RESUMEN

OBJECTIVES: This study aims to review the current role of various ultrasonographic methods in the evaluation of the upper airway in patients with obstructive sleep apnea. METHODS: A literature review was performed on the medical databases: Pubmed, Web of Science, Scopus and Embase. After analyzing the available studies, six of them were selected for data extraction. RESULTS: All selected studies demonstrated that it is possible to use ultrasonography as a method of evaluating the upper airway. Studies with gray-scale ultrasound concluded that the lateral pharyngeal wall and tongue are thicker in patients with obstructive sleep apnea compared to non-apneic patients. Moreover, studies with tissue characterization ultrasound, nowadays called quantitative ultrasound, have identified unique features in obstructive sleep apnea patients: standardized backscatter ultrasonography demonstrated that this particular sound wave analysis is associated with the severity of obstructive sleep apnea. Ultrasonography with elastography shows that the electrical stimulus generated in the hypoglossal nerve results in greater stiffness on the side of the tongue that is stimulated; whereas studies show conflicting results regarding the evaluation of baseline tongue stiffness in obstructive sleep apnea patients compared to non-apneic subjects. CONCLUSION: There is feasibility of different methods of ultrasonographic evaluation of the upper airway, with emphasis on ultrasonographic methods of tissue characterization, such as elastography, which proved to be a promising method of evaluating the mechanical properties of the muscles involved in the pathogenesis of obstructive sleep apnea and which require further studies for a better elucidation of its applicability.

RESUMEN

(1) Background: Home sleep apnea testing, known as polysomnography type 3 (PSG3), underestimates respiratory events in comparison with in-laboratory polysomnography type 1 (PSG1). Without head electrodes for scoring sleep and arousal, in a home environment, patients feel unfettered and move their bodies more naturally. Adopting a natural position may decrease obstructive sleep apnea (OSA) severity in PSG3, independently of missing hypopneas associated with arousals. (2) Methods: Patients with suspected OSA performed PSG1 and PSG3 in a randomized sequence. We performed an additional analysis, called reduced polysomnography, in which we blindly reassessed all PSG1 tests to remove electroencephalographic electrodes, electrooculogram, and surface electromyography data to estimate the impact of not scoring sleep and arousal-based hypopneas on the test results. A difference of 15 or more in the apnea-hypopnea index (AHI) between tests was deemed clinically relevant. We compared the group of patients with and without clinically relevant differences between lab and home tests (3) Results: As expected, by not scoring sleep, there was a decrease in OSA severity in the lab test, similar to the home test results. The group of patients with clinically relevant differences between lab and home tests presented more severe OSA in the lab compared to the other group (mean AHI, 42.5 vs. 20.2 events/h, p = 0.002), and this difference disappeared in the home test. There was no difference between groups in the shift of OSA severity by abolishing sleep scoring in the lab. However, by comparing lab and home tests, there were greater variations in supine AHI and time spent in the supine position in the group with a clinically relevant difference, either with or without scoring sleep, showing an impact of the site of the test on body position during sleep. These variations presented as a marked increase or decrease in supine outcomes according to the site of the test, with no particular trend. (4) Conclusions: In-lab polysomnography may artificially increase OSA severity in a subset of patients by inducing marked changes in body position compared to home tests. The location of the sleep test seems to interfere with the evaluation of patients with more severe OSA.

Asunto(s)

RESUMEN

Abstract Objective: Weight loss is one of the most often prescribed treatments to reduce the level of sleep apnea severity; however, objective assessment of airway alterations after loss of weight has only been studied in the last decades. This study aimed at evaluating alterations after weight loss reported in the literature. Methods: A literature review was performed in the medical databases: PubMed, Web of Science, Scopus and Embase. A total of 681 articles were found in the databases and after evaluation only 10 studies were selected for data extraction. Results: Most studies observed an increase of the area in the retropalatal region; some indicating that this increase occurred mostly in the lateral pharyngeal region. Studies with volumetric reconstruction showed a significant reduction in parapharyngeal fat deposits, lateral wall and tongue fat, and volumetric reduction in all soft tissues of the pharynx, pterygoid and genioglossus muscles. Studies evaluating craniofacial bone structures showed a reduction in the airway height by bringing the hyoid closer to the posterior nasal spine and a reduction in the distance from the hyoid to the chin. Conclusion: There is a limited number of studies with a good level of scientific evidence evaluating changes in the upper airways after weight loss and how these changes impact obstructive sleep apnea. The studies included in this review indicate that weight loss increases the airways space by reducing the volume of the parapharyngeal structures, particularly at the retropalatal site, where there is an apparent gain in the lateral area of the airway and hyoid relocation.

