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1.
Artigo em Chinês | MEDLINE | ID: mdl-32086898

RESUMO

Objective:To determine whether taking spirolactone orally after H-UPPP may relieve laryngeal edema and complications for patients with obstructive sleep apnea(OSA). Method:Fifty patients with OSA to undergo H-UPPP operation were randomly divided equally to the intervention group(taking spirolactone 20 mg orally twice a day for 7 days after H-UPPP) or the control group, all patients received conventional therapy after H-UPPP including anti-infection, hemostatic treatment, fluid replacement and expectorant by fogged absorption. The pharyngeal wound, diet, sleep and speaking pronunciation of all patients in each group were evaluated every other day in 7 days postoperation. The minimum oxygen saturation of blood(SaO2) during sleep at night each day and the period needed for staphyledema resolution of all patients were recorded and compared between each group. Result:Postoperatively, the intervention group had significantly slighter bleeding at wound site, better sleep and more legible speaking pronunciation than the control group after 3 days to 5 days(P<0.05). The wound dehiscence of the intervention group was significantly slighter than the control group within 7 days after operation(P<0.05). During 3 days to 7days after operation, the intervention group had a significantly better diet than the control group(P<0.05). The average minimum SaO2during sleep at night in the intervention group was significantly higher than that in the control group from 3 days to 5 days post operation(P<0.05). Period needed for staphyledema resolution in the intervention group(4.1±1.5) days was significantly shorter than that in the control group(5.9±1.8) days (P<0.05). Conclusion:Taking spirolactone orally after H-UPPP may relieve laryngeal edema and complications for OSA patients, and it will also shorten the period needed for staphyledema resolution.


Assuntos
Edema Laríngeo/tratamento farmacológico , Apneia Obstrutiva do Sono/cirurgia , Espironolactona/uso terapêutico , Humanos , Palato Mole/cirurgia , Faringe/cirurgia , Úvula/cirurgia
2.
J Laryngol Otol ; 134(1): 81-85, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31964457

RESUMO

BACKGROUND: Defining the risk factors for Eustachian tube dysfunction can facilitate its prevention. It is hypothesised that Eustachian tube dysfunction as measured by the Eustachian Tube Dysfunction Questionnaire-7 is associated with obstructive sleep apnoea syndrome. METHODS: The questionnaire was systematically translated into Hebrew and validated in the accepted manner. This questionnaire was applied to obstructive sleep apnoea syndrome patients before and after expansion sphincter pharyngoplasty, in pre-set time intervals. The results were compared to those of controls from the general population. RESULTS: Thirty-one patients (males:females = 19:12) were enrolled in the obstructive sleep apnoea syndrome group. Mean age was 43 years (range, 31-55 years) and mean body mass index was 28 kg/m2 (range, 27-30 kg/m2). Median apnoea-hypopnea index (pre-operatively) was 34 events per hour. The questionnaire scores in expansion sphincter pharyngoplasty candidates were significantly worse than in controls (p < 0.001). Expansion sphincter pharyngoplasty did not change Eustachian tube function in the long term, but was associated with additional self-limiting Eustachian tube dysfunction in the first two post-operative months. CONCLUSION: Eustachian tube dysfunction is significantly worse in patients with obstructive sleep apnoea syndrome compared to controls. Expansion sphincter pharyngoplasty is not associated with Eustachian tube function improvement.


Assuntos
Otopatias/fisiopatologia , Tuba Auditiva/fisiopatologia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/fisiopatologia , Faringe/cirurgia , Inquéritos e Questionários , Resultado do Tratamento
3.
Ann Otol Rhinol Laryngol ; 129(2): 201-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31609127

