Uvulopalatopharyngoplasty for nasal blockage 21 years after total rhinectomy.

BACKGROUND: Total rhinectomy is an invasive procedure that significantly impairs the intranasal turbulence, humidification and heating of inspired air. The use of uvulopalatopharyngoplasty for the treatment of sleep-disordered breathing disorders such as primary snoring and obstructive sleep apnoea has diminished over the past years because of the emergence of less invasive procedures and alternative therapeutic options. This clinical record presents the treatment of a long-term side effect of total rhinectomy using uvulopalatopharyngoplasty. CASE REPORT: In 1997, a 62-year-old male underwent total rhinectomy for a nasal schwannoma, followed by rehabilitation with a nasal prosthesis. Twenty-one years later, he presented with severe complaints of nasal blockage and breathing difficulties during both daytime and night-time. Clinical examination revealed no major anomalies besides significant velopharyngeal narrowing. Thus, in 2019, uvulopalatopharyngoplasty was performed to re-establish velopharyngeal patency. Hereafter, the symptoms of nasal blockage disappeared, resulting in an improved quality of life. CONCLUSION: Uvulopalatopharyngoplasty may prove useful to treat selected patients with daytime breathing difficulties due to velopharyngeal narrowing.

Uvulopalatopharyngoplasty May Reduce the Incidence of Dementia Caused by Obstructive Sleep Apnea: National Insurance Service Survey 2007-2014.

STUDY OBJECTIVES: Numerous studies have found that obstructive sleep apnea (OSA) causes or exacerbates dementia, including Alzheimer disease and vascular dementia. However, the evidence is often conflicting. Moreover, no study has investigated the effect of surgical treatment for OSA on dementia. METHODS: This retrospective cohort study analyzed data from the Korea National Health Insurance Corporation. A total of 125,417 participants (age 40 years or older) with a new diagnosis of OSA between 2007 and 2014 were included. The participants were classified into two groups: those who underwent uvulopalatopharyngoplasty (UPPP group, n = 12,664) and those who underwent no surgical treatment (no surgery group, n = 112,753). Propensity score matching by age and sex was used to select the control group of 627,085 participants. Mean follow-up duration was 4.6 ± 2.3 years. The primary endpoint was newly diagnosed Alzheimer dementia, vascular dementia, or other types of dementia. RESULTS: Compared with the control group, the hazard ratio (HR) and 95% confidence interval of dementia was calculated for patients with OSA. In the no-surgery group, the incidence of Alzheimer disease (HR 1.30 [1.22-1.38]), vascular dementia (HR 1.20 [1.05-1.36]), and other types of dementia (HR 1.35 [1.20-1.54]) was significantly higher than those among the control group. In the UPPP group, the incidence of Alzheimer disease (HR 1.08 [0.80-1.45]), vascular dementia (HR 0.58 [0.30-1.12]), and other types of dementia (HR 1.00 [0.57-1.77]) was similar to control levels. CONCLUSIONS: Uvulopalatopharyngoplasty may have a preventive effect on dementia in patients with OSA.

Upper Airway Stimulation in Patients Who Have Undergone Unsuccessful Prior Palate Surgery: An Initial Evaluation.

Upper airway stimulation therapy (UAS) is a new option for treatment of obstructive sleep apnea (OSA) in patients unable to tolerate continuous positive airway pressure (CPAP). We set out to evaluate the effectiveness of UAS in patients who have undergone prior palate surgery. We designed a retrospective review and evaluated patients undergoing UAS at 2 academic centers. We recorded demographic and pre- and postoperative polysomnogram (PSG) data. We compared the cohort of patients who had undergone prior palate surgery, "prior surgery," to the cohort who had not, "no prior surgery." A total of 164 patients were included in the study: 23 in the prior surgery and 141 in the no prior surgery groups. The mean age was significantly higher in the no prior surgery group ( P = .020). There were no other significant differences when comparing demographic, quality of life, or PSG variables between cohorts. UAS therapy is an option to treat OSA in patients having undergone unsuccessful prior palate surgery.

