Alexander Baisch

Multilevel Surgery for Obstructive Sleep Apnea: Short-Term Results

OBJECTIVE: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA). STUDY DESIGN AND SETTING: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery. RESULTS: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 ± 20.0 vs 20.7 ± 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. CONCLUSION: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful.

Anatomic Changes After Hyoid Suspension for Obstructive Sleep Apnea: An MRI Study

OBJECTIVE: To assess the effects of isolated hyoid suspension on subjective and objective parameters of obstructive sleep apnea and to evaluate changes in upper airway anatomy with the help of standardized magnetic resonance imaging. STUDY DESIGN AND SETTING: Fifteen patients received isolated hyoid suspension. Changes in respiratory disturbance index were assessed with polysomnography, and anatomical changes with standardized magnetic resonance imaging. Snoring, daytime sleepiness, and functional parameters were assessed with questionnaires. Lateral x-ray cephalometry was performed preoperatively. RESULTS: Mean respiratory disturbance index was reduced from 35.2 ± 19.1 to 27.4 ± 26.2. Forty percent of the patients were classified as responders. Daytime sleepiness improved significantly. Relevant changes in upper airway anatomy could not be detected. There were no remarkable differences between responders and nonresponders in regard to imaging. CONCLUSIONS: Hyoid suspension is effective only in a subgroup of patients and does not lead to relevant changes in airway diameters in the awake patient. Magnetic resonance imaging and x-ray cephalometry do not add additional information for patient selection. SIGNIFICANCE: The reported clinical effects of hyoid suspension are more likely due to functional changes in airway collapsibility than to an enlargement of the upper airway.

In Vitro Analysis of Differential Expression of Collagens, Integrins, and Growth Factors in Cultured Human Chondrocytes

OBJECTIVES: Tissue engineering represents a promising method for the construction of autologous chondrogenic grafts for reconstructive surgery. In cultured chondrocytes, the dedifferentiation and proliferation of the cells are critical factors that influence the generation of transplants. The aim of our study was to find and characterize markers for cell proliferation and dedifferentiation in cultured chondrocytes. STUDY DESIGN AND SETTING: Human chondrocytes were isolated from septal cartilage and held in primary cell culture. Cells were harvested after 1, 6, and 21 days. The differentiation of the cells was investigated with bright-field microscopy, the expression patterns of various proteins using immunohistochemistry, and the expression of distinct genes with the microarray technique. RESULTS: The chondrocytes showed a strong proliferation. After 6 and 21 days, collagen 9 and 10 were downregulated; collagen 11 was activated. Collagen 1 and 2 were downregulated after 6 days but were reactivated after 21 days. Tumor growth factor β (TGF-β)1 was strongly expressed on days 1, 6, and 21, TGF-β2 was never expressed, and TGF-β3 and -β4 were upregulated from day 1 to day 21. The TGF-β receptor III was expressed on days 1, 6, and 21. Integrin β1, β5, and α5 were upregulated from day 1 to day 21; integrin β3 was downregulated. CONCLUSION AND SIGNIFICANCE: Collagens 3, 4, 8, 9, and 11 might be new markers for the dedifferentiation of chondrocytes. Collagen 2 might be a marker for the synthetic activity of the cells rather than the dedifferentiation. TGF-β3 and -β4 might influence the dedifferentiation, which is fortified by the expression of TGF-β receptor III. Integrin β1, β5, and α5 might be involved in signal transmission for the dedifferentiation.

Adjustable Tongue Advancement for Obstructive Sleep Apnea: A Pilot Study

Objectives: Surgical treatment of obstructive sleep apnea (OSA) caused by hypopharyngeal collapse of the upper airway can be considered in patients who are intolerant to continuous positive airway pressure (CPAP). The present procedures addressing the hypopharynx are invasive and have substantial morbidity and limited efficacy. Methods: Ten patients (mean age, 44 years) with moderate to severe OSA, ie, an apnea-hypopnea index (AHI) between 15 and 50, with CPAP intolerance were included in a prospective, nonrandomized, multicenter study to evaluate the feasibility, safety, and efficacy of a novel tongue advancement procedure. The procedure consists of the implantation of a tissue anchor in the tongue base and an adjustment spool at the mandible. Titration of this tissue anchor results in advancement of the tongue and a patent upper airway. Results: The mean AHI decreased from 22.8 at baseline to 11.8 at the 6-month follow-up (p = 0.007). The Epworth Sleepiness Scale score decreased from 11.4 at baseline to 7.7 at the 6-month follow-up (p = 0.094), and the snoring score decreased from 7.5 at baseline to 3.9 at the 6-month follow-up (p = 0.005). Four technical adverse events were noted, and 1 clinical adverse event occurred. Conclusions: Adjustable tongue advancement is a feasible and relatively safe way to reduce the AHI and snoring in selected patients with moderate to severe OSA and CPAP intolerance. Technical improvements and refinements to the procedure are ongoing.

