Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Abstract Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of amultilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

Long-term outcomes of supracricoid partial laryngectomy with cricohyoidoepiglottopexy and its modified version

To investigate the long-term outcomes of supracricoid partial laryngectomy with cricohyoidoepiglottopexy [CHEP] and its modified version, in which we reserve the poster inferior borders of both thyroid cartilage laminas to protect swallowing function. This retrospective survival analysis was performed in 86 patients, wherein 46 undergoing CHEP and 40 undergoing modified CHEP. Their decannulation data were reviewed. We used swallowing quality-of-life questionnaire to measure the quality-of-life in 53 of the 65 survivals at the end of the follow-up period in 2011. Of the 53 patients, 24 underwent CHEP, while the remaining by modified CHEP. The log rank test showed no significant difference in survival distributions of 2 the groups [p=0.92]. The decannulation rate was 93.5% in CHEP and 100% in modified CHEP, showing no significant difference. The time span of decannulation in CHEP was 19.0 +/- 4.6 days, significantly longer than [14.0 +/- 2.3 days] the modified CHEP [p=0.000]. As to quality-of life data, one-way multivariate analysis of variance, revealed a significant multivariate main effect for groups [p=0.001], and significant univariate main effects in 5 scales out of 11 [p<0.05], which showed a better swallowing life quality in modified CHEP. There was no significant difference in survival rate between the 2 surgeries. The modified CHEP succeeded in earlier decannulation and better long-term swallowing life quality. Thus, modified CHEP is worth promoting, as long as indications were strictly conformed

Esvaziamento cervical supraomoióideo estendido em câncer oral N0 e N1 / Extended supraomohyoid neck dissection in N0 and N1 oral cancer

Introdução: o tratamento do pescoço no carcinoma espinocelular (CEC) de língua oral e soalho de boca sem metástase detectadas clinicamente permance controverso. Objetivo: analisar o resultado após esvaziamento cervical supraomo-hióideo(ECSOH) estendido ao nível IV. Método: analisamos, restrospectivamente, 40 pacientes com estadiamento cl[inico NO e N1 de 1996 a 2002. Havia 29 homenzs e 11 mulheres, cujas idades variaram de 46 a 83 anos (mediana, 63). Foram estadiados como T1 (2), T2(24), T3(13) e T4(1). Todos foram submetidos a ECSOH estendido ao nível IV. Resultados: dentre os 34 pacientes estadiados como N0, os achados histológicos foram confirmados em 29 (85,3%), enquanto que cinco foram estadiados como pN positivo. Assim, havia seis pacientes pN1 e cinco pN2a. Dos seis pacientes estadiados clinicamente como N positivo, não houve falso-positivos. Todos os pacientes com linfonodos positivos foram tratados com radioterapia adjuvante. Recidiva cervical ocorreu em 6,9% dos pacientes N) (2/29), 28,6% pN1(2/7) e 50% dos pN2a (2/4). Foram encontradas metástases ocultas em cadeia IV em dois casos (5%) entre aqueles estadiados como pN2a e nenhuma metástase em cadeia V. Tdoas as recidivas ocorreram nos níveis II e III. Conclusão: uma taxa de 14,7% dos pacientes estadiados como N) clinicamente apresentaram metástases ocultas. Todas as metástases pN1 ocorreram nso níveis I ou II. Cinco por cento dos pN2a apresentaram metástases ocultas em cadeia IV. Recidiva cervical ocorreu em 6,9% dos pacientes pN), 28,6% dos pN1 e 50% dos pN2a. Todas as recidivas ocorreram nos níveis I e II.

Introduction: the neck treatment in the squamous cell carcinoma (SCC) of the oral tongue and floor of the mouth without clinical metastasis remains controversial. Objective: to analyze the outcomeafter supraomohyoid neck dissection (SOHND) extended for level IV for those patients. Methods: we retrospectively analyzed 40 patients with clinically N0 and N1 stage SCC from 1996 to 2002. There were 29 men and 11 women whose ages varied from 46 to 82 (median, 63). They were staged as T1(2), T2(24), T3(13), and T4(1). They underwnt SOHND extended for level IV. Results: camong the 34 patients staged as N0, the histologic findings confirmed that in 29 (85.3%), whereas 5 were staged as pN positive. Thus, there were 6 patients staged a pN1 and 5 patients were pN2a. Among the 6 patients staged as clinical N positive, there was no false-positive case. All patients with node positivity received adjuvant radiation therapy. Neck failure occurred in 6.9% of the pN0 patients (2/29), 28.6% of the pN1 patients (2/7), and 50% of the pN2a group (2/4). Occult metastasis in level IV occurred in 2 cases (5%) among those sateged as pN2a and no one had it at leval V. All recurrences occurred in levels II and III. Conclusion: a rate of14.7% of patients clinically staged as N0 necks showed occult metastasis. All the pN1 metastasis occurred in level I or II. Occult metastasis in level IV occurred in 5% of the pN2a cases. Neck failure occurred in 6.9% of the pNO patients, 28.6% of the pN1 patients, and 50% of the pN2a. All recurrences occurred in levels II and III.

Suprahyoid pharyngotomy for base of tongue carcinoma

Carcinoma of the tongue remain one of the greatest management challenges for the head and neck surgeon because of the adverse effects of treatment on oral and pharyngeal function. In early carcinoma of the base of tongue however, the prognosis is encouraging and function of swallowing and speech is preserved despite surgery. Suprahyoid pharyngotomy is one of the surgical approaches advocated for resection of base of tongue tumours with primary anastomosis.

Quiste tirogloso y la operación de Sistrunk en niños / Thyroglosal duct cyst. Sistrunk's operation in children

Introducción. El quiste tirogloso es una anomalía congénita debida a la persistencia de un conducto fibroepitelial ubicado entre la tiroides y su origen, el foramen de la lengua y el piso de la boca. La operación de Sistrunk es la de elección para eliminar el quiste. Material y métodos. En un estudio retrospectivo se analizaron los expedientes de 30 años con diagnóstico de quiste tirogloso operados en un periodo de tres años. Conclusiones. Probablemente el quiste tirogloso es más frecuente en México que en otros países. Predomina en el sexo masculino y entre los cinco y diez años de edad. La operación de Sistrunk fue efectuada en 100 por ciento de los casos. Hubo recurrencia en todos los niños que no se operaron con este procedimiento

Evaluation of the role of expansion hyoidplasty with and without hyoid suspension intreating obstructive sleep apnea

Obstructive sleep apnea [OSA] remains a therapeutic challenge, despite growing knowledge of the pathophysiology of the disease and development of new treatment modalities. This study included 50 patients with obstructive sleep apnea syndrome [OSAS] who underwent expansion hyoidplasty [EHP], 16 patients had EHP with hyoid suspension [HS] and 34 patients had EHP without HS. A subset of patients felt a subjective postoperative improvement confirmed by polysomnographic examination. EHP with HS, and EHP without HS had the same efficacy in treating the OSAS. Postoperative complications were minor irrespective of the surgical method used

Cistos do ducto do tiroglosso com carcinoma papilífero numa índia Txukahamäe / Thyroglossal duct cyst with papillary carcinoma in a Txukahamae indian

Relatamos a ocorrência de cistos do ducto do tiroglosso com carcinoma papilífero numa india Txukahamäe do Parque Nacional do Xingu. A punçäo aspirativa com agulha fina do cisto do ducto do tiroglosso possibilitou o diagnóstico pré-cirúrgico do carcinoma. O exame anatomopatológico do conjunto extraído confirmou cistos do ducto do tiroglosso e carcinoma papilífero.