RESUMEN

OBJECTIVE: Weight loss is one of the most often prescribed treatments to reduce the level of sleep apnea severity; however, objective assessment of airway alterations after loss of weight has only been studied in the last decades. This study aimed at evaluating alterations after weight loss reported in the literature. METHODS: A literature review was performed in the medical databases: PubMed, Web of Science, Scopus and Embase. A total of 681 articles were found in the databases and after evaluation only 10 studies were selected for data extraction. RESULTS: Most studies observed an increase of the area in the retropalatal region; some indicating that this increase occurred mostly in the lateral pharyngeal region. Studies with volumetric reconstruction showed a significant reduction in parapharyngeal fat deposits, lateral wall and tongue fat, and volumetric reduction in all soft tissues of the pharynx, pterygoid and genioglossus muscles. Studies evaluating craniofacial bone structures showed a reduction in the airway height by bringing the hyoid closer to the posterior nasal spine and a reduction in the distance from the hyoid to the chin. CONCLUSION: There is a limited number of studies with a good level of scientific evidence evaluating changes in the upper airways after weight loss and how these changes impact obstructive sleep apnea. The studies included in this review indicate that weight loss increases the airways space by reducing the volume of the parapharyngeal structures, particularly at the retropalatal site, where there is an apparent gain in the lateral area of the airway and hyoid relocation.

Asunto(s)

RESUMEN

Introduction: Obstructive sleep apnea (OSA) is a known risk factor for development of carotid atherosclerosis. The treatment of OSA, through positive pressure devices or surgical procedures, may reduce the signs of subclinical atherosclerosis in apneic patients. Objective: The decrease of carotid intima-media thickness (CIMT) after treatment of OSA remains a highly controversial issue. Our purpose is to compare CIMT, which represents an early sign of atherosclerosis, before and at least 6 months after lateral pharyngoplasty in patients with OSA. Material and Methods: A total of 17 patients with OSA who underwent lateral pharyngoplasty were submitted to common carotid Doppler ultrasonography, 24-hour ambulatory blood pressure monitoring and type-1 polysomnography before and at least 6 months after surgery. Results: The median apnoea-hypopnoea index decreased from 22.6 to 5.9 (p<0.001). There were significant improvements in the arousal index, minimum oxyhaemoglobin saturation, Epworth sleepiness scale and reported snoring intensity. The surgical success rate (Shers criteria) obtained with the procedure was 76.4%. There was no significant variation in the mean CIMT after surgeries (right carotid artery, mean, 0.67 and 0.72 mm; left carotid artery, mean, 0.69 and 0.70 mm, pre- and postoperative, respectively, both p>0.05). Blood pressure measurements also did not significantly change. Conclusion: Notwithstanding a significant improvement in OSA after lateral pharyngoplasty, there was no significant reduction in CIMT in a follow-up of 6 months.

RESUMEN

STUDY OBJECTIVES: Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep. METHODS: Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared. RESULTS: The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference: 14%; 95% confidence interval: -12% to 40%; P = .453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size: 0.05 and 0.03, respectively), and negative effort dependence (difference: -6%; 95% confidence interval: -16% to 4%) were also similar in both procedures. CONCLUSIONS: In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep. CLINICAL TRIAL REGISTRATION: Registry: clinicaltrials.gov; Name: Natural and Drug Sleep Endoscopy; URL: https://clinicaltrials.gov/ct2/show/study/NCT03004014; Identifier: NCT03004014.

