Examination of the Upper Air Passages by Means of A Lateral X-Ray

Abstract

A lateral X-ray affords a good impression both of the size of the various spaces of the upper air passage and of their relative positions. This examination is made in a direction which differs 90⁰ from that of the method using mirrors and tubes. The latter methods, however, afford no correct information as to the natural size and shape of the spaces because the subject opens the mouth and even extends the tongue.

Examination of the upper air passages by means of a lateral X-ray affords satisfactory information on the many anatomical anomalies and functional disorders.

The method of investigation is described, and the anatomical conditions in the upper air passages and their variations are demonstrated with the aid of such X-rays. A number of cases of constriction of the upper air passage are discussed, with special reference to the established fact that an asthenic posture of the body, with passive sagging of the cervical spine, can be the cause of a constriction of the air passage. This constriction is localized in such cases between the base of the tongue and the spine. Attempts at prevention and correction of this constriction are demonstrated. Photographs of a patient suffering from paralysis of the swallowing centre are presented. Mention is made of a remarkable property of the cervical spine in such cases. It was found that, by increased active curvature, the cervical spine can play its rôle in the process of swallowing if necessary, independent of the dirigism of the swallowing centre. The importance of this fact in the case of dysphagia is pointed out. So it was observed that the cervical spine, by virtue of active curvature, can be an aid in swallowing, whereas by passive sagging it may impede respiration.

Man therefore owes it to his orthostatic position to maintain this erect posture at all times. Yet how many children have assumed a slight stoop even before they leave school!

In view of the results of this investigation it seemed to be of importance that the untoward consequences of this faulty posture be pointed out. Preventive measures against such faults must be taken early in life. This holds true especially for asthenic children in whom some constriction in the more distal part of the air passages has previously developed (asthma, bronchitis).