Obstructive sleep apnoea syndrome-CT evaluation

Case contributed by Dr Gaurav Som Prakash Gupta

Presentation

History of obstructive sleep apnea syndrome. .

Patient Data

Age: 45
Gender: Female

Patient for evaluation of sinuses and airways, evaluate for vocal cord palsy

Modality: CT

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 upto the level of the carina was evaluated and following observations are made-:

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

Uvula and the soft palate appear to be unusually long and appear to be mildly thickened.

The retro-Ganthal airway is also narrowed with area of approximately 122 Sq., mm  while scanning with quiet breathing . This space increased to an area of 250 Sq. mm while scanning during Valsalva (continuous positive airway pressure). The narrowing of the retro-palatine airway appears to be due to exaggerated posterior location of the tongue and the retroganthal soft tissue (including mylohyoid and Digastric muscle). 

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

Analysis of larynx and the tracheal column:  The epiglottis and aryepiglottic space appears normal. The vallecular air spaces appear to be normal. Bilateral pyriform sinus is symmetrical. The cricoarytenoid joint appears to be normal on both sides. The aryepiglottic fold and the true vocal cord appear to be normal. True vocal cord shows normal orientation with normal appearance of the glottis in scanning during quiet respiration, during Valsalva as well as during phonation of alphabet E. The tracheal air column ppears to be normal without any evidence of abrupt narrowing.  Incidental note made of superior mediastinum and cervical lymph node which however are small than 10mm in size.

CONCLUSION:- Reduced retro-palatine and retroganthal airway space possibility due to  Thickened and unusually long soft palate/uvula. Relatively small size of mandible leading to exaggerated posterior location of the retroganathal soft tissue including base of tongue, the Digastric  and myelhyoid muscles. Note also made of mild DNS towards left side with S-shaped configuration of the nasal septum; however, nasal airways appear to be spacious. Minimal mucosal thickening in left maxillary sinus and mild patchy mucosal thickening in ethmoidal sinus.

Case Discussion

This patient will benefit form mandibular advancement surgery.

However, this patient is unlikely to be significantly benefited by CPAP therapy.

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Case Information

rID: 24304
Case created: 6th Aug 2013
Last edited: 31st Mar 2016
System: Head & Neck
Inclusion in quiz mode: Excluded

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