Asunto(s)

Asunto(s)

RESUMEN

Abstract Introduction: There is no consensus on a single classification system for the obstructive findings in drug-induced sleep endoscopy. Previous classification systems have neglected to address the upper retropalatal obstruction, the segmental division of the lateral pharyngeal wall and the primary or secondary nature of laryngeal collapse. Objective: To propose, illustrate and evaluate a more comprehensive and yet simple classification for drug-induced sleep endoscopy findings. Methods: Cross sectional study in a tertiary sleep surgery unit. A total of 30 patients with obstructive sleep apnea underwent drug-induced sleep endoscopy according to a new classification system called LwPTL, and its findings were analyzed according to obstructive sleep apnea severity and body mass index. LwPTL incorporates the description of upper retropalatal collapse, distinguishes the lateral pharyngeal wall collapse into three levels and clarify when laryngeal collapses are primary or secondary. Results: 93.3% of the patients presented lateral pharyngeal wall collapse, usually at the level of the velum (73.3%). 80% presented multilevel collapse. Regarding the upper retropalatal region, LwPTL identified 10% of the cases presenting lateral salpingopharyngeal obstruction and 6.6% with high palatal collapse. 3.3% presented epiglottic collapse. Patients presenting lower levels of collapse, either from the lateral wall and/or tongue and/or larynx, represented 30% of the cases and had significantly more severe obstructive sleep apnea, without significant differences in body mass indexes. Conclusion: LwPTL seems a simple and straightforward staging system for classifying drug-induced sleep endoscopy, distinguishing the important upper retopalatal obstruction and the primary and secondary laryngeal collapses, providing more information for appropriate treatment selection.

Resumo Introdução: Não há consenso sobre um sistema único de classificação para os achados obstrutivos da endoscopia do sono induzido por drogas. Os sistemas de classificação anteriores negligenciaram a abordagem da obstrução retropalatal alta, a divisão segmentar da parede lateral da faringe e a natureza primária ou secundária do colapso laríngeo. Objetivo: Propor, ilustrar e avaliar uma classificação mais abrangente e simples para os achados da endoscopia do sono induzido por drogas. Método: Estudo transversal em uma unidade terciária de cirurgia do sono. Foram submetidos à endoscopia do sono induzido por drogas 30 pacientes com apneia obstrutiva do sono, de acordo com um novo sistema de classificação denominado LwPTL, e seus achados foram analisados de acordo com a gravidade da apneia obstrutiva do sono e índice de massa corpórea. O LwPTL incorpora a descrição do colapso retropalatal alto, distingue o colapso da parede faríngea lateral em três níveis e esclarece quando os colapsos laríngeos são primários ou secundários. Resultados: Apresentaram colapso da parede faríngea lateral 93,3% dos pacientes, geralmente no nível do palato mole (73,3%). Em 80% dos pacientes o colapso foi multinível. Em relação à região retropalatal alta, o LwPTL identificou 10% dos casos com obstrução salpingo-faríngea lateral e 6,6% com colapso alto do palato. Em 3,3% ocorreu colapso epiglótico. Pacientes com colapso em regiões baixas, tanto da parede lateral e/ou língua como e/ou laringe, representaram 30% dos casos e apresentaram apneia obstrutiva do sono significativamente mais grave, sem diferenças significantes no índice de massa corpórea. Conclusão: O LwPTL parece um sistema de estadiamento simples e direto para classificar os achados da endoscopia do sono induzido por drogas, distingue a importante obstrução retropalatal alta e os colapsos laríngeos primários e secundários, fornece mais informações para uma seleção adequada do tratamento.

Asunto(s)

RESUMEN

INTRODUCTION: There is no consensus on a single classification system for the obstructive findings in drug-induced sleep endoscopy. Previous classification systems have neglected to address the upper retropalatal obstruction, the segmental division of the lateral pharyngeal wall and the primary or secondary nature of laryngeal collapse. OBJECTIVE: To propose, illustrate and evaluate a more comprehensive and yet simple classification for drug-induced sleep endoscopy findings. METHODS: Cross sectional study in a tertiary sleep surgery unit. A total of 30 patients with obstructive sleep apnea underwent drug-induced sleep endoscopy according to a new classification system called LwPTL, and its findings were analyzed according to obstructive sleep apnea severity and body mass index. LwPTL incorporates the description of upper retropalatal collapse, distinguishes the lateral pharyngeal wall collapse into three levels and clarify when laryngeal collapses are primary or secondary. RESULTS: 93.3% of the patients presented lateral pharyngeal wall collapse, usually at the level of the velum (73.3%). 80% presented multilevel collapse. Regarding the upper retropalatal region, LwPTL identified 10% of the cases presenting lateral salpingopharyngeal obstruction and 6.6% with high palatal collapse. 3.3% presented epiglottic collapse. Patients presenting lower levels of collapse, either from the lateral wall and/or tongue and/or larynx, represented 30% of the cases and had significantly more severe obstructive sleep apnea, without significant differences in body mass indexes. CONCLUSION: LwPTL seems a simple and straightforward staging system for classifying drug-induced sleep endoscopy, distinguishing the important upper retopalatal obstruction and the primary and secondary laryngeal collapses, providing more information for appropriate treatment selection.

