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.

Prosthetic rehabilitation of soft palate resection edentulous patient with maxillary obturator / 대한치과보철학회지

This report is a case of 76-year old male patient who had difficulty in swallowing, pronunciation and suffered regurgitation of food. The patient lacks uvula and both tonsils, had short palatoglossal arch and soft palate, as well as defective left palatopharyngeal arch. The height and width of the soft palate defect were measured by reconstructing the Computed Tomography (CT) image in three dimensions. Phonation and soft palate obstructing ability were examined by nasometry and nasal endoscopy. Evaluations on phonetics and swallowing were done and improvements were shown. The patient was satisfied with the results of treatment.

Incidence of bifid uvula and its relationship to submucous cleft palate and a family history of oral cleft in the Brazilian population / Incidence of bifid uvula and its relationship to submucous cleft palate and a family history of oral cleft in the Brazilian population

Abstract Introduction: Bifid uvula is a frequently observed anomaly in the general population and can be regarded as a marker for submucous cleft palate. Objective: In this study aimed to determine the frequency of bifid uvula and submucous cleft palate and their relationship with oral clefts in a Brazilian population. Methods: We conducted a transversal, descriptive and quantitative study of 1206 children between August 2014 and December 2015. A clinical examination of the children was conducted by means of inspection of the oral cavity with the aid of a tongue depressor and directed light. After the clinical examination in children, parents answered a questionnaire with questions about basic demographic information and their family history of oral clefts in their first-degree relatives. After application of the questionnaires, the information collected was archived in a database and analyzed by the statistical program SPSS® version 19.0, by applying Chi-Square tests. Values with p < 0.05 were considered statistically significant. Results: Of the 1206 children included in this study, 608 (50.40%) were female and 598 (49.60%) were male (p = 0.773). The average age of children was 3.75 years (standard deviation ± 3.78 years). Of the 1206 children studied, 6 (0.5%) presented with bifid uvula. Submucosal cleft palate was not found in any child. When the family histories of children were examined for the presence of nonsyndromic cleft lip and/or cleft palate, no first degree relatives presented with the congenital anomaly. Conclusion: This study revealed that the incidence of bifid uvula and submucous cleft palate in this population was quite similar to previously reported incidence rates. Our study suggests an intensification of new reviews, with broader and diverse populations, seeking to associate the occurrence of bifid uvula, submucous cleft palate and oral clefts.

Resumo: Introdução: A úvula bífida é uma anomalia frequentemente observada na população em geral e pode ser considerada como um marcador de fissura palatina submucosa. Objetivo: Determinar a frequência de úvula bífida e fissura palatina submucosa e sua relação com fissura orais em uma população brasileira. Método: Realizamos um estudo transversal, descritivo e quantitativo de 1.206 crianças entre agosto de 2014 e dezembro de 2015. O exame clínico das crianças foi realizado por meio da inspeção da cavidade oral com auxílio de um abaixador de língua e luz direcionada. Após o exame clínico nas crianças, os pais responderam a um questionário com perguntas sobre informações demográficas básicas e antecedentes de fendas orais em familiares de primeiro grau. As informações coletadas foram arquivadas em um banco de dados e analisadas pelo programa estatístico SPSS® versão 19.0, aplicando testes de Qui-Quadrado. Os valores com p < 0,05 foram considerados estatisticamente significativos. Resultados: Das 1.206 crianças incluídas neste estudo, 608 (50,40%) eram do gênero feminino e 598 (49,60%) do masculino (p = 0,773). A idade média das crianças foi de 3,75 anos (desvio-padrão ± 3,78 anos). Das 1.206 crianças estudadas, seis (0,5%) apresentavam úvula bífida. A fissura palatina submucosa não foi encontrada em nenhuma criança. Quando as histórias familiares de crianças foram examinadas quanto à presença de fissura de lábio e/ou palato não sindrômica, nenhum parente de primeiro grau apresentava esta anomalia congênita. Conclusão: Este estudo revelou que a incidência de úvula bífida e fissura palatina submucosa nesta população é bastante semelhante às taxas de incidência previamente relatadas. Nosso estudo sugere uma intensificação de novas revisões, com populações mais amplas e diversas, buscando associar a ocorrência de úvula bífida, fissura palatina submucosa e fissura orais.

