Luiz Carlos Gregório

Association of Systematic Head and Neck Physical Examination With Severity of Obstructive Sleep Apnea—Hypopnea Syndrome†

Objectives/Hypothesis To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea–hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea–hypopnea index (AHI).

Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma

BACKGROUND Elective treatment of the neck in oral squamous cell carcinoma has changed over the last 20 years. The main object of this report is to present the results of a multi-institutional prospective study designed to compare standard treatment with modified radical classical neck dissection (MRND) to supraomohyoid neck dissection (SOH) in the management of the clinically negative neck in oral cancer patients. PATIENTS AND METHODS A total of 148 patients were included in the trial. All patients had previously untreated T2 to T4 N0 squamous cell carcinoma of the oral tongue (62 cases), floor of the mouth (49 cases), inferior gingiva (12 cases), or retromolar trigone (25 cases). Tumor stages were T2, 91; T3, 27; and T4, 30. There were no significant imbalances between groups. RESULTS The false-negative rate was 28%, and most positive nodes were sited at level II and III. Complications were seen in 41% of MRND patients and in 25% of SOH patients (P = 0.043). Median total duration of hospitalization was 9 days in MRND patients and 7 days in the SOH group. To date, 19 and 16 patients presented with local and neck recurrences, respectively. The 60-month actuarial survival rates were 63% in the MRND group and 67% in the SOH group (P = 0.7150). CONCLUSIONS This study demonstrates that the recurrence and survival rates were similar in both groups. SOH neck dissection can be recommended as standard elective treatment for patients with T2-T4 oral squamous cell carcinomas.

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas

Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients.

Head and Neck Physical Examination: Comparison Between Nonapneic and Obstructive Sleep Apnea Patients†

Study Objectives: The purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients.

Genioplasty for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome and mandibular retrognathia

UNLABELLED Obstructive sleep apnea syndrome is a complex disease, which the etiology is multifactorial and incompletely understood. Surgery with genioglossus advancement is indicated in hypopharynx obstruction. AIM evaluate the efficacy and complications of genioplasty technique for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS polysomnography, physical examination and cephalometric analysis were performed in 10 non-obese patients, who presented mild or moderate OSAHS, an apnea-hypopnea index (AHI) between 5 and 30, with hypopharynx obstruction and mandibular retrognathia. RESULTS the AHI preoperative mean of 12.4+/-4.6 decreased to a postoperative mean of 4.4+/-5.7 (p < 0,001). When 50% reduction of preoperative AHI was chosen as a parameter, its rate was 70% (7/10). Cephalometric analysis revealed an increase in the posterior airway space (PAS) in all patients, from a preoperative mean value of 7.9+/-2.3mm to a postoperative mean value of 10.8+/-2.5mm (p < 0,001). CONCLUSION genioplasty for genioglossus advancement seemed to reduce OSAHS signs, thus, it can be considered as an option for the surgical treatment of patients with hypopharynx obstruction. Data collected supports this surgical procedure as an option in patients with OSAHS and mandibular retrognathia.

Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Our aim was to determine if anatomical abnormalities of the upper airway (UA) and facial skeleton of class III severely obese patients are related to the presence and severity of obstructive sleep apnea syndrome (OSAS). Forty-five patients (69% females, mean age 46.5 +/- 10.8 years) with a body mass index (BMI) over 40 kg/m(2) underwent UA and facial skeletal examinations as well as polysomnography. Mean BMI was 49 +/- 7 kg/m(2) and mean neck circumference was 43.4 +/- 5.1 cm. Polysomnographic findings showed that 22% had a normal apnea-hypopnea index (AHI) and 78% had an AHI over 5. The presence of OSAS was associated with younger age (P = 0.02), larger neck circumference (P = 0.004), presence of a voluminous lateral wall (P = 0.0002), posteriorized soft palate (P = 0.0053), thick soft palate (P = 0.0014), long uvula (P = 0.04), thick uvula (P = 0.0052), and inferior turbinate hypertrophy (P = 0.04). A larger neck circumference (P = 0.02), presence of a voluminous lateral wall (P = 0.04), posteriorized soft palate (P = 0.03), and thick soft palate (P = 0.04) were all associated with OSAS severity. The prevalence of OSAS in this group was high. A larger neck circumference and soft tissue abnormalities of the UA were markers for both the presence and severity of OSAS. Conversely, no abnormalities in the facial skeleton were associated with OSAS in patients with morbid obesity.

Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

Obstructive sleep apnea syndrome is a complex disease, which the etiology is multifactorial and incompletely understood. Surgery with genioglossus advancement is indicated in hypopharynx obstruction. AIM: evaluate the efficacy and complications of genioplasty technique for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: polysomnography, physical examination and cephalometric analysis were performed in 10 non-obese patients, who presented mild or moderate OSAHS, an apnea-hypopnea index (AHI) between 5 and 30, with hypopharynx obstruction and mandibular retrognathia. RESULTS: the AHI preoperative mean of 12.4±4.6 decreased to a postoperative mean of 4.4±5.7 (p < 0,001). When 50% reduction of preoperative AHI was chosen as a parameter, its rate was 70% (7/10). Cephalometric analysis revealed an increase in the posterior airway space (PAS) in all patients, from a preoperative mean value of 7.9±2.3mm to a postoperative mean value of 10.8±2.5mm (p < 0,001). CONCLUSION: genioplasty for genioglossus advancement seemed to reduce OSAHS signs, thus, it can be considered as an option for the surgical treatment of patients with hypopharynx obstruction. Data collected supports this surgical procedure as an option in patients with OSAHS and mandibular retrognathia.

Avaliação da artéria etmoidal anterior pela tomografia computadorizada no plano coronal

The anterior ethmoidal artery (AEA) is an important point for frontal and ethmoid sinuses surgery. CT scans can identify landmarks to help the surgeon find the AEA. AIM: To identify the landmarks of the AEA on the orbital medial wall and on the lateral wall of the olfactory fossa. and to correlate the presence of supraorbital ethmoidal cells with spotting the anterior ethmoidal artery canal. MATERIALS AND METHODS: Retrospective review of 198 direct coronal paranasal sinuses computed tomography (CT) scans from August to December, 2006. RESULTS: Supraorbital pneumatization was seen in 35% (70 scans). The AEA canal was seen in 41% (81 scans). The anterior ethmoidal sulcus was seen in 98% (194 scans) and the anterior ethmoidal foramen was seen in all the scans (100%). CONCLUSION: The anterior ethmoidal foramen and the anterior ethmoidal sulcus were anatomical landmarks present in almost 100% of the scans studied. There was a correlation between the presence of supraorbital pneumatization and AEA canal visualization.

Rhinolithiasis as cause of oronasal fistula

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.

Study of Rabbit Septal Cartilage Grafts Placed on the Nasal Dorsum

OBJECTIVE To compare the reabsorption characteristics of fresh septal cartilage autografts, preserved homografts, and preserved autografts in the nasal dorsum of rabbits. METHODS Rabbit nasal dorsum cartilage grafts were placed in 3 groups. The first group used fresh autologous cartilage; the second group, alcohol-preserved homologous cartilage; and the third group, alcohol-preserved autologous cartilage. Each rabbit received 2 grafts, one crushed and another noncrushed. After 16 weeks, the grafts were removed for analysis. RESULTS No graft calcification occurred in any group. Chondrogenesis was observed in all groups. The fresh autograft group had the best results in the evaluation of the area of graft recovered and chondrocyte viability. The preserved autologous and homologous grafts did not differ in relation to any of the variables analyzed. Crushed grafts had inferior results in the area of graft recovered and chondrocyte viability compared with the noncrushed forms. No significant difference among the 3 groups was noted in the thickness of the fibrous capsule that developed around the graft. CONCLUSIONS The fresh cartilage autograft was superior to the crushed and uncrushed preserved homografts and autografts; both types of preserved grafts had equivalent histological results. The uncrushed forms were superior to the crushed forms.