[Laser-assisted tonsillotomy in children with obstructive sleep apnea and adenotonsillary hyperplasia--experiences as an outpatient procedure]. / Die Lasertonsillotomie bei der obstruktiven Schlafapnoe aufgrund adenotonsillärer Hyperplasie im Kindesalter--Ergebnisse aus der Praxis.

BACKGROUND: The adenotonsillar hyperplasia is the most relevant cause for the obstructive sleep apnea in children. Since several years laser-assisted tonsillotomy becomes more common as an alternative treatment especially in children having no tonsillitis history. The therapeutical effect of laser-assisted tonsillotomy in combination with the traditional adenotomy treating the obstructive sleep apnea in children has not yet been researched. In addition literature indicates less pain and fast recovery of the children compared to conventional tonsillectomy. MATERIALS AND METHODOLOGY: Starting May 2000 until May 2004 laser-assisted tonsillotomy and adenotomy have been performed in 50 outpatient children, mean age of 5.3 +/- 1.7 years, with adenotonsillar hyperplasia and possible sleep apnea. Postoperatively the parents of the patients were questioned with an anonymous questionnaire. Pre- and postoperative symptoms and Brouillette score, the degree of pain and the post-surgical time of recovery have been investigated. RESULTS: 36 questionnaires have been evaluated. The follow-up time was between 4 weeks and 4 years (mean = 1.3 years). With regard to the symptoms snoring, difficulty breathing during sleep and apnea 32 of the children (89%) were symptom-free after laser-assisted tonsillotomy with adenotomy. The Brouillette-score improved significantly (p = 0.001), snoring was reduced in 91%, difficulty breathing in 93% and apnea in 100% of the children. The pain of the surgical intervention has been valued by the patient's parents as mild to moderate. Postoperatively 91.6% of the children recovered within 6 days (mean = 4.7 days), no bleeding occurred. CONCLUSION: Outpatient laser-assisted tonsillotomy with adenotomy can be recommended in children with adenotonsillar hyperplasia and possible obstructive sleep apnea. The surgical intervention is less painful, the children recover more quickly and the results on snoring, difficulty breathing and apnea are equal in comparison to conventional tonsillectomy with adenotomy. In addition the recommended procedure shows less post-operative complications.

Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy.

PURPOSE: To apply virtual-endoscopic mode to display the nasal cavity and to evaluate clinical application of virtual endoscopy in comparison with nasal fiberoptic endoscopy. MATERIALS AND METHODS: Eleven patients were examined by virtual endoscopy after axial spiral computed tomography (CT) scanning was performed. In addition, 9 out of these 11 patients underwent fiberoptic endoscopy. Spiral CT scanning was performed with 1-mm collimation, 0.5- to 1-mm increment, 25-250 mA s, and pitch 1-2. Virtual endoscopy was performed by Explorer software package. RESULTS: Virtual endoscopy could clearly demonstrate anatomic structures in the nasal cavity, septal deviation, stenosis and obstruction of the middle meatus, turbinate hyperplasia, and pathological masses larger than 3 mm in diameter. However, "false adhesions" may appear in virtual endoscopy. The main limitation of virtual endoscopy was the inability to evaluate mucosa and its surface. CONCLUSION: Virtual endoscopy of the nasal cavity is a new and noninvasive method. It can demonstrate normal and pathological structures in the nasal cavity. Its ability to visualize is comparable with fiberoptic endoscopy except for evaluating mucosal surface and secretions. In the future, this method will probably be a basic instrument of computer-assisted surgery in the midfacial region.