Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.488
Filtrar
1.
Int J Oral Maxillofac Surg ; 49(2): 200-206, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31272901

RESUMO

The aim of this study was to investigate the efficacy of platelet-rich fibrin (PRF) in decreasing the incidence of wound breakdown in relocation pharyngoplasty performed for the treatment of obstructive sleep apnoea (OSA). This prospective clinical study included 30 OSA patients. They were divided into two groups according to a random table. One group underwent classic relocation pharyngoplasty as described by Li and Lee in 2009. The other group underwent relocation pharyngoplasty with the placement of PRF before suturing. The main outcomes measured during follow-up were the degree of postoperative pain (assessed using a visual analogue scale), wound dehiscence, and the time taken to return to a normal diet after surgery. There was a statistically significant difference in wound dehiscence, with less dehiscence in the PRF group (P=0.013). There was less pain on days 3, 5, and 10 postoperatively in the PRF group (P<0.001). The time taken to return to a normal diet was lower in the PRF group (P=0.001). There was a reduction in apnoea-hypopnoea index (AHI) at 6 months postoperative for all patients. PRF is a powerful bioactive tissue healing material that can provide an important option to decrease the incidence of palatal wound breakdown in relocation pharyngoplasty and in other palatal procedures.


Assuntos
Faringe , Fibrina Rica em Plaquetas , Apneia Obstrutiva do Sono , Humanos , Palato , Faringe/cirurgia , Estudos Prospectivos , Apneia Obstrutiva do Sono/cirurgia
2.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31801377

RESUMO

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Assuntos
Analgésicos/uso terapêutico , Anestesiologia , Anestésicos/uso terapêutico , Antieméticos/uso terapêutico , Pediatria , Padrões de Prática Médica , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Acetaminofen/uso terapêutico , Adenoidectomia , Extubação/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Fentanila/uso terapêutico , Humanos , Midazolam/uso terapêutico , Morfina/uso terapêutico , Óxido Nitroso/uso terapêutico , Ondansetron/uso terapêutico , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
3.
Ann Otol Rhinol Laryngol ; 129(1): 18-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31409097

RESUMO

INTRODUCTION: Transpalatal advancement (TPA) is a procedure that is used when modern variants of uvulopharyn-gopalatoplasty are unable to provide enough anterior traction. Although successful in reduction of obstructive sleep apnea (OSA) parameters, it also comes with procedure-specific risks. Formation of an oro-nasal fistula (ONF) is a complication that results in significant morbidity and a protracted treatment course. METHODS: After approval from the University of Wollongong Health Research Ethics Committee, a retrospective chart review of all cases undergoing TPA performed by a single surgeon over a 10-year period from 2008 to 2018 was performed. Patients underwent pre- and postoperative level 1 or 2 polysomnography. Factors potentially contributing to palatal complications, as well as pre- and postoperative polysomnographic parameters, subjective sleep questionnaires, and body mass index (BMI) were statistically analyzed where a P value <.05 was considered a significant result. RESULTS: A total of 59 patients were included. Overall palatal complication rate was 25.4% (15/59), with the most common being transient velo-palatal insufficiency (VPI) (8/59, 13.6%). ONF developed in 4/59 (6.8%) of patients. None of the analyzed contributing factors for palatal complications were statistically significant, except the presence of a high-arched palate and development of ONF. All analyzed sleep parameters, as well as BMI, were significantly different when comparing pre- to postoperative results. CONCLUSION: This study suggests that TPA has a role in current sleep surgery paradigms and can significantly improve both objective and subjective outcome measures of OSA. Surgeons contemplating TPA on patients with high-arched hard palates should do so with caution.