Asunto(s)

Asunto(s)

RESUMEN

INTRODUCTION: Upper airway nerve and muscle damage associated with obstructive sleep apnea may impair the strength and dynamics of pharyngeal and esophageal contractions during swallowing. OBJECTIVE: To evaluate the presence of alterations in pharyngoesophageal manometry in patients with obstructive sleep apnea with and without oropharyngeal dysphagia. METHODS: This study prospectively evaluated 22 patients with obstructive sleep apnea without spontaneous complaints of dysphagia, using a questionnaire, fiberoptic endoscopic evaluation of swallowing, and pharyngoesophageal manometry, including measurement of the upper and lower esophageal sphincter pressures and mean pharyngeal pressures at three levels during swallowing. RESULTS: The dysphagia group consisted of 17 patients (77.3%) in whom swallowing abnormalities were detected on fiberoptic endoscopic evaluation of swallowing (n = 15; 68.2%) and/or in the questionnaire (n = 7; 31.8%). The five remaining cases comprised a control group without oropharyngeal dysphagia. In all cases of abnormalities on fiberoptic endoscopic evaluation of swallowing, there was premature bolus leakage into the pharynx. There was no statistically significant difference between the groups regarding any of the pharyngoesophageal manometry measurements, age, or severity of obstructive sleep apnea. CONCLUSION: Pharyngoesophageal manometry detected no statistically significant difference between the groups with and without oropharyngeal dysphagia. .

INTRODUÇÃO: Lesões neurogênicas e musculares associadas à apneia obstrutiva do sono podem comprometer a força e a dinâmica das contrações faríngeas e esofágicas durante a deglutição. OBJETIVO: Verificar se há alterações na manometria faringoesofágica de pacientes com apneia obstrutiva do sono com e sem disfagia orofaríngea. MÉTODO: Foram avaliados, prospectivamente, 22 pacientes com apneia obstrutiva do sono sem queixa espontânea de disfagia, utilizando questionário, videoendoscopia da deglutição e manometria faringoesofágica, com medidas das pressões do esfíncter esofagiano inferior e superior e pressão média da faringe em três níveis durante a deglutição. RESULTADOS: 17 pacientes (77,3%) formaram o grupo com disfagia, por apresentarem alterações de deglutição na videoendoscopia da deglutição (n = 15; 68,2%) e/ou no questionário (n = 7; 31,8%). Os cinco restantes compuseram o grupo sem disfagia orofaríngea. Em todos os casos com alterações na videoendoscopia da deglutição houve escape precoce do bolo alimentar para a faringe. Não houve diferença significante entre os grupos com e sem disfagia em relação a todas as medidas de manometria, idade e gravidade da apneia obstrutiva do sono. Conclusões: A manometria faringoesofágica não demonstrou diferença significante entre os grupos com e sem disfagia orofaríngea. .

Asunto(s)

RESUMEN

INTRODUCTION: Upper airway nerve and muscle damage associated with obstructive sleep apnea may impair the strength and dynamics of pharyngeal and esophageal contractions during swallowing. OBJECTIVE: To evaluate the presence of alterations in pharyngoesophageal manometry in patients with obstructive sleep apnea with and without oropharyngeal dysphagia. METHODS: This study prospectively evaluated 22 patients with obstructive sleep apnea without spontaneous complaints of dysphagia, using a questionnaire, fiberoptic endoscopic evaluation of swallowing, and pharyngoesophageal manometry, including measurement of the upper and lower esophageal sphincter pressures and mean pharyngeal pressures at three levels during swallowing. RESULTS: The dysphagia group consisted of 17 patients (77.3%) in whom swallowing abnormalities were detected on fiberoptic endoscopic evaluation of swallowing (n=15; 68.2%) and/or in the questionnaire (n=7; 31.8%). The five remaining cases comprised a control group without oropharyngeal dysphagia. In all cases of abnormalities on fiberoptic endoscopic evaluation of swallowing, there was premature bolus leakage into the pharynx. There was no statistically significant difference between the groups regarding any of the pharyngoesophageal manometry measurements, age, or severity of obstructive sleep apnea. CONCLUSION: Pharyngoesophageal manometry detected no statistically significant difference between the groups with and without oropharyngeal dysphagia.

