Long-term quality of life outcomes of maxillomandibular advancement osteotomy in patients with obstructive sleep apnoea syndrome.

This study was performed to evaluate the long-term impact of maxillomandibular advancement (MMA) surgery on the apnoea-hypopnoea index (AHI) and quality of life (QoL) in patients with obstructive sleep apnoea syndrome (OSAS). The medical files of 12 OSAS patients who underwent MMA by one surgeon between 1995 and 1999 were reviewed retrospectively. Patients received a clinical assessment, polysomnography, and QoL questionnaires as part of routine care preoperatively (n=12), within 2 years postoperative (n=12), and again in 2016 (n=9). A successful surgical outcome was defined as an AHI decrease of >50% with <20 events/h. Of the 66.7% (8/12) of patients who were initially cured, 66.7% (4/6) remained stable at a median follow-up of 19 years. Only the two patients with the highest AHI showed abnormal Epworth Sleepiness Scale scores. After convalescence, most patients reported stable symptomatic improvement. Aesthetic changes were found acceptable and all but one patient stated that they would undergo the surgery again. It is concluded that MMA is a safe and effective procedure. Ageing and weight gain might counterbalance the positive effects of surgery in the long term. It is therefore suggested that re-evaluation every 5 years should be scheduled, since a spontaneous AHI increase over time does not seem to be reflected by symptomatic changes.

Three-dimensional volumetric changes in the upper airway after maxillomandibular advancement in obstructive sleep apnoea patients and the impact on quality of life.

Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder, characterized by repetitive airway obstructions, causing disruptive snoring and daytime sleepiness. Maxillomandibular advancement (MMA), which enlarges the upper airway, is a therapeutic surgical approach. However, no study has performed an upper airway sub-region analysis using validated three-dimensional (3D) anatomical and technical limits on cone beam computed tomography (CBCT). Hence, this prospective, observational trial was performed to evaluate 3D volumetric changes in the upper airway according to validated 3D cephalometric landmarks, before and after MMA, for all patients with a polysomnography diagnosis of OSA (apnoea-hypopnoea index (AHI) ≥5). The secondary objective was to evaluate the impact of MMA on the AHI and in a subjective manner with the Epworth Sleepiness Scale (ESS) and OSA questionnaire. Eleven consecutive OSA patients were included. A significant volume increase in the oropharynx (P=0.002) and hypopharynx (P=0.02) was observed, in contrast to a non-significant volume reduction in the nasopharynx (P >0.05). The median AHI (P=0.03) and ESS score (P=0.004) decreased significantly as a result of surgery. In conclusion, MMA significantly enlarges the airway volume of the oropharynx and hypopharynx and is associated with improved quality of life.

[Neurostimulation in the treatment of chronic pain]. / Les techniques de neurostimulation dans le traitement de la douleur chronique.

Different types of neurostimulation are proposed essentially in cases of chronic neuropathic pain, non controlled by anticonvulsivants and antidepressants. The aim is usually to activate a failing inhibitory system, involved in the transmission and the modulation of the nociceptive stimulus. The site of stimulation (transcutaneous, spinal cord, thalamic) is choosen according to the severity of pain and especially the degree of lemniscal dysfunction evaluated by clinical and electrophysiological data. Transcutaneous electrical stimulation and spinal cord stimulation are efficient for neurogenic pain secondary to partial deafferentation. When dysfunction or lesion extend to the pre-ganglionic portion, it's preferable to propose stereotactic thalamic stimulation or central gyrus stimulation. The analgesic effect concerns permanent burning pain in the context of sensitive deafferentation: after distal nervous lesions, radicular, plexular or spinal lesions or after stroke with ischemic lesions along the nociceptive pathways. These different methods must only be proposed if there is a frequent clinical and technical monitoring.

[Prognostic factors of post-traumatic vegetative states: 522 cases]. / Facteurs pronostics des états végétatifs post-traumatiques: 522 cas.

Long-term prognosis of post-traumatic vegetative state (VS) remains poorly defined. Three kinds of data have been collected for 522 patients in VS 1 month after head injury: pre-traumatic data; early data, collected during the first two weeks after trauma; late data, collected one month or more after trauma. Statistical relationships have been searched for, between these data and outcome one year after trauma, according to the Glasgow Outcome Scale. Some late data appear as essential prognostic factors of VS: threat blink; complications; ventricular dilatation; motor score (Glasgow Coma Score); spontaneous eye movements. Pretraumatic data then take place: age; previous deficiencies. Other data (especially early data) seem to have a weaker influence or outcome.