velopharynx and oropharynx. Notably, neck extension significantly decreased compliance of the oropharyngeal airway wall. Neck flexion and bite opening decreased maximum oropharyngeal airway size and increased closing pressure of the velopharynx and oropharynx. Our results indicate the importance of neck and mandibular position for determining patency and collapsibility of the passive pharynx.




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