Tratamiento de recesión única de clase III con injerto libre subepitelial mediante técnica de colgajo de doble papila reposicionado: informe de un caso clínico / Treatment of a single Class III recession combining free subepithelial connective tissue graft and a double papilla repositioned flap: report of a clinical case

Objetivo: mostrar y evaluar los resultados clínicos de un procedimiento de cirugía plástica periodontal, efectuada para cubrir una recesión radicular de clase III de Miller, con una técnica bilaminar. Además, analizar el aumento de la banda de encía y el cambio de biotipo gingival de la pieza dentaria. Caso clínico: paciente femenino de 30 años de edad, con una recesión gingival de Clase III de Miller por vestibular de la pieza 43 que no sobrepasa la línea mucogingival, con pérdida interproximal de tejidos duros y blandos. El tratamiento consiste en un colgajo de doble papila a espesor parcial, con injerto libre subepitelial tomado del paladar, con seguimiento a 1 año. Conclusiones: la técnica bilaminar es una solución viable en casos de recubrimiento radicular poco predecibles, como la recesión de clase III de Miller. El biotipo gingival se vio engrosado y la encía queratinizada no sufrió variaciones.

Use of autologous platelet-rich plasma in complete cleft palate repair.

OBJECTIVES/HYPOTHESIS: Evaluate the effect of topical application of autologous platelet-rich plasma (PRP) in primary repair of complete cleft palate and then compare the result with another group of patients using the same surgical technique, without application of PRP with regard to the incidence of oronasal fistula, velopharyngeal closure, and grade of nasality. STUDY DESIGN: Case control study. METHODS: This study was carried on 44 children with complete cleft palate with age range from 12 to 23 months. The children were divided into two age- and gender-matched groups: All children were subjected to the same technique of V-Y pushback repair of the complete cleft palate. In group A (22 children), the PRP prepared from the patient was topically applied between the nasal and oral mucosa layer during palatoplasty, whereas in group B (22 children) the PRP was not applied. RESULTS: All cases were recovered smoothly without problems. In group A, no oronasal fistula was reported, whereas in group B three patients (13.6%) had postoperative fistulae and two patients (9.1%) needed revision palatoplasty. At 6 months postoperative assessment, group A (with PRP application) showed significantly better grade of nasality (P = 0.024) and better endoscopic velopharyngeal closure (P = 0.016) than group B. CONCLUSION: Usage of autologous PRP in complete cleft palate repair is simple; effective; can decrease the incidence of oronasal fistula; and also significantly improves the grade of nasality and velopharyngeal closure, which decreases the need of further surgical intervention in cleft palate patients. LEVEL OF EVIDENCE: 3b. Laryngoscope, 126:1524-1528, 2016.

The effects of dexamethasone and levobupivacaine on postoperative pain in modified radiofrequency assisted uvulopalatoplasty (MRAUP) surgery.

The objective of this prospective, randomized study was to evaluate the effect of pre-emptive local infiltration of lidocaine, lidocaine plus dexamethasone, levobupivacaine and levobupivacaine plus dexamethasone on postoperative pain in Modified Radiofrequency Assisted Uvulopalatoplasty (MRAUP) cases. Sixty adult patients (44 males and 16 females) aged 32-51 years with simple snoring were divided into four groups. The anesthesia of the patients in the first group was achieved with lidocaine HCl, in the second group, with lidocaine HCl and dexamethasone sodium phosphate, in the third group, with levobupivacaine, and in the fourth group, levobupivacaine and dexamethasone sodium phosphate. All the patients were applied Modified Radiofrequency Assisted Uvulopalatoplasty technique. The pain experienced by the patients during swallowing and at rest on the 1st, 3rd, 5th, 7th, and 10th day and analgesic consumption were evaluated using standard 10 cm visual analog scales. The mean duration of operation in the group that received lidocaine HCl was 22 ± 3 min, while in the group that received levobupivacaine HCl was 27 ± 4 min. There were statistically significant differences between the groups for analgesic effects on the 1st, 3rd, 5th, and 7th day and for the amount of analgesics used, on the 1st, 3rd, and 5th day. The best results were obtained in the group that received levobupivacaine HCl and steroid (p < 0.001). Steroid and local anesthetic combinations are superior to controls in the management of postoperative pain in MRAUP surgery.

Application of parecoxib in post-uvulopalatopharyngoplasty analgesia.

