Diagnosis and treatment of snoring in adults-S2k Guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery.

OBJECTIVES: This guideline aims to promote high-quality care by medical specialists for subjects who snore and is designed for everyone involved in the diagnosis and treatment of snoring in an in- or outpatient setting. DISCUSSION: To date, a satisfactory definition of snoring is lacking. Snoring is caused by a vibration of soft tissue in the upper airway induced by respiration during sleep. It is triggered by relaxation of the upper airway dilator muscles that occurs during sleep. Multiple risk factors for snoring have been described and snoring is of multifactorial origin. The true incidence of snoring is not clear to date, as the incidence differs throughout literature. Snoring is more likely to appear in middle age, predominantly in males. Diagnostic measures should include a sleep medical history, preferably involving an interview with the bed partner, and may be completed with questionnaires. Clinical examination should include examination of the nose to evaluate the relevant structures for nasal breathing and may be completed with nasal endoscopy. Evaluation of the oropharynx, larynx, and hypopharynx should also be performed. Clinical assessment of the oral cavity should include the size of the tongue, the mucosa of the oral cavity, and the dental status. Furthermore, facial skeletal morphology should be evaluated. In select cases, technical diagnostic measures may be added. Further objective measures should be performed if the medical history and/or clinical examination suggest sleep-disordered breathing, if relevant comorbidities are present, and if the subject requests treatment for snoring. According to current knowledge, snoring is not associated with medical hazard, and generally, there is no medical indication for treatment. Weight reduction should be achieved in every overweight subject who snores. In snorers who snore only in the supine position, positional treatment can be considered. In suitable cases, snoring can be treated successfully with intraoral devices. Minimally invasive surgery of the soft palate can be considered as long as the individual anatomy appears suitable. Treatment selection should be based on individual anatomic findings. After a therapeutic intervention, follow-up visits should take place after an appropriate time frame to assess treatment success and to potentially indicate further intervention.

Bone formation with a biphasic calcium phosphate combined with fibrin sealant in maxillary sinus floor elevation for delayed dental implant.

OBJECTIVES: The aim of this study was to evaluate the extent and quality of new bone 6 months after sinus lift with biphasic micro- and macroporous calcium phosphate combined with fibrin sealant (MBCP-FS) and the 1-year implant success rate in the augmented site. MATERIAL AND METHODS: MBCP-FS was applied to one sinus in 96 subjects requiring augmentation for delayed dental implant placement. In subjects who required bilateral lifts (N = 33), the MBCP-FS sinus was randomly selected; the contralateral sinus was grafted with autologous bone (mixed with Bio-Oss when harvested bone volume was insufficient. Panoramic views were taken periodically prior to and up to 18 months post-lift. Histomorphometric analysis was conducted on biopsies taken during implant placement 6 months after augmentation. Implant functionality and prosthesis success were assessed clinically 1 year after implant placement. RESULTS: In MBCP-FS sinuses, 20.6 ± 8.5% new, mainly lamellar bone was observed. Implants were placed as planned in 78/85 evaluable subjects (91.8%) 6 months after sinus lift. Graft heights remained stable 1 year after placement; 94.7% (142/150) of implants were functional. The amount and quality of new bone and implant success rates with MBCP-FS were similar to autologous bone graft (mixed with Bio-Oss in 30/31 evaluable subjects). MBCP-FS was safe and well-tolerated. CONCLUSIONS: MBCP-FS is safe and effective in sinus floor elevation for dental implant placement, supporting bone regeneration and with high 1-year implant success rates similar to autologous bone mixed with Bio-Oss.

Outcome and histopathologic regression in oral squamous cell carcinoma after preoperative radiochemotherapy.

BACKGROUND AND PURPOSE: Preoperative radiochemotherapy has been reported to enhance tumor response and to improve long-term survival in advanced squamous cell carcinoma of the head and neck. This retrospective study evaluates regression rate and long-term survival in 228 patients with primary oral squamous cell carcinoma treated by neoadjuvant radiochemotherapy and radical surgery. PATIENTS AND METHODS: All patients with biopsy-proven, resectable oral squamous cell carcinoma - TNM stages II-IV without distant metastasis - received preoperative treatment consisting of fractioned irradiation of the primary and the regional lymph nodes with a total dose of 40 Gy and additional cisplatin (n = 160) or carboplatin (n = 68) during the 1st week of treatment. Radical surgery and neck dissection followed after a delay of 10-14 days. The study only included cases with histologically negative resection margins. RESULTS: After a median follow-up of 5.2 years, 53 patients (23.2%) had experienced local-regional recurrence. The median 2-year disease-specific survival (DSS) rate was 86.2%. 5-year DSS and 10-year DSS were 76.3% and 66.7%, respectively. Complete histological local tumor regression after surgery (ypT0) was observed in 50 patients (21.9%) and was independent of pretreatment tumor classification. Uni- and multivariate survival analysis revealed that ypT- and ypN-stage were the most decisive predictors for DSS. CONCLUSION: Preoperative radiochemotherapy with cisplatin/carboplatin followed by radical surgery attains favorable long-term survival rates. This applies especially to cases with complete histological tumor regression after radiochemotherapy, which can be assumed for one of five patients.

