Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome

OBJECTIVES: The primary objective is to determine the effectiveness of multilevel (tongue base and palate) temperature controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). The secondary objective is to compare multilevel TCRFTA to nasal continuous positive airway pressure (CPAP). STUDY DESIGN AND METHODS: The study is a controlled case series of one investigator's experience with multilevel TCRFTA for patients with OSAS. Twenty-two subjects with mild to severe OSAS, without tonsil hypertrophy, completed multilevel TCRFTA (mean 4.8 tongue base and 1.8 palate treatment sessions) and had both pre- and posttreatment polysomnography. Primary outcomes included change from baseline in apnea/hypopnea index (AHI), daytime somnolence, and reaction time testing measured 2 to 3 months after TCRFTA. Secondary outcomes included change in other respiratory parameters, OSAS related quality of life, and upper airway size. Comparison of 18 patients treated with TCRFTA for mild to moderate OSAS (AHI > 5 and < or = 40) is made with 11 matched patients treated with nasal CPAP for mild to moderate OSAS. RESULTS: Multilevel TCRFTA significantly improved AHI (P = .001), apnea index (P = .02), as well as respiratory and total arousal indices (P = .0002 and P = .01). Significant improvement with moderate or large treatment effect sizes were noted for OSAS related quality of life (P = .01) and daytime somnolence (P = .0001), with a trend toward significant improvement in reaction time testing (P = .06), with mean posttreatment normalization of all three outcome measures. Fifty-nine percent of subjects demonstrated at least a 50% reduction in AHI to less than 20. The targeted upper airway, measured in the supine position, demonstrated a trend toward significant improvement in mean cross sectional area (P = .05) and volume (P = .10). Side effects of TCRFTA were infrequent, mild, and self-limited. No significant correlation between pretreatment parameters and outcome improvement was noted. Nasal CPAP resulted in significant improvement in AHI (P = .0004) to near normal levels, with an associated improvement in OSAS related quality of life (P = .02) and a trend toward significant improvement in daytime somnolence (P = .06). Reaction time testing demonstrated no significant improvement (P = .75). No significant differences were seen for change in AHI, OSAS related quality of life, daytime somnolence, or reaction time testing between multilevel TCRFTA and CPAP. CONCLUSION: Multilevel (tongue base and palate) TCRFTA is a low-morbidity, office-based procedure performed with local anesthesia and is an effective treatment option for patients with OSAS. On average, abnormalities in daytime somnolence, quality of life, and reaction time testing demonstrated improvement from baseline and were normalized after treatment. Polysomnographic respiratory parameters also demonstrated significant improvement with multilevel TCRFTA.     

Plasticity of the different neuropeptide-containing nerve fibres in the tongue of the diabetic rat

Common oral complications of diabetes mellitus are xerostomia, impairment of taste, atrophic lesions of the tongue, leukoplakia, lichen oris planus, and tumours, which might be the consequence of chronic inflammation and changes in innervation. In this work, we examined the density of different neuropeptide-containing nerve fibres immunohisto- and immunocytochemically in the root of the control and diabetic rat's tongue. Quantitative analysis showed that the number of immunoreactive (IR) nerve fibres was decreased after 1 week of the streptozotocin treatment, which was prevented by immediate insulin treatment. However, after 4 weeks duration of diabetes, the number of all investigated IR nerve fibres increased significantly (p<0.05), which was further enhanced by the delayed insulin treatment. The numbers of substance P (SP) and vasoactive intestinal polypeptide IR perikarya were also increased by insulin treatment. The electron-microscopic investigations showed that some of the nerve terminals from diabetic animals were found in degeneration. After 4 weeks duration of diabetes, the number of inflammatory cells as well as the mast cell/nerve fibre contacts was also increased. The immunocells also showed IR for SP and neuropeptide Y in the diabetic rats. The insulin treatment decreased both the number and the immunoreactivity of these cells. The increased synthesis and/or regeneration of neuropeptide-containing nerves might indicate the plasticity of nerve fibres in diabetes mellitus, which might happen as a consequence of the changes in the level of neurotrophic factors released by increased number of inflammatory cells or as an effect of insulin.     