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)

The development of techniques served to widen the lateral velopharyngeal space for treating OSAHS / 临床耳鼻咽喉头颈外科杂志

Since Fujita first described uvulopalatopharyngoplasty(UPPP)in 1981,UPPP and its modified procedures have been widely used to treat obstructive sleep apnea and hyponea syndrome(OSAHS).However,despite of its wide application,the success rates was uncertain,ranging from 20% to 80%,with patients of varing Friedman stages.It is well known that the principle of UPPP is to remove the redundant tissue of palate,elongated uvula and hypertrophic tonsils in order to widen the anteroposterior space at the level of palate.But recently,surgeons have found that not only the collapse of soft palate but also the collapse of lateral wall at the palate level can contribute to the obstruction of upper airway at the level of palate.As a result,many surgeries which can widen the lateral velopharyneal space have sprung up in these years.This review focuses on the development of techniques that emphasize the enlargement of lateral velopharyneal space in patients with OSAHS.

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

Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell's Palsy Patients

BACKGROUND AND OBJECTIVES: To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy. SUBJECTS AND METHODS: This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. RESULTS: EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p0.05). CONCLUSIONS: Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals.

Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: Surgical treatment is considered as a secondary treatment option for obstructive sleep apnea (OSA). This study was performed to determine whether surgical treatment can be considered in patients with moderate-severe OSA as a treatment modality. MATERIALS AND METHODS: A total of 127 patients with moderate-severe OSA were retrospectively enrolled. The anatomic narrowing sites were mainly evaluated using cephalometry and drug induced sleep endoscopy (DISE), and then multi-level surgeries were performed. RESULTS: Both uvula and soft palate were the most frequent narrowing sites and a total of 110 patients showed upper airway narrowing more than two anatomic structures. A total of 79 patients (62.1%) were categorized as responders and 48 patients (39.1%) were non-responders. After multi-level sleep surgeries, patients' subjective symptoms and sleep parameters were significantly improved. However, AHI was not considerably decreased. Non-responders to sleep surgeries showed relatively higher rates of severe OSA and body mass index. Tongue base narrowing, incomplete corrections of nasal pathologies and soft palate were significant factors for lower success rates. CONCLUSION: We estimate that sleep surgery might be a therapeutic option for moderate to severe patients with OSA. A delicate pre-operative evaluation for upper airway narrowing is necessary to adapt sleep surgery to these patients.

Difference in F-18 FDG Uptake After Esophagogastroduodenoscopy and Colonoscopy in Healthy Sedated Subjects / 대한핵의학회잡지

PURPOSE: We aimed to evaluate the difference in fluorodeoxyglucose (FDG) uptake in sedated healthy subjects after they underwent esophagogastroduodenoscopy (EGD) and colonoscopy procedures.METHODS: The endoscopy group (n = 29) included healthy subjects who underwent screening via F-18 FDG positron emission tomography/computed tomography (PET/CT) after an EGD and/or colonoscopy under sedation on the same day. The control group (n = 35) included healthy subjects who underwent screening via PET/CT only. FDG uptake in the tongue, uvula, epiglottis, vocal cords, esophagus, stomach, duodenum, liver, cecum, colon, anus, and muscle were compared between the two groups.RESULTS: Maximum standardized uptake value (SUVmax) in the tongue, pharynx, larynx, and esophagus did not significantly differ between the endoscopy and control groups. In contrast, mean SUVmax in the whole stomach was 18 % higher in the endoscopy group than in the control group (SUVmax: 2.96 vs. 2.51, P = 0.010). In the lower gastrointestinal track, SUVmax from the cecum to the rectum was not significantly different between the two groups, whereas SUVmax in the anus was 20% higher in the endoscopy group than in the control group (SUVmax: 4.21 vs. 3.50, P = 0.002). SUVmax in the liver and muscle was not significantly different between the two groups. Mean volume of the stomach and mean cross section of the colon was significantly higher in the endoscopy group than in the control group (stomach: 313.28 cm³ vs. 209.93 cm³, P < 0.001, colon: 8.82 cm² vs. 5.98 cm², P = 0.001).CONCLUSIONS: EGD and colonoscopy under sedation does not lead to significant differences in SUVmax in most parts of the body. Only gastric FDG uptake in the EGD subjects and anal FDG uptake in the colonoscopy subjects was higher than uptake in those regions in the control subjects.

Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula

Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions.

Nuevas manifestaciones orales del síndrome branquio-óculo-facial: Caso clínico / New oral manifestations of Branchio-oculo-facial syndrome: Case report

El síndrome branquio-óculo-facial es una condición autosómica dominante con expresividad variable y que afecta particularmente las estructuras de la cara y cuello por un desarrollo inadecuado del primero y segundo arco branquial; presenta malformaciones de los ojos y oídos, con características faciales distintivas. Está asociado con alteraciones en el gen TFAP2A. Se presenta una paciente de 9 años con fenotipo de síndrome branquio-óculo-facial y la presencia de dos nuevas manifestaciones orales, la úvula bifida y la lengua con hendidura central parcial, no descritas hasta ahora en esta condición clínica.

The branchio-oculo-facial syndrome is a dominant autosomic condition with variable expressivity that affects particularly the facial and neck structures by an inadequate development of the first and second branchial arch. It is characterized by malformations of eyes and ears, with distinct facial characteristics. It is associated with alterations in TFAP2A gene. We present a patient with 9 years of age with phenotype of the branchio-oculo-facial syndrome and the presence of 2 new oral manifestations, the bifid uvula and the tongue with partial central cleft, not yet described in this clinical condition.

Prenatal diagnosis of epignathus with multiple malformations in one fetus of a twin pregnancy using three-dimensional ultrasonography and magnetic resonance imaging

Epignathus is an extremely rare type of congenital teratoma arising in the oral cavity. Although it is a benign tumor, it is associated with high mortality and morbidity rates because of severe airway obstruction and other malformations. We present a case of epignathus affecting one fetus in a twin pregnancy. The tumor was associated with multiple congenital malformations including cleft palate, bifid tongue, bifid uvula, congenital heart defect, and bilateral inguinal hernias. The diagnostic value of three-dimensional ultrasonography and magnetic resonance imaging was explored with respect to antenatal counseling and peripartum management.

Transcervical tongue partial reduction combined with uvulopalatopharyngoplasty in treatment of obstructive sleep apnea-hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To treat severe obstructive sleep apnea-hypopnea syndrome (OSAHS) with transcervical tongue partial reduction and evaluate treating effect.</p><p><b>METHODS</b>Forty four patients of severe OSAHS were treated with transcervical tongue partial reduction + uvulopalatopharyngoplasty (UPPP). Apnea hypopnea index (AHI), minimal oxygen percent saturation, body mass index (BMI), area of retroglossal region were measured for diagnosis and evaluation.</p><p><b>RESULTS</b>AHI decreased from (67.5 ± 21.1) times/h to (10.5 ± 6.8) times/h (t = 2.1, P < 0.01). The lowest oxygen percent saturation increased from 0.694 ± 0.009 to 0.829 ± 0.008 (t = 4.3, P < 0.01). The area of retroglossal region increased from (291.7 ± 107.8) mm² to (398.1 ± 94.5) mm² (t = 3.318, P < 0.05). Four patients complained dysphagia half year after operation. One patient complained about pharyngeal fistula, which disappeared in 2 weeks. One patient appeared hypoglossis bleeding, which stopped after compression.</p><p><b>CONCLUSION</b>Transcervical tongue partial reduction is an effective attempt and supplement for OSAHS with retroglossal region narrow.</p>

