Effect of mouth breathing on upper airway structure in patients with obstructive sleep apnea / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and healthy individuals during oral or nasal breathing, and explore the relevant influencing factors. Methods:Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed. ①The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed; ②The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing. Results:The control group consisted of 15 males and 5 females, with an apnea-hypopnea index （AHI）<5 events/h, while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation （LSaO2） was 79.5% ±10.0%. In the both groups, the vertical distance between the mandible and the posterior pharyngeal wall decreased （P<0.05）; The long axis of tongue body decreased （P<0.05）, and the contact area between tongue and palate decreased. There was no significant change in the total volume of the retropalatine（RP） and retroglossal（RG） airway in the control group （P>0.05）. However, the minimum cross-sectional area and volume of the RP airway in OSAHS decreased （P<0.001）. The lateral diameters of uvula plane in OSAHS decreased during mouth breathing, which was contrary to the trend in the control group （P=0.017）. The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing （P=0.001）; The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway （P<0.001）. Conclusion:Mouth breathing leads to the shortening of the long axis of the tongue, the reduction of the contact area between the soft palate and the tongue, vertical distance between the mandible and the posterior pharyngeal wall, and the cross-sectional area of the epiglottis plane. These changes vary between OSAHS patients and controls. During mouth breathing, the diameters, areas and volumes of the RP area decreased, and were more significant in severe cases.

Experiencia en pacientes operados de roncopatía y apnea obstructiva del sueño / Clinical experience in patients with surgery of rhonchopathy and obstructive sleep apnea syndrome

RESUMEN Introducción: La uvulopalatofaringoplastía (UPPP) es un procedimiento ampliamente difundido en el tratamiento del ronquido y el síndrome de apnea e hipopnea obstructiva del sueño (SAHOS), ya que permite aumentar el área de sección transversal de la vía aérea superior y eliminar tejidos obstructivos. Conocer el grado de satisfacción de los pacientes con la cirugía es importante para nuestro desempeño. Objetivo: Evaluar la satisfacción de los pacientes con el procedimiento UPPP con cirugía nasal con datos subjetivos mediante la aplicación de una encuesta para ser respondida de forma anónima. Material y método: Estudio observacional, descriptivo. Se envió vía email una encuesta de 4 preguntas cerradas creada en la plataforma online MonkeySurvey a los pacientes que fueron sometidos a UPPP (faringoplastía de relocalización) con cirugía nasal entre 2015 y 2016. Resultados: 27 pacientes respondieron la encuesta. Sesenta y seis coma seis por ciento tenían ronquido primario y/o SAHOS leve, 33,3% SAHOS severo. La edad media al momento de la cirugía fue 41 años. El tiempo de seguimiento medio fue 10 meses (324 meses). Noventa y dos coma cinco por ciento de los pacientes están satisfechos con la cirugía UPPP; 81,4% refieren que recomendarían la cirugía a otra persona. Noventa y dos coma cinco por ciento refieren mejoría en los ronquidos. Noventa y cinco coma seis por ciento de los pacientes con somnolencia diurna refiere mejoría. Conclusión: La cirugía UPPP con técnica faringoplastía de relocalización combinada con cirugía nasal en pacientes con ronquido primario y SAHOS ha demostrado una alta tasa de satisfacción según la percepción de los pacientes en el seguimiento desde los 3 meses hasta los 2 años posoperatorios.

ABSTRACT Introduction: Uvulopalatopharyngoplasty (UPPP) is a widely used surgical procedure for snoring and obstructive sleep apnea syndrome (OSAS), since it allows to increase of the cross-sectional area of the upper airway and elimination of obstructive tissues. Knowing the degree of satisfaction of patients with surgery is important for our performance. Aim: To evaluate patient satisfaction with UPPP procedure (relocation pharyngoplasty) with nasal surgery with subjective data through the application of a survey to be answered anonymously. Material and method: Observational, descriptive study. A survey of 4 closed questions created in the MonkeySurvey online platform was sent to patients who underwent UPPP with nasal surgery between 2015 and 2016 via email. Results: 27 patients answered the survey. 66.6% had primary snoring and/or mild OSAS, 33.3% severe OSAS. The average age at the time of surgery was 41 years. The mean follow-up time was 10 months (3-24 months). 92.5% of patients are satisfied with UPPP surgery; 81.4% reported that they would recommend surgery to another person. 92.5% reported improvement in snoring. 95.6% of patients with daytime somnolence reported improvement. Conclusion: UPPP surgery with relocation pharyngoplasty technique combined with nasal surgery in patients with primary snoring and OSAS has shown a high satisfaction rate according to the perception of patients at follow-up from 3 months to 2 years postoperative.

