Tongue base suspension and radiofrequency volume reduction: a comparison between 2 techniques for the treatment of sleep-disordered breathing.

PURPOSE: Lingual suspension (LS) and tongue base radio frequency volume reduction (RFVR) have been proposed as means of correcting the obstruction caused by the collapse or hypertrophy of the tongue base in patients having sleep-disordered breathing (SDB). The aim of this study was to evaluate and compare long-term results (6 months and 2 years) in a population of 24 patients having mild obstructive sleep apnea syndrome (OSAS), of whom 12 were treated with LS and 12 with RFVR. MATERIALS AND METHODS: The study included 24 patients having mild OSAS (apnea-hypopnea index between 10 and 20). All patients were assessed by means of the Epworth Sleepiness Scale, collection of anthropomorphic data, fiber-optic evaluation with Muller's maneuver, cephalometric assessment, and polysomnography. Lingual suspension was performed under general anesthesia with cervical cutaneous access. Radio frequency volume reduction was performed under local anesthesia with an Ellman Surgitron Dual RF unit (Ellman International, Inc., New York, NY), using a resterilizable bipolar terminal prototype. The same ear, nose, and throat examinations and polysomnography were carried out 6 months and 2 years after the surgical procedure. RESULTS: The results were evaluated according to the criteria by Sher (Sleep. 1996,19:156-177); after 6 months, the success percentage was 67% in patients treated with LS and 75% in those with RFVR. These percentages dropped to 42% in the first group and 33% in the second group after 24 months. CONCLUSIONS: Lingual suspension and RFVR are simple procedures that can be quickly performed and are well tolerated by patients. However, their effectiveness drops after 2 years. Our experience has therefore led us to conclude that the minimally invasive treatment for tongue base surgery can guarantee long-term results only in 42% and 33% of patients, respectively. Moreover, RFVR is preferable because it is simpler to perform and less invasive than LS, and it can be repeated over time.

Adenotonsillectomy in obstructive sleep apnea syndrome. Proposal of a surgical decision-taking algorithm.

OBJECTIVE: The incidence of snoring in the pediatric population is 10% and the incidence of OSAS is equal to 2-3%. Sometimes, primary snoring and OSAS overlap and only polysomnography can differentiate the two disorders but its use is complex, expensive and highly controversial. The purpose of this paper is to demonstrate the value of the clinical assessment associated with the patient's history in selecting children with OSAS and to validate the therapeutic algorithm, thereby employing polysomnography only for selected cases. METHODS: A population of 118 patients was considered, selected by means of a questionnaire that indicated OSAS and a clinical evaluation that confirmed the diagnosis. The studied group underwent clinical assessment complete with fibreoptic survey as well as nocturnal pulse oxymetry, orthodontic and phoniatric evaluation. Regardless of the adenotonsillar size, all the selected children underwent adenotonsillectomy and were evaluated after 3 months with the help of a questionnaire, ORL examination and nocturnal pulse oxymetry. RESULTS: In all the patients we witnessed the disappearance of apnea. A 80.5% of children benefited from the surgical procedure. A 12.7% continued to present minor symptoms. A 6.8% continued to snore in a discontinuous manner, but without apnea: these children were re-assessed after a further 6 months with nocturnal pulse oxymetry and no oxymetric alteration was demonstrated. There were no significant differences between the degree of upper airway obstruction and the surgical outcome. CONCLUSION: The history and clinical exam are sensitive tools, even though relatively aspecific. Our results confirm the validity of the history and clinical exam as a screening method as well as the role of the surgical procedure that can re-establish the patency of the upper airways and to contrast the neuromuscular hypotonia as a result of the effect of the surgical scar. If it is true that primary snoring and OSAS are a continuum, our approach regarding surgery may be defined as a form of prevention regarding a pathology with potential complications. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. It is an option to be used only in unsuccessful adenotonsillectomies and for those children who have complicated presentations from the outset.

Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea.

BACKGROUND: Schwannomas of the larynx are rare lesions in the pediatric age group. METHODS: In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea. RESULTS: Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically. CONCLUSION: Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required.