March 24, 2013 Ashok Balasundaram, BDS, DDS, MDS, MS, Diplomate ABOMR
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Abstract
Cone-beam computed tomography (CBCT) is primarily used for a variety of dental purposes, but it may also yield nondental findings that can have significant implications for patient health. For example, physicians should be aware that CBCT can identify some of the etiopathogenic causes of obstructive sleep apnea, as occurred in the case described in this report. The patient was a 76-year-old man who presented to a dentist for implant therapy. A CBCT that had been performed in preparation for dental implant placement revealed the presence of a large hypopharyngeal lesion that was obstructing the airway. An otolaryngologist excised the lesion, which on biopsy proved to be a lipoma. Following removal of the lesion, the patient's episodic sleep apnea and snoring resolved. Medical physicians should be aware of maxillofacial CBCT technology and its ability to identify lesions that could cause potential life-threatening situations.
October 31, 2012 Taha Tahir Bekci, MD; Mesut Tezer, MD; Nurdogan Ata, MD; Levent Emre, MD
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Abstract
We describe 2 cases of obstructive sleep apnea syndrome (OSAS) that were found to be caused by the presence of laryngeal masses. Both patients presented with a long-standing history of snoring, gasping for air while sleeping, excessive daytime sleepiness, and morning headaches. In both patients, the lesions were discovered by fiberoptic nasopharyngoscopy. Patient 1, a 46-year-old man, declined surgery, and his lesions (and OSAS) resolved spontaneously in 4 months. Patient 2, a 39-year-old man, did undergo excision of his mass, and he also experienced an alleviation of OSAS.
August 10, 2012 Ümit Tunçel, MD; Hasan Mete İnançlı, MD; Şefik Sinan Kürkçüoğlu, MD; Murat Enoz, MD
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Abstract
We conducted a retrospective study of 35 adults who had undergone tongue base suspension in addition to other surgery for the treatment of obstructive sleep apnea syndrome (OSAS). Our goal was to determine the most effective surgical approach by comparing these patients’ preoperative apnea-hypopnea index (AHI) with their postoperative scores at 6 months. The 35 patients were divided into three groups based on a preoperative assessment of their level of airway obstruction; the assessment included a determination of AHI and endoscopic findings during the Müller maneuver. Patients in group 1 (n = 9) exhibited unilevel obstruction, and they were treated with lateral pharyngoplasty; patients in group 2 (n = 13) also had unilevel obstruction, and they underwent Z-palatoplasty; patients in group 3 (n = 13) had multilevel obstruction, and they underwent combined surgery. Postoperatively, all three groups exhibited statistically significant improvements in AHI, but we determined that of the three approaches, multilevel surgery was significantly more effective (p < 0.001).
August 10, 2012 Selmin Karataylı-Özgürsoy, MD; Alp Demireller, MD
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Abstract
We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients—18 males and 2 females, aged 15 to 52 years (mean: 42.1)—who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure.
July 13, 2011 Mark T. Agrama, MD
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Abstract
The author conducted a retrospective study of 8 adults with euthyroid goiter that had resulted in tracheal compression and led to moderate to severe obstructive sleep apnea (OSA). The purpose of the study was to evaluate the effects of thyroidectomy on the apnea-hypopnea index (AHI) in these patients and to determine if there is a relationship between tracheal compression and OSA. These patients had been treated by the author in a community hospital over a 4-year period. All 8 patients had reported compressive symptoms of orthopnea and dysphagia, and 3 of them also reported dyspnea. Computed tomography of the neck and chest had been used to confirm the extent of goiter and tracheal compression. OSA had been confirmed with preoperative polysomnography. At 90 days post-thyroidectomy, repeat polysomnography had been obtained. At follow-up, all 8 patients had reported symptomatic control of compressive symptoms, and 7 patients had demonstrated postoperative improvement in their AHI. Overall, the mean postoperative AHI had decreased from 52.1 to 36.6-a statistically significant reduction of 29.8% (p < 0.05). The results of this study suggest that thyroidectomy for tracheal compression secondary to goiter can significantly alleviate symptoms and improve AHI in those patients who experience OSA. Evaluation of all patients with OSA should include screening for goiter-induced tracheal compression.