Assuntos
Doenças Nasais/epidemiologia , Fístula Bucal/epidemiologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Complicações Pós-Operatórias/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Insuficiência Velofaríngea/epidemiologia , Adulto , Idoso , Causalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 830-836, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795544

RESUMO

Objective: To study the effect on immune indexes in children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after resection of adenoid and/or tonsil. Methods: A total of 100 children with OSAHS due to adenoid hypertrophy were enrolled in Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Dalian Medical University from December 2016 to December 2018. Some cases were complicated with tonsil hypertrophy or chronic tonsillitis. 6 ml of fasting peripheral venous blood were collected from all subjects at the 1st day before surgery, 4th day, 1 month, 3 months and 6 months after surgery to detect lymphoid subsets percentage (CD3(+), CD4(+),CD8(+), CD4/CD8, CD19, NK) and level of immunoglobulin (IgG, IgA, IgM). Grouping: group A was a total of 51 cases with adenoid hypertrophy after Adenoid plasma ablation; group B was a total of 27 cases with adenoid hypertrophy and chronic tonsillitis after plasma ablation of adenoid and tonsil; and group C was a total of 22 cases hypertrophy of adenoid and tonsil after plasma ablation of adenoid and tonsil.In the baseline data, age, gender and other variables were analyzed by anova and chi-square test, repeated measurement anova was used for intra-group and inter-group comparison of observation indicators at different time points after operation, and independent sample t-test was used for comparison between the two groups at observation points 3 months after operation. Results: (1) In group A, the percentage of CD19 lymphocytes before surgery was higher than that at 4th day after surgery, and the difference was statistically significant (21.85±6.20 vs.19.18±5.91, P<0.05). The other immune indexes were not statistically different before and after surgery (P>0.05). (2) In group B, the percentage of CD19 lymphocytes, CD3(+)T lymphocytes, CD8(+)T lymphocytes and the level of IgG at 4th day after surgery were significantly different between those before surgery (all P<0.05). At the 1st month after surgery, the percentage of CD3(+)T lymphocytes, CD8(+)T lymphocytes, CD19 lymphocytes and the level of IgG were significantly different between those before surgery (all P<0.05). The other immune indexes were not statistically different before and after operation (P>0.05). (3) In group C, the percentage of CD19 lymphocytes and the CD3(+)T lymphocytes at 4th day after surgery were significantly different between those before surgery (all P<0.05).In the 1st month after surgery, the percentage of CD8(+)T lymphocytes and CD19 lymphocytes were significantly different between those before surgery (all P<0.05). The other immune indexes were not statistically different before and after operation (P>0.05). (4) Among three groups, the percentage of CD4(+)T lymphocytes, the levels of IgG and IgA before surgery between group A and Group B were statistically significant (all P<0.05). At 4th day after surgery, the percentage of CD4(+)T lymphocytes in group B and C were lower than those in group A, and the differences were statistically significant (32.22±6.14, 32.36±6.87 vs. 36.36±5.19, all P<0.05); the other immune indexes were not statistically different among each group before and after surgery (P>0.05). Conclusions: Resection of adenoid has no significant effect on the immune indexes in children with OSAHS. The children with OSAHS complicated with tonsil problems have immune index disorder before surgery. Surgery has a certain effect on the immune indexes of children with OSAHS in a short period of time, and tends to normal level after one month.


Assuntos
Tonsila Faríngea/cirurgia , Antígenos de Diferenciação de Linfócitos T/imunologia , Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/imunologia , Apneia Obstrutiva do Sono/cirurgia , Subpopulações de Linfócitos T/imunologia , Adenoidectomia , Tonsila Faríngea/imunologia , Tonsila Faríngea/patologia , Antígenos de Diferenciação de Linfócitos T/sangue , Criança , Humanos , Hipertrofia , Isotipos de Imunoglobulinas/sangue , Isotipos de Imunoglobulinas/imunologia , Contagem de Linfócitos , Tonsila Palatina/imunologia , Tonsila Palatina/patologia , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/etiologia , Tonsilectomia
5.
J Craniomaxillofac Surg ; 47(12): 1848-1854, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810851

