Background: In recent practice, we have used tissue transfer (pedicled or free flap) to augment the pharyngeal circumference of the neopharynx following salvage total laryngectomy, even in patients who have sufficient pharyngeal mucosa for primary closure. In this study, the rates of pharyngocutaneous fistula were compared in soft tissue flap reconstructed patients versus patients who underwent primary closure. Method: A retrospective assessment was carried out of all patients who had undergone a salvage total laryngectomy between 2000 and 2010. The presence or absence of a pharyngocutaneous fistula was compared in those who received reconstruction closure versus those who received primary closure. Results: The reconstruction closure group (n = 7) had no incidence of pharyngocutaneous fistula, whereas the primary closure group (n = 38) had 10 fistulas, giving pharyngocutaneous fistula rates of 0 per cent versus 26 per cent, respectively. Conclusion: The findings revealed a lower rate of pharyngocutaneous fistula with tissue transfer compared with primary closure of the neopharynx.
INTRODUCTION: Snoring is a common cause of marital disharmony and social embarrassment. Obstructive sleep apnoea (OSA) have further impact on Quality of Life (QoL). AIMS: First, to compare the impact of snoring and OSA on QoL; second, to assess the impact of laser palatoplasty (LAUP) on QoL in snorers. METHODS: We conducted a prospective cohort comparison of 191 snorers (mean age 46 years; 132 men, 59 women), 57 patients with OSA (mean age 47 years; 49 men, 8 women), and 105 patients, at a mean of 12 months (range, 4-24 months) after LAUP (mean age 45 years; 82 men, 23 women). All completed the Nottingham Health Profile (NHP) and the results were compared with established NHP population norms. RESULTS: The results are shown in Table 1. CONCLUSIONS: This is the largest QoL study of snorers to date and shows that both snoring and OSA have clear impacts on all six NHP domains. The magnitude of the impact in snoring approaches that for OSA for most parameters. The impact of OSA on the sleep domain in men is significantly higher than that of snoring. Energy and emotional reaction domains are significantly improved by LAUP in both sexes, to levels approaching those in the normal population. Also pain, sleep, social isolation and mobility in habitual snorers was helped by surgery. The NHP generic QoL health status measure is a useful tool for the assessment of sleep disorders.
The aim of this study was to assess the quality of information available on the World Wide Web regarding the treatment of snoring. The main data source was from internet searches using the three most popular search engines using the keywords "snoring treatment". First page websites were evaluated using the DISCERN instrument (assessing reliability and information given about treatment choices). Of the 135 websites identified, 16 unique websites were evaluated in the study (the remaining being adverts or repetitions). The websites had an average overall score of 2.37 out of 5 (range 1.19-4) and 37.5 % of the websites evaluated scored less than 2 out of 5 overall, suggesting very poor quality information. Highly ranked websites on popular search engines may not contain the most reliable information. Overall the information on the internet regarding the treatment of snoring is poor and patients should be encouraged to discuss their findings with a medical professional.
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