Obstructive sleep apnea (CT evaluation)

Patient for evaluation of sinuses & airways evaluate for vocal cord palsy

Evaluation of the nasopharyngeal and oropharyngeal airway:

Volume rendered images to highlight the nasopharyngeal and oropharyngeal airway were analyzed. The airway starting from the oropharynx up to the level of the carina was evaluated and the following observations are made:

On scanning during quiet breathing, there appears to be significant narrowing of the retropalatine nasopharyngeal airway which shows an area of ~54 mm² only. The size of the retropalatine airway increased during scanning with Valsalva maneuver (continuous positive airway pressure) with an area of ~70.8 mm²; however even this area is below normal range. 

The uvula and soft palate are unusually long and mildly thickened.

The retrognathal airway is also narrowed with area of ~122 mm² while scanning with quiet breathing. This space increased to an area of 250 mm² while scanning during Valsalva (continuous positive airway pressure). The narrowing of the retropalatine airway appears to be due to exaggerated posterior location of the tongue and the retrognathal soft tissue (including mylohyoid and digastric muscles). 

The subjective assessment of the volume-rendered images of the skull suggest posterior recession of the mandibular ramus (suggesting a relatively small mandibular condyle relative to the size of the maxillary sinuses).

Analysis of larynx and the tracheal column: The epiglottis and aryepiglottic space are normal. The vallecular air spaces are normal. Bilateral pyriform sinuses are symmetrical. The cricoarytenoid joint is normal on both sides. The aryepiglottic folds and the true vocal cords are normal. True vocal cords show normal orientation with normal appearance of the glottis during quiet respiration, during Valsalva, and phonation of the letter 'E'. The tracheal air column is normal without any evidence of abrupt narrowing. Incidental note made of superior mediastinal and cervical lymph nodes which are not enlarged.

CONCLUSION: Reduced retropalatine and retrognathal airway space possibility due to: thickened and unusually long soft palate/uvula. Relatively small size of mandible leading to exaggerated posterior location of the retrognathal soft tissue including base of tongue, the digastric and mylohyoid muscles. Note is also made of a very mild nasal septal deviation towards the left side with an S-shaped configuration of the nasal septum; however, the nasal airways remain capacious. Minimal mucosal thickening of the left maxillary sinus and mild patchy mucosal opacification of the ethmoidal air cells.