Asunto(s)

RESUMEN

As laringectomias parciais são utilizadas no tratamento do câncer de laringe. A alteração estrutural na via aérea superior decorrente da cirurgia pode predispor à Apneia Obstrutiva do Sono. OBJETIVO: Avaliar comparativamente os pacientes submetidos a laringectomias parciais horizontais e verticais quanto a prevalência e gravidade da apneia do sono e determinar possível papel para a espirometria neste grupo. MÉTODO: Pesquisa em prontuários. Avaliação dos pacientes por meio de anamnese, exame otorrinolaringológico, polissonografia, espirometria, videonasofibroscopia. Estudo tipo coorte transversal. RESULTADOS: 92,3% do total de 14 pacientes estudados apresentavam Apneia Obstrutiva do Sono. O índice de apneia/hipopneia médio foi significativamente maior entre os pacientes submetidos a laringectomias verticais (36,9) do que a horizontais (11,2), assim como a média da saturação mínima da oxi-hemoglobina, que foi de 85,9 no grupo da laringectomia horizontal e de 84,3 no grupo da laringectomia vertical. A espirometria demonstrou obstrução extratorácica alta em 100% dos pacientes com diagnóstico de Apneia Obstrutiva do Sono. CONCLUSÃO: Observamos alta incidência de apneia do sono em pacientes submetidos a laringectomias parciais. A doença tende a ser mais grave no grupo submetido a laringectomias verticais. A espirometria parece ser exame interessante para determinar pacientes de risco para diagnóstico de AOS nesta situação. NCT01157286. .

Partial laryngectomy is used in the treatment of laryngeal cancer. Structural alterations of the upper airway arising from partial laryngectomy can cause obstructive sleep apnea (OSA). OBJECTIVE: To compare the prevalence and severity of OSA in patients submitted to horizontal and vertical partial laryngectomy and assess the role of spirometry for these patients. METHOD: Cross-sectional clinical study with individuals offered partial laryngectomy. The included patients were assessed through interview, upper airway endoscopy, polysomnography, and spirometry. RESULTS: Fourteen patients were evaluated and 92.3% were found to have OSA. The apnea-hypopnea index was significantly higher among patients submitted to vertical laryngectomy (mean = 36.9) when compared to subjects offered horizontal laryngectomy (mean = 11.2). The mean minimum oxyhemoglobin saturation was 85.9 in the horizontal laryngectomy group and 84.3 in the vertical laryngectomy group. Spirometry identified extrathoracic upper airway obstruction in all patients with OSA. CONCLUSION: The studied population had a high incidence of obstructive sleep apnea. OSA was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy. Spirometry seems to be useful in the detection of cases of suspected OSA, as it suggests the presence of extrathoracic upper airway obstruction. .

Asunto(s)

RESUMEN

UNLABELLED: Partial laryngectomy is used in the treatment of laryngeal cancer. Structural alterations of the upper airway arising from partial laryngectomy can cause obstructive sleep apnea (OSA). OBJECTIVE: To compare the prevalence and severity of OSA in patients submitted to horizontal and vertical partial laryngectomy and assess the role of spirometry for these patients. METHOD: Cross-sectional clinical study with individuals offered partial laryngectomy. The included patients were assessed through interview, upper airway endoscopy, polysomnography, and spirometry. RESULTS: Fourteen patients were evaluated and 92.3% were found to have OSA. The apnea-hypopnea index was significantly higher among patients submitted to vertical laryngectomy (mean = 36.9) when compared to subjects offered horizontal laryngectomy (mean = 11.2). The mean minimum oxyhemoglobin saturation was 85.9 in the horizontal laryngectomy group and 84.3 in the vertical laryngectomy group. Spirometry identified extrathoracic upper airway obstruction in all patients with OSA. CONCLUSION: The studied population had a high incidence of obstructive sleep apnea. OSA was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy. Spirometry seems to be useful in the detection of cases of suspected OSA, as it suggests the presence of extrathoracic upper airway obstruction.