RESUMO

OBJECTIVES: Understand the utility and technique of injection pharyngoplasty with autologous fat for the treatment of mild to moderate velopharyngeal insufficiency in adults without a history of cleft palate. METHODS: Consecutive case series of 11 patients (mean [SD] 41 ± 21 years of age) who underwent injection pharyngoplasty with autologous fat from 2012 to 2018 at a tertiary care center. Patients were followed for a mean of 8.6 ± 8 months with pre versus postoperative evaluations of improvement in rhinophonia, dysphagia, and velopharyngeal closure by nasopharyngoscopy (scored: 0, none; 1, mild; 2, moderate; 3, near-complete; 4, complete). RESULTS: Patient selection and surgical techniques are described. Mean improvements were 2.3 ± 0.86 for rhinophonia, 2.0 ± 0.89 for dysphagia, and 3.0 ± 0.95 for velopharyngeal closure by nasopharyngoscopy. Five (45%) patients underwent subsequent intervention, including four repeat fat injections and three sphincter pharyngoplasties. There were two transient complications-donor site hematoma and subjective nasal obstruction. CONCLUSIONS: Although objective assessments are lacking to date, this is among the first reports to demonstrate the effectiveness and safety of injection pharyngoplasty with autologous fat for velopharyngeal insufficiency in a population of adults without a history of cleft. We found, on average, moderate improvement in rhinophonia and dysphagia, and near-complete improvement in velopharyngeal closure by nasopharyngoscopy; however, a portion of patients required subsequent intervention.


Assuntos
Tecido Adiposo/transplante , Faringe/cirurgia , Insuficiência Velofaríngea/cirurgia , Adulto , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
4.
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
5.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 837-842, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795545

RESUMO

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esôfago/cirurgia , Faringectomia/mortalidade , Faringe/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Neoplasias Esofágicas/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Fatores de Risco
6.
Eur Arch Otorhinolaryngol ; 276(12): 3413-3417, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520163

RESUMO

PURPOSE: Pharyngeal flap surgery used for treatment of velopharyngeal insufficiency (VPI) may be followed by obstructive sleep apnea (OSA) especially if the patient has developed adenoid hypertrophy. However, adenoidectomy may adversely affect speech in these patients. The aim of this study was to assess the effectiveness of transnasal endoscopic power-assisted adenoidectomy in relieving OSA in patients with adenoid hypertrophy who underwent pharyngeal flap surgery, and the impact of the procedure on their speech. METHODS: Transnasal endoscopic power-assisted adenoidectomy for nine children presenting with adenoid hypertrophy was performed. The patients had previously undergone pharyngeal flap surgery for treatment of VPI. Flexible nasopharyngoscopy was used in the diagnosis of adenoid hypertrophy. Pre- and postoperative polysomnography with measurement of apnea-hypopnea index (AHI) was done. Additionally, auditory perceptual assessment of speech (APA) and nasalance scores was measured pre- and postoperatively. RESULTS: All patients were shown to have OSA by polysomnography, and a larger adenoid size was significantly associated with a higher AHI. We achieved a significant improvement in AHI after adenoidectomy. However, six patients still demonstrated OSA, albeit with a reduced severity. Speech was not adversely affected postoperatively as the APA and nasalance scores showed non-significant changes. CONCLUSION: Adenoid hypertrophy may be encountered in children who undergo pharyngeal flap surgery, which may cause OSA. Transnasal endoscopic power-assisted adenoidectomy is a safe and effective method for treatment of OSA in those patients without prejudicing the pharyngeal flap, and it has no adverse effect on speech.


Assuntos
Adenoidectomia/métodos , Tonsila Faríngea/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Apneia Obstrutiva do Sono/etiologia , Insuficiência Velofaríngea/cirurgia , Tonsila Faríngea/patologia , Adolescente , Criança , Pré-Escolar , Endoscopia/efeitos adversos , Feminino , Humanos , Hipertrofia/cirurgia , Masculino , Faringe/cirurgia , Polissonografia , Complicações Pós-Operatórias , Apneia Obstrutiva do Sono/diagnóstico , Fala , Retalhos Cirúrgicos , Resultado do Tratamento
7.
World Neurosurg ; 132: e40-e52, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520759

