{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:26:45Z","timestamp":1760059605590,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Even with advanced management involving pharmacologic and ventilatory strategies, respiratory dysfunction increases morbidity and reduces the quality of life. This narrative review examines how craniofacial and cervical manipulative interventions\u2014including nasomaxillary skeletal expansion, breathing re-education, and structural techniques\u2014may holistically optimize airway function by enhancing neurological and lymphatic dynamics, modulating vagal tone, reducing pharyngeal collapsibility, and supporting immune regulation across diverse clinical settings. Objectives: To explore manual techniques that influence respiratory and autonomic function and to evaluate their reported clinical efficacy and supporting evidence, particularly in the context of airway disorders such as asthma and pneumonia. Methods: A narrative review of the literature from PubMed and Google Scholar was conducted using search terms related to airway function and osteopathic manipulative techniques (OMTs). The inclusion criteria spanned 2010\u20132025 English-language peer-reviewed full-text articles on airway function, OMT, and emergency airway maneuvers. Clinical trials, observational studies, and reviews were included; non-peer-reviewed content and animal studies (unless mechanistically relevant) were excluded. Chapman\u2019s reflexes related to respiratory function were incorporated to highlight somatic\u2013visceral correlations. Key Findings: The techniques reviewed included frontal lift, vomer manipulation, maxillary and zygomatic balancing, and cervical adjustments. Thoracic OMT methods, such as diaphragm doming and lymphatic pump techniques, were also addressed. Emergency techniques, such as the BURP and Larson maneuvers, prone positioning, and high-frequency chest wall oscillation, were presented as comparative strategies to OMTs for acute airway management. Conclusions: Craniofacial and cervical manipulations can be a promising adjunct for enhancing airway function. However, the current literature displays heterogeneity and lack of large-scale randomized trials, which emphasize the necessity for standardized research and the establishment of clinical guidelines with the collected evidence.<\/jats:p>","DOI":"10.3390\/jcm14134494","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T05:53:13Z","timestamp":1750917193000},"page":"4494","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Airway Function Through Craniofacial and Cervical Manipulations and Emergency-Anesthesia Maneuvers: Applications in Airway Function Enhancement, Pneumonia, and Asthma\u2014Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1291-1838","authenticated-orcid":false,"given":"Jason","family":"Park","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz","family":"Benitez","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amethyst","family":"Hamanaka","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghulam Husain","family":"Abbas","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ala-Too International University, Bishkek 720048, Kyrgyzstan"},{"name":"Department of Medicine, Mass General Brigham, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Faluade","sequence":"additional","affiliation":[{"name":"Independent Scholar of Anesthesiology & Pain Medicine, Houston, TX 77004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6390-7692","authenticated-orcid":false,"given":"Sjaak","family":"Pouwels","sequence":"additional","affiliation":[{"name":"Department of Surgery, Bielefeld University\u2014Campus Detmold, Klinikum Lippe, 32756 Detmold, Germany"},{"name":"Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Eller","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1136\/thoraxjnl-2015-206780","article-title":"Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and\/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease: Table 1","volume":"70","author":"Torres","year":"2015","journal-title":"Thorax"},{"key":"ref_2","first-page":"276","article-title":"Epidemiology and management of common pulmonary diseases in older persons","volume":"67","author":"Crothers","year":"2012","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1089\/acm.2005.11.103","article-title":"Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans: A pilot study","volume":"11","author":"Cutler","year":"2005","journal-title":"J. Altern. Complement. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"An, H.J., Kim, A.Y., and Park, S.J. (2021). Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke. Medicina, 57.","DOI":"10.3390\/medicina57080826"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1750-4732-4-2","article-title":"Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: A randomized controlled trial","volume":"4","author":"Noll","year":"2010","journal-title":"Osteopath. Med. Prim. Care"},{"key":"ref_6","first-page":"e37515","article-title":"Cervicogenic Angina and Dyspnea Secondary to Cervical Radiculopathy","volume":"15","author":"Chu","year":"2023","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Anwar, S., Arsalan, A., Zafar, H., Ahmad, A., and Hanif, A. (2022). Effects of breathing reeducation on cervical and pulmonary outcomes in patients with non specific chronic neck pain: A double blind randomized controlled trial. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0273471"},{"key":"ref_8","unstructured":"Bath, M., Nguyen, A., and Bordoni, B. (2023). Physiology, Chapman\u2019s Points. StatPearls, StatPearls Publishing."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4300\/JGME-D-22-00480.1","article-title":"Narrative Reviews: Flexible, Rigorous, and Practical","volume":"14","author":"Sukhera","year":"2022","journal-title":"J. Grad. Med. Educ."},{"key":"ref_10","first-page":"568","article-title":"The cranial bowl. 1944","volume":"100","author":"Sutherland","year":"2000","journal-title":"J. Osteopath. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"213","DOI":"10.34297\/AJBSR.2019.03.000665","article-title":"A Study to Investigate the Effect of \u201cFrontal Lift\u201d Osteopathic Manipulative Technique (OMT) in Patients with Chronic Sinusitis","volume":"3","author":"Lintonbon","year":"2019","journal-title":"Am. J. Biomed. Sci. Res."