RESUMO

PURPOSE: The aim of this study was to evaluate the impact of extubation time on postoperative complications in patients undergoing bimaxillary orthognathic surgery. We therefore retrospectively compared the effect of early extubating (EE) in the operating room versus delayed extubating (LE) on the intensive care unit (ICU) regarding postoperative complications and length of ICU/hospital stay (LOICUS/LOHS). Furthermore, we analyzed the influence of the PAS change on postoperative complications. METHODS: The clinical data of 117 patients were retrospective analyzed regarding postoperative complications using Clavian-Dindo Classification. Volumetric calculations of the pre- and postoperative PAS were conducted using ITK-SNAP software. The Fisher's exact test was performed to evaluate the significance of differences between categorical variables. Continuous variables were analyzed using the Mann-Whitney U-Test or the Kruskal-Wallis one-way analysis of variance. Regression analysis was used estimating predictors for postoperative complications. RESULTS: EE led to significant shortening of LOICUS (p < 0.001) and LOHS (p = 0.023). In total, we recorded 38 complications (minor n = 30; major n = 8) within the hospital stay. Complication rates were without significant differences with respect to the postoperative ventilation strategy. Large changes in PAS volume led to an increase in the major complication rates (p = 0.031). Increase or decrease of PAS was independent from postoperative complication rates (p = 1.000). Higher body mass index (p = 0.04) and a higher ASA PS score (p = 0.016) were associated with increased major complication rates. CONCLUSION: Early extubation after surgery is a safe procedure and is associated with a reduced LOICUS and LOHS. Complications seem to occur more frequently in marked changes of the PAS and should be considered in perioperative risk stratification.


Assuntos
Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Apneia Obstrutiva do Sono/cirurgia , Adolescente , Adulto , Extubação , Feminino , Humanos , Tempo de Internação , Masculino , Osteotomia Mandibular/efeitos adversos , Osteotomia Mandibular/métodos , Duração da Cirurgia , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos/métodos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Apneia Obstrutiva do Sono/etiologia
6.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 415-421, Out.-Dez. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1024301

RESUMO

Introduction: Upper airway obstruction at multiple sites, including the velum, the oropharynx, the tongue base, the lingual tonsils, or the supraglottis, has been resulting in residual obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (TA). The role of combined lingual tonsillectomy and tongue base volume reduction for treatment of OSA has not been studied in nonsyndromic children with residual OSA after TA. Objective: To evaluate the outcomes of tongue base volume reduction and lingual tonsillectomy in children with residual OSA after TA. Methods: A retrospective chart review was conducted to obtain information on history and physical examination, past medical history, findings of drug-induced sleep endoscopy (DISE), of polysomnography (PSG), and surgical management. Pre- and postoperative PSGs were evaluated to assess the resolution of OSA and to determine the improvement in the obstructive apnea-hypopnea index (oAHI) before and after the surgery. Results: A total of 10 children (5 male, 5 female, age range: 10­17 years old, mean age: 14.5 ± 2.6 years old) underwent tongue base reduction and lingual tonsillectomy. Drug-induced sleep endoscopy (DISE) revealed airway obstruction due to posterior displacement of the tongue and to the hypertrophy of the lingual tonsils. All of the patients reported subjective improvement in the OSA symptoms. All of the patients had improvement in the oAHI. The postoperative oAHI was lower than the preoperative oAHI ( p < 0.002). The postoperative apnea-hypopnea index during rapid eye movement sleep (REM-AHI) was lower than the preoperative REM-AHI ( p = 0.004). Obstructive sleep apnea was resolved in children with normal weight. Overweight and obese children had residual OSA. Nonsyndromic children had resolution of OSA or mild OSA after the surgery. Conclusions: Tongue base reduction and lingual tonsillectomy resulted in subjective and objective improvement of OSA in children with airway obstruction due to posterior displacement of the tongue and to hypertrophy of the lingual tonsils (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Tonsilectomia , Adenoidectomia , Apneia Obstrutiva do Sono/cirurgia , Língua/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Registros Eletrônicos de Saúde
7.
J Craniomaxillofac Surg ; 47(12): 1839-1847, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31699397

