Vivien J. Challis

Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications

BACKGROUND The sniffing position is often considered optimal for direct laryngoscopy. Another concept of airway configuration involving a laryngeal vestibule axis and two curves has also been suggested. We investigated whether this theory can be supported mathematically and if it supports the sniffing position as being optimal for direct laryngoscopy. METHODS Magnetic resonance imaging scans were performed in 42 normal adult volunteers. The airway passage was divided into two curves-primary (oro-pharyngeal curve) and secondary (pharyngo-glotto-tracheal curve). Airway configuration was evaluated in the neutral, extension, head lift, and sniffing positions. The airway passage, point of inflection (where the two curves meet), its tangent, and the line of sight were plotted on each scan. RESULTS The point of inflection lay within the laryngeal vestibule in all positions. The head lift and sniffing positions caused the tangent to the point of inflection to approximate the horizontal plane. The sniffing, extension, and head lift positions caused a reduction in the area between the line of sight and the airway curve compared with the neutral position. CONCLUSIONS A two-curve theory is proposed as a basis for explaining airway configuration. The changes in these curves with head and neck positioning support the sniffing position as optimal for direct laryngoscopy. Application of this new concept to other forms of laryngoscopy should be investigated.

Physically Realizable Three-Dimensional Bone Prosthesis Design With Interpolated Microstructures

We present a new approach to designing three-dimensional, physically realizable porous femoral implants with spatially varying microstructures and effective material properties. We optimize over a simplified design domain to reduce shear stress at the bone-prosthetic interface with a constraint on the bone resorption measured using strain energy. This combination of objective and constraint aims to reduce implant failure and allows a detailed study of the implant designs obtained with a range of microstructure sets and parameters. The microstructure sets are either specified directly or constructed using shape interpolation between a finite number of microstructures optimized for multifunctional characteristics. We demonstrate that designs using varying microstructures outperform designs with a homogeneous microstructure for this femoral implant problem. Further, the choice of microstructure set has an impact on the objective values achieved and on the optimized implant designs. A proof-of-concept metal prototype fabricated via selective laser melting (SLM) demonstrates the manufacturability of designs obtained with our approach.