Long-term results of uvulopalatopharyngoplasty for snoring.

Snoring is a disease of listeners and one which can cause significant disruption in an otherwise peaceful household. Uvulopalatopharyngoplasty (UPPP) was initially described in 1981 for the treatment of obstructive sleep apnea, and since that time only one large series has evaluated it as a treatment for snoring. Various therapeutic strategies have been described for the treatment of snoring, but UPPP seems to hold the most promise. A retrospective review was undertaken of over 100 patients undergoing UPPP since 1984 to evaluate the efficacy of the procedure in controlling the symptom of snoring. The group of patients who will benefit most from this procedure is identified.     

悬雍垂腭咽成形术后鼻咽狭窄和腭咽关闭不全的防治

1964年日本学者Ikematsu报道,采用手术方法治疗打鼾,其缩小悬雍垂、软腭上提、腭舌弓和腭咽弓缝合扩大咽腔等手术原则和步骤,至今仍在沿用[1].     

Long-term results of KTP/532 laser uvulopalatopharyngoplasty

The symptom of snoring is no longer one of humorous content and with the ever increasing awareness of its detriments, it has become even more important to find a treatment that would be immensely beneficial to the patient. We would like to present our experiences with the use of the KTP/532 Laser in performing the UP3. This study is significant as it presents a long term four year follow up of cases based on the patients' assessments. The technique itself is tailor made to suit the individual patient, ensuring optimal results which revealed that most patients i.e.; 84% were extremely pleased with the operation. The series also showed minimal morbidity and no intra or post-operative complications which reiterates the need for meticulous, atraumatic technique and judicious, discriminate selection of patients.     

Uses and complications of uvulopalatopharyngoplasty

Uvulopalatopharygoplasty has become widely performed for chronic snoring and for cases of obstructive sleep apnoea. Unfortunately this operation is not without morbidity and complications. We report our results of a prospective series of 50 patients undergoing uvulopalatopharyngoplasty with a minimum follow-up of one year. Snoring was abolished in 18 (36 per cent) and substantially reduced in the remainder. Obstructive sleep apnoea syndrome, identified in 11 patients pre-operatively, was reduced in severity in all but three. Troublesome complications were seen in 18 (36 per cent) patients, namely intermittent velopharyngeal incompetence in five (10 per cent), pharyngeal dryness in 11 (22 per cent) and loss of taste in five (10 per cent). One patient had nasopharyngeal stenosis requiring correction. A cautious approach to this operation is required with rigorous case selection. The importance of full assessment and careful follow-up should not be underestimated.     

Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers: a 5- to 9-year follow-up of 400 consecutive patients

BACKGROUND: Heavy snoring and the obstructive sleep apnea syndrome are associated with increased morbidity and mortality in patients with cardiovascular disease. The effect of uvulopalatopharyngoplasty on mortality has been questioned. OBJECTIVE: To investigate long-term survival after palatal surgery. DESIGN: An observational retrospective case-control study with a 5- to 9-year follow-up. SETTING: A university medical center. PATIENTS: Four hundred consecutive heavy snorers (median age, 47 years), 256 of whom had obstructive sleep apnea syndrome. The mean +/- SD body mass index (calculated as weight in kilograms divided by the square of height in meters) of all included patients was 27.1+/-4.2. Comparison was made with 744 control patients (median age, 43 years) who underwent nasal surgery during the same period and a matched general control population. INTERVENTION: Uvulopalatopharyngoplasty or laser uvulopalatoplasty between 1986 and 1990. MAIN OUTCOME MEASURES: Mortality and causes of death up to 9 years after surgery. RESULTS: High blood pressure at the time of surgery and subsequent death due to cardiovascular disease were 3 times more frequent in the patients with obstructive sleep apnea syndrome than in both control groups (P<.01), but the overall long-term mortality was not increased either in snorers or in persons with sleep apnea. The cumulative survival rate was more than 96% for the 400 patients, the 744 controls, and the matched general population. CONCLUSIONS: No increased mortality was seen following palatal surgery in this long-term follow-up of 400 consecutive, on average, nonobese snorers, 256 of whom had obstructive sleep apnea syndrome. This might indicate a positive survival effect of surgery.     

