ABSTRACT
To evaluate the role of endoscopic versus external surgery in the treatment of inverted papillomas, the clinical courses of 35 patients over a period of 10 years were reviewed. 13 patients were treated endoscopically whereas 15 were treated with an external approach. 7 patients with a post operative follow up of less than 12 months were excluded from the study. Recurrences occurred in 4 patients, 2 patients had been treated by endoscopic surgery and 2 by medial maxillectomy by lateral rhinotomy. 3 patients were diagnosed with squamous cell carcinoma. Salvage surgery was performed by an external procedure or endoscopically depending on the extension of the recurrence. Late complications occurred in both groups: cosmetic complaints and epiphora were more frequently encountered after external treatment. Functional complaints were noted after endoscopic treatment. If there is no evidence of associated malignancy, if complete exposure of the tumor is possible and long term follow up is feasible, the authors propose endoscopic surgery as first line treatment to excise the body of the tumor, assess it's extension, and remove the root of the tumor. If this is not the case, medial maxillectomy by external approach should be performed.
Subject(s)
Endoscopy , Maxillary Sinus Neoplasms/surgery , Nose Neoplasms/surgery , Papilloma, Inverted/surgery , Adolescent , Adult , Aged , Carcinoma, Squamous Cell/surgery , Chi-Square Distribution , Child , Female , Follow-Up Studies , Humans , Male , Maxillary Sinus Neoplasms/diagnosis , Middle Aged , Neoplasm Recurrence, Local , Nose Neoplasms/diagnosis , Papilloma, Inverted/diagnosis , Retrospective Studies , Time FactorsABSTRACT
OBJECTIVE: To describe a surgical procedure for the treatment of severe obstructive sleep apnea syndrome (OSAS), the procedure's indications, and its results. STUDY DESIGN: A retrospective study of 10 male patients with OSAS treated by tongue base reduction with hyoepiglottoplasty (TBRHE) at the Foch Hospital (Suresnes, France) between 1994 and 1997. Patients had a mean body mass index (BMI) of 32 kg/m2, a mean respiratory disturbance index (RDI) of 70 events/h, and a mean minimal oxygen saturation of 78%. They had refused positive airway pressure therapy or wished to discontinue it. METHODS: Subtotal tongue base reduction preceded by lingual neurovascular bundle identification and derouting, epiglottal verticalization, mouth floor horizontalization, and hyoid bone repositioning was performed, associated in some cases to uvulopalatopharyngoplasty (UPPP). Indications were based on a site-related obstruction, on the absence of craniofacial deficiencies, and on the presence of hyolingual abnormalities determined by cephalometry and magnetic resonance imaging. RESULTS: TBRHE associated to UPPP in most cases had an 80% success rate, based on a postoperative RDI below 20 events/h and a reduction of the preoperative RDI of more than 50%. Snoring and excessive daytime sleepiness decreased or disappeared, respectively, in 100% and 90% of the cases. No neurovascular complications occurred. CONCLUSION: TBRHE is a safe procedure for the neurovascular bundle. Associated to a pharyngotomy, it is an effective treatment for severe OSAS attributable to tongue base obstruction. These results require confirmation in a larger series of patients.
Subject(s)
Epiglottis/surgery , Hyoid Bone/surgery , Sleep Apnea Syndromes/surgery , Tongue/surgery , Adult , Female , Humans , Hyoid Bone/abnormalities , Magnetic Resonance Imaging , Male , Mouth Floor/surgery , Palate/surgery , Positive-Pressure Respiration/methods , Postoperative Care , Preoperative Care , Retrospective Studies , Severity of Illness Index , Sleep Apnea Syndromes/diagnosis , Surgical Procedures, Operative , Tongue/abnormalities , Treatment Outcome , Uvula/surgeryABSTRACT
Two treatments are habitually proposed for snoring without obstructive sleep apnea syndrome: the surgical pharyngotomy, and the treatment by laser done in the office. Our study analyses retrospectively, by telephone questionnaire, a group of 168 snorers, without obstructive sleep apnea syndrome, treated by pharyngotomy (n = 71) or CO2 laser (n = 97) between 1989 and 1993. Results after a mean follow-up of 5 years, with a minimal of 3 years, show for the two procedures the same efficacity, and an equivalent prevalence of side effects. The rate of satisfaction for the patient and her bed-partner is about 50%, in relation to a degradation of therapeutic effect in the long run. We propose to precisely the results and the indications of the surgery and the laser for treatment of uncomplicated rhonchopathy.
Subject(s)
Laser Therapy/methods , Palate, Soft/surgery , Pharynx/surgery , Snoring/surgery , Uvula/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Period , Preoperative Care , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
Many surgical techniques are proposed for the treatment of baldness. We have made a selection of these techniques using criteria of efficacy, good patient tolerance and ease of implementation. Based on a retrospective analysis of 150 patients, we elaborated a strategy for surgical treatment of baldness.