AHI Outcomes Are Superior after Upper Airway Reconstructive Surgery in Adult CPAP Failure Patients.

OBJECTIVE: This study aims to evaluate Apnea-Hypopnea Index (AHI) outcomes of upper airway adult obstructive sleep apnea (OSA) reconstructive surgery, as compared with outcomes of suboptimal continuous positive airway pressure (CPAP) therapy, in response to reviews claiming unreliable surgical AHI reduction. STUDY DESIGN: Prospective cohort study. SETTING: Single-surgeon series at medical centers within Wollongong, Australia. SUBJECTS AND METHODS: Adult patients with OSA who were partial device users or who refused CPAP were considered candidates for upper airway surgery (N = 48). Subjects underwent physical examination and polysomnography before and after surgery. Three groups were delineated on the nature of their suboptimal CPAP therapy: group 1, partially using CPAP or refusing long-term CPAP despite adherence (with available download data); group 2, unable or refusing to use CPAP with 2 sleep studies over time; group 3, unable or refusing to use CPAP with 1 sleep study over time. Collected data included demographics and AHI outcomes. RESULTS: Average AHI across all 3 groups with suboptimal CPAP therapy before surgery was 30.24 ± 17.17 events per hour sleep, as compared with the average postoperative AHI of 7.65 ± 6.59 events per hour sleep. This decrease was shown to be statistically significant with Wilcoxon signed-rank test (P < .0001). CONCLUSIONS: AHI outcomes are superior with surgery in untreated or suboptimally treated adult OSA patients prescribed CPAP.

Radiofrequency coblation of congenital nasopharyngeal teratoma: a novel technique.

Introduction. Congenital nasopharyngeal teratomas are rare tumours that pose difficulties in diagnosis and surgical management. We report the first use of radiofrequency coblation in the management of such tumours. Case Report. A premature baby with a perinatal diagnosis of a large, obstructing nasooropharyngeal mass was referred to the ENT service for further investigations and management. The initial biopsy was suggestive of a neuroblastoma, but the tumour demonstrated rapid growth despite appropriate chemotherapy. In a novel use of radiofrequency coblation, the nasooropharyngeal mass was completely excised, with the final histopathology revealing a congenital nasopharyngeal teratoma. Conclusion. We report the first use of radiofrequency coblation to excise a congenital nasopharyngeal teratoma and discuss its advantages.

Surgical decompression in bell's palsy - our viewpoint.

Bell's palsv or acute idiopathic lower motor neuron facial palsy is a common cause of facial palsy seen in clinical practice. The cause of this disease is not exactly known though there arc many theories regarding Ils etiology. In this article, we present the theory of "Tertiary is chacmia " in eases of pertinent Bell's palsy. Our concept of Tertiary ischaemia is further supported by histological findings of the nerve sheath biopsy taken during surgical decompression In eases of Bell' s palsy. The procedure, of performing posterior tympanotomy and improving the exposure of the middle ear structures therein is also explained.

An unusual case of impacted oesophageal foreign body.

Impacted sharp foreign bodies in the oesophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as oesophageal perforation can occur. We hare reported a rare case of impacted denture in the oesophagus where endoscopic removal was not possible due to the perforation already caused by the denture, sinee this would have caused an oesophageal laceration, which could have proved fatal. Hence surgical removal had to be performed with repair of the oesophageal perforation.