Treatment of primary epiglottis collapse in OSA in adults with glossoepiglottopexy: a 5-year experience.

Objective: To review our 5-year experience with a modified version of glossoepiglottopexy for treatment of obstructive sleep apnoea syndrome (OSA) in two hospitals. Methods: A retrospective analysis was carried out on a cohort of adult patients affected by OSA suffering from primary collapse of the epiglottis who underwent a modified glossoepiglottopexy. All patients underwent drug-induced sleep endoscopy, polysomnographic and swallowing evaluation, and assessment with the Epworth Sleepiness Scale (ESS). Results: Forty-nine patients were retrospectively evaluated. Both the apnoea-hypopnoea index (AHI) (median AHIpost-AHIpre = -22.4 events/h; p < 0.001) and oxygen desaturation index (ODI) showed a significant postoperative decrease (median ODIpost-ODIpre = -18 events/h; p < 0.001), as did hypoxaemia index (median T90% post-T90% pre = -5%; p < 0.001). The ESS questionnaire revealed a significant decrease in postoperative scores (median ESSpost-ESSpre =- 9; p < 0.001). None of the patients developed postoperative dysphagia. Conclusions: Our 5-year experience demonstrates that modified glossoepiglottopexy is a safe and reliable surgical technique for treatment of primary epiglottic collapse in OSA patients.

Retroperitoneal ganglioneuroma in a 15-year-old boy, an interesting case studied through multimodal imaging.

Benign ganglioneuroma contains mature autonomous ganglion cells, including satellite cells and long axonal processes, as well as Schwann cells, which come from neural crest-derived cells that form the adrenal medulla and sympathetic nervous system during embryonic development and is a rare benign tumor which occurs spontaneously and can also occur during radiotherapy or chemotherapy, accounting for 0.72% -1.6% of primary retroperitoneal tumors, commonly found in the posterior mediastinum and retroperitoneum, and affected patients usually have no symptoms due to of its non-functional feature, although several complications can arise if the tumor is large enough to press against adjacent organs.

Role of functional and anatomic study in sleep endoscopy for treatment of OSA.

Objective: To describe a clear and intuitive way to analyse the anatomical meaning of images observed in Drug-induced Sleep Endoscopy (DISE) to fully understand the obstructive dynamics and therefore opt for a tailor-made pharyngeal surgical technique. Methods: From January 2016 to December 2020, 298 patients who underwent DISE were selected according to inclusion criteria. Results: The case series consisted of 204 males and 94 females with a mean age of 56 years. Body mass index ranged from 19 kg/m2 to 34 kg/m2 with a median of 26.5 kg/m2. Median Apnoea-Hypopnea Index (AHI) was 27 (range 5-62.3). The authors also observed four palate pharyngeal phenotypic patterns of collapse and clarify the morphology and role of the main muscles involved in upper airway collapse. Conclusions: DISE is fundamental to determine the collapse site in patients affected by obstructive sleep apnoea syndrome. The velopharyngeal region is the most common site of obstruction and lateral pharyngeal wall collapse is the major determining factor. DISE can lead to a deeper understanding of the obstructive dynamic patterns and a more precise identification of the muscle bundles responsible for upper airway collapse.

Rapid maxillary expansion for the treatment of nasal obstruction in children younger than 12 years.

OBJECTIVE: To assess short- and long-term effects of rapid maxillary expansion (RME) on nasal flow in young children. Since RME has been reported to positively influence nasal obstruction in subjects with respiratory problems by reducing nasal resistance, a similar efficacy of RME could be expected in children with deciduous and/or mixed dentition who are affected by maxillary constriction and nasal obstruction from a different cause. DESIGN: Prospective study of children younger than 12 years, with different grades of malocclusion and oral breathing. Data included active anterior rhinomanometry in both the supine and orthostatic positions, as well as radiographic cephalometric measurements. SETTING: Tertiary care university hospital. Data were prospectively collected from 2005 to 2007. PATIENTS: Nasal flow and resistance were measured in 65 children younger than 12 years, with mixed or deciduous dentition and different grades of malocclusion and oral breathing. MAIN OUTCOME MEASURE: Efficacy of RME for resolution of maxillary constriction. RESULTS: After RME, an improvement of nasal flow and resistance has been recorded in patients, in the supine position, who presented both anterior and posterior obstruction. Less notable changes were shown in isolated forms of obstruction and in the orthostatic position. CONCLUSION: In cases of maxillary constriction and nasal airway obstruction, RME has proved to be efficient for the improvement of nasal respiration in children via a widening effect on the nasopharyngeal cavity.