Hiperplasia de la úvula: presentación de un caso clínico / Hyperplasia of the uvula: report of a clinical case

La hiperplasia de la úvula es una entidad poco frecuente. Puede tener diversas causas, tales como: surgir a partir de un proceso infeccioso; por reacciones alérgicas; angioedema hereditario (HANE) (14,16); inhalación de sustancias psicoactivas (7); traumatismos ocasionados por procedimientos como intubación o extubación endotraqueal, así como durante la aspiración de los líquidos de la cavidad oral en procedimientos quirúrgicos. (7,14,16) El alargamiento de la úvula, en algunos casos, se manifiesta asintomático. Este trabajo tiene como objetivo la descripción de esta entidad, la presentación de un caso clínico, y su manejo clínico-quirúrgico (AU)

The hyperplasia of the uvula is a rare entity, it can have diverse causes, such as: of an infectious process, allergic reactions, hereditary angioedema (HANE), (14 16) inhalation of psychoactive substances (7) traumatisms caused by procedures such as, intubation or endotracheal extubation, as well as during the aspiration of liquids from the oral cavity in surgical procedures (7,14,16). The lengthening of the uvula, in some cases, is asymptomatic. The aim of this work is the description of this entity, the presentation of a clinical case, and the clinical and surgical management (AU)

Quiste epidermoide de úvula palatina: presentación de un caso: revisión de la literatura / Epidermoid cyst of uvula: presentation of case: review of the literature

El quiste epidermoide es una entidad dermatológica frecuente, siendo muy rara su ubicación en la cavidad oral, con una mayor prevalencia a nivel de la cavidad oral. Es considerada de etiología congénita, aunque se presenta predominantemente en adulto jóvenes. Generalmente son masas bien circunscritas, decrecimiento lento y asintomáticos, aunque los ubicados en la cavidad oral y orofaringe pueden provocar trastornos fonatorios, deglutorios y respiratorios. El diagnóstico es clínico, siendo el diagnóstico diferencial con los quistes dermoides y teratoides solo posible con el estudio histopatológico. El tratamiento es quirúrgico y elpronóstico favorable sin recidivas. Se presenta un caso de quiste epidermoide localizado en la úvula palatina, en un varón de 6 meses de vida, tratado quirúrgicamente, con la excéresis del tumor por un abordaje trasoral

The epidermoid cyst is a frequent dermatological entity, being very rare its location in theoral cavity, with a higher prevalence at the level of the floor of the oral cavity. It is considered of congenitaletiology, although it occurs predominantly in young adults. They are generally well circumscribed, slowgrowing and asymptomatic masses, although those located in the oral cavity and oropharynx can causephonatory, swallowing and respiratory disorders. The diagnosis is clinical, being the differential diagnosiswith the dermoid and teratoid cysts only possible with the histopathological study. The treatment is surgicaland the prognosis is favorable without relapses. We present a case of epidermoid cyst located in uvula, in amale of 6 months of life, treated surgically, with the tumor excision by a transoral approach

Radiofrequency uvulopalatoplasty for primary snoring

Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP[uvulopalatopharyngo plasty], and laserassisted uvulopalatoplasty [LAUP]. Among the surgical methods, RAUP [radiofrequency assisted uvulopalatoplasty] is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score [soft palate position] one or two, an elongated uvula, grade one and two of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale [VAS] of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant [P=0.223]. When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant [From 1.8 to 1.9, P=0.78]. Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients [5.7%], nasal speech in 2 [5.7%] and exacerbation of snoring in 2 [5.7%] patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up.