Effects of hyoid position on surgical treatment outcome for patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the predictive value of the position of the hyoid in surgical outcomes of velopharyngeal surgery for obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>The polysomnography, CT, and anthropometry data were retrospectively reviewed from patients who underwent revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) simply or the combination of H-UPPP and transpalatal advance pharyngoplasty (TAP) for OSAHS from July 2008 to December 2011. OSAHS was diagnosed by polysomnography (PSG) in 128 patients who underwent H-UPPP or H-UPPP with TAP surgery for their sleep disorder. After surgical treatment, the patients were evaluated by PSG.</p><p><b>RESULTS</b>The 128 patients included were all male, the mean age of these patients was (39.6±8.5) years, ranged from 19 to 66 years. Seventy-seven patients were successfully treated and 51 did not respond to surgical treatment. The overall apnea hypopnea index (AHI) improved from (58.2±22.4) times/h preoperatively to (20.6±18.1) times/h postoperatively (t=14.9, P<0.001). The vertical distance from inferior margin of hyoid to the inferior mandibular margin (D-HM) was the only parameter that had a significant difference between responders [(14.6±7.7)mm] and non-responders [(19.4±8.0)mm] (t=3.452, P=0.001). D-HM, AHI and the lowest blood oxygen saturation were significant predictors of surgical outcomes (P<0.05). There was a significant correlation between the D-HM and the postoperative AHI (r=0.284, P=0.001). The D-HM of ≥23 mm could predict the postoperative AHI of >10 times/h a specificity of 95.2%.</p><p><b>CONCLUSION</b>The D-HM is a negative predictor of surgical outcomes, patients with a D-HM of ≥23 mm are inappropriate candidates for velopharyngeal surgery.</p>

Comparison of the effects of different analgesic methods after UPPP / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effects of different analgesia methods after UPPP.@*METHOD@#Ninety cases of patients uvulopalatopharyngoplasty were divided into 3 groups randomly, and 30 cases in each group. The group A was the blank control group without any analgesia measures. The cases in group B were treated with intramuscular injection of parecoxib sodium 40 mg after surgery immediately, and continued injecting 40 mg after 12 hours, 24 hours and 36 hours respectively. 100 mg tramadol replaced 40 mg parecoxib sodium in group C. The VAS scoring was performed after surgery 12, 24, 36, 48, 72, 96 hours in 3 groups, and we observed adverse reaction such as lethargy, nausea, vomiting, dizziness, skin rash and so on.@*RESULT@#The group B and C reduced the pain significantly compared with blank control group. The pain scores in group B were significantly decreased than that in group C (P<. 05).@*CONCLUSION@#The analgesic effect of parecoxib sodium after UPPP is significant and better than tramadol. It is worthy to use widely in clinical due to its better effect and less side effect.

Analysis of bleeding cause after uvulopalatopharyngoplasty with endotherm knife / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summary and analyze the bleeding causes after uvulopalatopharyngoplasty(UPPP) with endotherm knife, and preventive measures will be given to effectively reduce postoperation hemorrhage.@*METHOD@#Two hundred and twenty-six cases of obstructive sleep apnea hypopnea syndrome (OSAHS) adult patients, were carryed out UPPP under general anesthesia with endotherm knife to observe postoperation hemorrhage.@*RESULT@#Eight cases out of 226 patients or 3.5% occurred postoperation hemorrhage, 2 cases after 1 or 2 days, 6 cases after 6 or 12 days. The postoperation hemorrhage stopped by local compression hemostasis or bi-polar coagulation hemostasis, and no more bleeding occurred.@*CONCLUSION@#The minimal trauma, quick operation and less-bleeding will be caused by UPPP with endotherm knife. Few patients 3.5% had a small amount of bleeding after operation, but no serious bleeding occured. Hemorrhage often happened during pseud mucosa falling off period. The bleeding was related with using skill of endotherm knife during operation, postoperation pse-ud mucosa falling off, local inflammation, improper eating and emotional stress of patients.

