title: The transnasal esophagoscopy documentation dilemma.
abstract: OBJECTIVE
  To determine radiographically the anatomic length difference between the nasal and oral aerodigestive tracts and to clarify gaps in the literature regarding standardized landmark measurements and documentation techniques in transnasal esophagoscopy, as opposed to traditional transoral esophagoscopy.
  
  
  METHODS
  This is a prospective radiographic cohort study.
  
  
  METHODS
  Digital computerized tomography measurement techniques were used to determine the difference in length between the nasal and oral aerodigestive tracts. Using sagittal plane images from consecutive patients, the mean nares-cricoid (NC) distance, upper incisor-cricoid (IC) distance, and their mean differences were determined. Male, female, and overall distances and differences were calculated. Standard deviations, 95% confidence intervals, and 90% prediction intervals were also calculated. Mean difference data were applied to reported standard oral esophagoscopy landmark measurements to convert to standard landmark measurements from the nares.
  
  
  RESULTS
  Overall mean NC and IC distances were 175.4 mm and 147.5 mm, respectively. For males, these mean distances were 185.5 mm and 155.0 mm, respectively. For females, these mean distances were 165.3 mm and 140.0 mm, respectively. Overall mean NC to IC difference was 27.9 mm. The mean NC to IC difference for males and females was 30.5 mm and 25.2 mm, respectively.
  
  
  CONCLUSIONS
  Historically, landmark and report measurements in esophagoscopy have been measured and standardized from the upper incisor. This study demonstrates and clarifies the inherent anatomic length difference of the nasal and oral aerodigestive tracts and the resultant documentation dilemma produced by transnasal esophagoscopy techniques. These data provide easy conversion of esophagoscopy measurements reported from the incisors or nares, providing better communication between endoscopists of different disciplines and techniques.
authors.affiliation: Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA. jmgarner@ent.umsmed.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Garner
authors.forename: John
authors.initials: J
authors.lastname: Schweinfurth
authors.forename: Warren
authors.initials: W
authors.lastname: May
authors.forename: John
authors.initials: J
authors.lastname: Faust
mesh_terms: D015331:Cohort Studies; D004282:Documentation / Q000379:methods* / Q000592:standards; D049631:Esophageal Sphincter, Upper / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007830:Larynx / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008297:Male; D008482:Mediastinum / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014827:Vocal Cords / Q000033:anatomy & histology / Q000000981:diagnostic imaging