Anterior‐Commissure Laryngoscope Extraction of Esophageal Coins in Children Using an Apnea Technique

Abstract

Objectives: Age-related sarcopenia has been recognized in skeletal muscles in relation to the decreased body mass index (BMI). In the swallowing muscles, however, there have been few findings concerning sarcopenia. We studied whether muscle volume of the pharyngeal constrictors decreases with age in healthy adults.Methods: A retrospective review of head and neck magnetic resonance imaging (MRI) of 207 adults (138 males and 69 females, 21-96 years old) examined at the Department of Otolaryngology-Head and Neck Surgery of Kyushu University Hospital between 2010 and 2013 was performed. We measured muscle thickness at 4 levels (mid-mandibular level, hyoid level, vocal fold level, and cricopharyngeal level) with OsiriX software. In each level, measuring points were set at median and 3 points with equal intervals in both sides on axial view of T2-weighted MRI images. Averaged values of constrictor thickness were statistically analyzed in correlation to their age and BMI.Results: The pharyngeal constrictor muscles appeared thickest at the hyoid level (male: 2.18 ± 0.77 mm, female: 1.79 ± 0.83 mm), which showed no significant correlation to age (r = 0.03 in male and 0.07 in female, P > .1) and BMI (r = 0.27 and 0.33, respectively, P > .1). Results at other levels were almost the same as those at the hyoid. Laterality of the muscle thickness was observed at the cricopharyngeal level (left > right).Conclusions: The pharyngeal constrictors appear not to become thin in proportion to age and BMI, unlike skeletal muscles. Branchiogenic swallowing muscles may be tolerable against aging, as compared to skeletal muscles.Objectives: (1) To evaluate the efficacy and safety of coin extraction with the anterior-commissure laryngoscope during apnea in children less than 10 years old. (2) To present the sociodemographic characteristics of this population and analyze the differences in foreign body features. (3) To describe heart rates (HR), minimal O 2 saturation, and end-tidal CO 2 (ETCO 2 ) during the procedure. Methods: In this retrospective chart review study, consecutive patients with a diagnosis of cervical esophageal coin who underwent this procedure between May 2011 and December 2013 at our institution (n = 59) were evaluated and data analyzed. Age (independent variable) was categorized as ≤1, >1 and <5, ≥5 and ≤10 years old.Results: The mean and standard deviation (SD) of age was 3.1 ± 2.4 years. The majority were Medicaid participants (87.5%). We successfully removed the coin in 94.9% (n = 59) of our cases with this technique. Among children completing the technique, children ≤1 year of age were more likely to ingest pennies (100%), whereas children ≥5 years old more likely ingested quarters (50%; P = .01) Younger children showed higher HR than older groups and baseline values were similar to intraoperative ones (P < .001). The length of apnea was 57.7 ± 25.2 seconds. The median minimum O 2 saturation was 99.5% (min 93, max 100), and the media and SD of the ETCO 2 at the end of the procedure was 35.7 ± 4.8 mm Hg.Conclusions: ...