Correlação entre a classificação de Friedman e Índice de Apneia-Hipopneia em portadores de Síndrome da Apneia e Hipopneia Obstrutiva do Sono / Correlation between the Friedman classification and the Apnea-Hypopnea Index in a population with OSAHS

ASAHOS é uma doença importante no cenário médico atual pela sua correlação com doenças cardiovasculares crônicas e suas consequências socioeconômicas. OBJETIVOS: Determinar a correlação entre a classificação de Friedman com a gravidade da doença pelo Índice de Apneia e Hipopneia em pacientes com SAHOS, para a avaliação e indicação cirúrgica. MATERIAIS E MÉTODOS: Estudo transversal. Foram avaliados e classificados 143 pacientes, na escala de Epworth, Friedman e quanto à gravidade da SAHOS pelo IAH. RESULTADOS: 112 pacientes se submeteram ao estudo de polissonografia no laboratório de sono. Uma crostabulação foi feita entre a Classificação de Friedman e o IAH. As variáveis se relacionam com p<0,05. Encontramos uma relação em que os pacientes com SAHOS leve tendem a ter uma menor classificação de Friedman (melhores resultados cirúrgicos). Da mesma forma os pacientes classificados como SAHOS moderada a grave possuem maior prevalência da classificação de Friedman III e IV (menor sucesso com uvulopalatofaringoplastia). p<0.05. CONCLUSÃO: Concluímos que a classificação de Friedman se correlaciona com a gravidade da SAHOS. Quanto maior a classificação de Friedman, maior tende a ser a gravidade da apneia nesse estudo.

OSAHS is an important disease in current medical settings because of its association with chronic cardiovascular diseases and socioeconomic impacts. AIMS: to establish the correlation between the Friedman Classification and the OSAHS severity through the Apnea-Hypopnea Index) in patients with OSAHS for assessment and surgery purposes. MATERIALS AND METHODS: Cross-sectional study. We evaluated and classified 143 patients, using the Epworth's and Friedman's scale and OSAHS severity according to the AHI. RESULTS: 112 patients were submitted to polysomnography. We compared the Friedman Score and the IAH. The variables were associated with p<0.05. We found that patients with light OSAHS, tended to have a lower Friedman classification (better surgical result). By the same token, patients with moderate to severe OSAHS had a greater prevalence of Friedman's score of III and IV; p< 0.05 (lower success rates from uvulopalatopharyngoplasty). CONCLUSION: We conclude that the Friedman's classification correlates with OSAHS severity - the higher the Friedman's score, the more severe is the OSAHS.

Surgical treatment of snoring & obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) syndrome is a potentially serious disorder affecting millions of people around the world. Many of these individuals are undiagnosed while those who are diagnosed, often exhibit poor compliance with nightly use of continuous positive airway pressure (CPAP), a very effective nonsurgical treatment. Various surgical procedures have been proposed to manage and, in some cases, treat OSA. In this article we review methods used to assess the sites of obstruction and a number of surgical procedures designed to address OSA. Effective surgical management of OSA depends upon developing a complete database and determining different levels of obstruction, which may include nasal, nasopharyngeal, oropharyngeal, and hypopharyngeal/retrolingual, or a combination of these sites. A systematic approach to clinical evaluation, treatment planning and surgical management is recommended and is likely to result in more predictable outcomes. Surgical treatment may involve various procedures that are performed in different stages depending on the patient’s sites of obstruction. The most commonly performed procedures include nasal reconstruction, uvulopalatopharyngoplasty (UPPP), advancement genioplasty, mandibular osteotomy with genioglossus advancement, and hyoid myotomy and suspension. In more severe cases, maxillomandibular advancement (MMA) with advancement genioplasty may be indicated. Even after appropriate surgical treatment, some patients may demonstrate continued obstruction with associated symptoms. Published indications for surgical treatment include an elevated respiratory disturbance index (RDI) with excessive daytime somnolence (EDS), oxygen desaturations below 90 per cent, medical co-morbidities including hypertension and arrhythmias, anatomic abnormalities of the upper airway and failure of medical treatment. The success of surgery in OSA is generally measured by achieving a (RDI) of less than 5, improvement of oxygen nadir to 90 per cent or more with no desaturations below 90 per cent and quality of life improvements with elimination or significant reduction of OSA symptoms. From a practical point of view, achieving these goals may be extremely difficult without patients’ cooperation, most notably in the realm of weight loss and maintenance of a healthy lifestyle.

