Ten-year changes in clinical features of patients monitored by polysomnography in OSA diagnosis and treatment centers:Data analysis based on a large sample disease database / 中国耳鼻咽喉头颈外科

OBJECTIVE Aimed to analyze the demographic,anthropometric,severity,and common comorbidities of individuals with suspected obstructive sleep apnea(OSA)referred to the OSA diagnosis and treatment center of the Sixth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from 2012 to 2021.METHODS Data of subjects with suspected OSA who underwent polysomnography(PSG)from January 2012 to December 2021 were collected.Subjects were categorized into five groups based on the PSG study date with a two-year interval.Clinical characteristics trends were compared across groups,focusing on the comparison between 2020-2021 and 2018-2019 to explore changes after COVID-19 epidemic.RESULTS 1.A total of 5870 subjects were included from 2012 to 2019[age(43.2±12.7)years,21.7％females].OSA prevalence was 84.8％.Over the two-year intervals,age,female proportion,OSA severity,and other indicators showed no significant changes.Body mass index(median 26.8kg/m2 to 26.0kg/m2)and overweight rates(78.1％to 73.4％)decreased yearly,as did the proportions of subjects who smoked(38.1％to 27.8％)and consumed alcohol(13.5％to 6.4％).The prevalence of hypertension increased yearly(40.3％to 51.8％),while awareness rates gradually decreased(70.3％to 59.4％).Diabetes prevalence remained relatively stable(9.4％to 9.7％),with increased awareness(49.5％to 66.2％).Dyslipidemia prevalence remained high(76.7％to 78.3％),with low awareness rates(20.8％to 28.7％).2.A total of 805 subjects were included from 2020 to 2021.Compared with 2018-2019,the proportion of females decreased(14.9％vs.22.0％),and OSA severity increased(apnea-hypopnea index 40.4 times/h vs.29.2 times/h).Prevalence rates of hypertension,diabetes,dyslipidemia(47.1％,6.9％,62.1％)and awareness rates(52.4％,57.7％,17.8％)were lower than those from 2018-2019.3.Compared with subjects with known their comorbidities,unknown subjects had significantly higher levels of systolic blood pressure(141 mmHg vs.134 mmHg),diastolic blood pressure(93 mmHg vs.85 mmHg),fasting blood glucose(7.87 mmol/L vs.6.07 mmol/L),and low-density lipoprotein(3.08 mmol/L vs.2.91 mmol/L)(P＜0.05).CONCLUSION From 2012 to 2021,individuals with suspected OSA referred for PSG test showed a tendency toward younger age,lower proportion of females,fewer comorbidities,but increased OSA severity.The awareness rate of comorbidities needs improvement,emphasizing the importance of a multidisciplinary approach to the diagnosis and treatment of OSA.

Clinical application of the modified scalp coronal incision in the treatment of zygomatic complex fractures / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the application of the modified scalp coronal incision in the treatment of zygomatic and zygomatic arch fracture, and analyze its prognosis. METHODS A retrospective analysis of 236 cases with zygomatic and zygomatic arch fracture from 2008 to 2016 was performed. They were treated with zygomatic and zygomatic arch fracture open reduction and firm fixation by the modified scalp coronal incision and postoperative mouse rehabilitation. After 3-6 months, the infection of incision, facial paralysis, occlusal, degree of mouth opening, facial deformity and subjective satisfaction index were followed up. The prognosis and recovery were evaluated. RESULTS 1. All of the patients had no postoperative incision infection, subcutaneous hematoma, temporal region sag, bald, and permanent facial paralysis. They all got satisfied face recovery. 2. All patients with occlusal disorders and limited mouth opening obtained functional occlusal and ideal degrees of mouth opening. Satisfaction was 97％. CONCLUSION The modified coronal scalp incision in the reconstruction of 3 d structure of zygomatic and zygomatic arch, has the advantages of a clear operation field and accurateresetting, good restoration of face, concealed scar. It contributes to the protection of the facial nerve and vascular structureand reduces the incidence of surgical complications.

