Forces created by mandibular advancement devices in OSAS patients: a pilot study during sleep.

BACKGROUND: The aim of this study was to measure forces created by progressive mandibular advancement with an oral device, during natural sleep, in a sample of adult patients with obstructive sleep apnea syndrome (OSAS). METHODS: A pressure transducer system was placed on the acrylic arms of a two-piece oral appliance (Herbst type) used by nine moderate to severe OSAS patients, in addition to all captors routinely used for polysomnography. Strains on the left and right sides were collected, during stable sleep stages without arousal, for each step of 1 mm advancement. RESULTS: The mean force in this sample was 1.18 N/mm and showed an almost linear evolution. Measurements showed intra- and inter-individual variability. CONCLUSION: The force values recorded in this study may explain the occlusal and skeletal side effects associated with long-term use of these oral appliances. They illustrate the influence of the extent of mandibular advancement, and indicate a possible dose-dependent effect.

[The set-up of obstructive sleep apnea treatment]. / Mise en place du traitement du SAHOS.

The therapeutic strategy of obstructive sleep apnea syndrome (OSAS) is dependent on the illness severity, which is influenced by several factors as the presence of comorbidities (particularly cardiovascular comorbidities), the importance of diurnal drowsiness and the number of abnormal respiratory events. Whereas the treatment is most often palliative and uncomfortable, its success is closely dependent on its compliance. The way of starting the treatment of OSAS is therefore an essential topic, which will condition its long-term acceptance.

Titrated mandibular advancement versus positive airway pressure for sleep apnoea.

The aim of this study was to compare mandibular advancement device (MAd) therapy and continuous positive airway pressure (CPAP) for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) after one-night polysomnographic (PSG) titration of both treatments. 59 OSAHS patients (apnoea/hypopnoea index (AHI): 34+/-13 events x h(-1); Epworth scale: 10.6+/-4.5) were included in a crossover trial of 8 weeks of MAd and 8 weeks of CPAP after effective titration. Outcome measurements included home sleep study, sleepiness, health-related quality of life (HRQoL), cognitive tests, side-effects, compliance and preference. The median (interquartile range) AHI was 2 (1-8) events x h(-1) with CPAP and 6 (3-14) events x h(-1) with MAd (p<0.001). Positive and negative predictive values of MAd titration PSG for treatment success were 85% and 45%, respectively. Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL. The reported compliance was higher for MAd (p<0.001) with >70% of patients preferring this treatment. These results support titrated MAd as an effective therapy in moderately sleepy and overweight OSAHS patients. Although less effective than CPAP, successfully titrated MAd was very effective at reducing the AHI and was associated with a higher reported compliance. Both treatments improved functional outcomes to a similar degree. One-night titration of MAd had a low negative predictive value for treatment success.

Vertebrobasilar occlusive disorders presenting as sudden sensorineural hearing loss.

BACKGROUND: Isolated sudden sensorineural hearing loss (SSHL) has been rarely related to vertebrobasilar occlusive disorders (VBOD). This is an important issue for both neurologists and otolaryngologists, since the management and prognosis of this type of hearing loss widely differs from that of hearing loss from other causes. OBJECTIVES: To describe the clinical characteristics and report the incidence of SSHL related to VBOD. METHODS: Retrospective analysis of clinical charts from 333 patients admitted for SSHL in a large ear, nose, and throat emergency tertiary care center from 1999 to 2002. RESULTS: Four cases (1.2%) of VBOD as the unique cause of SSHL were diagnosed among 333 patients. The most typical features of these cases were the presence of one of the following characteristics: (1) bilateral SSHL, (2) associated occipital or posterior nuchal pain, and (3) the occurrence of delayed neurologic deficits. The underlying vascular disease affected the vertebral arteries: dissection in two cases and atherosclerosis in two other cases. The audiometric features of hearing loss were endocochlear in one case, of both types in one case, and unknown in two cases. Hearing recovered partially or completely. CONCLUSIONS: Our results confirm the low incidence of SSHL related to VBOD and show that the observation of endocochlear audiometric features cannot preclude a central cause in SSHL. The clinical presentation of our cases related to VBOD emphasize that a careful follow-up of any patient with SSHL is warranted and that the presence of nuchal pain suggestive of arterial dissection in younger subjects, a past history of atherosclerosis or embolism in older patients, or the occurrence of delayed associated neurologic symptoms should be considered with particular caution in this situation.

[Endoscopic resection of the frontal sinus floor following the Draf procedure: long term results and therapeutic algorithm]. / Résection endoscopique du plancher du sinus frontal selon la technique de Draf. Résultats à long terme et algorithme thérapeutique.

OBJECTIVES: Endoscopic resection of the frontal sinus floor is a minimally invasive and functional surgical procedure designed for the treatment of inflammatory sinus diseases, which avoids the side-effects of external osteoplastic obliteration. The aim of the study was to evaluate long term results and to determine computed tomographic criteria predictive of success. PATIENTS AND METHODS: Our study reports the results of 20 patients operated for nasofrontal stenosis associated or not with osteitis or secondary mucocele. RESULTS: A successful result was obtained in 90% with a mean follow-up of 3.5 years. Failures (2) were attributed to insufficient resection and to frontal sinus osteogenesis. CONCLUSION: Endoscopic frontal sinusotomy is a safe and effective procedure for large sinuses with large distance between nasion and cribriform plate, but not in case of osteogenesis and multiple mucoceles. In case of unfavourable anatomy, or for the aforementioned pathologies, the obliteration procedure should be preferred.

[Scintigraphy by l'Octreoscan in the management of head and neck paragangliomas]. / La scintigraphie à l'Octréoscan dans la prise en charge des paragangliomes de la tête et du cou.

OBJECTIVE: To assess the usefulness of somatostatin receptor scintigraphy [Octreoscan] in a series of 18 patients referred for a suspicion of paraganglioma of the head and neck between July 2001 and February 2002. PATIENTS AND METHODS: Sixteen patients had one or several paragangliomas of the head and neck diagnosed on conclusive conventional imaging including CT and MR scan. In two patients, radiological data were not conclusive. Planar images were obtained 4 and 24 hr after the iv injection of 148-185 MBq [Octreoscan]. RESULTS: Twenty-two hot spot lesions were detected. Twenty of these lesions corresponded to the twenty known paragangliomas. The volume of the smallest tumor was 0.2 cm(3). In one patient, intense thyroid nodule uptake led to the surgical diagnosis of oncocytoma. In two lesions, where conventional imaging was not conclusive, arteriography showed a typical aspect of meningioma; one patient was operated on and histology confirmed this diagnosis. No evidence of abnormal uptake was seen in site previously operated on (3 patients). CONCLUSION: Octreotide scintigraphy is a very sensitive method for detection of paraganglioma of head and neck. It provides information on potential tumor sites in the whole body after one single injection. It could be used as a screening test in patients at risk (familial or known paraganglioma) in order to detect paraganglioma at an early stage and, thus to reduce the surgical morbidity, as well as in the follow-up after surgery to detect recurrences.

[Hemangiopericytoma of the infra-temporal fossa. Apropos of a clinical case]. / Hémangiopéricytome de la fosse infra-temporale. A propos d'un cas clinique.

We observed the case of a young woman with haemangiopericytoma in the subtemporal fossa. Diagnosis problems and the access route were discussed. Good exposure was achieved at the price of minor aesthetic and functional impairment. The prognosis of these potentially malignant tumors is uncertain.