Murat Binar

Do Pharyngeal Surgeries for Snoring and Obstructive Sleep Apnea Have an Impact on Nasalance Scores

Objective:Most of the surgeries which are used in the treatment of habitual snoring and obstructive sleep apnea (OSA) mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty (ESP), lateral pharyngoplasty (LP), and anterior palatoplasty (AP) on nasalance scores. Subjects and Methods:Forty-nine consecutive patients with primary snoring or OSA who underwent AP, LP, and ESP procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed with Nasometer II instrument (model 6400; Kay Elemetrics, Lincoln Park, NJ) by reading 3 passages that were categorized according to the amount of nasal consonants (oral, oro-nasal, and nasal passages), preoperatively, and 3 months after surgery. Results:There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all 3 passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, 2 patients after AP, and 7 patients after ESP. None of these symptoms showed persistence and diminished approximately at 1-month follow-up. Conclusion:Anterior palatoplasty, LP, and ESP seem not to have any impact on nasalance scores of males.

A meta‐analysis of surgical success rates in Congenital stapes fixation and juvenile otosclerosis

To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO).

Do Pharyngeal Surgeries for Treatment of Snoring and Sleep Apnea Have an Impact on Nasalance

Objectives: Most of the surgeries used in the treatment of snoring and obstructive sleep apnea mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty, lateral pharyngoplasty, and anterior pharyngoplasty on nasalance. Methods: Forty-four consecutive patients with primary snoring or obstructive sleep apnea (OSA) who underwent anterior palatoplasty, lateral pharyngoplasty, and expansion sphincter pharyngoplasty procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed by using Nasometer II instrument (model 6400; Kay Elemetrics) preoperatively and 3 months after surgery. Results: The mean preoperative nasalance score for AP, LP, and SP groups were 49.06±10.72, 46.65±8.70, and 48±10.95, respectively. The mean postoperative nasalance score for AP, LP, and SP groups were 48.25±8.78, 46.82±5.2, and 49.36±10.81, respectively. There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all three passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, two patients after AP, and five patients after SP. None of these symptoms showed persistence, and they revealed at approximately 1-month follow-up. Conclusions: The results of this study showed that these surgical techniques did not lead to an objective velopharyngeal insufficiency, since no significant change in nasalance scores was observed.

Intraoral excision of a huge retropharyngeal lipoma causing dysphagia and obstructive sleep apnea

Lipomas, derived from the mesenchyme, are the most common soft-tissue tumors in the body, but only 15% of them are located in the head and neck region.1 Head and neck lipomas usually arise from posterior cervical triangle and the incidence of lipoma in the retropharyngeal region is very rare.2,3 Herein, we present a case of retropharyngeal lipoma causing progressive dysphagia and obstructive sleep apnea (OSA) which is treated by transoral surgical excision. We also review the literature to discuss the management of retropharyngeal lipomas causing OSA. To the best of our knowledge, present case shows the most huge retropharyngeal lipoma in the English literature causing dysphagia and OSA.

Life Priorities in Head and Neck Cancer Patients Between Ages of 45 to 65.

Diseases in head and neck cancer patients and applied therapies according to former affect life quality to a higher extent. In this paper, life priorities in 49 patients with head and neck cancer who referred to Gulhane Military Medical Academy for diagnostic and therapeutic purposes and the relationship between these priorities and sociodemographic properties have been studied. Following life priorities have been observed more important for the patients: to communicate with people in social places, to eat without any help by themselves, external appearance, taste and odor sense, continuing sexual life. Other priorities have been observed less important for the patients: attending social activities like cinema and theater, swimming pool and sea sports, money required for check-ups, necessities like time. Besides, these necessities do not show dissimilarities to any significant extent according to sociodemographic properties of the patients.

Anterior Palatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis:

Objective The aim of this study was to determine the general outcomes and surgical success rates of anterior palatoplasty (AP) in patients with obstructive sleep apnea (OSA). Data Sources A systematic review of the literature and meta-analysis of published data were performed by searching the Cochrane, SAGE, MEDLINE, and Google Scholar databases, from January 1, 2007, to March 27, 2017, using relevant keywords. Review Methods The search scanned for studies with patients who had undergone AP (with or without tonsillectomy) as a single-stage, single-level surgical intervention for treatment of OSA. Two independent reviewers (M.B. and O.K.) inspected titles and abstracts of the studies according to established criteria. The full texts were then reviewed to extract the clinical and polysomnographic data. The primary outcome was the surgical success rate, defined as a reduction in the apnea-hypopnea index (AHI) of 50% or greater and an AHI of less than 20 postoperatively. The PRISMA statement was followed. Results After systematic evaluation of potentially relevant articles, 14 studies were downloaded, and 6 studies, consisting of 170 patients, met the study criteria. A fixed effects model was used to analyze the data. The surgical success rate of AP was 60.6%. No serious complications were reported in the literature. Conclusion The results of the present meta-analysis support AP as a moderately effective surgical method for the treatment of OSA. Comparative and randomized controlled prospective studies showing long-term results, with pre- and postoperative data, should be conducted to demonstrate the exact outcomes and reliability of this surgical technique.