RESUMO

This study aimed to compare the effectiveness and feasibility of inverted-L osteotomy (ILO) and sagittal split ramus osteotomy (SSRO) on obstructive sleep apnea (OSA) treatment. According to different surgery procedures, 28 OSA patients who underwent maxillomandibular advancement (MMA) were divided into 2 groups (group A: ILO, n = 9; group B: SSRO, n = 19). Polysomnography (PSG) and Epworth sleepiness scale (ESS) on T0, T1and T2 were used to evaluate the effectiveness of OSA treatments. Patients' airway structures and facial appearances were also evaluated. From T0 to T1, the mean apnea-hypopnea index (AHI,/per hour) dropped from 69.2 ± 8.4 to11.2 ± 2.4 (P < 0.01) in group A and from 54.6 ± 14.6 to 9.4 ± 5.4 (P < 0.01) in group B; LSpO2 (lowest pulse oxygen saturation, %) increased from 66.5 ± 7.7% to 88.2 ± 4.6 (P < 0.01) and from 76.6 ± 10.7%to 89.4 ± 2.4% (P < 0.01) while the mean ESS score decreased by 51% in group A and 44% in group B. Most patients (group A: 88.9%; group B: 84.3%) were satisfied with their postoperative appearance. Mild relapse was observed in both groups on T2. This study concluded that MMA containing ILO and MMA containing SSRO are both feasible and effective for selected OSA patients.


Assuntos
Avanço Mandibular/métodos , Osteotomia Sagital do Ramo Mandibular , Apneia Obstrutiva do Sono/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Maxila/cirurgia , Osteotomia/métodos , Polissonografia , Estudos Retrospectivos , Resultado do Tratamento
8.
Artigo em Chinês | MEDLINE | ID: mdl-31623035

RESUMO

Objective:To explore the effect of surgical treatment for OSA with laryngopharyngeal reflux(LPR). Method:A retrospective analysis was made in 42 patients diagnosed as moderate to severe OSA with LPR and treated with modified-coblation assisted Uvulopalatopharyngoplasty(M-CAUP). The results of PSG, reflux symptom index(RSI), reflux finding score(RFS) and 24-hour esophageal pH monitoring before and after operation were compared. Result:The AHI after operation was significantly lower than that before operation(P<0.05), and the average oxygen saturation and minimum blood pressure saturation were increased(P<0.05). The total scores of RSI and RFS after operation were lower than those before operation(P<0.05). The percentage of time of pH<4.0 in esophagus 24 hours after operation was lower than that before operation(P<0.05). Conclusion:For patients with moderate to severe OSA combined with LPR with oropharyngeal obstruction, surgical treatment can not only reduce airway stenosis and obstruction, but also improve the symptoms and signs of LPR.


Assuntos
Refluxo Laringofaríngeo/complicações , Apneia Obstrutiva do Sono/cirurgia , Monitoramento do pH Esofágico , Humanos , Faringe , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações
10.
Artigo em Chinês | MEDLINE | ID: mdl-31434375

RESUMO

Objective: To investigate the effect of nasal cavity ventilation expansion techniques in treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with nasal obstruction. Methods: Thirty-two OSAHS patients with nasal obstruction hospitalized from January 2017 to January 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital Affiliated to Anhui Medical University were selected, with 28 males and 4 females, aged 40.3±8.5 years old (x±s), and treated with individualized nasal cavity ventilation expansion techniques. Nasal acoustic reflex and resistance examination, polysomnography (PSG) monitoring were performed before and three months after operation. Nasal obstruction symptom evaluation (NOSE) and Quebec sleep questionnaire (QSQ) were completed as well. The nasal acoustic reflex, nasal resistance, NOSE, QSQ score, apnea hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO(2)) before and after operation were compared and analyzed. SPSS 22.0 software was used for statistical analysis. Results: After the operation, the total nasal resistance and total score of NOSE scale of patients decreased significantly as well as the total score of QSQ scale increased significantly ((0.140±0.043) kPa·s/L vs (0.277±0.067) kPa·s/L, 9.84±4.11 vs 53.00±11.57, 5.67±0.43 vs 3.86±0.46, t value was 10.687, 18.035, -16.904, respectively, all P<0.05), and the scores of five dimensions increased in varying degrees. Among the indexes of PSG, there was no significant difference in AHI and LSaO(2) values before and after operation, but AHI decreased and LSaO(2) increased. Conclusion: Nasal cavity ventilation expansion techniques can effectively alleviate the symptoms of nasal obstruction in OSAHS patients and improve their sleep and quality of life.


