Objective: To investigate the disease types, clinical characteristics, and emergency manage ment measures for critical cases in the oral emergency department, and to provide a reference for improving the basic emergency rescue capabilities of dental practitiers. Methods: A retrospellive analysis was conducted on patients with complete medical records who were admitted to the Department of Oral Emergency, Peking University School and Hospital of Stomatology from January 2006 to September 2025. Basic information and rescue data of the patients were collected, and the disease composition, key characteristics of clinical treatment and disease outcome were studied and analyzed. Results: A total of 92 patients were included, with an average age of 47 years (4 to 88 years, median 49 years). There were 62 male patients (67.4%) and 30 female patients (32.6%). Among the critically ill patients who visited the oral emergency department in the past 20 years, 61.9% were diagnosed with maxillofacial hemorrhage and cardiovascular accidents, accounting for 38.0% (35/92) and 23.9% (22/92) of the rescued patients, respectively, which were the most common diagnoses in emergency rescue. The next most common were upper airway obstruction in 17 cases and vasovagal syncope in 13 cases, accounting for 32.6% of the rescued patients. Among the 35 cases of maxillofacial hemorrhage, 20 patients (57.1%) had maxillofacial trauma, and 17 patients (48.6%) developed hemorrhagic shock. The study observed that secondary hemorrhage and airway obstruction caused by maxillofacial tumors were common causes of oral critical rescue, accounting for 34.3% (12/35) and 12/17 of the hemorrhage and airway obstruction cases, respectively. The study observed that 5 patients with airway obstruction caused by space infection received emergency treatment, accounting for 29.4% (5/17) of the airway obstruction patients. In the rescue work of oral emergencies, electrocardiogram monitoring (98.9%, 91/92), oxygen inhalation (96.7%, 89/92), and opening of venous access (78.3%, 72/92) were the most commonly used supportive treatment techniques; tracheal intubation was the main measure for respiratory system emergency rescue, followed by cricothyrotomy and tracheotomy. All 15 patients with cardiac arrest received cardiopulmonary resuscitation treatment, and 8 patients underwent defibrillation. Adrenaline was the most frequently used drug in emergency rescue, mainly applied to patients with cardiac arrest and anaphylactic shock, followed by nitroglycerin, lidocaine, dopamine, aspirin, and midazolam. The rescue success rate of the 92 cases receiving emergency treatment was 91.3% (84/92), and 8 deaths included 3 cases of cardiac arrest caused by airway obstruction and 5 cases of respiratory and circulatory failure. Conclusions: Dental practitioners should be able to quickly identify medical emergencies and immediately carry out emergency rescue. Oral departments should be equipped with relevant emergency drugs and equipment, and medical staff should receive regular emergency skills training to improve their ability to handle medical emergencies and enhance medical safety.

Idiopathic subglottic and upper tracheal stenosis is an uncommon cause of progressive airway obstruction, predominantly affecting middle-aged women. We report the case of a female patient who presented with progressive stridor at rest over 12 months, without antecedent airway instrumentation or systemic disease. Flexible nasoendoscopy demonstrated irregular subglottic mucosa with airway narrowing, and computed tomography confirmed a 1.5 cm segment of circumferential mucosal thickening resulting in significant luminal compromise. Comprehensive autoimmune screening was negative, supporting an idiopathic aetiology. The patient underwent endoscopic balloon dilatation with adjunctive mucosal trimming, resulting in immediate symptomatic improvement. This case highlights the importance of thorough diagnostic evaluation and minimally invasive management of idiopathic upper tracheal stenosis.

Polysomnography is the standard tool for assessing obstructive sleep apnea (OSA) severity; however, it does not provide information regarding the anatomical site or extent of upper airway obstruction. Drug-induced sleep endoscopy (DISE) serves as a dynamic method to evaluate airway collapse under sleep-like conditions, thereby helping to bridge this gap. However, its clinical utility is limited by inter-observer variability and subjectivity in interpretation. We developed internally and externally validated deep learning models utilizing convolutional neural networks based on EfficientNet-B2 and Attention Multiple Instance Learning to predict the degree of airway obstruction (DISE-V-obs, DISE-OTE-obs) and the primary cause of obstruction (DISE-OTE-cause) using DISE videos from 1904 patients across five Korean hospitals. The F1 scores for DISE-V-obs, DISE-OTE-obs, and DISE-OTE-cause were 84.7%, 74.7%, and 88.2%, respectively. These objective predictions of obstruction degree and primary cause may enhance clinical decision-making and treatment planning for patients with OSA.

The key pathophysiological feature of obstructive sleep apnea（OSA） is dynamic collapse of the upper airway during sleep. Polysomnography（PSG） and awake imaging can assess disease severity and anatomical structure, but they are unable to characterize the dynamic process of airway collapse during sleep. Drug-induced sleep endoscopy（DISE） enables direct visualization of the sites and patterns of obstruction and has become an important tool for dynamic upper airway evaluation. However, its application remains limited by issues related to sedation consistency, classification standardization, and insufficient quantitative assessment. In recent years, the integration of DISE with pharyngeal pressure monitoring, airflow analysis, electromyography, and artificial intelligence has continued to evolve, with the potential to improve the standardization and quantification of upper airway evaluation in OSA and to provide support for precision intervention.