Effect of classic uvulopalatopharyngoplasty and laser-assisted uvulopalatopharyngoplasty on voice acoustics and speech nasalance

Uvulopalatopharyngoplasty [UPPP] is a commonly used surgical technique for oropharyngeal reconstruction in patients with obstructive sleep apnea [OSA]. This procedure can be done either through the classic or the laser-assisted uvulopalatopharyngoplasty [LAUP] technique. The purpose of this study was to evaluate the effect of classic UPPP and LAUP on acoustics of voice and speech nasalance, and to compare the effect of each operation on these two domains. The study included 27 patients with a mean age of 46 years. All patients were diagnosed with OSA based on polysomnographic examination. Patients were divided into two groups according to the type of surgical procedure. Fifteen patients underwent classic UPPP, whereas 12 patients were subjected to LAUP. A full assessment was done for all patients preoperatively and postoperatively, including auditory perceptual assessment [APA] of voice and speech, objective assessment using acoustic voice analysis and nasometry. Auditory perceptual assessment of speech and voice, acoustic analysis of voice and nasometric analysis of speech did not show statistically significant differences between the preoperative and postoperative evaluations in either group [P>.05]. The results of this study demonstrated that in patients with OSA, the surgical technique, whether classic UPPP or LAUP, does not have significant effects on the patients' voice quality or their speech outcomes

Use of Muller's maneuver in the evaluation of patients with sleep apnea: literature review / Utilização da manobra de Müller na avaliação de pacientes apnéicos: revisão da literatura

Sleep apnea-hypopnea syndrome was described twenty years ago, and since then there have been doubts and controversies regarding it. Fiberoptic nasopharyngoscopy with Muller's maneuver, first described by Borowieck and Sassin (1983), is among them. AIM: Careful literature review on Muller's maneuver, regarding whether it can predict the sucess of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disorder. DISCUSSION AND LITERATURE REWIEW: Literature has shown that there isn't a consensus about the use of Muller's maneuver. In spite of being technically easy, inexpensive and widely used, it is very unespecific and subjective. CONCLUSION: The importance of Muller's maneuver in evaluating apneic patients has been questioned, because there are controversies whether it can predict the sucess of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disease.

A Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono é uma patologia descrita há apenas vinte anos, havendo ainda várias dúvidas e controvérsias a seu respeito. Nesse âmbito inclui-se a nasofibrolaringoscopia com Manobra de Müller descrita por Borowieck e Sassin em 1983 e motivo de análise neste artigo. OBJETIVO: Revisão da literatura, com análise crítica e comparativa a respeito da capacidade da nasofibrolaringoscopia com manobra de Müller de predizer o sucesso da uvulopalatofaringoplastia, o local de colapso da via aérea superior e a gravidade da doença. DISCUSSÃO E REVISÃO DA LITERATURA: A revisão da literatura mostra que não há um consenso sobre a utilização da manobra de Müller, pois apesar de ser um exame de fácil execução, custo e tempo efetivos, é também bastante inespecífico e subjetivo. CONCLUSÃO: A relevância da manobra de Müller na avaliação do paciente apnéico tem sido questionada, pois há controvérsias na literatura quanto a sua capacidade de predizer o sucesso da cirurgia orofaríngea, o local de colapso da via aérea superior e a gravidade da apnéia.

Estudo comparativo entre cetorolaco e cetoprofeno no controle da dor pós-operatória de uvulopalatofaringoplastia / A comparative study between Ketorolac and Ketoprofen in postoperative pain after uvulopalatopharyngoplasty