March 31, 2011 Gül Özbilen Acar, MD, Murat Yener, MD, Harun Cansiz, MD, Engin Acioğlu, MD, and Nukhet Tuziner, MD
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Abstract
Lingual tonsil hyperplasia is a rare condition that may cause obstructive sleep apnea (OSA). In the management of OSA, the lingual tonsils should be evaluated during the otorhinolaryngologic examination. We report the case of a 66-year-old man with findings of upper airway obstruction secondary to excessive lingual and palatine tonsil hyperplasia and with MRI findings of bilateral cervical lymphadenopathy. We review the clinical, radiologic, and histopathologic aspects of this case, and we discuss the surgical options for treating massive reactive lymphoid hyperplasia in conjunction with OSA.
January 1, 2011 Andrew C. Picel, MD and Terence M. Davidson, MD
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Abstract
Obstructive sleep apnea (OSA) is often associated with reduced pharyngeal muscle tone and an anatomically narrowed pharyngeal airspace. We describe 2 cases of aberrant internal carotid arteries that were diagnosed during evaluations of patients with suspected OSA. It is possible that these anatomic anomalies contributed to airspace narrowing in these patients. These 2 cases represent an interesting presentation of sleep apnea, and they provide a reminder of the importance of clinically recognizing carotid artery aberrations in order to avoid arterial damage during routine oropharyngeal procedures.
March 1, 2010 Jeffrey Coury, DO, Jonathan Steinfeld, MD, David Zwillenberg, MD, and Seth Zwillenberg, MD
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Abstract
Esophageal hamartoma is a rare entity, as only 7 cases have been previously reported in the English-language literature. Common symptoms include dysphagia, weight loss, and vomiting. Life-threatening airway obstruction can also occur. Because of the nonspecific nature of the symptoms, patients with these dangerous polyps are often misdiagnosed as having more common entities such as gastroesophageal reflux, peptic ulcer disease, or achalasia. Most of these tumors are missed on esophagoscopy and radiologic studies, and they can go undiagnosed for years. We diagnosed an esophageal hamartoma in an infant girl who had first presented when she was 8 days old with symptoms of apnea and cyanosis. The patient had undergone a multitude of tests since her birth, and she was eventually diagnosed with episodic bradycardia. When the patient was 6 weeks old, we discovered a polyp on nasopharyngolaryngoscopy, and we removed it by microdirect laryngoscopy and esophagoscopy. This patient was the youngest of the 8 who have now been reported to have been diagnosed with a hamartomatous polyp, and she was the only one to have presented with apnea (secondary to airway obstruction) and bradycardia. We recommend microdirect laryngoscopy and esophagoscopy to remove these pedunculated cervical esophageal lesions. A transcervical approach is warranted for sessile distal esophageal polyps. Esophageal polyps are an interesting entity in view of their rarity and intriguing presentations. Because esophageal obstructions can be life-threatening, further evaluation by laryngoscopy, bronchoscopy, and esophagoscopy is warranted when symptoms of dysphagia, vomiting, intermittent apnea, bradycardia, and weight loss persist despite conventional treatment.
July 31, 2008 Ali M. Strocker, MD, Alen N. Cohen, MD, and Marilene B. Wang, MD
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Abstract
We retrospectively reviewed the outcomes of 40 patients who had undergone outpatient uvulopalatopharyngoplasty (UPPP) for the treatment of moderate to severe obstructive sleep apnea (OSA) in order to determine the safety of the procedure in an outpatient setting. Postoperatively, 36 of the 40 patients (90%) were discharged home the day of surgery without morbidity; 3 other patients stayed overnight for nonmedical reasons, and 1 patient who was already an inpatient remained hospitalized for unrelated medical issues. No postoperative complications occurred, and all patients reported a resolution of OSA symptoms and improvement in sleep. Based on a combination of our data and those of previous studies, we conclude that patients with significant OSA can safely undergo UPPP as an outpatient procedure. We recommend that guidelines regarding the perioperative care of patients with OSA be adjusted to include consideration of treatment in an outpatient setting.
February 1, 2007 Thomas P. Stern, MD; Dennis Auckley, MD
May 31, 2004 James Chan, MD; Lee M. Akst, MD; Isaac Eliachar, MD
April 30, 2004 Alan J. Saffran, MD; Richard F. Clark, PA-C