Comment on “Dysphagia and Obstructive Sleep Apnea in Acute, First-Ever, Ischemic Stroke”

We recently read the article by Losurdo et al published in the Journal of Stroke and Cerebrovascular Diseases.1 The authors suggest that both obstructive sleep apnea (OSA) and dysphagia are highly prevalent in first-ever, ischemic stroke, and these pathologies are associated in acute ischemic stroke. This is an interesting study, and the outcomes of the study are important for not only neurological sciences but also sleep medicine. We would like to emphasize 2 important issues regarding this article that should be taken into consideration. First, the authors mention that respiratory events were scored according to the current standard American Academy of Sleep Medicine criteria, and apnea hypopnea index (AHI) was calculated. AHI is the total number of events per hour, consisting of hypopneas, obstructive apneas, central apneas, and mixed apneas; therefore, in the polysomnography test, central apnea may be a component of total apneas. Central sleep apnea (CSA) is found rarer than OSA, and it occurs due to a temporary cessation of respiratory rhythmogenesis in neural respiratory networks during sleep.2 Frequently seen neurological diseases such as infarctions, arteriosclerosis, hemorrhage, tumors, head trauma, encephalitis, or other infectious diseases may cause central apnea during sleep.3 We want to point out that if the patient has ischemic stroke and apnea, he may also have CSA or Cheyne–Stokes breathing (CSB) besides OSA.4 Some of the patients included in present study may have predominantly CSA rather than OSA. The authors give no information about neither CSA nor CSB. Second, the endoscopic examination of the upper airway is one of the mandatory steps in the management of patients with OSA.5 The term “upper airway obstruction” in OSA may comprise functional (dynamic) obstructions, anatomical (i.e., large tonsils, septum deviation, nasal polyps) obstructions, or both. Endoscopic assessment shows not only the anatomical properties and closing patterns of the upper airway but also other pathologies such as nasopharyngeal, oropharyngeal, and hypopharyngeal mass lesions. Hypopharyngeal lesions may represent both OSA and dysphagia independent of stroke.6 Elderly patients with OSA and dysphagia are more likely to have a mass lesion in the hypopharyngeal region of upper airway compared with young patients, and the mean age is 66.9 ± 11.9 years in this study. So, the patients with newly diagnosed OSA may have unrecognized mass lesion causing mechanic obstruction and dysphagia in the upper airway if they are not evaluated with an endoscopic examination. Therefore, endoscopic evaluation is also mandatory for differential diagnosis of dysphagia especially in elderly patients with OSA. We appreciate the authors for their valuable work; however, we think that the materials and methods of this article lack aforementioned issues. Our comments do not minify the value and importance of this article, but the previously discussed points cannot be totally excluded from the management of patients with stroke having both OSA and dysphagia.

Another cause of difficult airway in an elderly patient: Tongue-base abscess

OBJECTIVE An abscess of the tongue base is rare, but it can be a potentially life-threatening situation in elderly patients. CASE REPORT A 72-year-old male patient presented with mid-anterior neck swelling, odynophagia, poor oral hygiene and severe dyspnoea. After a difficult intubation, the muscles were dissected via a submental suprahyoid approach and the abscess was drained. CONCLUSION Poor oral hygiene may predispose elderly patients to tongue-base abscesses. An early decision should be made for surgical drainage due to the risk of airway obstruction.

Chronic sialadenitis due to the stone inside the accessory duct of submandibular gland

PurposeSialolithiasis is the most common cause of chronic sialadenitis. In this case report, intraoperative finding of an accessory submandibular duct, obstructed with stone, originating from the same gland nearby the main Warthon’s duct, is presented.Case reportA 22-year-old male patient, suffering from eating-related pain and swelling in his left submandibular region, was diagnosed with left sublandibular gland sialadenitis with radiologically manifested sialolithiasis, and gland excision was advised. Surgery was performed under general anesthesia. When the full anatomical scenery was delineated before excision of the gland, we surprisingly encountered two submandibular ducts originating from ipsilateral gland, one of them was obstructed with stone. After two ducts were ligated, the gland with sialolith was excised. According to histopathologic examination, the duct obstructed with stone was identified as the accessory duct and the other one was the main Wharton’s duct. Postoperative days were uneventful; no neurologic complication was observed.ConclusionsOtolaryngologists should be aware of anatomic variations of the submandibular duct(s) to avoid possible complications, especially intraoperatively, because rutine preoperative radiologic preparation does not include investigation of possible accessory ducts.

A tertiary center experience with velopharyngeal surgical techniques for treatment of snoring and obstructive sleep apnea

OBJECTIVES The aim of this study was to assess the outcomes of patients who treated with the relatively new surgical procedures; anterior palatoplasty (AP), Cahali lateral pharyngoplasty (CLP), and expansion sphincter pharyngoplasty (ESP) for habitual snoring or obstructive sleep apnea (OSA). METHODS Prospective series of 93 patients were evaluated. The performed surgical techniques, polysomnographic outcomes, pre- and postoperative clinical parameters, and complication rates were assessed. RESULTS There were 14 snorers and 79 OSA patients. The mean age was 40.7 years, mean BMI was 27.67kg/m2, and the mean follow-up time was 5.90 months. There were 30 subjects in AP, 30 subjects in CLP, and 33 subjects in ESP groups. Apnea hypopnea index (AHI) improved from 16.90 to 14.27 (p=0.135) in AP, from 17.69 to 12.05 in CLP (p=0.004), and from 26.83 to 9.08 in ESP groups (p<0.001). When surgical success criteria is defined as more than 50% reduction in AHI to final AHI <15events/h, success rates were 45%, 64%, and 74% in AP, CLP, and ESP groups, respectively. Epworth Sleepiness Scale and visual analog scale for snoring significantly decreased after all procedures (p<0.05). The minimum oxygen saturation significantly increased after all procedures, however, only ESP caused statistically significant improvements in oxygen desaturation index, mean SaO2 and the percentage of sleep time with SaO2 below 90%. During the follow-up period, 61 of 93 patients (65.6%) indicated one or more complaints, but none of them was persistent. CONCLUSION We suggest that these relatively new velopharyngeal surgical techniques are effective in the management of snoring and OSA without causing persistent side-effects, and ESP is one step ahead of the other two techniques.