A dor no pós-operatório imediato apresenta-se como um grave problema, requerendo do médico uma adequada assistência. Na Otorrinolaringologia, merece atenção especial a dor após uvulopalatofaringoplastia (UPFP). OBJETIVO: Comparar a eficácia na analgesia pós-operatória do cetorolaco com o cetoprofeno em UPFP. PACIENTES E MÉTODOS: Estudo prospectivo, randomizado, duplo-cego com 24 pacientes submetidos à UPFP, divididos em 2 grupos, sendo que 14 receberam cetorolaco e 10 cetoprofeno. Avaliação da intensidade da dor através de escala visual analógica e necessidade do uso associado de opióide (tramadol). RESULTADOS: Dos 14 pacientes que receberam cetorolaco, apenas 3 (21 por cento) necessitaram uso complementar de opióide, enquanto que 7 (70 por cento) do grupo do cetoprofeno o fizeram. Após 12 horas de cirurgia, houve um predomínio de 71 por cento dos pacientes que receberam cetorolaco, com dor leve ou até ausência desta, enquanto 70 por cento dos do cetoprofeno referiram dor moderada ou incômoda. Após 24 horas de cirurgia, 60 por cento dos pacientes que fizeram uso de cetoprofeno referiam dor moderada a incômoda, ao passo que 86 por cento dos do cetorolaco referiram dor leve à ausência. CONCLUSÃO: Conclui-se que o cetorolaco é mais eficaz em relação ao cetoprofeno no tratamento da dor pós-operatória imediata de UPFP, pois houve dor de menor intensidade e menor uso de opióide.

Postoperative pain is a serious problem, requiring an appropriate response from the medical doctor. In otolaryngology special attention is needed after uvulopalatopharyngoplasty (UP3). AIM: To compare the efficacy of postoperative analgesia using ketorolac and ketoprofen after UP3. PATIENTS AND METHODS: A prospective, randomized, double-blind study was made of 24 patients that were divided into 2 groups (14 received ketorolac and 10 received ketoprofen). Pain intensity was based on an analog visual scale and the need for opioids (tramadol). RESULTS: Of the 13 patients that received ketorolac, 3 (21 percent) required opioids; 7 of 10 (70 percent) patients in ketoprofen group used opioids. 12 hours after surgery, 71 percent of the patients that received ketorolac had mild or absence of pain. 70 percent of the ketoprofen users reported moderate to significant pain. 24 hours after surgery, 60 percent of the patients using ketoprofen reported moderate to significant pain, while 86 percent of the ketorolac users reported mild or absence of pain. CONCLUSION: We concluded that ketorolac is more effective compared to ketoprofen in the treatment of immediate postoperative pain after UP3, as patients using ketorolac had less pain and used opioids to a lesser degree.

Pain-relieving effect of local steroid injection in uvulopalatopharyngoplasty.

An analytical prospective study was performed to determine the post-operative pain-relieving effect of local steroid suspension injection in uvulopalatopharyngoplasty. From February 2000 to October 2000, 48 adult patients from 20 to 67 years of age, were scheduled to receive uvulopalatopharyngoplasty. Triamcinolone acetonide (Kenacort A) was injected onto the raw surface of the left-sided tonsillar fossa and left-sided soft palate after tonsillectomy and uvulopalatopharyngoplasty. Other preoperative and post-operative medications including antibiotics, anesthesia and surgical techniques were standardized. Visual analog scales were used to assess the level of pain sensation on the left and right side of the throat daily from day 0 (Operative day) to post-operative day 10. A paired t-test showed significant differences in post-operative pain level between the study side (left) and the control side (right) at day 2, day 4, and in the overall analysis (p < 0.05).

Doble colgajo de úvula en el cierre primario de la fisura palatina / Uvular double flap for palatine fissure closure

Presentamos una técnica de alargamiento del paladar,en una casuística de 47 pacientes tratados en el Hospital de Agudos Carlos G Durand,durante el período comprendido entre Noviembre de 1988 a Mayo de 1999.Dicha cirugía consiste en la confección de un doble colgajo con ambas semi-úvulas,que mediante una Zetaplastia prolongan el velo del paladar,pudiendo asociar la misma a cualquier procedimiento del cierre de la fisura palatina.Consideramos que dicha técnica es una alternatoc aválida para mejorar la compentencia velo-faríngea

Resultados preliminares do efeito do antibiótico tópico no controle da dor pós laup / Preliminary Results of Topic Antibiotic Effect in the Post LAUP Pain Control

