Glossopexia--evaluation of a new surgical method for treating obstructive sleep apnea syndrome.

Uvulopalatopharyngoglossoplasty, UPPGP, is a modification of the uvulopalatopharyngoplasty, UPPP, technique, originally used for surgical treatment of the obstructive sleep apnea syndrome. The first method seems to be the more successful. However, polysomnography performed after UPPGP showed that about 35% of the patients still had obstructive apnea periods during sleep. Eight of these patients were reoperated with a new technique which is a combination of partial tongue resection and anterior suspension of the tongue (glossopexia). After glossopexia all the patients were subjectively relieved of their symptoms. However, polysomnography carried out postoperatively demonstrated that only 2 patients were objectively cured. The authors want to stress the necessity of meticulous polysomnographical registration pre- and postoperatively. Subjective and objective parameters recorded before and after surgery are discussed.

Palatopharyngoglossoplasty in the treatment of patients with obstructive sleep apnea syndrome.

A new technique (palatopharyngoglossoplasty (PPGP)) has been developed for surgical treatment of patients with the obstructive sleep apnea syndrome (OSAS). In 20 operated patients 18 reported immediate marked improvement of daytime sleepiness, alertness and vigilance during the day, and of working capacity. However, polysomnography carried out pre- and postoperatively showed that only 10 patients were "cured", defined as 50% or more reduction in apnea/hypopnea index (AHI). Cephalometric analysis pre- and postoperatively indicated that nonresponders had a long and narrow posterior airway space, and we suggest that during sleep this part of the upper airway collapses before as well as after the operation. The discrepancy between the subjective improvement observed after PPGP and the postoperative reduction in AHI may be due to reduced/eliminated snoring and/or improvement in sleep quality after the operation.

Cephalometric analysis in patients with obstructive sleep apnoea syndrome. I. Skeletal morphology.

Facial skeletal morphology was studied by cephalometric analysis in 25 patients with obstructive sleep apnoea syndrome (OSAS) and ten controls. The hyoid bone was more inferiorly positioned in patients (at the level of cervical vertebrae C4-C6) than in controls (C3-C4 level). The height and length of the nasal cavity was normal, while the length of the bony nasopharynx was moderately reduced. The mandibular plane inclination was slightly larger in patients as was the anterior face height. Mandibular retrognathia was demonstrated in six patients (24 per cent), but the angles of maxillary and mandibular prognathism was within normal limits when the group was considered as a unity. Cephalometric analysis is highly recommended as a diagnostic aid in OSAS patients, especially when surgical intervention is considered.

Cephalometric analysis in patients with obstructive sleep apnoea syndrome: II. Soft tissue morphology.

Oropharyngeal soft tissue profiles were studied by cephalometric analysis in 25 patients with obstructive sleep apnoea syndrome (OSAS) and 10 controls. The length of the soft palate was significantly higher in patients (48.0 +/- 4.3 mm. (mean +/- SD) than in controls (35.3 +/- 4.6 mm.) (p less than 0.001), as was the distance of close contact between the tongue and the soft palate (23 +/- 12 mm. and 10 +/- 8 mm., respectively) (p less than 0.01). The area of the soft palate, measured in the sagittal plane, was 4.85 +/- 0.80 cm.2 and 2.88 +/- 0.62 in the patient and the control group, occupying 39 +/- 8 per cent and 21 +/- 5 per cent of the pharyngeal area (p less than 0.001). The lower outline of the tongue, represented by the line between vallecula (V) and the hyoid bone (AH) was more inferiorly positioned in patients, apparently giving the tongue a more upright position with more of the tongue tissue at the hypopharyngeal level than found in normals. The pharyngeal airway space had significantly reduced anteroposterior dimensions both at the nasopharyngeal and velopharyngeal level (P less than 0.001) as well as the hypopharyngeal level (p less than 0.05). Cephalometric analysis is highly recommended as a valuable tool in the presurgical evaluation of OSAS patients.

Cephalometric analysis and surgical treatment of patients with obstructive sleep apnea syndrome. A preliminary report.