De novo interstitial deletion of 15q22q23 with global developmental delay and hypotonia: the first Korean case / 소아과

Interstitial deletions involving the chromosome band 15q22q24 are very rare and only nine cases have been previously reported. Here, we report on a 12-day-old patient with a de novo 15q22q23 interstitial deletion. He was born by elective cesarean section with a birth weight of 3,120 g at 41.3-week gestation. He presented with hypotonia, sensory and neural hearing loss, dysmorphism with frontal bossing, flat nasal bridge, microretrognathia with normal palate and uvula, thin upper lip in an inverted V-shape, a midline sacral dimple, severe calcanovalgus at admission, and severe global developmental delay at 18 months of age. Fluorescence in situ hybridization findings confirmed that the deleted regions contained at least 15q22. The chromosome analysis revealed a karyotype of 46,XY,del(15) (q22q23). Parental chromosome analysis was performed and results were normal. After reviewing the limited literature on interstitial 15q deletions, we believe that the presented case is the first description of mapping of an interstitial deletion involving the chromosome 15q22q23 segment in Korea. This report adds to the knowledge of the clinical phenotype associated with the 15q22q23 deletion.

Cephalometric Variables Significantly Associated with Apnea Hypopnea Index in Suspected Obstructive Sleep Apnea Patients : A Preliminary Study

OBJECTIVES: The purpose of this study is to find the cephalometric variables which are significantly correlated with the apnea-hypopnea index (AHI) in suspected Korean obstructive sleep apnea (OSA) patients. METHODS: We examined lateral cephalogram and attended-full night laboratory polysomnography of the 40 participants who complained of OSA symptoms. The correlation analysis was conducted to find the cephalometric variables which are significantly correlated with the AHI. RESULTS: The correlation analysis showed that the higher AHI was associated with the longer distance between hyoid and mandibular plane (p = 0.023), the longer distance between C3 and hyoid (p = 0.014), the longer tongue length (p = 0.003), the larger inferior tongue area (p = 0.008), the larger anterior displacement of the hyoid bone (p = 0.024), the longer distance between posterior nasal spine and the tip of the soft palate (p = 0.021), and the larger cross-sectional area of soft palate (p = 0.001) of cephalogram in erect position. The higher AHI was correlated with the longer distance between hyoid and mandibular plane (p = 0.008), the longer tongue length (p = 0.037), the larger inferior tongue area (p = 0.013), the thicker uvula (p = 0.004), the longer distance between retrognathion and hyoid (p = 0.025), and larger cross-sectional area of soft palate (p = 0.001) of cephalogram in supine position. CONCLUSIONS: The present preliminary results showed the candidate measurements of cephalogram which are significantly correlated with the AHI in suspected OSA.

Therapeutic effects of oral appliance combined with uvulopalatopharyngoplasty on obstructive sleep apnea hypopnea syndrome / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To explore the long-term effects of the uvulopalatopharyngoplasty (UPPP) combined with oral appliance (OA) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Thirty patients with severe OSAHS confirmed by polysomnography (PSG) according to their apnea hypopnea index (AHI) and lowest SaO2 during sleep were selected using random permutation table and divided into only UPPP group(U group, n = 15) and UPPP with OA group (UA group, n = 15). The follow-up period was 2 years. PSG was performed in 0.5 year and 2 years after operation. AHI, lowest SaO2 and Tmax were tested and evaluated.</p><p><b>RESULTS</b>The effectiveness of two groups was the same after 0.5 year. Two years after operation, the values [AHI: (18.06 ± 2.24) times/h; lowest SaO2: (88.64 ± 10.37)% and Tmax: (20.5 ± 17.6) s] in UA group were better than that [AHI: (49.73 ± 3.35) times/h; lowest SaO2: (79.56 ± 4.87)% and Tmax: (41.3 ± 19.7) s] in U group. The number of effectiveness was 9 and the number of ineffectiveness was 6 in U group, while in UA group, the number of effectiveness was 14 and the number of ineffectiveness was 1(P < 0.05).</p><p><b>CONCLUSIONS</b>Long-term result of combined treatment was better than that of UPPP only.</p>