Skin prick test using two different allergen prick reagents, a comparative study in Shanghai / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the results of skin prick test with allergens of Allergopharma company or ALK company in Shanghai area.@*METHOD@#The study included 9 233 patients diagnosed as allergic rhinitis. The patients were divided in to two groups (Allergopharma group and Alutard-SQ group) SPT was given from June, 2005 to Feb, 2013. The results of the positive rate using two reagents were analyzed and compared.@*RESULT@#There were no significant differences between the two groups in age and gender (P > 0.05). The total positive rate in Allergopharma group was 62.90%, and 59.68% in Alutard-SQ group. The positive rate in Allergopharma group was significantly higher than that in Alutard-SQ group (P < 0.01). Dermatophagoides farinae (Der f) and Dermatophagoides pteronyssinus (Der p) were identified as the mostly responsible allergens. The positive rate of Der f in Allergopharma group and Alutard-SQ group was 55.23% and 45.57% respectively. The same rate were 54.83% and 47.89% of Der p. There were significant differences of the positive rate of two allergens in both groups (P < 0.01).@*CONCLUSION@#The total positive rate was different using different allergens for SPT among the patients diagnosed as allergic rhinitis of the same area. Dust mites were identified as main allergens. The positive rate was different when using different reagents, which needed more attention to make the decision of specific immune therapy.

Reconstruction of external nose defect with local flaps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The role of different local flaps in small external nasal skin defect reconstruction was discussed.@*METHOD@#Forty-two cases of the small size nasal defects (diameter < 2 cm) were repaired with local external nose flap (includes the dorsal nasal flap, nasolabial flap and bilobed flap). The clinical and follow-up data were analyzed of patients with small external nasal skin defects, who accepted different local flaps reconstruction. Dorsal nasal flap, nasolabial flaps (includes island flap, slid flap and axial flap) and bilobed flap were tailored to reconstruct different external nasal defect. Twenty-seven patients were male and fifteen patients were female, the patients' age ranged from 28 to 74 years, the median age was 61 years. Thirty-eight cases resulted from resection of skin malignant tumor and four cases were benign lesions. The diameter of defects was 1-2 cm. The defects were reconstructed by single-stage dorsal nasal flap in 7 cases. There were 30 cases of caudolateral nasal defects were reconstructed by nasolabial flap, single-stage island nasolabial flap in 7 cases, axial flap in 18 cases and slid flap in 5 cases. Superior lateral defects were reconstructed by single-stage bilobed flap in 5 cases.@*RESULT@#All defects were repaired successfully. All tissue flaps survived and had not necrosis. There was no tumor recurrence during 3 months to 2 years follow-up.@*CONCLUSION@#The dorsal nasal flap, nasolabial flap and bilobed flap can be used safely and effectively to repair the small external nasal defect and have satisfactory curative effect.

Reconstruction of large external nose defect with forehead flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the role of forehead flap in large external nasal defect reconstruction.@*METHOD@#We retrospectively reviewed the clinical and follow-up data of 11 patients with large or full-thickness external nasal defects, which were reconstructed with single-or two-stage interpolated or island forehead flaps from January 2007 to June 2011. All patients were male,defects of 9 cases were resulted from resection of skin malignant tumor and traumatic defect in 2 cases. The average diameter of defects was 3.3 cm (2.5-5.0 cm). Four cases had alar full thickness defect. The supratrochlear and angular artery of the elders (>70 yrs) and patients with suspicious peripheral blood vessel lesions were scanned before the surgery by Doppler ultrasonic. The defects were reconstructed by two-stage interpolated flap in 7 cases; five cases were reconstructed by single-stage island flap technique. A nasolabial flap based on piriform aperture was turned into the nasal cavity to reconstruct the lining.@*RESULT@#All defects were repaired successfully. All tissue flap survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain at the 6th postoperative month.@*CONCLUSION@#The forehead flap, interpolated or island, can be used safely and effectively to repair the large external nasal defect in experienced hands.

The influence of surgery to the blood glucose and blood fat of the patients with severe OSAHS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the levels of the fasting blood glucose (FBG) and blood fat of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after surgery, meanwhile to analyze the influence on blood glucose and blood fat after the changes of body mass index (BMI), apnea-hypopnea index (AHI) and lowest oxygen saturation (LSpO2).@*METHOD@#Thirty-one patients with severe OSAHS were performed Z-palatoplasty (ZPP) or ZPP combined with genioglossus advancement with hyoid suspension (GAHM). Cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and FBG were detected before and after surgery.@*RESULT@#Preoperative HDL was negatively related to BMI and AHI, but not LSpO2. After surgery the BMI, AHI, LSpO2, HDL and FBG were all improved. The change of HDL had correlation with the changes of BMI and AHI, and there was linear correlation with HDL and BMI (r= -0.36).@*CONCLUSION@#The surgery of ZPP and ZPP combined with GAHM can improve the AHI, LSpO2, BMI, the FBG and blood fat of the patients with OSAHS. Lose weight and rectifying sleep disordered breathing were important to improve glycolipid metabolism disorder of the patients with OSAHS.