In vitro analysis of matrix proteins and growth factors in dedifferentiating human chondrocytes for tissue-engineered cartilage.

Conclusions With ongoing culture and dedifferentiation of chondrocytes, significant changes in the expression patterns of various collagens and the insulin-like growth factor (IGF) receptor were detected. The latter could play an important role in the differentiation of human chondrocytes. Objective Tissue engineering represents a promising method for the construction of autologous chondrogenic grafts for reconstructive surgery. So far, little is known about the expression of markers for cell proliferation and differentiation in cultured chondrocytes. Material and methods Human chondrocytes were isolated from septal cartilage (n=5) and held in primary cell culture. Cells were harvested after 24 h and 6 days. Proliferation was analyzed using an Alamar Blue assay. The differentiation of the cells was investigated using bright field microscopy, the expression patterns of various proteins using immunohistochemistry and the expression of distinct genes using a microarray technique. Results The chondrocytes showed strong proliferation (Day 0: 16.7±0.7 fluorescent units; Day 5: 52.4±2.2 fluorescent units) from the third day of cell culture in medium without growth factors. From this point onwards, a dedifferentiation of the chondrocytes could be observed. In cell culture, the chondrocytes expressed collagen 1 and 10 without expression of collagen 3. After 6 days of cell culture, they expressed collagen 2. The chondrocytes showed constant low expression of the fibroblast growth factor-2 receptor, but constant high expression of vascular endothelial growth factor, matrix metalloproteinase (MMP)2 and MMP9. The cells never expressed the epidermal growth factor receptor. The proportion of IGF receptor-expressing cells diminished significantly during cell culture.

[Subjective outcome after multi-level surgery in sleep-disordered breathing].

INTRODUCTION Previous results showed the high effectiveness of our multi-level surgery concept based on the modified hyoid suspension for obstructive sleep apnea (OSA). This study was aimed at evaluating the discomforts and side-effects of this surgical concept. METHODS Between November 2001 and June 2004, 102 patients with OSA and/or with laryngeal stenosis, who were all treated with a hyoid suspension in combination with surgery at the base of tongue, the soft palate or the nose, were included in the study. A questionnaire on discomfort and snoring was given to the patients. They were asked to answer the questions at the earliest 1 month after surgery. A reduction in snoring to a level which was tolerated by the bed-partner was regarded as success. RESULTS Half of the patients needed analgesics until the 14th day after surgery, complained dysphagia until day 20 and had problems with their speech until day 30. However, 84% indicated that they would undergo surgery again; 94% reported a successful reduction in their snoring. CONCLUSION Nearly all of the patients tolerated the discomforts and side-effects of our multi-level surgical concept. In combination with a reduction in snoring in 94% of all cases, this surgical concept was considered favorably by the patients.

Vakuumassistierte Therapie zur Wundbehandlung im Kopf-Hals-Bereich

ZusammenfassungChronische Wunden sind durch eine verlangsamte oder fehlende Wundheilung gekennzeichnet. Die Behandlung solcher Wunden führt neben einer Minderung der Lebensqualität der Betroffenen auch zu einer erheblichen Belastung für das Gesundheitssystem. Deshalb sind neue Konzepte in der Behandlung chronischer, nicht heilender Wunden von besonderer Bedeutung, um so die Behandlungsdauer und Kosten senken zu können. Das Konzept der lokalen Unterdrucktherapie ist nicht neu. In der Literatur werden viele Fälle nicht heilender Wunden beschrieben, die mit Hilfe der Vakuumversiegelung erfolgreich geschlossen werden konnten. Bis heute gibt es jedoch keine dokumentierte Anwendung der vakuumassistierten Wundbehandlung im Kopf-Hals-Bereich. Unser Fall demonstriert die erfolgreiche Anwendung der Vakuumversiegelung im Kopf-Hals-Bereich. Mit Hilfe des V.A.C.- („vacuum assisted closure“) Systems der Fa. KCI konnte eine nicht heilende Wunde erfolgreich verschlossen werden.AbstractChronic wounds are characterized by slow or nonexistent wound healing. Usually their treatment is expensive. Therefore new concepts in management are of interest in order to reduce treatment time and costs. One option is vacuum sealing. The concept of topical negative pressure is not new, and many chronic nonhealing wounds could be closed successfully with the help of vacuum sealing. Until now, there has been no documented case of vacuum sealing in head and neck reconstructive surgery. Our case shows the effectiveness of a vacuum-assisted device in successful closure of a chronic nonhealing wound in this region.

[Vacuum-assisted closure of nonhealing wounds in head and neck reconstructive surgery].

ZusammenfassungChronische Wunden sind durch eine verlangsamte oder fehlende Wundheilung gekennzeichnet. Die Behandlung solcher Wunden führt neben einer Minderung der Lebensqualität der Betroffenen auch zu einer erheblichen Belastung für das Gesundheitssystem. Deshalb sind neue Konzepte in der Behandlung chronischer, nicht heilender Wunden von besonderer Bedeutung, um so die Behandlungsdauer und Kosten senken zu können. Das Konzept der lokalen Unterdrucktherapie ist nicht neu. In der Literatur werden viele Fälle nicht heilender Wunden beschrieben, die mit Hilfe der Vakuumversiegelung erfolgreich geschlossen werden konnten. Bis heute gibt es jedoch keine dokumentierte Anwendung der vakuumassistierten Wundbehandlung im Kopf-Hals-Bereich. Unser Fall demonstriert die erfolgreiche Anwendung der Vakuumversiegelung im Kopf-Hals-Bereich. Mit Hilfe des V.A.C.- („vacuum assisted closure“) Systems der Fa. KCI konnte eine nicht heilende Wunde erfolgreich verschlossen werden.AbstractChronic wounds are characterized by slow or nonexistent wound healing. Usually their treatment is expensive. Therefore new concepts in management are of interest in order to reduce treatment time and costs. One option is vacuum sealing. The concept of topical negative pressure is not new, and many chronic nonhealing wounds could be closed successfully with the help of vacuum sealing. Until now, there has been no documented case of vacuum sealing in head and neck reconstructive surgery. Our case shows the effectiveness of a vacuum-assisted device in successful closure of a chronic nonhealing wound in this region.

Subjektives Outcome der Mehretagenchirurgie bei schlafbezogenen Atemstörungen

INTRODUCTION Previous results showed the high effectiveness of our multi-level surgery concept based on the modified hyoid suspension for obstructive sleep apnea (OSA). This study was aimed at evaluating the discomforts and side-effects of this surgical concept. METHODS Between November 2001 and June 2004, 102 patients with OSA and/or with laryngeal stenosis, who were all treated with a hyoid suspension in combination with surgery at the base of tongue, the soft palate or the nose, were included in the study. A questionnaire on discomfort and snoring was given to the patients. They were asked to answer the questions at the earliest 1 month after surgery. A reduction in snoring to a level which was tolerated by the bed-partner was regarded as success. RESULTS Half of the patients needed analgesics until the 14th day after surgery, complained dysphagia until day 20 and had problems with their speech until day 30. However, 84% indicated that they would undergo surgery again; 94% reported a successful reduction in their snoring. CONCLUSION Nearly all of the patients tolerated the discomforts and side-effects of our multi-level surgical concept. In combination with a reduction in snoring in 94% of all cases, this surgical concept was considered favorably by the patients.

R170: Palatal Implants for OSA Are Superior to Placebo Treatment

patients were operated using SST twice. RESULTS: After a mean follow-up of 9.5 months, 11 of 15 patients reported significant decrease in snoring and sleep apnea. Two patients reported some improvement. Two patients were out of contact. Patients had little pain and normal diet on the next day after surgery. There were minimal postoperative complications of SST: no nasopharyngeal regurgitation, much less pain, almost no bleeding and exposure, no disconnection of knots, no foreign body sense and no foreign body reaction. CONCLUSION: SST has the merits of both resection( widening of naso/oropharyngeal spaces) and no resection( safe, ease, less pain, short recovery time and minimal complications). SST with RFVR is a safe and effective palatal snoring procedure for snoring and sleep apnea. SIGNIFICANCE: SST is a new effective snoreplasty. It is possible to combine SST with other snoring operations. SST may be helpful to decrease the pressure of CPAP in sleep apnea.