OBJECTIVE: To investigate the postoperative analgesic effects of parecoxib for uvulopalatopharyngoplasty (UPPP). METHODS: Patients with obstructive sleep apnoea syndrome who underwent UPPP were randomly divided into two groups. In group A, the incision-local block was performed with 5 ml of 0.5% ropivacaine injected subcutaneously before the end of surgery, then 20 ml of physiological saline was injected intravenously every 12 h for 2 days. In group B, in addition to the incision-local block, 40 mg parecoxib was injected intravenously 30 min before the end of UPPP and 40 mg parecoxib was injected intravenously every 12 h for 2 days. Postoperative pain was measured using a visual analogue scale (VAS). Adverse reactions were recorded. RESULTS: A total of 40 patients were randomized (n = 20 per group). Under resting conditions, the mean ± SD VAS pain scores were significantly higher in group A compared with group B at 24 h and 48 h after UPPP (24 h 4.0 ± 0.8 versus 2.6 ± 0.6; 48 h 3.8 ± 0.7 versus 2.4 ± 0.5; respectively). Under swallowing conditions, the mean ± SD VAS pain scores were significantly higher in group A compared with group B at 8 h, 24 h and 48 h after UPPP. Postoperative adverse reactions were similar in the two groups. CONCLUSION: Intravenous parecoxib combined with incision-local ropivacaine provided effective postoperative analgesia for patients with obstructive sleep apnoea syndrome, undergoing UPPP.

Gagging.

Gagging is a protective reflex to stop unwanted entry into the mouth and oropharynx. Some people have a reduced or absent reflex, while others have a pronounced one. Pronounced gag reflexes can compromise all aspects of dentistry, from the diagnostic procedures of examination and radiography to any form of active treatment. In some patients with marked gagging reflexes, it can lead to avoidance of treatment. Many techniques have been described that attempt to overcome this problem, and a variety of management strategies is necessary to aid the delivery of dental care. This is a review of the etiology of gagging problems, clinical assessment, and their classification and categorization prior to clinical treatment. It discusses as well methods for managing patients with gag reflexes during dental treatment.

Diagnosis and treatment of snoring in adults--S1 guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery.

INTRODUCTION: Snoring has received increased attention over the last years. Given its high prevalence and its impact on quality of life, diagnosis and treatment of snoring are of major importance. AIM OF THE GUIDELINE: This guideline aims to promote high-quality care by medical specialists for adults who snore. DIAGNOSTIC MEASURES: Before every intervention, a medical history, clinical examination and sleep test need to be performed. INTERVENTIONS: There is no need to treat snoring unless requested by the snorer. Invasive treatments should be selected with care; for surgical treatment, minimally invasive procedures are preferred. Weight reduction; the avoidance of sleeping pills, alcohol and nicotine; and a regular sleep-wake cycle can be recommended, although convincing evidence is lacking. Since currently, there is not enough evidence to confirm the effectiveness of muscle stimulation or other forms of muscle training, these treatments cannot be recommended. Snoring can be treated successfully with intraoral devices, but it is essential to select suitable subjects. Devices preventing sleep in the supine position can also be helpful in selected cases. The data on the success rates of surgical intervention are often limited to short-term follow-up studies, and not all interventions have been sufficiently evaluated. The techniques used to treat nasal obstruction in snorers are identical to those used for general nasal obstruction. Nasal surgery is only indicated when subjects complain about nasal obstruction. A significant amount of data is available for laser-assisted resection of excessive mucosa; however, resections can be performed with other tools. The efficacy of radiofrequency surgery at the soft palate has been documented in placebo-controlled trials. Soft palate implants can reduce snoring. Tonsillectomy or uvulopalatopharyngoplasty should be selected with care, especially as less invasive alternatives are available.

Rabdomiosarcoma de paladar blando. A propósito de un caso / Rabdomiosarcoma of soft palate. A case on purpose

Los rabdomiosarcomas (RMS) son tumores poco frecuentes. Descritos principalmente en la infancia y localizados en un 35% de los casos en cabeza y cuello. La localización orofaríngea es relativamente rara, siendo en estos casos la lengua, paladar, y mucosa bucal los lugares preferentes de asentamiento. Clásicamente los pacientes presentaban tasas muy bajas de curación con cirugía más radioterapia. La introducción a mediados de los años 70 de la quimioterapia sistémica como tratamiento complementario ha mejorado la supervivencia de manera importante. En este artículo se describe el caso de un paciente adolescente que presentó un RMS a nivel del paladar blando, el procedimiento diagnóstico y la decisión terapéutica adoptada tras revisión de los últimos estudios al respecto

The rabdomiosarcoma (RMS) are infrequent tumors. They are principally described in infancy and located in 35% of the cases in head and neck. The nasopharynx localisation is relatively rafe, being in these cases the tongue, palate and oral mucosa the preferent places of establishment. Classically the patient presented very low standard healing with surgery and radiotherapy. The introduction in the middle 70 of systematic chimiotherapy as complementary treatment, improved the survival rate in large scale. In this article the case of an adolescent patient, who presented a RMS at the level of the soft palate, the diagnostic procedure and the therapeutic decision adopted, after revision of the last studies at this respect, are described

Radiofrequency vs laser in the management of mild to moderate obstructive sleep apnoea: does the number of treatment sessions matter?

