Objectives/Hypothesis Our objective was to determine whether drug‐induced sleep apnea (DISE) affects the successfulness of the surgical outcome. Study Design Prospective, seven‐country, nonrandomized trial. Methods There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group. Results There were 170 patients in the DISE group and 156 patients in no‐DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no‐DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no‐DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no‐DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea‐hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no‐DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no‐DISE group it was 13.2 ± 8.8 (P = .023). The age‐, gender‐, BMI‐adjusted percentage change in AHI for the DISE group was −48.4 ± 31.9, whereas in the no‐DISE group it was −59.8 ± 18.6 (P < .001). The age‐, gender‐, and BMI‐adjusted success rate for the DISE group was 66.5%, whereas in the no‐DISE group it was 80.8% (P = .004). The age‐, gender‐, and BMI‐adjusted change in SBP for the DISE group was −6.1 ± 8.6, whereas in the no‐DISE group it was −13.3 ± 11.1 (P < .001). The age‐, gender‐, and BMI‐adjusted change in DBP in the DISE group was −5.2 ± 12.1, whereas in the no‐DISE group it was −12.4 ± 11.7 (P < .001). The mean age‐ and gender‐adjusted change in BMI for the DISE group was −4.6 ± 12.9, whereas in the no‐DISE group it was −6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08. Conclusions DISE may not significantly affect surgical success in OSA. Level of Evidence 2c Laryngoscope, 130:551–555, 2020
To study the clinicopathological profile, recurrence and malignant potential of the inverted papilloma of nose and paranasal sinuses in relation to the definitive diagnosis and the management undertaken. A total number of 52 cases of histologically proven inverted papilloma managed in our department of otolaryngology over a 10-year period (May 1998-April 2008) were followed up (until October 2009) and the results were analyzed retrospectively to find out any incidence of recurrence of these tumours. A total of 52 inverted papilloma cases were managed with different surgical interventions. Male:female ratio was found to be 10:1. The mean follow up period was 74 months (range 16 months-11 years). Recurrence was observed in 20 (38%) cases. 23% had recurrence without any specific histological pattern, 12% had recurrence with focal dysplasia and 4% had recurrence with malignant transformation into squamous cell carcinoma (SCC). Post-operative radiotherapy was given to 8% (four cases) with malignant transformation. The management of inverted papilloma depends on its size and extension. Recurrence can be minimized by an appropriate surgical planning. Careful endoscopic assessment is essential to detect early recurrence. Recurrent inverted papilloma should be treated more aggressively. Malignant transformation in inverted papilloma should be managed like any aggressive sino-nasal malignancy.
Objectives/Hypothesis: To investigate long-term complications of newer reconstructive palate surgery techniques. Study Design: Retrospective case-series analysis. Methods: Retrospective six-country clinical study of OSA patients who had nose and palate surgery. Results: There were 217 patients, mean age = 43.9 AE 12.5 years, mean body mass index = 25.9 AE 4.7, mean preoperative apnea-hypopnea index [AHI] = 30.5 AE 19.1, follow-up 41.3 months. A total of 217 palatal procedures were performed, including 50 expansion sphincter pharyngoplasties (ESP), 34 functional expansion pharyngoplasties (FEP), 40 barbed reposition pharyngoplasties (BRP), 64 modified uvulopalatopharyngoplasties (mUPPP), 11 uvulopalatal flap procedures (UPF), nine suspension pharyngoplasties (SP), eight relocation pharyngoplasties (RP), and one z-pharyngoplasty (ZPP). Complications included were constant and/or felt twice per week; dry throat (7.8%), throat lump feeling (11.5%), throat phlegm (10.1%), throat scar feeling (3.7%), and difficulty swallowing (0.5%). Of the 17 patients who had a dry throat complaint, two were constant (one SP, one RP), 15 were occasional (10 mUPPP, three SP, two BRP). Of the 25 patients with the throat lump feeling, four were constant (three RP, one ZPP), 21 were occasional (10 mUPPP, five SP, five UPF, one BRP). Of the 22 patients with the throat phlegm feeling, four were constant (two SP, two RP), 18 were occasional (10 mUPPP, four BRP, two FEP, two SP). Of the eight patients with throat scar feeling, eight were occasional (four SP, two mUPPP, one FEP, one RP), none were constant. One patient had difficulty swallowing (RP procedure). There was no velopharyngeal incompetence, taste disturbance, nor voice change. Highest symptom complaints were mUPPP, SP, and RP, whereas the lowest symptom complaint was ESP.Conclusions: Newer palatal techniques have shown to have less long-term complications compared to the older ablative techniques.
Objective: Does nasal surgery affect multilevel surgical success outcome. Methods: Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. Results: There were 575 patients in nose group, 160 patients in no nose group. The
Pleomorphic adenoma of the base of the tongue is a rare tumour. A case of a 40-year-old female with pleomorphic adenoma of the tongue base is reported here, with a review of the literature. Complete excision of the mass was done transorally under general anaesthesia.
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