The effectiveness of different surgical techniques in the treatment of obstructive sleep apnea syndrome. Clinical and polysomnographic outcomes.

AIM: The aim of this study is to emphasiz technique in the treatment ofe the importance of DISE in the treatment of OSAS and to evaluate the effectiviness of surgical treatment methods in patients who have undergone OSAS Surgery. MATERIAL AND METHODS: Patients with OSAS were evaluated using preoperative and postoperative Epworth Sleepiness Scale results and preoperative and postoperative sixth month polysomnography (PSG) results. All patients had a DISE preoperatively to assess the upper airway and to decide the surgical approach. RESULTS: There were 44 men (78.6%) and 12 women (21.4%) included in the study. According to the preoperative the Apnea-hypopnea index (AHI), 19 (33.9%) patients were mild OSAS, 19 (33.9%) were severe OSAS and 18 (32.2%) were moderate OSAS. According to the postoperative AHI, 24 (42.9%) patients had only simple snoring. Postoperatively there were 20 (35.7%) mild OSAS, 7 (12.5%) moderate OSAS and (8.9%) severe OSAS detected. When comparing preoperative and postoperative AHI, the greatest decrease was observed in the combined oropharynx and tongue base surgery group. CONCLUSIONS: OSAS is a disease caused by multiple levels of obstruction. The results of this study show a small, statistically significant reduction in the AHI after combined oropharynx and tongue base surgery. KEY WORDS: Drug Induced Sleep Endoscopy, Obstructive Sleep Apnea Syndroma, Polysomnography.

Epithelioid Hemangioendothelioma of the Mastoid Bone with Extension of Middle Cranial Fossa: A Case Report.

Epithelioid hemangioendothelioma (EHE) is a rare sarcoma of vascular origin. It is frequently seen in the liver, lungs and bones. Cases with mastoid bone and intracranial extension are rarer. A 40 year old male, presented with a history of progressive headaches and a mass in the postauricular region for a duration of three months. Computer tomography of the temporal bone showed an approximately 40 × 30 mm soft tissue with osteolytic bony changes located in the mastoid bone. Epithelioid hemangioendothelioma is a rare sarcoma of vascular origin. Surgery is the first line of therapy. Prognosis is generally good, and may be better for primary intracranial disease than that for EHE originating elsewhere.

Endonasal Endoscopic Removal of a Langerhans Cell Histiocytosis from Far Lateral Frontal Sinus.

Introduction: Langerhans cell histiocytosis (LCH) is a rare disease in adults, and it is even uncommon in pediatric populations, affecting only 1-2 people per million. A LCH located in the frontal sinus is exceptionally unusual. We present a case of LCH located in the far lateral of the frontal sinus and discuss management as well as surgical techniques to control this far lateral frontal sinus lesion. Case Presentation: A 39 year old female, presented with a history of progressive headaches and purulent nasal discharge for three months. Computed tomography (CT) of the sinuses showed an approximately 15 × 10 mm soft tissue with osteolytic bony changes located in lateral wall of the frontal sinus on the left side. Total tumor removal was achieved by minimally invasive endonasal endoscopic surgery with a periorbital suspension technique. Histopathologic analysis revealed LCH and the patient was referred to a hematologist for further treatment. Conclusion: LCH is a rare hematological pathology. It should be diagnosed timely and treated with a multidisciplinary approach. To get a definitive diagnosis a biopsy is mandatory. Having LCH in the far lateral frontal sinus can be challenging for a biopsy even for experienced surgeons. Using curved instruments while performing an endonasal periorbital suspension technique makes it possible to access the lateral wall of the frontal sinus safely and provides an effective surgical route similar to traditional open approaches without causing any external scars.