RESUMO

BACKGROUND: Schwannomas encompassing the superior parapharyngeal space are challenging lesions because of the anatomical complexity of this region and the frequent involvement of the neurovascular structures of the jugular foramen. The purpose of this study is to report the technical aspects and the advantages of the anterolateral approach, here proposed for schwannomas of this complex area. METHODS: The main steps of the anterolateral approach are described in detail, along with the results of a consecutive series of 38 patients with a retrostyloid superior parapharyngeal schwannoma involving the jugular foramen operated on by means of this route between 1999 and 2019. RESULTS: The supine position is generally preferred. The medial border of the sternocleidomastoid muscle, mastoid tip, and superior nuchal line are the landmarks for the hockey-stick skin incision. The accessory nerve is retrieved and mobilized cranially. Detachment of the sternocleidomastoid, digastric, and nuchal muscles allows for a 180° exposure of the extracranial side of the jugular foramen. Three working corridors, namely the pre-carotid, pre-jugular, and retro-jugular, allow access to the deeper part of the jugular foramen area and the superior parapharyngeal space. In the present series, a gross total resection was achieved in 89.4% of the patients. Three recurrences occurred after an average follow-up of 80.5 ± 51 months. CONCLUSIONS: The anterolateral approach is highly effective in the treatment of retrostyloid superior parapharyngeal space schwannomas involving the jugular foramen. Its simplicity of execution, versatility, and very low morbidity are among its main strengths.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Faringe/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/epidemiologia , Músculos Faríngeos/anatomia & histologia , Músculos Faríngeos/cirurgia , Faringe/diagnóstico por imagem , Decúbito Dorsal , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Eur Arch Otorhinolaryngol ; 276(11): 2963-2973, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31486936

RESUMO

PURPOSE: Office-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings. METHODS: PubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed. RESULTS: Of 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial. CONCLUSION: Office-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Laringe/cirurgia , Salas Cirúrgicas/economia , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Faringe/cirurgia , Anestesia Geral/economia , Anestesia Local/economia , Humanos , Países Baixos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Estados Unidos
10.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 338-342, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040026

RESUMO

Abstract Introduction The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF). Objective In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL. Methods This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TLwas performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique. Results A total of 33 patients underwent TL, and 13 of themunderwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities (p = 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old (p = 1.00). Conclusions The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Faringe/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Grampeadores Cirúrgicos , Técnicas de Sutura/instrumentação , Resultado do Tratamento , Fístula Cutânea/prevenção & controle , Esôfago/cirurgia
11.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383687

RESUMO

Reconstruction of neopharynx after total laryngectomy is a challenging task. Various locoregional flaps like pectoralis major myocutaneos/ latismus dorsi flaps and free flaps have their own limitations and advantages. To overcome this, we used facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy (DK Gupta technique). This flap is thin, pliable, without any gravitational pull and without any risk of anastomosis failure and hence has advantage of both locoregional and free flaps and eliminates the limitations of both. It is simple, reproducible and reliable reconstructive option for neopharynx. We present a case report, review of literature and this novel technique for an excellent outcome and recommend to use it as the new workhorse of neopharyngeal reconstruction.


Assuntos
Retalhos de Tecido Biológico/transplante , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Faringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Artérias/transplante , Face/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade
12.
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
13.
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
14.
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
15.
Acta Otolaryngol ; 139(10): 902-907, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31282782

RESUMO

Background: Patients with severe obstructive sleep apnea (OSA) require safe and effective surgical treatment. Objectives: To evaluate the effectiveness of combined Z-palatopharyngoplasty (ZPPP) and partial glossectomy via 70-degree endoscopy-assisted coblation (Eco-TBR) on severe OSA. Materials and methods: Twenty-two consecutive patients with severe OSA were enrolled between September 2014 and July 2016. The lingual artery was evaluated by contrasted computed tomography (CT). Drug-induced sleep endoscopy (DISE) was performed to determine the necessity of multilevel surgery. Combined ZPPP and Eco-TBR were performed. Polysomnographic parameters were collected pre-operatively and 6 months post-operatively. Results: No adverse events were observed postoperatively. The short-term ( < 12 months) rate of total surgical effectiveness was 63.6% (14/22), with Friedman classifications as follows: I (1/1), Friedman II (6/10) and Friedman III (7/11). There were no differences between Friedman classification groups. The differences in AHI, apnea index (AI), mean blood oxygen, and percentage of cumulative time with oxygen saturation < 90% (CT 90%) were different compared to preoperative levels. Tonsil size was also significantly larger in the multi-level surgery group (2.14 ± 1.03) compared with the control group (1.13 ± 0.64). Conclusions and significance: Combined ZPPP and Eco-TB is safe and effective, with good surgical effectiveness for the treatment of severe OSA patients.


