Mikio Yagisawa

Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep.

Sixty patients diagnosed with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The effects of surgery were studied based on endoscopic findings during drug-induced sleep and determination of the apnea-hypopnea index (AHI) before and after the operation. Changes in the form of the airway during sleep in the recumbent position were observed, and the role of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was determined. The site of airway obstruction during sleep induced by i.v. injection of 10 mg of diazepam was classified into five types, and changes in AHI and the site of airway obstruction were compared before and after surgery. Changes in airway morphology during sleep in the supine and recumbent positions were also compared before surgery. The postoperative improvement rate was 74.4% for the soft palatal type of obstruction, 76.2% for the tonsillar type, 53.3% for the circumferential palatal type and 34.0% for the mixed type. Treatment produced excellent or good effects for the soft palatal and tonsillar types of obstruction. However, many patients with the circumferential palatal and mixed types of obstruction showed only some improvement or no change. Good airway morphology was maintained in the recumbent position by patients with the soft palatal type of obstruction. With the circumferential palatal and mixed types of obstruction, improvement can be expected from operations which include surgical treatment of the posterior pharyngeal wall or lateral funiculus, or with midline laser glossectomy. A good operative outcome can be predicted in patients showing improvement of apnea in the recumbent position preoperatively.

Application of lingual tonsillectomy to sleep apnea syndrome involving lingual tonsils.

In sleep apnea syndrome, surgical treatment is applied in obstructive-type cases and some mixed-type cases. If the obstructive part is in the root of the tongue, forward transfer of the tongue, lingual tonsillectomy and laser midline glossectomy are applied. In this study, we demonstrate the surgical technique of lingual tonsillectomy using an ultrasonic coagulating dissector (SonoSurg) with a blade tip shape developed in our department. We conclude that lingual tonsillectomy using SonoSurg, which we have frequently used, should be the first choice of treatment for snoring and sleep apnea caused by hypertrophy of the lingual tonsils from the viewpoints of effectiveness, prevention of hemorrhage, safety and handling.

Dynamic MRI diagnosis of sleep-disordered breathing.

According to the obstructive site, the different types of obstructive-type sleep-disordered breathing are classified as the soft palate type, palatine tonsil type, soft palate and depressed lingual root type, depressed lingual root type and epiglottis type. In this study, we conducted dynamic MRI examinations of the oral, pharyngeal and lingual root sites in patients with obstructive sleep-disordered breathing, and studied the usefulness of MRI as a diagnostic tool for the examination of such obstructive sites.

The Role of Natural Killer Cells in Human Tonsillar Tissue Focussing on the Change of Tonsillar Tissue with Aging

The natural killer (NK) activity of tonsillar lymphocytes is low and NK-cells are small in number. In tonsillar tissue, NK-cells were present in the germinal center, which is where B-cells are located. This suggests that B-cells are related to NK-cells. Judging from the rates of augmentation of NK-activity of INF-alpha, INF-beta, and from the fact that there is no difference in the rate of NK-activity augmentation between tonsillar and peripheral blood lymphocytes with IFN added, it is highly unlikely that there is much difference between the ratios of pre-NK cells and NK-cells. The fact that the NK-activity augmentation in the tonsil rose to approximately double that of peripheral blood on the addition of IL-2 suggests that the percentage of immature NK-cells is high in the tonsil. This supposition is in agreement with the morphological findings. In the infected and child tonsil, it is probable that NK-cells are at an immature stage, that NK-activity is low, that B-cells are active, and that immunoglobulin production is in progress.

Laryngeal Lymphangioma—Case Report

Laryngeal lymphangioma is extremely rare. We have been able to find only seventeen cases reported in world literature. We recently, treated a patient suffering from laryngeal lymphangioma in our department. The female patient, aged 36, complained of hoarseness for several months. Indirect laryngoscopy revealed a growth on her right false vocal cord. Under general anesthesia, tracheostomy and laryngofissure were performed for removal of this neoplasm. The tumor was microscopically diagnosed as lymphangioma. The symptoms disappeared after surgery and there has been no recurrence. The pertinent literature on this rare disease is reviewed.