OBJECTIVE AND HYPOTHESIS: Obstructive sleep apnea (OSA) is a relatively common and serious problem with many medical and social consequences. Laser and radiofrequency are two recent techniques used to treat OSA and they can be carried out under local anaesthesia, but they need multiple sessions to achieve satisfactory outcome and are associated with better short-term than long-term outcomes. In this work we compare the two modalities as regards the optimal number of treatment sessions needed to achieve a favourable outcome in the short and long term. STUDY DESIGN: A total of 150 patients with apnoea hypopnoea index (AHI) between 5 and 30 events per hour, no morbid obesity and retropalatal site of obstruction were included in this prospective study. METHODS: Patients were randomly and equally divided into two groups, each comprising 75 patients. The first group was treated with bipolar radiofrequency volumetric tissue reduction of the palate (BRVTR) and the second group was treated with laser-assisted uvulopalatoplasty (LAUP). Each group was further subdivided into five subgroups each consisting of 15 patients. The first group received one treatment session, the second received two sessions, the third received three sessions, the fourth received four sessions and the fifth group received five treatment sessions. Evaluation of efficiency of both techniques in treating OSA was assessed objectively by polysomnography. RESULTS: In those treated with BRVTR; at least three sessions were needed to achieve a favourable outcome in OSA in the short and long term. In those treated with LAUP, a single treatment session was enough to achieve a favourable outcome on OSA in the short term, while two sessions were needed to achieve the same long-term outcome. DISCUSSION: In OSA, fewer treatment sessions are needed with LAUP (one session) than with BRVTR (three sessions) to achieve a favourable outcome. In LAUP more treatment sessions (two) are needed to maintain a longer-term favourable outcome than those needed to achieve short-term favourable outcome (one session), which is not the case with BRVTR (three sessions are needed to achieve both short- and long-term favourable results).

[Surgical treatment of obstructive sleep-apnoea syndrome]. / Chirurgische behandeling van obstructief slaapapneusyndroom.

5 patients, 4 males aged 41, 32, 52 and 49 years and 1 female aged 57 years, suffered from socially unacceptable snoring and hypersomnolence in the daytime. They were evaluated for obstructive sleep-apnoea syndrome. After polysomnography and sleep endoscopy was performed to establish the severity of the sleep-apnoea syndrome and the level(s) of upper airway obstruction, a patient-specific treatment was performed. Conservative therapy with continuous positive airway pressure (CPAP) was refused by 4 patients, while 1 patient discontinued therapy after complaints of nose obstruction. This patient underwent radiofrequency thermotherapy (RFTT) of the inferior turbinates. The other patients underwent uvulopalatopharyngoplasty (UPPP), RFTT of the soft palate, hyoidthyroidpexia (HTP) and 'multilevel' surgery: UPPP, HTP and RFTT of the tongue base, respectively. All patients showed improvement after surgery. Although its longterm effects are not yet known, surgical treatment is an option for patients with obstructive sleep-apnoea syndrome who cannot or will not undergo CPAP.

[Clinicophoniatric assessment of efficacy of combined treatment of snoring patients].

A comprehensive clinicophoniatric examination of 55 patients before and after an original treatment of rhonchopathy allowed assessment of efficacy of this treatment consisting of surgery combined with electromyostimulation. A modified technique of uvulopalatopharyngoplasty, a standard package of phonopedic tasks used for assessment of a functional condition of the vocal-speech apparatus in insufficiency of palatopharyngeal valve are described.

[Innovative bipolar radiofrequency volumetric reduction with "ORL-Set" for treatment of habitual snorers]. / Bipolare Radiofrequenz-Volumenreduktion mit "ORL-Set" bei habituellem Rhonchus.

BACKGROUND: The present study was undertaken in an effort to assess the use and the efficacy of an innovative radiofrequency system (RaVoR, Select-Sutter, Freiburg i. Br.) and the bipolar electrodes conceived by the author for the treatment of habitual, disruptive snoring. The author's own surgical method takes into account a number of published retrospective studies on radiofrequency application in the treatment of snoring and is based on important anatomical, physiopathological and histological knowledge. PATIENTS AND METHODS: Thirty-one patients diagnosed with primary snoring and five patients with associated sleep apnea syndrome (SAS) were treated according to the method and with the RaVoR system in the past three years. The intensity as well as the snoring density was assessed on a numeric analogue scale (NAS; ranging from 0 = "patient doesn't snore anymore" to 4 = "patient continues to snore as before"), which was filled out by the partner preoperatively and postoperatively after 6 months and 2 years. RESULTS: Snoring was reduced in 31 (86 %) patients (NAS

Acoustic reflection: review and clinical applications for sleep-disordered breathing.