Assuntos
Cavidade Nasal/cirurgia , Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Apneia Obstrutiva do Sono/cirurgia , Adulto , Técnicas de Diagnóstico do Sistema Respiratório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Polissonografia , Qualidade de Vida , Reflexo Acústico , Apneia Obstrutiva do Sono/diagnóstico
12.
Int J Pediatr Otorhinolaryngol ; 126: 109600, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382217

RESUMO

OBJECTIVE: Velopharyngeal stenosis (VS) is a rare devastating complication of adenotonsillectomy that causes obstructive sleep apnea (OSA). Its treatment is challenging and has a high recurrence rate. The aim of this study was to assess the efficacy of a bivalved uvular flap technique with topical application of mitomycin C for treatment of this problem. STUDY DESIGN: Case series. METHODS: Fourteen children with VS after adenotonsillectomy were treated with a bivalved uvular flap technique with application of mitomycin C after release of the adhesions and removal of scar tissue. Preoperative and postoperative evaluation of patients were performed. Flexible nasopharyngoscopy was used to assess the patency of the velopharynx, and apnea/hypopnea (A/H) index and minimum O2 saturation were measured before and after surgery. RESULTS: Adequate patent airway was obtained in all patients as seen by oropharyngeal examination and flexible nasopharyngoscopy. Additionally, significant improvement in A/H index and minimum O2 saturation were achieved postoperatively. CONCLUSION: The bivalved uvular flap technique with topical application of mitomycin C after removal of scar tissue is an effective treatment for VS that may follow adenotonsillectomy in children.


Assuntos
Adenoidectomia , Doenças Faríngeas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/cirurgia , Retalhos Cirúrgicos/transplante , Tonsilectomia , Úvula/transplante , Criança , Pré-Escolar , Terapia Combinada , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Mitomicina/uso terapêutico , Inibidores da Síntese de Ácido Nucleico/uso terapêutico , Doenças Faríngeas/etiologia , Apneia Obstrutiva do Sono/etiologia , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Resultado do Tratamento
13.
Acta otorrinolaringol. esp ; 70(4): 215-221, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185398

RESUMO

Objetivos: El objetivo de este estudio es presentar las indicaciones y resultados de la faringoplastia de expansión como tratamiento del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). En segundo lugar, comparar los hallazgos de la somnoscopia (drug-induced sleep endoscopy –DISE-) antes y después de la cirugía. Material y métodos: El diseño del estudio fue una cohorte prospectiva de pacientes tratados quirúrgicamente de 2015 a 2016. Todos los pacientes fueron diagnosticados de SAHOS leve a grave y no toleraban la CPAP. Todos tenían DISE y polisomnografía previa a la cirugía, y posterior a la misma. Los criterios de inclusión fueron la edad, entre 18 años y 70 años, amígdalas pequeñas (tamaños 1 y 2), estadio clínico de Friedman II y III, y colapso lateral mayoritario en la DISE preoperatoria. Se les realizó únicamente cirugía del paladar, usando la técnica de faringoplastia de expansión. Resultados: Se incluyeron 17 pacientes, el 52,94% eran pacientes con SAHOS grave. La edad media fue de 42 años, el índice de masa corporal media fue de 28. La tasa de éxito quirúrgico según los criterios de Sher fue del 82,35%. El 41,17% presentó un índice de apnea-hipopnea postoperatoria inferior a 10. El 75% de los pacientes lograron no tener que usar la CPAP. Conclusión: La faringoplastia de expansión es una técnica segura como tratamiento del SAHOS en pacientes con amígdalas pequeñas, grado Friedman I y II y colapso de paredes laterales en somnoscopia, en ausencia de colapso multinivel. La DISE postoperatoria demostró la mejoría del colapso lateral obtenida con la expansión


Objectives: The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery. Material and methods: The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty. Results: Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP. Conclusion: Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Músculos Faríngeos/cirurgia , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Obstrução das Vias Respiratórias/cirurgia , Endoscopia/métodos , Polissonografia , Estudos Prospectivos , Sono/efeitos da radiação , Medicamentos Indutores do Sono/farmacologia , Técnicas de Sutura , Resultado do Tratamento
14.
Artigo em Chinês | MEDLINE | ID: mdl-31327203

