The extracellular matrix of the lateral pharyngeal wall in obstructive sleep apnea.

STUDY OBJECTIVES: To compare the components of the extracellular matrix in the lateral pharyngeal muscular wall in patients with and without obstructive sleep apnea (OSA). This may help to explain the origin of the increased collapsibility of the pharynx in patients with OSA. DESIGN: Specimens from the superior pharyngeal constrictor muscle, obtained during pharyngeal surgeries, were evaluated using histochemical and immunohistochemical analyses to determine the fractional area of collagen types I and III, elastic fibers, versican, fibronectin, and matrix metalloproteinases 1 and 2 in the endomysium. SETTING: Academic tertiary center. PATIENS: A total of 51 nonobese adult patients, divided into 38 patients with OSA and 13 nonsnoring control subjects without OSA. INTERVENTIONS: Postintervention study performed on tissues from patients after elective surgery. MEASUREMENTS AND RESULTS: Pharyngeal muscles of patients with OSA had significantly more collagen type I than pharyngeal muscles in control subjects. Collagen type I was correlated positively and independently with age. The other tested components of the extracellular matrix did not differ significantly between groups. In a logistic regression, an additive effect of both the increase of collagen type I and the increase in age with the presence of OSA was observed (odds ratio (OR), 2.06; 95% confidence interval (CI), 1.17-3.63), when compared with the effect of increased age alone (OR, 1.11; 95% CI, 1.03-1.20). CONCLUSION: Collagen type I in the superior pharyngeal constrictor muscle was more prevalent in patients with OSA and also increased with age. It was hypothesized that this increase could delay contractile-relaxant responses in the superior pharyngeal constrictor muscle at the expiratory-inspiratory phase transition, thus increasing pharyngeal collapsibility.

Lateral pharyngoplasty versus uvulopalatopharyngoplasty: a clinical, polysomnographic and computed tomography measurement comparison.

STUDY OBJECTIVE: To compare the lateral pharyngoplasty procedure with uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). DESIGN: Prospective randomized study. SETTING: Academic tertiary center. PATIENTS: Twenty-seven adults with OSAHS originally selected for treatment with UPPP. INTERVENTIONS: Patients were randomly assigned to 2 groups: in one group, we performed the lateral pharyngoplasty (15 cases), and in the other, we did the UPPP (12 cases). MEASUREMENTS AND RESULTS: We compared treatment outcomes through the evaluation of OSAHS-related symptoms and the analysis of polysomnographic tests and computed tomography measurements of pharyngeal airway. The lateral pharyngoplasty group achieved a statistically greater reduction in body weight, excessive daytime sleepiness, and apnea-hypopnea index. In addition, only in this group did we observe a statistically significant increase in the amount of deep sleep stages and improvement in morning headaches. Patients from the UPPP group did not present significant changes in the polysomnographic parameters. Pharyngeal airway measurement outcomes were similar in both groups and did not reflect the clinical and polysomnographic differences we observed. CONCLUSIONS: Lateral pharyngoplasty produces better clinical and polysomnographic outcomes in the treatment of OSAHS than does UPPP, without resultant differences in the cross-sectional measurements of the pharyngeal airway between these treatments.

Abscesso retrofaríngeo pós adenoidectomia / Retropharyngeal abscess after adenoidectomy

Neste trabalho descreveremos um caso de abscesso retrofaríngeo associado à subluxaçäo atlanto-axial pós adenoidectomia. O paciente apresentou evoluçäo favorável com a instituiçäo de antibioticoterapia sistêmica e drenagem cirúrgica. Este tipo de complicaçäo ocorrida após adenoidectomia é bastante rara, devendo o otorrinolaringologista estar atento à mesma. As principais causas de abscesso retrofaríngeo encontradas na bibliografia form: trauma e ingestäo de corpo estranho. As principais complicaçöes pós adenoidectomia encontradas incluiam sangramento, reaçöes referentes ao agente anestésico, hipernasalidade, otalgia, cervicalgia e estenose nasofaríngea.