Sleep-disordered breathing (SDB) affects more than 4% of the adult population with an even higher prevalence within high-risk groups. Nasal continuous positive air pressure, although considered the current gold standard treatment for SDB, demonstrates poor patient compliance. Alternative therapies, such as palatal surgeries and airway orthotics, lack validated candidacy selection protocols, resulting in varying success rates. Although much has been published over the last several years regarding the effect of these therapies on the upper airway, no publication has presented an accounting of the use of acoustic reflection (AR) to evaluate airway characteristics pre- and post-treatment with these alternative therapies. This article will review AR and our current knowledge base of the pathological airway characteristics that can be assessed through AR. It will include the advantages, limitations, and potential clinical usefulness of this diagnostic modality in the treatment of patients with SDB.

Transoral radiofrequency treatment of snoring.

OBJECTIVES/HYPOTHESIS: Radiofrequency ablation (RFA) may effectively treat snoring with acceptable patient tolerance. STUDY DESIGN: A cohort of patients with unacceptable snoring underwent RFA to the soft palate between October 1997 and May 2000. Before the therapy, a family member or significant other person was interviewed to rate snoring loudness. METHODS: Snoring was rated on a visual analog scale of 0 to 10 (in which 0 was no snoring and 10 was horrific snoring) before and after therapy. All patients were treated with transoral RFA administered under local anesthesia at 6-week intervals. RESULTS: Complete data were available for 60 of the 75 treated patients. The average number of treatment sessions per patient was 1.8. These patients received an average energy of 1845 J. Overall the average snoring score was 8.9 before therapy and 3.5 after therapy. Fifty-one patients (85%) were considered to have major improvement in snoring loudness. A total of 9 patients (15%) were nonresponders. CONCLUSIONS: RFA to the soft palate is a viable option to treat socially unacceptable snoring. Inadequate response to therapy may reflect misdiagnosis or delivery of an insufficient amount of energy.

New developments in the therapy of obstructive sleep apnea.

This review of the literature summarizes new trends in the diagnosis and treatment of obstructive sleep apnea (OSA) over the last 3 years. A literature search in Medline on 5 March 2000 using the keywords "OSA" and "OSAS" identified 123 papers. Another 86 articles were added from the references of the first 123 papers. New trends were observed concerning measurements of quality of life. There are new developments regarding conservative treatment, for example, nasal continuous positive airway pressure (nCPAP) therapy and oral devices. With regard to surgical treatment of OSA new surgical procedures, the radiofrequency technique, and the concept of multilevel surgery are discussed. After more than 25 years of interdisciplinary sleep medicine there still are some new developments of interest for ears, nose, and throat surgeons, which indicate the need for the involvement of otorhinolaryngologists in modern sleep medicine.

The effect of uvulopalatopharyngoplasty without tonsillectomy using local anaesthesia: a prospective long-term follow-up.

This paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Side-effects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still 'responders' with an apnoea index (AI) reduction of > 50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Side-effects are common, but diminish with time.

Intraoperative expansion of the palate by the tumescent technique.

Intraoperative rapid expansion of soft tissue of the palate is reported. Tissue is recruited by repeated injections of an isotonic solution in a tumescent-like technique, thus producing increasing swelling of the palatal soft tissue. Straight direct closure of palatal clefts and fistulas is achieved with minimal scarring at the midline, no secondary healing of raw surfaces, and satisfactory and encouraging results.

Laser-assisted uvulopalatoplasty for habitual snoring without sleep apnea: outcome and complications.

Thirty patients suffering from habitual snoring were subjected to laser-assisted uvulopalatoplasty with a KTP/532 laser under local anesthesia. The patients selected for the present study had no complaints of severe sleep apnea. The surgical procedure included bilateral vertical incision through the palate at the base of the uvula with or without removal of the lower half of the uvula. Ninety-three percent of the patients showed apparent improvement of snoring following the operation. However, other sleep-related symptoms such as sleep quality and daytime sleepiness were not significantly improved. No major or critical complications such as massive bleeding and asphyxia occurred. Post-operative pain on deglutition disappeared in most patients 2 weeks after the operation. This procedure is safe, minimally invasive and effective for habitual snoring without apnea.