RESUMO

Objective:TThe aim of this study is to investigate the effect of in vitro cultured Calculus Bovis on the inflammation of oropharynx and body in patients with OSA during the perioperative period of H-UPPP.Method:Eighty patients with OSA and H-UPPP indications were enrolled. The patients were divided into experimental group and control group by random number table, 40 cases in each group. The experimental group was given in vitro cultured Calculus Bovis, while the control group was not given bovine bezoar in vitro. The postoperative oropharyngeal pain, time to resume normal diet, local edema, concentration of IL-1ß, IL-8 and TNF-α in saliva, and concentration of IL-1ß, IL-8 and TNF-α in blood were compared between the two groups. Result:The pain of oropharynx in the experimental group was lighter than that in the control group on the 3rd, 5th and 7th day after operation (P<0.05), but there was no significant difference in the pain of oropharynx between the two groups on the 1st day after operation(P>0.05); the time of restoring normal diet in the experimental group was shorter than that in the control group (P<0.05); the edema of oropharynx in the experimental group was lighter than that in the control group on the 5th and 7th day after operation (P<0.05).The levels of IL-1ß, IL-8 and TNF-α in saliva were lower than those in control group on the 3rd, 5th and 7th day after operation (P<0.05), and the levels of IL-1ß, IL-8 and TNF-α in blood on the 5th and 7th day after operation were lower than those in control group (P<0.05).Conclusion:In vitro perioperative period of H-UPPP can improve the postoperative sore throat and local edema of oropharynx, shorten the time of normal diet and reduce the expression of related inflammatory factors in oropharynx and blood.


Assuntos
Ácidos Cólicos/uso terapêutico , Inflamação/prevenção & controle , Materia Medica/uso terapêutico , Orofaringe/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Apneia Obstrutiva do Sono/cirurgia , Animais , Bovinos , Humanos , Interleucina-1beta/análise , Interleucina-8/análise , Período Pós-Operatório , Fator de Necrose Tumoral alfa/análise
15.
Int J Pediatr Otorhinolaryngol ; 125: 141-146, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306896

RESUMO

OBJECTIVES: 1. To compare outcomes after tonsillectomy for pediatric patients with obstructive sleep apnea (OSA) given morphine intra-operatively and post operatively compared to those who were not - specifically Recovery Room (RR) time, length of stay (LOS), Emergency Department (ER) visits. STUDY DESIGN: Retrospective case series with chart review. SETTING: Tertiary care children's hospital. SUBJECTS AND METHODS: All children between 1 and 17 years old who had undergone tonsillectomy in a single institution from 2013 to 2016. Comparison between children who had received morphine intra-operatively was made for outcomes. RESULTS: 556 patients were included, 73 patients had morphine intraoperatively and 483 did not; these latter children were older (8.8 vs 6.5 years, P < 0.001), and had fewer episodes of obstructive apnea and hypopnea (AHI 4.47 vs 10.15, p = 0.003) than children who did not receive intra-op morphine. There were no differences in co-morbidities including asthma, whether they had a sleep study, time in the operating room, emergence time, RR time, airway complications, IMC/PICU admission for respiratory distress, ER visits, readmissions, bleeding or post-discharge nurse phone calls. There was a longer LOS (25.9 vs 21.4 h, P = 0.011) for the group receiving intra-op morphine. CONCLUSION: Children with OSA who receive intra-op morphine have a longer LOS suggesting that its use should be examined more closely in this population.


