Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, produc- ing favorable results with good applicability in otolaryngology clinical practice.

Accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea / Acurácia da tonometria arterial periférica no diagnóstico da apneia obstrutiva do sono

ABSTRACT INTRODUCTION: The use of handheld devices that assess peripheral arterial tonometry has emerged as an auxiliary method for assessment and diagnosis of obstructive sleep apnea syndrome. OBJECTIVE: To evaluate the accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea. METHODS: Contemporary cohort cross-sectional study. Thirty patients with suspected obstructive sleep apnea underwent peripheral arterial tonometry and assisted nocturnal polysomnography concomitantly. RESULTS: The mean apnea/hypopnea index by peripheral arterial tonometry was significantly higher than that by polysomnography (p < 0.001), but the values of both sleep studies were significantly correlated (r = 0.762). There was a high correlation between variables: minimum oxygen saturation (r = 0.842,p < 0.001), oxygen saturation < 90% (r = 0.799, p < 0.001), and mean heart rate (r = 0.951, p < 0.001). Sensitivity and specificity were 60% and 96.2% (AUC: 0.727;p = 0.113), respectively, when at a threshold value of 5 events/h. In severe cases (≥30 events/h), the result was a sensitivity of 77.8% and a specificity of 86.4% (AUC: 0.846, p = 0.003). CONCLUSION: Peripheral arterial tonometry is a useful portable device for the diagnosis of obstructive sleep apnea; its accuracy is higher in moderate and severe cases.

RESUMO Introdução: A utilização de dispositivos portáteis, que avaliam a tonometria arterial periférica, surge como método adjuvante para avaliação e diagnóstico da síndrome da apneia obstrutiva do sono. Objetivo: Avaliar a acurácia da tonometria arterial periférica no diagnóstico da apneia obstrutiva do sono. Método: Estudo de coorte contemporânea com corte transversal. Trinta pacientes com suspeita de apneia obstrutiva do sono foram submetidos a tonometria arterial periférica e a polissonografia noturna assistida simultaneamente. Resultados: A média do índice de apneia/hipopneia pela tonometria arterial periféricafoi significativamente maior do que a da polissonografia (p < 0,001), porém os valores de ambos os estudos do sono foram significativamente correlacionados (r = 0,762). Houve alta correlação entre as variáveis: saturação mínima de oxigênio (r = 0,842, p < 0,001), saturação de oxigênio < 90% (r = 0,799, p < 0,001) e média de frequência cardíaca (r = 0,951, p < 0,001). A sensibilidade e especificidade foram 96,2% e 60% (AUC: 0,727, p = 0,113), respectivamente, quando limiar de 5 eventos/hora. Nos casos graves (≥ 30 eventos/hora), o resultado foi uma sensibilidade de 77,8% e uma especificidade de 86,4% (AUC: 0,846, p = 0,003). Conclusão: A tonometria arterial periférica é um dispositivo portátil útil no diagnóstico da apneia obstrutiva do sono e sua acurácia é maior nos casos moderados e graves.

Tratamento endoscópico do câncer de laringe com laser de CO2: 25 anos de experiência / Laser endoscopic microsurgery for the treatment of laryngeal carcinoma: 25-year experience

Introdução: o tratamento endoscópico do câncer laríngeo foi aprimorado desde o desenvolvimento do microscópico cirúrgico e do laser de CO2, que permitiram maior precisão diagnóstica e terapêutica. Objetivo: descrever a experiência de 25 anos de tratamento endoscópico do carcinoma laríngeo com laser de CO2 em nosso serviço. Métodos: Desenho do estudo: revisão retrospectiva; de 1979 a 2004, 188 pacientes com carcinoma laríngeo foram submetidos à microcirurgia com laser de CO2. Resultados: dos 188 pacientes, 172 apresentavam carcinoma glótico (29,07% Tis; 50,58% T1a; 4,07% T1b; 12,21% T2; e 4,07% T3) e 16, supraglótico (44% T1; 12% T2; e 44% T3). Nos casos de carcinoma glótico, realizaram-se cordectomias tipo I, II e III. Carcinomas glóticos T1 e T2 foram submetidos apenas à cirurgia endoscópica. Houve 13 casos de recorrência, sendo oito tratados com radioterapia, quatro com laringectomia parcial e um com total. Os carcinomas supraglóticos T1 e T2 foram submetidos a tratamento endoscópico. Todos os T3 apresentavam invasão do espaço pré-epiglótico e foram submetidos à laringectomia supraglótica com esvaziamento cervical. Conclusão: o tratamento endoscópico de carcinoma laríngeo com laser de CO2 é uma opção terapêutica eficiente para casos iniciais de carcinomas glótico e supraglótico, mantendo as funções locais, sem prejuízo dos resultados oncológicos.

Introduction: the endoscopic treatment of laryngeal cancer has improved with the development of the surgical microscopy and the CO2 laser, which have made possible more accurate diagnoses and therapies. Objectives: to report the 25-year experience in endoscopic treatment of laryngeal cancer with CO2 laser. Methods: Study design: retrospective review. From 1979 to 2004, 188 patients of our department with laryngeal cancer underwent CO2 laser microsurgery. Results: there were 172 patients with laryngeal glottic cancer (29.07% Tis, 50.58% T1a, 4.07% T1b, 12.21% T2, and 4.07% T3) and 16 patients with supraglottic cancer (44% T1, 12% T2, and 44% T3). Glottic tumors were treated either with type I, II or III cordectomies. T1 and T2 glottic tumors underwent sole endoscopic surgery. Thirteen of the 172 patients had local recurrence, eight underwent radiotherapy, four underwent partial laryngectomy, and one was submitted to total laryngectomy. T1 and T2 supraglottic tumors were submitted to microsurgery. All T3 supraglottic tumors had preepiglottic invasion and underwent supraglottectomy with neck dissection. Conclusion: endoscopic treatment for laryngeal cancer is an efficient therapy for early glottic and supraglottic cancers. This therapy makes the local function possible without prejudice to oncological results.