Comparison of the state of sleep in patients with sleep-disordered breathing before and after surgical treatment.

In 19 surgically treated patients with sleep-disordered breathing for whom electroencephalograms could be recorded before and after surgery, and in 10 patients who suffered from daytime lethargy as assessed using the Epworth Sleepiness Scale (ESS) score, correlations between the stages of sleep before surgery and the ESS score and apnea-hypopnea index (AHI) were evaluated, and changes in AHI and the stages of sleep after surgery were examined. Neither the preoperative severity of AHI nor the ESS score showed an association with the stages of sleep. The improvement in the quality of sleep tended to be greater as the percentage improvement in the ESS score increased.

A Case of Aspergillosis of the Frontal Sinus.

We report an extremely rare case of aspergillosis of the frontal sinus. The patient was a 47-year-old man who presented with the chief complaint of left forehead pain. A nasal examination, CT and MRI suggested mycosis of the frontal sinus. The patient subsequently underwent endoscopic sinus surgery and aspergillosis was diagnosed based on the histopathological findings. Good results were obtained with irrigation of the frontal sinus after surgery. To our knowledge, there have been only four reports of frontal sinus mycosis in Japan, including ours. Aspergillus species was the causative organism in all four cases, and intracranial invasion was present in all of the patients except the one described here.

Two Cases of Sleep Apnea Syndrome Caused by Primary Hypothyoidism.

Two cases of obstructive sleep apnea (OSAS) caused by primary hypothyroidism are reported.The first patient was a 66-year-old man who complained of sleep apnea with an apnea/hypopnea index (AHI) of 50.8 per night as assessed by all night monitoring. Hypothyroidism was subsegently suspected when he showed delayed recovery from general anesthesia following surgery involving UPPP (uvulo-palato-pharyngoplasty). Hypothyroidism was diagnosed on the basis of blood tests. His snoring and apnea improved after 2 months of levothyroxine sodium administration and the AuI changed from 50.8 to 13.0.The second patient was a 73-year-old man with an AHI of 41.3 per night as assessed by all night monitoring. Hypothyroidism was diagnosed on the basis of blood tests and was suspected because of his slow speech. He was similarly treated with levothyroxine sodium. The AHI did not decrease after treatment for 4 months. His desaturation time (the rate of O2 saturation less than 90%) improved however, from 56.6 to 31.9, and the symptoms of hypothyroidism also recovered markedly. In both patients, elevated creatine phosphokinase (CPK), dull facial expression, peripheral edema, and slow speech were recognized and these were suggestive of hypothyroidism. The type of sleep apnea was mainly obstructive in both patients.

A Questionnaire-Based Survey of Patients after Obstructive Sleep Apnea Syndrome Surgery. Comparison with Improvement in Apnea-Hypopnea Index.

The following six parameters were studied in 119 patients who responded to a questionnairebased long-term survey of 208 adults who had undergone surgery for obstructive sleep apnea syndrome in the previous 8 years: 1) snoring, 2) sleep apnea, 3) daytime sleepiness, 4) nocturnal arousal, 5) malaise, and 6) quality of sleep.The patients were divided into a markedly or moderately improved group (group A) and a slightly improved or unchanged group (group B) based on improvement of the apnea-hypopnea index (AHI) after surgery.In group A, improvement of snoring, sleep apnea, daytime sleepiness, and quality of sleep tended to decrease over the long term.In group B, improvement of these four symptoms was more marked than improvement of the AHI in the early postoperative period (1 year after surgery), with a significant difference between the two. The same pattern was also apparent in the long-term results.There was no major difference between the improvement of nocturnal awakening or malaise and improvement of the AHI over either the short or long term in groups A or B.

A Case of Abnormal Dental Eruption in the Nasal Cavity

A boy, aged 10, showed an abnormal eruption of an incisor in the right nasal cavity. Including our case, there were 126 cases, involving 131 teeth, of dental abnormalities reported in the literature of this country. Statistically, there were 8 men and 5 women, more cases involving supernumerary teeth than normal teeth, more teeth. Involving permanent than deciduous teeth, more involving the incisors than canines and more in the left nare than the right.