Oropharyngeal soft tissue profiles were studied by cephalometric analysis in 25 patients with obstructive sleep apnea syndrome (OSAS) and 10 controls. The length of the soft palate was significantly longer in patients (mean 48 mm) than in controls (mean 35 mm), as was the distance of close contact between the tongue and the soft palate. The thickness of the soft palate measured in the midsagittal plane was larger (mean 14 mm) than in the control group (mean 11 mm). The hyoid bone was more inferiorly positioned in patients than in controls, apparently giving the tongue a more upright position with more of the tongue tissue at the hypopharyngeal level than found in normals. In patients, the nasopharyngeal airway space, as well as the oropharyngeal airway space, had significantly reduced anteroposterior dimensions. Based on these data a new and modified surgical technique for treatment of OSAS patients has been developed. The surgical procedure is described, and some preliminary results concerning the effect of this operation in 16 patients are reported.

Effect of human fibrin adhesive on the ear. An electrophysiological study of auditory function in the guinea pig correlated to light and electron microscopy of middle ear mucosa and inner ear structures.

The effect of human fibrin adhesive applied to the middle ear has been studied in guinea pig. Auditory function was measured using acoustically evoked brainstem responses. Middle and inner ear structures were studied with light, transmission and scanning electron microscopy. A transitory conductive hearing loss was observed, but after 8 weeks the auditory function appeared normal. Microscopy of the middle and inner ear failed to show any tissue damage.

Sequelae of meningococcal disease - studied about six weeks after hospital admission.

As part of a greater project (MenOPP), the type, distribution and frequency of sequelae after meningococcal disease (MCd) were estimated on the basis of examinations carried out about six weeks after hospital admission. Well documented sequelae were found in about 18% of 102 MCd cases compared to about 3% in 61 control patients. In 18 control patients with meningitis/septicemia due to other bacteria, the sequelae frequency was 11%. Our MCd sequelae results correspond with many of those published during the last few years. The frequency of uncertain sequelae was about the same (16%) in the MCd and the control group patients. A routine examination six weeks and one year after a MCd episode seems to be useful for the individual patient and for the research on better prophylaxis and improved treatment.

Bone scintigraphy in the diagnosis of fracture and infection of the temporal bone.

The sensitivity of 99mTc-MDP-bone-scintigraphy in the diagnosis of temporal bone fracture was found equal to that of conventional radiography if the patients were examined 10 days after the trauma. Temporal bone osteomyelitis with concomitant moderate osteosclerosis was demonstrated by bone scintigraphy in 5 cases of mastoiditis with atypical symptoms. A case of apicitis was for the first time demonstrated by scintigraphy. A low sensitivity of 67Ga-scintigraphy was demonstrated by positive 99mTc-bone-scintigraphy and negative 67Ga-scintigraphy in a patient with atypical mastoiditis. 99mTc-scintigraphy was negative in 5 cases of otitis media suppurativa and in 3 cases of otitis media chronica cum cholesteatoma, all with slight degree of osteosclerosis in the mastoid. The sensitivity of 99mTc-bone-scintigraphy in fracture and osteomyelitis of the temporal bone seems to be a function of the amount of reactive new bone formed.

Phytanic acid storage disease: hearing maintained after 15 years of dietary treatment.

Heredopathia atactica polyneuritiformis is a biochemically defined disease with a specific dietary treatment. It is an autosomal inborn error of metabolism. The phytanic acid is of exogenous origin and stems mainly from preformed phytanic acid in foods. In two Norwegian patients, serum phytanic acid has been brought down to normal levels and one of them has been followed for 15 years. During this period of dietary treatment there was no worsening of hearing.

Hearing threshold level and middle ear pressure in children with phonetic/phonemic disability.

Middle ear disease and hearing loss of moderate degree is a factor which alone or in combination with others, have been suggested to create phonetic/phonemic disability. The aim of the present investigation was to throw light upon this question. Twentytwo children with phonetic/phonemic disability, 19 boys and 3 girls, age 4.5-6.5 years, were examined. Twentytwo normal speaking children served as a control group. Oto-rhinolaryngological examination, tympanometry and hearing threshold measurements were performed. Abnormal middle ear pressure (less than -50 mm H2O) in one or both ears, and statistical significant elevated hearing threshold levels for pure tones (p less than 0.05) were found in 15 of the 22 children with phonetic/phonemic disability. Upper respiratory tract diseases, which may cause middle ear dysfunction, were supposed to be the etiology in most cases. Consequently, in all children with phonetic/phonemic disability, careful examination including tympanometry and accurate measurements of hearing threshold levels should be performed.