Asunto(s)

RESUMEN

Tratamento da apneia obstrutiva do sono por meio da faringoplastia lateral consiste na miotomia e reposicionamento dos músculos da parede lateral da faringe. A disfagia após cirurgia faríngea é influenciada pela dor, pelo incômodo das suturas, pela cicatrização e pela adaptação às alterações estruturais da faringe. A experiência com a faringoplastia mostra que o músculo constritor superior da faringe exerce um papel de pouca importância na deglutição, sua miotomia é totalmente compensada pela ação dos demais músculos da orofaringe. O estilofaríngeo exerce importante papel na deglutição. OBJETIVO: Avaliar, diariamente, evolução da deglutição nos pacientes submetidos à faringoplastia lateral com identificação e preservação do músculo estilofaríngeo. MÉTODO: O estudo é prospectivo e avaliamos a deglutição de 20 pacientes, por meio da aplicação diária de uma escala analógica visual desde o primeiro pós-operatório até a normalização da deglutição. RESULTADOS: Os pacientes retornaram a sua dieta livre habitual, em média, 10,9 dias após as cirurgias e referiram apresentar deglutição normal, em média, com 21,6 dias. Todos os casos referiram retornar à deglutição normal no pós-operatório, com um prazo de recuperação de 33 dias. CONCLUSÃO: Todos os pacientes submetidos à faringoplastia com preservação do músculo estilofaríngeo referiram normalização da deglutição em até 33 dias após a cirurgia.

Lateral pharyngoplasty manages obstructive sleep apnea through the myotomy and repositioning of the muscles of the lateral pharyngeal wall. Dysphagia after any pharyngeal surgery is influenced by pain, discomfort from the sutures, the healing process and by the adaptation to the changes in pharyngeal structures. Experience with lateral pharyngoplasty has shown that the superior pharyngeal constrictor muscle plays a minor role in swallowing. One of them, the stylopharyngeus muscle, seems to play an important role during swallowing. OBJECTIVE: The aim of this study is to provide a daily analysis of the follow-up of the swallowing function. METHOD: We have prospectively evaluated the swallowing function in 20 patients, through the daily application of a visual analogue scale from the first post-op until the complete disappearance of dysphagia. RESULTS: Patients have returned to their normal feeding habits in a mean of 10.9 days after the procedures and they presented a completely normal swallowing, on average, 21.6 days after the surgeries. All patients recover normal swallowing after the procedures, with a maximum recovery time of 33 days. CONCLUSION: In this study, all patients who underwent lateral pharyngoplasty with total preservation of the stylopharyngeus muscle reported complete normalization of swallowing with a recovery time up to 33 days.

Asunto(s)

RESUMEN

UNLABELLED: Inverted papilloma (IP) comprises 0.5-4% of benign nasal tumors. The importance is shown by local aggressiveness, a high recurrence rate and the possibility of malignant transformation. The treatment is controversial, but endoscopic approaches tends to be the choice today. AIM: To describe clinical, epidemiological and treatment of IP cases in a tertiary hospital. METHODS: Retrospective study consisting of chart reviews of 26 patients diagnosed with IP; evaluation of tumor location, clinical staging, follow up, tumor recurrence, malignancy, type of surgery and postoperative complications. RESULTS: There were 13 men and 13 women, the mean age was 57.8 years. The mean follow up time was 29.4 months; the recurrence rate was 7.6%. There was a preponderance of T3 and T4 tumors and a 3.8% malignancy rate. All patients underwent surgical treatment, mostly endonasal endoscopic surgery. CONCLUSION: IP is an uncommon nasal tumor that originates mainly in the lateral nasal wall, but it also affects the paranasal sinuses. Advances in endoscopic surgery are gaining room due to lower invasiveness and success rates similar to traditional external techniques for completely resecting the tumor. There is a lower recurrence rate, and endoscopy a definitive treatment for malignancy cases in this study.