Assuntos
Endoscopia , Glossectomia , Palato/cirurgia , Faringe/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Apneia Obstrutiva do Sono/cirurgia , Resultado do Tratamento
16.
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
17.
Otolaryngol Head Neck Surg ; 161(3): 401-411, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31184261

RESUMO

OBJECTIVES: To evaluate the long-term efficacy and potential predictors of uvulopalatopharyngoplasty (UPPP) among adult patients with obstructive sleep apnea (OSA). DATA SOURCES: A systematic search was conducted through PubMed/Medline, Embase, Web of Science, and the Cochrane Library until December 2018. REVIEW METHODS: Full-text articles were selected that studied adult patients who underwent single-level UPPP or its modification for OSA and had a long-term follow-up (at least 34 months) with objective sleep study results. Studies that had no objective outcomes or performed other surgical procedures for OSA were excluded. RESULTS: Of 2600 studies, 11 were included. Meta-analysis comparing long-term post- and preoperative outcomes showed significant improvements, with an 15.4 event/h (46.1%) decrease of apnea-hypopnea index. Compared with the short-term outcomes (3-12 months), the long-term outcomes were less effective, with apnea-hypopnea index increasing 12.3 events/h (63.8%) and the surgical response decreasing from 67.3% to 44.35%. Subanalysis of individual patient data showed significant correlations of baseline body mass index, lowest arterial oxygen saturation, and proportion of sleep time with oxygen saturation <90% with long-term surgical response. CONCLUSIONS: Despite the surgical efficacy decreasing over time, UPPP and its modification are an effective surgical method for adult OSA in both the short term and the long term after the surgery. Baseline body mass index, lowest arterial oxygen saturation, and proportion of sleep time with oxygen saturation <90% were potentially predictive for long-term surgical response. Case-control studies of the long-term surgical effect of OSA are needed.


Assuntos
Palato Mole/cirurgia , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia , Adulto , Humanos , Resultado do Tratamento
18.
Eur Arch Otorhinolaryngol ; 276(8): 2345-2348, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31190222

RESUMO

BACKGROUND: "Barbed snore surgery" (BSS) represents one of the last innovation for obstructive sleep apnea syndrome (OSAS) surgical management. Although this technique represents an effective and minimally invasive surgery, it is not still widespread in many ENT centers. The aim of our study was to develop an inexpensive surgical simulator useful to expedite the surgical learning curve for BSS in untrained ENT surgeons. MODEL ASSEMBLY: The simulator is a simple model composed of a manually shaped silicone palate (3 × 4 × 1 cm) fixed on a resin skeleton (21 × 16 × 12 cm) using a transparent silicon rubber. The mandible is fixed bilaterally with the aid of two screws allowing for modular inter-incisive distance. SIMULATION: Barbed anterior pharyngoplasty (BAPh) was readily performed on the simulator to show the feasibility of this BSS model. All surgical steps were carried out determining a lift and a shortening of the palate as in real surgery. CONCLUSIONS: This is the first surgical model that provides a realistic, easily repeatable training in the performance of BSS. Our BSS surgical model is very inexpensive with a cost of approximately 19.25$ dollars and it is manufactured to facilitate a worldwide diffusion of this promising palatal surgery for OSAS.