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder caused by recurrent collapse of a structurally vulnerable upper airway during sleep. The nasal cavity, soft palate, lateral pharyngeal walls, tongue base, hyoid complex, and craniofacial skeleton each influence airway caliber and stability. A detailed knowledge of their anatomy is essential for surgical planning. This narrative review summarizes key anatomic features relevant to upper pharyngeal surgery, including the role of nasal obstruction and the internal nasal valve, palatal muscle and parapharyngeal fat, and the lateral palatal space as a target for reconstructive palatal and lateral wall procedures. We further outline lower pharyngeal strategies, such as genioglossus advancement, hyoid myotomy- suspension, and tongue base reduction, which address retroglossal collapse and adverse skeletal- soft tissue relationships. Maxillomandibular advancement and hypoglossal nerve stimulation are discussed as anatomy-driven multilevel and neuromodulatory options. Across these modalities, an anatomically grounded, phenotype-based approach is central to optimizing patient selection, minimizing complications, and improving long-term surgical outcomes in OSA.

Laryngomalacia is the most common congenital anomaly of the larynx and a leading cause of inspiratory stridor in infants. Stridor and noisy breathing are key clinical manifestations that may signify varying degrees of respiratory compromise and can provide insight into the level of airway obstruction. A comprehensive evaluation of the upper airway is essential in children suspected of having laryngomalacia to ensure accurate diagnosis and appropriate management of both the primary condition and any associated comorbidities. Laryngomalacia presents along a spectrum of severity, with mild cases often requiring only close observation, while more severe forms may necessitate surgical intervention such as supraglottoplasty. Anesthetic management in these patients presents significant challenges due to the potential for airway obstruction, particularly during induction and emergence from anesthesia. This case report details the successful perioperative anesthetic management of a two-month-old male infant with congenital laryngomalacia undergoing elective inguinal hernia repair. It highlights the critical importance of meticulous airway planning, the maintenance of spontaneous ventilation, and a collaborative, multidisciplinary approach to optimize patient safety and outcomes.

While growth hormone therapy has been associated with the potential risk of upper airway obstruction and hypertrophy, it may also cause glottic or subglottic edema and stridor, even in patients without adenotonsillar tissue. Clinicians should consider medication-induced airway changes in Prader-Willi Syndrome patients with complex airway histories to optimize management.

Background Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent upper airway obstruction and fragmented sleep. Temporomandibular disorder (TMD) comprises musculoskeletal conditions affecting the temporomandibular joint and masticatory muscles, often presenting with pain and functional limitations. Both conditions share clinical features such as sleep disturbance and musculoskeletal discomfort, suggesting a possible relationship. However, the prevalence of TMD among patients with OSA and its association with clinical characteristics remains insufficiently explored. Objectives The main objective of this study is to determine the prevalence of symptoms suggestive of TMD among patients with severe OSA using the Fonseca Anamnestic Index (FAI) and to evaluate the association between TMD severity and selected demographic and clinical variables, including age, gender, body mass index (BMI), and OSA-related symptoms. Methods This cross-sectional, multicentric, observational study was conducted from August 2024 to August 2025 at the Department of Prosthodontics and Crown & Bridge, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, India, in collaboration with the Departments of Prosthodontics and Crown & Bridge and Respiratory Medicine at King George's Medical University, Lucknow, India. A total of 110 adults aged 18-60 years with polysomnography-confirmed severe OSA (apnea-hypopnea index ≥ 30 events/hour) were enrolled. Patients with prior OSA or TMD treatment, temporomandibular joint surgery or fracture, malocclusion, orthodontic history, recent analgesic use, neurological disorders, or unwillingness to provide consent were excluded. Symptoms suggestive of TMD were assessed using the FAI. Demographic, clinical, and OSA-related variables were recorded. Descriptive statistics and association analyses were performed to evaluate relationships between TMD severity and clinical parameters. Results The study population had a mean age of 48.28 ± 8.80 years, with a predominance of male participants. More than three-fourths of the participants were overweight or obese, and hypertension was the most frequently reported comorbidity. Symptoms suggestive of TMD were identified in 52.7% of patients, with mild TMD being the most prevalent category. No statistically significant associations were observed between TMD severity and age, gender, or BMI. Among OSA-related symptoms, excessive daytime sleepiness demonstrated a statistically significant association with TMD severity (p < 0.05), whereas snoring, witnessed apneas, morning headache, and non-restorative sleep did not show significant associations. Conclusion A relatively high prevalence of symptoms suggestive of TMD was observed among patients with severe OSA. TMD severity showed no significant association with most demographic or anthropometric variables. Although excessive daytime sleepiness was associated with TMD severity, this finding should be interpreted cautiously, given the cross-sectional design. These results represent descriptive observations, and further comparative and longitudinal studies are required to clarify the relationship between OSA-related symptoms and TMD.