Asunto(s)

RESUMEN

Papiloma invertido (PI) corresponde a 0,5 por cento-4 por cento dos tumores nasais benignos. A importância está na agressividade local, taxa de recorrência elevada e possibilidade de transformação maligna. O tratamento é controverso, encontrando melhor suporte na cirurgia endoscópica. OBJETIVO: Descrever aspectos clínico-epidemiológicos e tratamento dos casos de PI de um hospital terciário. CASUÍSTICA E MÉTODO: Estudo retrospectivo, realizado por revisão de prontuários de 26 pacientes com diagnóstico de PI nasal, avaliando localização tumoral, estadiamento clínico, tempo de seguimento, recidiva tumoral, malignidade, tipo de cirurgia realizada e complicações pós-operatórias. RESULTADO: Na casuística, havia 13 homens e 13 mulheres, com idade média de 57,8 anos. O tempo médio de seguimento foi de 29,4 meses, com 7,6 por cento de taxa de recidiva. Houve predomínio de tumores T3 e T4 e 3,8 por cento de taxa de malignidade. Todos foram submetidos a tratamento cirúrgico, predominando a cirurgia endoscópica endonasal. CONCLUSÃO: O PI é um tumor nasal originado principalmente na parede lateral nasal, mas também acomete seios paranasais. Avanços na cirurgia endoscópica vêm ganhando destaque pela menor invasividade e taxas de sucesso semelhantes às técnicas tradicionais externas, permitindo a exérese completa do tumor e proporcionando menor taxa de recidiva e tratamento completo no caso de malignidade.

Inverted papilloma (IP) comprises 0.5-4 percent of benign nasal tumors. The importance is shown by local aggressiveness, a high recurrence rate and the possibility of malignant transformation. The treatment is controversial, but endoscopic approaches tends to be the choice today. AIM: To describe clinical, epidemiological and treatment of IP cases in a tertiary hospital. METHODS: Retrospective study consisting of chart reviews of 26 patients diagnosed with IP; evaluation of tumor location, clinical staging, follow up, tumor recurrence, malignancy, type of surgery and postoperative complications. RESULTS: There were 13 men and 13 women, the mean age was 57.8 years. The mean follow up time was 29.4 months; the recurrence rate was 7.6 percent. There was a preponderance of T3 and T4 tumors and a 3.8 percent malignancy rate. All patients underwent surgical treatment, mostly endonasal endoscopic surgery. CONCLUSION: IP is an uncommon nasal tumor that originates mainly in the lateral nasal wall, but it also affects the paranasal sinuses. Advances in endoscopic surgery are gaining room due to lower invasiveness and success rates similar to traditional external techniques for completely resecting the tumor. There is a lower recurrence rate, and endoscopy a definitive treatment for malignancy cases in this study.

Asunto(s)

RESUMEN

UNLABELLED: Lateral pharyngoplasty manages obstructive sleep apnea through the myotomy and repositioning of the muscles of the lateral pharyngeal wall. Dysphagia after any pharyngeal surgery is influenced by pain, discomfort from the sutures, the healing process and by the adaptation to the changes in pharyngeal structures. Experience with lateral pharyngoplasty has shown that the superior pharyngeal constrictor muscle plays a minor role in swallowing. One of them, the stylopharyngeus muscle, seems to play an important role during swallowing. OBJECTIVE: The aim of this study is to provide a daily analysis of the follow-up of the swallowing function. METHOD: We have prospectively evaluated the swallowing function in 20 patients, through the daily application of a visual analogue scale from the first post-op until the complete disappearance of dysphagia. RESULTS: Patients have returned to their normal feeding habits in a mean of 10.9 days after the procedures and they presented a completely normal swallowing, on average, 21.6 days after the surgeries. All patients recover normal swallowing after the procedures, with a maximum recovery time of 33 days. CONCLUSION: In this study, all patients who underwent lateral pharyngoplasty with total preservation of the stylopharyngeus muscle reported complete normalization of swallowing with a recovery time up to 33 days.

Asunto(s)

RESUMEN

OBJECTIVES: The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION: Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS: We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS: We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS: There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.

Asunto(s)

RESUMEN

OBJECTIVES: The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION: Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS: We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS: We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS: There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.

Asunto(s)