},{"key":"ref_12","first-page":"109","article-title":"An Osteopathic Approach to Chronic Sinusitis","volume":"2","author":"Karagic","year":"2011","journal-title":"J. Allergy Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"10","DOI":"10.53702\/i2375-5717-34.4.10","article-title":"The Effect of Osteopathic Manipulative Treatment on Acute Post COVID-19 Anosmia and Ageusia Symptoms: A Case Report","volume":"34","author":"Mehra","year":"2024","journal-title":"AAO J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.5005\/jp-journals-10013-1346","article-title":"Efficacy of Osteopathic Manipulative Treatment in the Patient of Chronic Rhinosinusitis: A Case Report","volume":"11","author":"Baisakhiya","year":"2020","journal-title":"Int. J. Clin. Rhinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"319","DOI":"10.4103\/joacp.JOACP_315_19","article-title":"Airway management in maxillofacial trauma","volume":"37","author":"Saini","year":"2021","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"348","DOI":"10.7556\/jaoa.2018.069","article-title":"Osteopathic Manipulation Shown to Improve Upper Airway Stabilization","volume":"118","author":"King","year":"2018","journal-title":"J. Osteopath. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1089\/acm.2011.0031","article-title":"Suboccipital Decompression Enhances Heart Rate Variability Indices of Cardiac Control in Healthy Subjects","volume":"19","author":"Giles","year":"2013","journal-title":"J. Altern. Complement. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1515\/jom-2020-0213","article-title":"Occipitoatlantal decompression and noninvasive vagus nerve stimulation slow conduction velocity through the atrioventricular node in healthy participants","volume":"121","author":"Dalgleish","year":"2021","journal-title":"J. Osteopath. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jbmt.2020.08.018","article-title":"Direct measurement of the rhythmic motions of the human head identifies a third rhythm","volume":"26","author":"Rasmussen","year":"2021","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yao, S., Hassani, J., Gagne, M., George, G., and Gilliar, W. (2014). Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia. J. Vis. Exp., 50687.","DOI":"10.3791\/50687-v"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"774","DOI":"10.7556\/jaoa.2020.121","article-title":"An Osteopathic Modular Approach to Asthma: A Narrative Review","volume":"120","author":"Schend","year":"2020","journal-title":"J. Osteopath. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1515\/jom-2020-0040","article-title":"Effect of osteopathic manipulative treatment on pulmonary function testing in children with asthma","volume":"121","author":"Jones","year":"2021","journal-title":"J. Osteopath. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/ni.3049","article-title":"The immunology of asthma","volume":"16","author":"Lambrecht","year":"2015","journal-title":"Nat. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hough, K.P., Curtiss, M.L., Blain, T.J., Liu, R.M., Trevor, J., Deshane, J.S., and Thannickal, V.J. (2020). Airway Remodeling in Asthma. Front. Med., 7.","DOI":"10.3389\/fmed.2020.00191"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jbmt.2025.05.050","article-title":"Objective measurement of Cranial Rhythmic Impulse (CRI): Visual analysis of an observational case series","volume":"44","author":"Strada","year":"2025","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1515\/jom-2024-0122","article-title":"The effect of osteopathic manipulative treatment on chronic rhinosinusitis","volume":"125","author":"Rowane","year":"2025","journal-title":"J. Osteopath. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"St\u0119pnik, J., K\u0119dra, A., and Czaprowski, D. (2020). Short-term effect of osteopathic manual techniques (OMT) on respiratory function in healthy individuals. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0235308"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ctim.2011.10.008","article-title":"Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: A pilot study","volume":"20","author":"Zanotti","year":"2012","journal-title":"Complement. Ther. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"M\u00e9riaux, F., Stubbe, L., and Guyon, A. (2024). Physiological Mechanisms Underlying the Primary Respiratory Mechanism (PRM) and Cranial Rhythmic Impulse (CRI) in Osteopathy: A Systematic Review. Healthcare, 12.","DOI":"10.3390\/healthcare12242503"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2519\/jospt.1997.26.2.95","article-title":"The Controversy of Cranial Bone Motion","volume":"26","author":"Rogers","year":"1997","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1053\/j.jvca.2018.10.028","article-title":"Larson\u2019s Maneuver to Facilitate Endotracheal Intubation Using Videolaryngoscopy","volume":"33","author":"Hill","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"0300060520925325","DOI":"10.1177\/0300060520925325","article-title":"The \u201cBURP\u201d maneuver improves the glottic view during laryngoscopy but remains a difficult procedure","volume":"48","author":"Yu","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"391","DOI":"10.17085\/apm.21026","article-title":"The effects of backward, upward, rightward pressure maneuver for intubation using the OptiscopeTM: A retrospective study","volume":"16","author":"Oh","year":"2021","journal-title":"Anesth. Pain. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s44254-022-00002-2","article-title":"Prone position: How understanding and clinical application of a technique progress with time","volume":"1","author":"Gattinoni","year":"2023","journal-title":"Anesthesiol. Perioper. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1152\/japplphysiol.91386.2008","article-title":"The prone position results in smaller ventilation defects during bronchoconstriction in asthma","volume":"107","author":"Harris","year":"2009","journal-title":"J. Appl. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3109\/02770903.2012.757773","article-title":"High-Frequency Chest Wall Oscillation Successful in Controlling Refractory Asthma","volume":"50","author":"Bose","year":"2013","journal-title":"J. Asthma"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e5912","DOI":"10.1097\/MD.0000000000005912","article-title":"Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation","volume":"96","author":"Chuang","year":"2017","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s40560-025-00795-x","article-title":"The effects of prolonged prone positioning on response and prognosis in patients with acute respiratory distress syndrome: A retrospective cohort study","volume":"13","author":"Yan","year":"2025","journal-title":"J. Intensive Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4494\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:58:22Z","timestamp":1760032702000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":38,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134494"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134494","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,6,25]]}}}