Tissue engineered muscle implantation for tongue reconstruction: a preliminary report

OBJECTIVES/HYPOTHESIS: Because current tongue reconstructive methods introduce adynamic, variably sensate tissue into the mouth, the critical functions of the tongue in articulation and deglutition may be compromised. The objective of this work was to introduce a combination of myoblasts and scaffolding material into rat hemiglossectomy defects and to examine the extent of neomuscle formation in the reconstructed area, under the hypothesis that the presence of myoblasts leads to formation of new muscle. STUDY DESIGN: Randomized, prospective animal study. METHODS: Myoblasts were harvested from neonatal Lewis rats, and a growth factor enriched collagen gel was prepared. Syngeneic adult animals received either hemiglossectomy alone or reconstruction with one of four experimental reconstructive preparations: collagen gel alone, collagen gel with suspended myoblasts, the gel-cell combination in undifferentiated muscle construct form by way of tissue culture for 7 days in a preformed mold, or differentiated constructs, cultured in myoblast fusion medium. After 6 or 16 weeks, animal weight gain was recorded, animals were killed, and the tongues harvested. The tissue was examined histologically, and quality of the muscular regenerate was rated on a scale according to predefined criteria. RESULTS: Animals in all groups gained weight appropriately. In groups receiving hemiglossectomy alone or acellular (gel only) reconstruction, there was significant scarring and lack of neomuscle formation. In groups receiving myoblast transplantation, either by way of gel suspension or in the form of undifferentiated or differentiated constructs, muscle quality was superior to controls. CONCLUSIONS: Myoblast transplantation into hemiglossectomy defects appears to lead to new muscle formation and does not inhibit normal weight gain in animals after tongue implantation.     

Angioplasty or Stenting in Adult Coarctation of the Aorta? A Retrospective Single Center Analysis Over a Decade

For over 11 years, endovascular treatment by angioplasty (PTA) alone or stenting of adult coarctation at a single center was evaluated. We retrospectively reviewed 28 consecutive patients (31 interventions), median age 25 years, treated between 1991 and 2002, 20 of whom had native coarctation. Thirteen patients had PTA alone (16 procedures) (10 kissing balloon angioplasty comprising 12 interventions, and 3 single balloon angioplasty comprising 4 interventions) and 15 patients were stented (15 procedures), including 6 secondary and 9 primary stents. There were no procedural or 30-day complications. For the whole group, the median follow-up was 6.6 years (range 1–10 years). In the PTA group, median follow-up was 9 years (range 3–10) and in the stenting group it was 3 years (range 1–5). There were 9 restenoses in the PTA group (6 after kissing balloons and 3 after single balloon) comprising 56% of the angioplasties (9/16 procedures). There was 1 restenosis in the stenting group diagnosed at computed tomography (CT). The patient was clinically well. For the whole group there were significant reductions in systolic blood pressure (BP) (p = 0.0003), diastolic BP (p = 0.004) and number of drugs per patient (p = 0.045) at latest follow-up post-treatment. Five patients discontinued therapy. Analysis of the groups revealed that the reduction of systolic and diastolic BP and number of drugs did not reach statistical significance in the PTA group but were significant in the stent group. The endovascular management of adult coarctation is safe. Stents may be more effective than PTA alone but longer-term follow-up of stents is required.     

Massive tongue swelling following the use of synthetic saliva

A 5-year-old boy with cerebral palsy and severe learning difficulties developed massive tongue swelling of sudden onset following the use of synthetic saliva. Acute airway obstruction and severe stridor ensued which required tracheal intubation and transfer to paediatric intensive care. The child was treated with intravenous steroids, antihistamines and epinephrine. With cessation of synthetic saliva, the swelling gradually resolved and the child was extubated on day 5.     

舌鳞癌患者术前颈部淋巴结分期价值的探讨

目的:通过分析颈淋巴结转移与其临床特点的关系,对可能有助于判断颈淋巴结转移的临床指标进行评价。方法:比较170例舌鳞癌患者临床分期与病理分期的符合率,分析淋巴结的数目、最大淋巴结长径、最大淋巴结所在区域及淋巴结实质的影像学表现与颈淋巴结转移的关系。结果:颈淋巴结临床N分期与病理N分期的总符合率为60%,其中N1～N3期病例的符合率仅为17.6%(12/68)。多个淋巴结肿大患者的颈淋巴结转移率高于单个淋巴结肿大者;最大淋巴结长径≥2cm患者的颈淋巴结转移率高于<2cm患者;临床最大淋巴结在同侧Ⅰ区组与同侧Ⅱ、Ⅲ区组患者的颈淋巴结转移率差异有统计学意义,P<0.05;在影像学(CT为主)上表现淋巴结实质异常,发生颈淋巴结转移的概率较高。结论:临床N分期与病理N分期的总符合率比较低。若舌癌患者在术前颈部检查中发现肿大淋巴结数目≥2、最大淋巴结长径≥2cm或淋巴结实质异常时,发生颈淋巴结转移的概率均>50%。因此,具有以上指标之一的舌鳞癌患者行颈淋巴结清除是安全的。     

Does Tongue Size Differ Between Patients With and Without Sleep‐Disordered Breathing?