Assuntos
Adenoidectomia/efeitos adversos , Analgésicos Opioides/administração & dosagem , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Hospitalização , Humanos , Lactente , Tempo de Internação , Masculino , Dor Pós-Operatória/etiologia , Polissonografia , Estudos Retrospectivos , Resultado do Tratamento
16.
Acta Otolaryngol ; 139(9): 793-797, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268381

RESUMO

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular comorbidities including hypertension, arteriosclerosis, and heart failure. Uvulopalatopharyngoplasty (UPPP) is a frequently performed surgical treatment for OSA. Aims/Objectives: To analyze if UPPP can improve cardiac parameters associated with atherosclerosis and reduce the cardiac burden in OSA patients. Material and methods: A prospective cohort study was performed at a single tertiary care center where OSA patients undergoing UPPP were evaluated. Preoperative and 6-month postoperative cardiac parameters namely carotid artery intima-media thickness (CIMT), arterial stiffness parameters, echocardiography, and polysomnography (PSG) results were compared. Results: Fifty three patients were included in the study. The success and response rate of UPPP was 60.4%. Following the surgery, significant reduction in arterial stiffness index (ß) (12.4 ± 4.1 vs. 11.2 ± 4.0, p = .01), and elasticity modulus (Ep) (172.8 ± 68.3 vs. 156.6 ± 55.3, p = .05) was noticed. Additionally, echocardiographic parameters namely velocity across aortic valve (121.9 ± 22.9 vs. 109.4 ± 17.7, p = .01) and velocity across pulmonary valve (107.4 ± 16.4 vs. 94.2 ± 16.9, p < .01) significantly decreased following UPPP. Conclusions and significance: UPPP significantly improves parameters related to carotid atherosclerosis and has the potential to reduce cardiac burden in OSA patients.


Assuntos
Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia , Adulto , Aterosclerose/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Espessura Intima-Media Carotídea , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole/cirurgia , Faringe/cirurgia , Polissonografia/métodos , Estudos Prospectivos , Medição de Risco , Apneia Obstrutiva do Sono/diagnóstico , Centros de Atenção Terciária , Resultado do Tratamento
17.
J Laryngol Otol ; 133(7): 622-626, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31288877

RESUMO

BACKGROUND: Barbed pharyngoplasty aims to reduce lateral retropalatal obstruction by pulling up the soft palate anterolaterally. However, barbed pharyngoplasty can be less efficient in some cases of obstructive sleep apnoea, especially in the presence of an elongated uvula with redundant tissues over it. This paper describes an attempt to overcome this drawback by modifying barbed pharyngoplasty, using a single continuous suture technique. METHODS: Thirty-four patients were assigned to two groups based on the surgical procedure performed. Those with an elongated uvula were treated with modified barbed pharyngoplasty (n = 17); the others were treated with barbed pharyngoplasty (n = 17). Pre- and post-operative quality of life questionnaires, and questionnaires concerning diet, pain and return to activity, were completed. Pre- and post-operative polysomnography was performed as an objective measurement. RESULTS: There was no significant difference between barbed pharyngoplasty and modified barbed pharyngoplasty in terms of outcomes. However, reductions in the apnoea/hypopnea index, Epworth Sleepiness Scale and snoring visual analogue scale scores were greater in the modified barbed pharyngoplasty group. CONCLUSION: Modified barbed pharyngoplasty is a safe and feasible method, and eliminates the need for surgical resection of the redundant soft tissues around the uvula while lifting up the uvula base.


Assuntos
Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole , Estudos Prospectivos , Qualidade de Vida , Técnicas de Sutura , Resultado do Tratamento
18.
Artigo em Chinês | MEDLINE | ID: mdl-31262106