阻塞性睡眠呼吸暂停综合征悬雍垂腭咽成形术的临床观察

目的探讨悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）对阻塞性睡眠呼吸暂停综合征（obstructivesleepapneasyndrome，OSAS）的远期疗效及对糖、脂代谢的影响。方法对32例OSAS患者（中度6例，重度26例）连续观察术前、术后1个月、术后3年时的呼吸紊乱指数（respiratory disturbance     

阻塞性呼吸暂停低通气综合征患者悬雍垂腭咽成形术的长期疗效及对生活质量的影响

目的探讨阻塞性睡眠呼吸暂停综合征(obstruction sleep apnea syndrome,OSAS)患者悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)的长期疗效和手术前后生活质量的变化.方法经多导睡眠监测仪(polysomnograph,PSG)确诊的42例OSHAS患者行UPPP手术,比较手术治疗前后Epworth嗜睡评分(Epworth sleep score,ESS)和生活质量,分析其相关性及术后1～2年的随访结果.结果术前OSAHS患者生活质量明显下降,主观问卷指标与呼吸暂停低通气指数(apnea hypopnea index,AHI)和最低血氧饱和度(lowest saturation,L-SAT)有明显的相关性;术后患者生活质量明显提高,但与AHI和L-SAT无明显的相关性.结论 UPPP手术能明显提高患者的生活质量,但术后ESS评分变化与AHI、L-SAT之间无明显的相关性.因此,在UPPP手术的长期随访中,主观生活质量调查不能替代客观PSG监测的评估.     

阻塞性睡眠呼吸暂停低通气综合征患者腭咽成形术后并发症发生率对比分析

目的：评估悬雍垂腭咽成形术(UPPP)手术治疗OSAS患者术后出现咽部干燥、咽异物感等并发症发生率。方法：对经UPPP手术治疗后OSAS患者52例,进行术后随访评估。随访采用问卷方法,与正常人咽部干燥及咽异感症作对比。结果：随访5年中,OSAS组46例排除糖尿病的患者中,16例出现咽部干燥,对照组63例中12例出现,差异有统计学意义(P＜0.05);OSAS组22例出现咽异感症,对照组12例出现,差异有统计学意义（P＜0.01）。结论：OSAS患者UPPP术后咽异感症及咽部干燥患者较多,为创伤刺激及瘢痕愈合所致,应予重视。UPPP术后出现音色改变的可能性不大。     

Long-term hearing results following vestibular surgery in meniere's disease

Objectives: The purpose of this study is to evaluate the long-term hearing changes following vestibular surgery in patients with Meniere's disease. Study Design: This is a retrospective analysis of patients operated on in a tertiary referral center setting. Methods: Preoperative, postoperative, and 3- to 9-year postoperative audiograms were analyzed in two patient groups. Twenty-one patients underwent posterior fossa vestibular neurectomy (VN) and five, mastoid endolymphatic sac decompression and shunt (ELS). All frequencies, four-frequency pure-tone averages (PTAs), spondee thresholds, and speech recognition scores were compared for operated ear against nonoperated ear of VN subjects. The results were subjected to a covariance analysis. VN and ELS patients whose hearing deteriorated from “serviceable” (PTA ≤70 dB hearing level) and speech recognition ≤30%) to nonserviceable status were compared using nonparametric statistics. Results: Progressive hearing loss beyond the rate of change of the normal contralateral ear was evident in all patients. Serviceable hearing dropped from 81% to 43% of patients an average of 4 years following VN. Conclusions: VN patients have significant hearing deterioration over time in the operated ear. This finding suggests that continued postoperative medical management is necessary for patients undergoing VN. Laryngoscope, 108:1470–1473, 1998     

阻塞性睡眠呼吸暂停综合征悬雍垂腭咽成形术的临床观察

目的 探讨悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）对阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS)的远期疗效及糖、脂代谢的影响。方法 对32例OSAS患者（中度6例，重度26例）连续观察术前、术后1个月、术后3年时的呼吸紊乱指数（respiratory disturbance index,RDI)、体块指数、血压、血糖、甘油三酯、胆固醇的变化。结果 以RDI下降75％为OSAS显效作标准：手术后1个月时显效率37．5％，3年后降为13．8％；有效率术后1个月为87．5％，3年后为55．2％。手术后3年体块指数、血压、血糖、甘油三酯、胆固醇均较手术前显著下降，统计学处理P值均＜0．05，差异有显著性意义。结论 UPPP能改善中、重度OSAS患者的低氧血症，降低血压，血糖、甘油三酯、胆固醇；远期疗效差于近期疗效。术后疗效可能与术前体块指数、RDI、上气道的骨骼结构及术后体重变化有关。     

