Background: Many patients with obstructive sleep apnea syndrome (OSAS) have multiple obstructive sites simultaneously such as the oropharynx, hypopharynx, and larynx. Multilevel surgery is starting to be widely performed by ENT surgeons and accepted by patients.Methods: Twenty consecutive patients with moderate or severe OSAS were treated with single-stage multilevel surgery. They underwent transoral robotic surgery for tongue base reduction or epiglottoplasty, expansion sphincter pharyngoplasty, and septoplasty.
Results:The average length of hospitalization was 5.2 ± 0.9 days. No serious complications were observed. At the postoperative control with polysomnography, the apnea-hypopnea index (AHI) had decreased by at least 50% in 90% of patients;improvements were observed in all sleep parameters.
Conclusion:Single-stage multilevel surgery has proven to be effective in treating patients with moderate to severe OSAS, without experiencing persistent complaints.Despite multiple levels of obstruction being operated in a single stage, airway safety was maintained in all patients. K E Y W O R D S expansion sphincter pharyngoplasty, multilevel surgery, OSAS, TORS 1 | INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is characterized by recurring events of partial or complete upper airway collapse during sleep.It is related to increased risk of cardiovascular diseases and causes daytime sleepiness altering the quality of life. To eliminate the collapsing points in the airway, continuous positive airway pressure (CPAP) is the first-choice treatment and the first option that is recommended to the patient. Nevertheless, a significant number of patients refuse CPAP treatment, and in this case, surgical treatment becomes an alternative along with weight loss, orthodontic, and positional therapy.Most OSAS patients have multilevel obstructions at sites including the oropharynx, hypopharynx, and larynx, so the best surgical management must be multilevel. 1
Descending mediastinal abscesses arising from oral (dental or peritonsillar abscess) or deep neck infections (DNIs) often become fatal without surgical drainage. Odontogenic origin was the most common cause of DNIs. We report the first clinical case of a patient with descending mediastinal abscess caused by DNI from Eggerthia catenaformis a Gram-positive anaerobic rod that can be rarely a human pathogen. The patient underwent the extraction of carious molars, cervical and thoracic surgical drainage, and targeted antibiotic therapy with resolution of the infection.
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