RESUMO

Objective: To investigate the effect of genioglossus (GG) activation at sleep onset on the outcome of velopharyngeal surgery in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods: Thirty-five patients between April 2014 and February 2015 in Beijing Tongren Hospital with OSAHS underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intraoral electrodes. The upper airway (UA) anatomy was evaluated by three-dimensional computer tomography (3D-CT) in OSAHS patients. Then, all of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty (UPPP) with uvula preservation or UPPP combined transpalatal advancement pharyngoplasty. All patients were followed-up using polysomnography 3-6 months after surgery. T-test or Wilcoxon test were used to compare the variables between groups, and Spearman correlation analysis was used to test the correlation between parameters. Results: Thirty-five patients received velopharyngeal surgery. Twenty-two patients (62.86%) were responders, and 13 patients (37.14%) were non-responders. Responders had a higher mean GGEMG during sleep onset (15.31±3.74 vs. 9.92±2.93, t=4.504, P=0.001). The decreased AHI was significantly positively related to the sleep onset mean GGEMG (r=0.541, P=0.004) and the change in GGEMG (r=0.422, P=0.028). The decreased AHI was significantly negatively related to the minimal cross sectional airway area (mCSA,ρ=0.629,P=0.000) and the minimal lateral airway dimension (mLAT, ρ=0.484, P=0.009) at velopharynx. Conclusions: The outcome of velopharyngeal surgery was affected by the mean GGEMG during sleep onset. We speculated that the patient with higher GGEMG at sleep onset and narrower velopharynx were more suitable candidates for velopharyngeal surgery.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/cirurgia , Língua/fisiopatologia , Eletromiografia , Humanos , Imagem Tridimensional , Palato/diagnóstico por imagem , Palato/cirurgia , Faringe/diagnóstico por imagem , Faringe/cirurgia , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Tomografia Computadorizada por Raios X , Língua/diagnóstico por imagem , Resultado do Tratamento , Úvula/diagnóstico por imagem , Úvula/cirurgia
19.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 33(6): 565-566;576, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31163538

RESUMO

Summary The patient was admitted with the complain about sleep snoring with suffocation last for half a year. Adenotonsillectomy was performed. Preoperative examination showed that there was no respiratory infection, or other surgical contraindications. The process of operation was successful. One day after surgery, the child developed chest pain and fever. Chest CT showed left lobar pneumonia. After Bronchoscopy and alveolar lavage and antibiotic use, the symptom was improved. General anesthesia and surgery were the cause of pneumonia. This case showed the association between lower respiratory tract infection and obstructive pathophysiological changes in the upper respiratory tract, and the possibility of complicated lobar pneumonia after adenotonsillectomy in children with OSA..


Assuntos
Adenoidectomia , Pneumonia , Apneia Obstrutiva do Sono , Tonsilectomia , Adenoidectomia/efeitos adversos , Criança , Humanos , Pneumonia/etiologia , Apneia Obstrutiva do Sono/cirurgia , Ronco , Tonsilectomia/efeitos adversos
20.
Am J Orthod Dentofacial Orthop ; 155(6): 791-800, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31153499

RESUMO

INTRODUCTION: The assessment of the volumetric changes of the airways after adenotonsillectomy has gained popularity among orthodontists, but the validity of such evaluation is not clear. METHODS: Thirty patients with obstructive sleep apnea diagnosed with the use of polysomnography (PSG) were evaluated according to the Apnea and Hypopnea Index (AHI), the obstructive apnea index (OAI), the oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO2), and the average oxygen saturation (ASpO2). The volume and the minimal cross-section of lower (oropharynx and velopharynx) and upper (nasopharynx) spaces of the airways were calculated. Patients were adenotonsillectomized; posttreatment data were collected after 12 months. Thirty comparison patients also had the volume of airways evaluated. RESULTS: A statistically significant improvement (P < 0.05) of most PSG parameters was observed after adenotonsillectomy: AHI from 14.5 to 5.2, OAI from 9.4 to 5.5, ODI from 14.6 to 6.5, and LSpO2 from 77% to 94%). A significant increase in airway volume of the lower space (from 2571.5 mm3 to 5276.3 mm3) and the upper space (from 726 mm3 to 1056.9 mm3), as well as in the minimal cross-section of the airways (from 98.5 mm2 to 335.8 mm2) was found in adenotonsillectomy patients. No significant volumetric changes of the airways were observed in the comparison patients. No significant correlation was found between PSG parameters and the dimensions of the airways before adenotonsillectomy. No significant correlation was found between changes of the PSG parameters and changes of the dimensions of the airways 12 months after the adenotonsillectomy. CONCLUSIONS: Adenotonsillectomy contributed to the increase of the airway volume and minimal cross-section, and to the improvement of the PSG parameters, but there was no correlation between the magnitude of the anatomic changes and the improvement of the breathing mode.


Assuntos
Adenoidectomia , Faringe/anatomia & histologia , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Brasil , Criança , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Faringe/diagnóstico por imagem , Polissonografia , Interpretação de Imagem Radiográfica Assistida por Computador , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA