George E. Anastassov

Edema in the upper airway in patients with obstructive sleep apnea syndrome

OBJECTIVE The purpose of this study was to investigate the histologic alterations in the upper airway in patients with obstructive sleep apnea syndrome. STUDY DESIGN Surgical specimens were obtained during non-laser-assisted uvulopalatopharyngoplasty from 5 adult patients (4 male and 1 female) with polysomnographically confirmed obstructive sleep apnea syndrome. RESULTS In all of the specimens, interstitial edema was present with mild inflammatory reaction. Fat was not at all prominent. CONCLUSIONS It is confirmed histologically that there is edema present in the upper airway in patients with obstructive sleep apnea syndrome. It is uncertain whether this edema is one of the causative mechanisms of the obstruction or a consequence of the syndrome.

Mandibular Ramus/Coronoid Process Grafts in Maxillofacial Reconstructive Surgery

PURPOSE To evaluate the utility of autogenous extended mandibular ramus and coronoid process bone grafts for maxillofacial reconstructive surgery. PATIENTS AND METHODS Twelve patients aged 23 to 76 years (mean, 52) who underwent extended ramus/coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or iatrogenic nasal deformity. All patients had either unilateral or bilateral combined coronoid process-mandibular ramus bone grafts for their reconstruction. There was 1 nasal reconstruction, 2 unilateral mandibles, 1 bilateral mandible, 4 unilateral maxillas, 1 unilateral maxilla and mandible combined, and 1 bilateral maxilla and mandible combined. RESULTS The procedure was considered a success when the patients deformities were reconstructed ad integrum and when there were no failures of the dental implants placed in the augmented areas as of the longest follow-up. All patients were successfully reconstructed. There was 1 infection at a donor site that resolved with local care and oral antibiotics. All but 1 of the maxillary and mandibular alveolar augmentations underwent endosteal implant placement approximately 4 to 6 months following grafting. The nasal reconstruction restored normal function and symmetry. CONCLUSION Using both the coronoid process of the mandible and the mandibular ramus as a source for autogenous bone graft can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.