The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation.

The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.

Results of coblation midline glossectomy for obstructive sleep apnea.

OBJECTIVE: The aim of this study is to determine the effectiveness of coblation midline glossectomy for obstructive sleep apnea (OSA) when used as an isolated procedure. We also aim to compare the effect of this surgical procedure on supine and non-supine apnea. MATERIALS AND METHODS: The medical records of patients who underwent isolated tongue base surgery as a part of step-wise surgeries between January 2014 and February 2019 are retrospectively reviewed. Pre-operative and post-operative Epworth sleepiness score (ESS), body mass index (BMI), and polysomnographic data, including the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), supine AHI, and non-supine AHI of the patients were compared. RESULTS: The study included 29 patients (26 male and 3 female). AHI improved significantly, decreasing from 34.9 ± 20.9 to 25.8 ± 17.6. Supine AHI decreased from 62.55 ± 28.23 to 55.18 ± 31.67 post-operatively, but this decrease was not significant. Non-supine AHI decreased significantly from 22.49 ± 24.02 to 14.08 ± 17.46. ESS and ODI also improved significantly. CONCLUSION: Coblation midline glossectomy is an effective surgical procedure when applied solely, with a success rate of 52%. Non-supine apnea benefits to a greater degree than supine apnea from this surgical procedure.

Effects of Expansion Sphincter Pharyngoplasty on the Apnea-Hypopnea Index and Heart Rate Variability.

PURPOSE: Heart rate variability (HRV) is a noninvasive and sensitive method used to evaluate autonomic function of the heart based on specific polysomnographic parameters. This study aimed to determine the effect of expansion sphincter pharyngoplasty (ESP) on HRV and the apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: This retrospective cohort study included patients who presented to the Department of Otorhinolaryngology, Hacettepe University Hospital (Ankara, Turkey), were diagnosed with OSA, and underwent ESP. Patient medical records, including demographic data, polysomnographic findings, and HRV parameters, were reviewed. The predictor variable was the effect of ESP on the AHI and the primary outcome variables were HRV parameters. Descriptive and bivariate statistics were computed using χ2 test, t test, and Mann-Whitney U test. RESULTS: The mean age of the 28 patients (20 men and 8 women) was 43 ± 9.9 years. Surgical success (AHI, <20; 50% decrease in the AHI) was achieved in 16 patients (57.1%). The AHI decreased in 22 patients (78.6%) but increased in 6 patients (21.4%) after ESP. The ratio of low-frequency power (LF) to high-frequency power (HF) decreased significantly in the patients with successful surgery and in those whose AHI decreased after surgery (P = .02 and P = .001, respectively). For the change in the LF/HF ratio, 19 patients had a decrease in sympathetic activity, whereas 9 had an increase in sympathetic activity, after ESP. A decrease in sympathetic activity after ESP was significantly associated with surgical success and a decrease in the AHI (P = .033 and P = .001, respectively). CONCLUSION: ESP is an effective surgical option for the treatment of OSA and lowers the AHI. Successful ESP plays a role in decreasing sympathetic activity of the heart, which might be associated with a decrease in the risk of cardiovascular disease.