Assuntos
Modelos Anatômicos , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Treinamento por Simulação , Apneia Obstrutiva do Sono/cirurgia , Custos e Análise de Custo , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Faringe/cirurgia , Apneia Obstrutiva do Sono/fisiopatologia , Ronco
19.
Cir. plást. ibero-latinoam ; 45(2): 169-173, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184224

RESUMO

Los cordomas son tumores malignos de crecimiento lento derivados de la notocorda. Habitualmente se localizan en el clivus y se presentan en mujeres en la tercera o cuarta décadas de la vida. La resección quirúrgica es su tratamiento de elección, pudiendo asociarse en casos selectos a radioterapia. En cordomas pequeños el tratamiento de elección es el abordaje endoscópico transnasal, transesfenoidal y para las lesiones extensas se prefiere el abordaje máxilo-mandibular con glosotomía. Para la reconstrucción, al igual que en otras áreas anatómicas, las ventajas de los tejidos óseos vascularizados sobre los no vascularizados son: la rápida consolidación, la resistencia a la infección, la reacción hipertrófica originada por la carga mecánica y la tolerancia a niveles terapéuticos de radiación. Presentamos el caso de una mujer de 24 años de edad con diagnóstico de cordoma en C2-C3, a quien se le realizó corpectomía C2-C3 y exéresis marginal de la lesión, seguida de reconstrucción con colgajo libre de peroné


Chordoma neoplasms are malignant tumors with a generally slow growth. They are usually located in the clivus. The most common presentation is in young women (third and fourth decades of life). Surgical resection is the main line of treatment, occasionally radiotherapy may be needed. As for small chordomas, transnasal endoscopical resection can be performed, however, for larger tumors a maxillo-mandibular surgical approach may be needed. For reconstruction purposes, the main advantages of using vascularized tissues are: rapid consoloditation, higher infection resistance and a hypertrophic reaction secondary to the mechanical stress. We present the case of a 24 years old female patient with a C2-C3 chordom; corpectomy and marginal resection of the tumor were performed, as well as reconstruction with a free fibula flap


Assuntos
Humanos , Feminino , Adulto , Cordoma/cirurgia , Cordoma/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Microcirurgia/instrumentação , Retalhos de Tecido Biológico , Faringe/patologia , Faringe/cirurgia , Fíbula/cirurgia
20.
Plast Reconstr Surg ; 143(6): 1246e-1254e, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136490

RESUMO

BACKGROUND: The pharyngeal flap is one of the oldest and most popular techniques for correction of velopharyngeal insufficiency. The authors describe a large series using a technique that combines a pharyngeal flap with a palate pushback to avoid common causes of operative failure while restoring the velopharyngeal mechanism. METHODS: A retrospective cohort study was performed of patients who underwent a pushback pharyngeal flap by a single surgeon from 2000 to 2017. All patients had a preoperative nasoendoscopy diagnostic of velopharyngeal insufficiency. Operative technique involved elevation of the hard palate mucosa through a retroalveolar incision, passage of the flap through the nasopharyngeal mucosa opening, and inset with sutures through the hard palate mucosa. RESULTS: There were 40 patients with a median age of 9.7 years. Preoperative closure patterns were predominately coronal (85.7 percent), with poor posterior wall motion and an average gap size of 27.5 mm. Postoperative complications included flap dehiscence (n = 1), transient dysphagia (n = 2), obstructive sleep apnea (n = 4), and a palatal fistula and/or persistent velopharyngeal insufficiency that required further surgery (n = 6). At an average of 2.5 years postoperatively, 91.7 percent of patients achieved adequate velopharyngeal function, with significant improvements in the majority of speech metrics (p < 0.001). CONCLUSIONS: The pushback pharyngeal flap is a safe and effective technique for treatment of velopharyngeal insufficiency. Advantages include high, secure inset with prevention of palatal scar contracture and shortening. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Palato/cirurgia , Faringe/cirurgia , Retalhos Cirúrgicos , Insuficiência Velofaríngea/cirurgia , Adolescente , Adulto , Idoso , Transtornos da Articulação/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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