A LAUP (Laser assisted uvulopalatoplasty) é uma técnica já reconhecida para tratar o ronco e o síndrome de apnéia obstrutiva do sono leve. Desde o início da LAUP, a dor tem sido o principal problema no pós operatório. O laser produz uma vaporização térmica superficial na mucosa palatal, onde desenvolve um processo inflamatório agudo, que passa a ser colonizada e infectada por bactérias residentes na orofaringe. Objetivo: Estudara efetividade do antibiótico tópico no controle da dor pós-operatória em pacientes operados de LAUP, associado com esquemas de analgesia tradicional. Material e método: Avaliamos prospectivamente 28 pacientes com uma idade média de 47 anos, que dividimos em dois grupos: um grupo controle: 15 pacientes, que receberam diclofenaco por via intramuscular, continuando pela via oral com diclofenaco e dipirona, benzocaina em spray e gargarejos freqüentes; um grupo problema: 13 pacientes, que receberam idêntica medicação analgésica sistêmica e tópica, à qual foi adicionada um spray de rifocina tópica, a ser aplicada no local da cirurgia por 10 dias. Resultados: observamos diferenças em todos os parâmetros analisados entre o grupo controle e problema; no grupo problema, registramos uma dor intermitente e de menor intensidade, um maior tempo no início, pouca interferência com a alimentação habitual e um menor tempo de duração dessa dor, quando em comparação com o grupo controle. Conclusão: O tratamento com antibiótico tópico associado à medicação analgésica e antiinflamatória é útil no controle da dor pós-LAUP pelo domínio do processo infeccioso que se forma no local da cirurgia.

LAUP (Laser assisted uvulopalatoplasty) is an already recognized technique to treat snoring and mild obstructive sleep apnea syndrome. Since the beginning of this procedure, pain has been the main problem in the post operative period. Laser produce a superficial termal vaporization of the soft palate mucosa and leads to an acute inflamatory process with secondary bacterial colonization and infection by the normal orofaringeal flora. Aim: We studied the effec-tivaness of topic antibiotic in the post operative pain control of the patients submitted to LAUP patients. Material and methods: We assessed prospectively 28 patients with mean age of 47 years old, divided into 2 groups: A control group of 15 patients received 75 mg. of potasium diclofenac (intramuscular) continuing post operatively with oral potasium diclofenac and dipirona, benzocaine spray and frequents garglings. The problem group of 13 patients received topic and sistemic analgesic medication and garglings similar to the control group. It was added to the benzocaine spray, rifocin spray, admistred on the operated area during 10 days. Results: We observed diferences in all of the analized parameters. In the problem group an intermitent and a lesser pain level was registred with, late begining and little influence with the habitual nourishment than the control group. Conclusion: A topic antibiotic treatment associated to analgesic and antinflamatory medication is usefull to control the post LAUP pain, reducing the infectares process produced on the operatedt area.

Uvulopalatopharyngoplasty: the treatment of obstructive sleep apnoea

Obstructive sleep apnoea [OSA] is a troublesome disease with a risk of long term complications. Uvulopalatopharyngoplasty [UPPP] is a useful surgical technique provided the site of obstruction is at the soft palate level. To assess the efficacy of this operative procedure. DESIGN: Case study. PERIOD: From 1990-1996. SETTING: ENT Department of Allied Hospital Faisalabad. PATIENTS AND METHODS: 15 patients admitted from outpatient department with symptoms of OSA and radiological confirmation of obstruction at soft palate level are included in this study. Apart from routine investigations ECG, X-ray of neck soft tissue lateral view, blood gases and Muller maneuver were done in all cases. OPERATIVE PROCEDURE: It includes standard tonsillectomy and removal of 1 cm of soft palate, uvula, anterior and posterior pillars and stitching them together to increase the oropharyngeal space. Majority of patients were between 21-40, all were males. Apnoea attack during sleep, excessive day time somnolence, excessive snoring and obesity were the main symptoms. Majority of the patients were satisfied with the result of operation. There were no longterm complications. Success of surgical procedure depends on patient selection and good operative technique. Our results compare favourably with other published series

Flow volume loop pattern in sitting and supine positions in obstructive sleep apnea

