Evaluation of upper airway obstruction in snoring patients using digital video stroboscopy.

Stroboscopy is routinely used in voice disorder clinics but its use in studying the mechanisms of upper airway obstruction in patients who snore has not yet been described. This study combines the use of stroboscopy during sleep nasendoscopy to evaluate the oscillations and vibrations observed during snoring in slow motion. In addition, we utilised the multi-dimensional voice programme simultaneously to study some of the acoustic parameters of snoring whilst visualising the dynamics of the upper airway. Forty-five patients with primary snoring or mild obstructive sleep apnoea were recruited at two different centres and underwent sleep nasendoscopy. The simultaneous use of acoustic analysis was included to ascertain whether sound analysis alone could replace the need for using the sedation endoscopy in these patients. The use of a stroboscopic light source indeed enhanced the visualisation during the procedure and some subtle aspects of the mechanisms of upper airway obstruction, such as vibrations of the posterior pharyngeal wall and mucosal waves were identified. Most of the patients in this study exhibited multilevel obstruction and thus acoustic analysis alone would not be sufficient in accurately locating the site of upper airway obstruction in snorers.

Toothache: an unlikely presentation of secondary breast malignancy.

An 81-year-old female presented to the maxillo-facial department with a 6-month history of left-sided toothache and upper lip and cheek numbness. She had previously undergone a right mastectomy for breast adenocarcinoma, followed 6 years later by left mastectomy with pneumonectomy for contralateral breast and lung metastases. Following buccal biopsies and MRI of the head and neck, the patient was referred to our head and neck team. The MRI showed a large left maxillary sinus mass and transnasal endoscopic biopsies under general anaesthesia of this confirmed distant breast carcinoma metastasis. The patient was discussed at the Head and Neck Multidisciplinary Team meeting. Further surgical resection was not thought appropriate and the patient has subsequently undergone curative dose radiotherapy to the face. She remains alive with symptom control 8 months following this presentation.

Essential oil compositions of three Lantana species from Monteverde, Costa Rica.

The leaf essential oils of three species of Lantana from Monteverde, Costa Rica (L. camara, L. velutina, and L. hirta) were obtained by hydrodistillation and the chemical compositions determined by GC-MS analysis. The principal components of L. velutina were limonene (21.4%), (E)-caryophyllene (23.4%) and bicyclogermacrene (8.2%). The leaf oil composition of L. hirta was relatively simple, containing mostly 1-octen-3-ol (64.6%), germacrene D (24.5%), and (E)-caryophyllene (10.9%). Two different samples of L. camara, however, yielded vastly different leaf oil compositions; one was dominated by sesquiterpenes, (E)-caryophyllene (30.3%), gamma-muurolene (27.2%), bicyclogermacrene (24.4%) and beta-elemene (14.2%); the second sample, on the other hand, was composed largely of fatty acid-derivatives, (Z)-3-hexenol and 1-octen-3-ol. The very different compositions for L. camara are consistent with the wide diversity of chemical compositions observed in previous reports for this species.