Pharmacokinetics of articaine hydrochloride in tumescent local anesthesia for liposuction.

The aim of the investigation was to assess the pharmacokinetic characteristics and safety of articaine HCl used in tumescent local anesthesia for liposuction. Maximum plasma concentrations of articaine HCl were observed from 136 to 264 ng/mL, on average, from 1.2 to 4.3 hours after the start of infiltration, depending on the area of liposuction. The average extent of absorption ranged from 827 to 2203 ng*h/mL. Average maximum plasma concentrations of articainic acid ranged from 1719 to 7292 ng/mL. The high articainic acid concentrations at 1 hour after the start of infiltration indicate that articaine HCl was hydrolyzed rapidly by esterases in tissue and plasma. Although up to 38.2 mg/kg body weight articaine HCl was applied, no cardiac side effects or symptoms of central nervous intoxication occurred. Articaine HCl provided a safe and sufficient analgesia for tumescent liposuction.

Resorbable versus titanium osteosynthesis devices in bilateral sagittal split ramus osteotomy of the mandible - the results of a two centre randomised clinical study with an eight-year follow-up.

BACKGROUND: This study was conducted to compare the long-term clinical outcome of patients with jaw disproportion who had had fixation with resorbable polylactic acid containing positioning screws with those who had had titanium positioning screws in bilateral sagittal split ramus osteotomy of the mandible (BSSO). PATIENTS AND METHODS: Sixty-six patients with isolated mandibular jaw disproportion were included and divided randomly into two treatment groups (resorbable and titanium). Patients were followed for 8 years postoperatively using a standardised protocol. Material-specific complications, functional problems and clinical findings within the former operation field were documented. Treatment stability was determined by occlusion criteria. RESULTS: Thirty-four patients (54%) were followed until the end of the study. No significant differences were observed in the outcomes of patients in the two groups related to the materials used for osteosynthesis or the long-term treatment stability. During the study, no foreign body reactions were observed. CONCLUSION: This study showed that resorbable and titanium positioning screws were equally effective as fixation devices in sagittal split osteotomy. Complete resorption of the resorbable screws could not be verified because of the absence of histological examination, however, the use of resorbable positioning screws can be considered as an alternative osteosynthesis material to conventional titanium osteosynthesis devices in sagittal split osteotomy.

Feasibility of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma.

INTRODUCTION: Microvascular bone grafts have evolved as the preferred technique for mandibular reconstruction in irradiated tumour patients. However immediate reconstruction by bridging plates remains an option for patients whose clinical condition is not favourable for microsurgical reconstruction. This retrospective study evaluates the performance of alloplastic mandibular reconstruction in patients following removal of oral squamous cell carcinoma. PATIENTS AND METHODS: Three hundred and thirty-four patients with primary (biopsy proven) oral squamous cell carcinoma without distant metastasis (stages II-IV), who were all treated by segmental mandibular resection and reconstruction by means of a titanium bridging plate were included. Two hundred and seventy-two patients received preoperative treatment, consisting of concomitant radiochemotherapy (RCT) (n=228), chemotherapy (n=34) and radiotherapy (n=10). Median follow-up was 5.1 years (min 0.3, max 18.0). RESULTS: The median 2-year-disease-specific survival rate (DSS) was 81.6%. Five-year-DSS and 10-year-DSS was 71.8% and 62.0%, respectively. One hundred and thirty-six plates were removed due to infection with intra- and/or extraoral exposure, seven plates because of fracture. Preoperative RCT (p=0.027), mandibular defects including the symphysis (p=0.016) and heavy smoking at the time of diagnosis (p=0.042) were associated with infection-related failure of the reconstruction plates. CONCLUSION: Reconstruction of mandibular defects with titanium bridging plates seems crucial in heavy smoking tumour patients with preoperative RCT as well as in mandibular defects including the symphysis.