Episodes of obstructive sleep apnea depend on posture assumed during sleep, being more frequent in the supine position. Findings on supine flow volume loop [FVL] may therefore correlate better with obstructive apneic episodes than sitting FVL. In this study we investigated the FVL pattern in 27 obstructive sleep apnea [OSA] patients having upper airway obstruction in both sitting and supine positions compared to 20 control subjects. Diagnosis of OSA was based on full night polysonographic study. Spirometric measures were done in either group in sitting and supine positions in a random fashion. Sixteen patients with oropharyngeal airway obstruction underwent uvulopalatopharyngo plasty. Polysomnography and FVL were repeated 6 weeks later and compared to preoperative pattern. Apnea-hypopnea index showed more than 50% improvement in 13 patients postoperatively. Spirometric features in OSA group were: Vital capacity [VC] was less in supine [2.4 +/- 0.5] than sitting position [2.7 +/- 0.6]. Both were less than normal group [4.2 +/- 0.9] p<0.05. Postoperatively, there was insignificantly increase in both supine [2.5 +/- 0.4] and sitting [2.8 +/- 0.5] VC in responders. The expiratory and inspiratory flow rates were less in supine position than sitting position throughout VC especially at higher lung volumes, both were less than normal group. The Expiratory flow curve showed an expiratory flow plateau which could be identified between 85-61% of VC in 83% of OSA in supine position and in 66% in sitting positions. The mid portion of expiratory curve was convex away from volume axis in 89% of cases of OSA compared to slightly concave one in normal group. On the other hand, the inspiratory flow curve showed an inspiratory plateau occurred in 66% of sitting OSA patients. It extended over 55% VC. Expiratory flow ratio MEF[50]/ M1F[50] ratio was higher in OSA[0.71 in sitting and 0.78 in supine] compared to control group [0.3 in sitting and 0.6 in supine]. In the postoperatively group the pattern of FVL was still retaining the preoperative features specially in the bad responders group. FVL reflects the dynamic upper airway narrowing in OSA patients. Two features are added to previously reported FVL characteristics in OSA patients. The pattern is more evident in supine position. It is persistent after surgical treatment. FVL is useful physiological test for studying behavior of upper airways in individual OSA patients rather than diagnostic tool for screening these patients. Supine FVL may be used as a helping tool to predict the postoperative success when sitting FVL is not fully informative in a Suspicious case

Síndrome de apnea obstructiva del sueño asociado a estenosis nasal; velofaringea y traqueal: manejo quirúrgico de un caso incluyendo uvulopalatofaringoplastía / Obstructive sleep apnea syndrome associated with nasal obstruction, velopharyngeal and tracheal: surgical management of a case including uvulopalatopharyngoplasty

Estudiamos a un varón de 47 años, con un síndrome de apnea ibstructiva del sueño (SAOS) grave. Encontramos estenosis nasal, velofaríngea y traqueal hipocalórica, oxigenoterapia y presión positiva continua nasal, además de medidas farmacológicas de sostén. Cuando la hipersomnia y la insuficiencia cardíaca derecha desaparecieron, se reparó quirúrgicamentre la estenosis traqueal. Finalmente se le realizó una uvulopalatofaringoplastía (UPFP) y resección de una sinequia nasal. En la acutalidad está asintomático sion medicamentos

Acompanhamento polissonográfico das apnéias do sono após uvulopalatofaringoplastia / Polysomnographic follow-up of sleep apneas after uvulopalatopharyngoplasty

Uvulopalatofaringoplastia (UPFP) foi realizada em 12 pacientes com apnéia do sono tipo obstrutiva. Comparamos aqui dados clínicos e traçados polissonográficos pré-operatórios aos realizados de um a três meses após a cirurgia. Sonolência excessiva diurna foi realizada parcialmente em 4 casos e totalmente em 8. Tempo total de sono, eficiência do sono, número de despertares e latência do sono mantiveram-se constantes. A latência REM foi acentuadamente maior após a cirurgia. A distribuiçäo dos estágios de sono foi semelhante nas duas avaliaçöes exceto pela ausência de estágio 4 verificada em menor número de casos no pós-operatório. Houve melhora da SaO2, encontrando-se valores abaixo de 80% em 10 pacientes no pré e em 4 no pós-operatório. Os índices de apnéia reduziram-se em todos os casos, mas apenas 4 atingiram valores normais