UPPP术后并发症发生率及危险因素分析

目的:探讨UPPP术后24 h内并发症的发生率及其危险因素,为早期预防术后并发症的发生提供理论依据.方法:回顾性分析162例接受UPPP手术的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,按照有无发生术后并发症进行分组,比较2组患者术前及术中各项临床指标的差异,对重要的临床参数作单因素及多元逐步Logistic回归分析.结果:31例(19.1%)患者术后24 h内出现并发症,包括呼吸并发症21例(13.0%),心血管并发症6例(3.7%),术后出血9例(5.6%).并发症组和无并发症组之间在BMI、AHI、LSAT及困难插管等方面均差异有统计学意义(均P<0.05).多因素回归分析显示,BMI(OR=1.136)、AHI(OR=4.828)及困难插管(OR=1.971)为术后24 h内出现并发症的独立危险因素.结论:OSAHS患者术前BMI、AHI及麻醉困难插管是预测术后24小时内出现并发症的主要指标.对于肥胖、严重OSAHS患者及插管困难患者,应提高警惕,做好围术期处理,避免术后并发症的发生.     

Clinical and functional analysis of long-term results of uvulopalatopharyngoplasty

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values < 6, CT 90% < 1%, and SaO2 Min > or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.     

Long-term results following mastoid obliteration in canal wall down tympanomastoidectomy

BACKGROUND: The primary goal in chronic otitis media is the creation of a dry, safe ear with hearing preservation and reconstruction. This study was designed to evaluate the authors' experience using autologous bone pate and conchal cartilage for mastoid obliteration in canal wall down tympanomastoidectomy. METHODS: A retrospective long-term review in 2003 of thirty-nine ears was performed, which underwent mastoid obliteration in canal wall down tympanomastoidectomy between 1993 and 2002 performed by the senior author. Data included questionnaire results, clinical observation as well as pre- and postoperative audiometry. RESULTS: Long-term follow-up shows, that 38 out of 39 ears maintained a small, dry, healthy mastoid cavity. Recurrent cholesteatoma occurred in a single patient. A self-cleaning mastoid bowl was achieved in 90 %, resulting in reduced follow-up visits. Postoperative vertigo in canal wall down revision surgery is clearly diminished due to the mastoid obliteration. Overall, 92 % of patients are satisfied with the surgical result. CONCLUSION: Obliteration of a canal wall down mastoid cavity by autologous bone pate and conchal cartilage is a reliable and effective technique that results in a dry, trouble free mastoid cavity in 90 % of the patients with chronic otitis media.     

Modified neoglottis reconstruction following total laryngectomy: Long-term follow-up and results

In 1978 a surgical procedure was developed to create a neoglottis from the upper tracheal rings to facilitate speech rehabilitation in patients who had undergone total laryngectomy for carcinoma of the larynx. To date, 45 such procedures have been performed and results indicate rapid postoperative speech rehabilitation in nearly all patients, good long-term speech results, and low morbidity. This procedure has served as a very successful alternative to the more frequently used tracheoesophageal puncture (TEP) and prosthetic valve technique.     

Long-term results of 100 consecutive comprehensive neck dissections: implications for selective neck dissections

OBJECTIVE: The optimal surgical procedure for the neck in patients with squamous head and neck cancers is controversial. Selective neck dissections have replaced modified radical neck dissections as the procedure of choice for the clinically negative (N0) neck and are now being considered for patients with early-stage neck disease. We report the long-term local recurrence rates in 100 consecutive patients undergoing a radical or modified radical neck dissection for clinically positive (N+) and N0 neck disease and review comprehensively the literature reporting and comparing regional control rates for both neck dissection types. PATIENTS: The clinical records of 100 consecutive patients who underwent a comprehensive neck dissection (levels I-V) for squamous head and neck cancers with a minimum of a 2-year follow-up were retrospectively reviewed for primary site of disease, clinical and pathologic neck status, histopathologic grade, neck dissection type, and the site and time of recurrence. RESULTS: Complete data were available for 97 patients on whom 99 neck dissections were performed. Three patients died from unknown causes. Seventy-six patients with N+ disease underwent a therapeutic neck dissection, while 24 patients with clinically N0 disease underwent an elective dissection. The overall neck recurrence rate in patients with controlled primary disease was 7%. The neck or regional failure rate for patients completing the recommended adjuvant radiotherapy was 4%. Six (25%) of 24 patients with clinically N0 disease had occult metastases. The recurrence rate for this group was 4%. CONCLUSION: Further study is needed to determine the optimal surgical management of the N0 and limited N+ neck.