[The effects of pressure level in veil on upper airway in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To observe the effects of pressure level in veil on upper airway in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and normal adults. METHOD: We scanned the upper airway from roof of nasopharynx to glottis with SIMENS 16 layer spiral CT scanner. The area and the dimensions of palate, uvula, and the region after lingua and epiglottis were measured by application of image work station. Forty-six patients with OSAHS and 35 normal adults were scanned by CT at 0 kPa water column and 0.784 kPa water column pressures in face mask, respectively. RESULT: The area and inner diameter of OSAHS patients upper airways were less than those of normal adults at the same pressure in face mask. The area and inner diameter of upper airway at the pressure of 0.784 kPa water column were more than those at 0 kPa water column in both OSAHS patients and normal adults, and the increased extent of normal adults were more than those of OSAHS patients. We measured the minimum increased normal Cross sectional area of palate, uvula, and the region after lingua and epiglottis when the pressure in the mask increased from 0 kPa to 0.784 kPa, and we made it as the standard. The 46 OSAHS patients were sorted into 17 cases (group 1) with normal dilation and 29 cases (group 2) with less dilation in such standard. There was not significant difference between the two groups at 0 kPa pressures in area and inner diameter, but the area and inner diameter of group 1 were more than those of group 2 at 0.784 kPa pressure. CONCLUSION: The increased pressure in face mask would lead to upper airway dilation both in OSAHS patients and normal adults, and the dilated extents of normal adults were significant more than those of OSAHS patients. The less dilation of OSAHS may be duo to anatomic constriction and some pharynx wall pathological changes.

[Frontal sinusitis after transfrontal craniotomy: causes and management].

OBJECTIVE: To explore the causes, clinical manifestation and therapy of frontal sinusitis after transfrontal craniotomy. METHODS: Thirty-three patients with frontal sinusitis after transfrontal craniotomy were included in the study. Among them, 7 cases had frontal sinus abscess and 4 cases had frontal sinus fistula. Twenty-three patients were treated with traditional frontal sinus surgery with facial incision. The nasofrontal dilatation tube was positioned for more than 3 months. Nine patients were treated with endoscopic frontal sinus surgery, and 1 patient was treated with combined endoscopic and traditional frontal sinus surgery, with nasofrontal dilatation tube positioned for less then 1 month. In the revision surgery, the bone wax and phlogistic acestoma were cleaned out in both operational methods. The causes of frontal sinusitis after transfrontal craniotomy were discussed by studying the frontal sinus CT image, and prior surgical data. RESULTS: All patients were followed up for more than 6 months after the nasofrontal dilatational tube was removed. Among 33 patients, two cases with traditional frontal sinus surgery were operated twice due to nasofrontal dilatation tube fall off in 1 month. In all 33 patients, 30 cases cured and 3 cases got better. There were no curative difference between two operational methods. CONCLUSIONS: The causes of frontal sinusitis after transfrontal craniotomy were inadequate sinus management in craniotomy and bone wax tamping in frontal sinus. There was more frontal sinus abscess and fistula occurring in frontal sinusitis after transfrontal craniotomy than that in ordinary frontal sinusitis. The therapy included cleaning out bone wax and phlogistic acestoma, and expanding the frontal sinus ostium. The satisfying curative effect was obtained in both operational methods, but endoscopic frontal sinus surgery was better because it is minimally invasive, no facial incision and quick recovery with less nasofrontal dilatational tube posting time.

[Relationship of lingual region upper airway stricture and lingua-palate position type in obstructive sleep apnea hypopnea syndrome patients].

OBJECTIVE: To explore the relationship ol lingual region upper airway stricture and lingua-palate position type in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. METHODS: One hundred patients with OSAHS were included in the study and divided into 4 groups by lingua-palate age, AHI, BMI and lowest SaO2, the dimensions and area of lingual region airway, the thickness of retropharyngeal and lateral pharyngeal tissue, the tongue width, tongue length and tongue area were compared among four groups. The multinomial step regression process was performed with SPSS software to explore the effects of lingua-palate position type on lingual region upper airway stricture. RESULTS: There were no statistical difference of age, BMI, AHI and lowest pulse oxygen among four groups OSAHS patients (P > 0.05). And the CT results showed: starting from type I to type IV, the area, coronal and arrowe diameter of lingual region upper airways were decreasing, tongue length, tongue area and the percentage of lingual region airway stricture were increasing, the percentage of lingual region airway stricture were 0/25, 3/39, 7/22, 14/14, respectively (P < 0.05). The multinomial step regression analysis showed that the area of lingual airway was the most important factor of lingua-palate position type, the unstandardized coefficient was -0.39, and standardized coefficient was -0.545. CONCLUSIONS: The study suggests that there is evident correlation between lingual region airway stricture and lingua-palate position type, and lingual region airway stricture can be roughly determined by lingua-palate position type.