A retrospective review of 135 patients surgically treated for obstructive sleep apnea syndrome (OSAS) from 1982 to 1987 was performed to identify perioperative complications and potential risk factors. The incidence of complications was 13% (18/135). Airway problems comprised 77% (14/18) of these complications, resulting in one death. There were three postoperative hemorrhages and one postoperative arrhythmia. Comparison of the complication group versus the noncomplication group showed a statistically significant difference in the minimum oxygen saturation (66% vs. 79%) and apnea index (75 vs. 57) on the pre-operative sleep study and in the amount of narcotic administered intraoperatively. Patients with intubation complications tended to be heavier, whereas patients with extubation complications received significantly more narcotic analgesia intraoperatively. Risk for a perioperative complication was not related to age, type of obstructive symptoms, medical problems, or concurrent septoplasty/tonsillectomy. A protocol for perioperative airway management is presented.
Oncocytic neoplasia of the parotid gland is a rare form of salivary gland disease with obscure etiology. The presence of multiple oncocytic morphologies in a single specimen is suggestive of transition between forms. Although oncocytic tumorigenesis secondary to acquired mitochondrial dysfunction is a plausible mechanism, few of these tumors actually harbor mtDNA alterations within the control region.
Laryngeal implantation for medialization has improved our ability to manage the patient with vocal fold motion impairment. We present preliminary data evaluating the use of preformed hydroxylapatite laryngeal implants and instrumentation for rapid determination of implant size and position. A window in the thyroid ala is created by means of a standard fenestra template. One of 5 prosthesis templates is inserted through the window for determination of correct size and position. The corresponding implant is then inserted and secured with a hydroxylapatite shim. Thirty-five patients have been implanted for vocal fold paralysis, and 4 patients were implanted for soft tissue deficits or bowing. Thirty-one of 35 patients have reported subjective improvement (89%). Improvement was demonstrated in 13 of 15 (87%) patients with complete preoperative and postoperative objective voice function measurements. Complications include 1 implant extrusion and 1 case of airway obstruction secondary to edema. Preliminary results indicate that prefabricated hydroxylapatite implants are effective for medialization thyroplasty. Advantages include a readily available implant selection, rapid determination of correct size and position, and improved implant stabilization with a hydroxylapatite shim.
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