OBJECTIVES/HYPOTHESIS: To determine whether there is a difference in the tongue size of patients with and without sleep-disordered breathing (SDB) and to evaluate whether tongue volume correlates with body mass index (BMI), neck circumference, age, Epworth Sleepiness Scale score, or apnea-hypopnea index (AHI). STUDY DESIGN: Nineteen patients (9 with SDB; 10 without SDB) were enrolled in this prospective study. METHODS: All patients completed a sleep questionnaire including the Epworth Sleepiness Scale and underwent a physical examination, portable sleep study, and magnetic resonance imaging (MRI) study. An examiner masked to the patients' disease status measured tongue volume from the MRI films. RESULTS: There was a trend for patients with SDB to have a larger tongue volume than patients without SDB (P = .065). Tongue volume only positively correlated with BMI (P = .005) and neck circumference (P = .013), but there was no correlation with age (P = .23) or AHI (P = .40). CONCLUSIONS: There is a statistical trend for patients with SDB to have larger tongue size compared with non-SDB patients, but tongue size is independent of AHI and correlates significantly with BMI and neck circumference. We interpret these findings to suggest that variations in tongue size alone cannot account for disease severity and may simply reflect the larger body habitus often seen in patients with SDB.     

Preoperative radiation therapy in squamous cell carcinoma of the anterior two-thirds of the tongue at the norwegian radium hospital

We examined the records of 118 patients with squamous cell carcinoma of the anterior two-thirds of the tongue treated during a 15 year period between 1958 and 1972 at The Norwegian Radium Hospital. They were staged according to the UICC 1978 system. Preoperative irradiation was employed in all patients, either with a radium needle implant or with external high energy irradiation or both. After a median delay of 3 months, surgical resection of the residual infiltrate was carried out. Histological examination of the resected tongue specimen was reported negative for residual tumor in 72 % of T₁N₀, 48 % of T₂N₀, and 29 % of T₃N₀ patients. The local control of the tumor of the tongue after negative post-irradiation histology was 91 % for T₁N₀ 68 % for T₂N₀, and 50 % for T₃N₀ patients. The local control of the tumor of the tongue after positive post-irradiation histology was 89 % for T₁N₀, 43 % for T₂N₀, and 30% for T₃N₀ patients. Surgery was, therefore, most effective in preventing local recurrence in the earlier stages. The local control of the neck after negative post-irradiation histology was 72 % for T₁N₀, 53 % for T₂N₀, and 3 out of 4 for T₃N₀ patients. The local control of the neck after positive post-irradiation histology was 22 % for T₁N₀, 43% for T₂N₀, and 50 % for T₃N₀ patients. More extensive use of external beam irradiation was noted in patients with advanced tumors. The five year survival of patients with negative post-irradiation histology was, for T₁N₀ 65% absolute and 73% relative; for T₂N₀ 53% absolute and relative; for T₃N₀ 50% absolute and relative. The five year survival of patients; with positive post-irradiation histology was, for T₁N₀ 39% absolute and 59% relative; for T₂N₀ 29% absolute and 40 % relative; for T₃N₀ 30 % absolute and relative. The difference observed between the groups of patients with negative and positive post-irradiation histology with respect to the control of the tumor in the neck and to the survival were statistically significant for T₁N₀ patients.     

A preliminary and clinical study of radiation therapy for tongue carcinoma

Four hundred and seventy-four patients with squamous cell carcinomas of the tongue were treated with radiation therapy at the Department of Radiology, Osaka University Hospital between 1978 and 1987. Brachytherapy was mainly employed for the majority of the patients with T1 and T2 lesions, whereas the combination of external irradiation and brachytherapy was the treatment of choice for the patients with infiltrative T2 and more advanced lesions. Patients treated with brachytherapy alone were given an estimated tumor dose of about 70Gy within a week. Patients treated with the combined therapy received an estimated tumor dose of about 30Gy to 50Gy within 3 to 5 weeks from external irradiation, followed by 50Gy to 60Gy within a week from brachytherapy. The treatments used in this study improved the survival. The 2-year local control rates were 85% in T1, 77% in T2, 60% in T3 and 33% in T4 lesions. The 5-year actuarial survival rates according to the T stage were 78% in T1, 64% in T2, 50% in T3 and 40% in T4 lesions. One hundred and four patients(28%) of three hundred and sixty nine patients who had negative lymph nodes clinically had cervical lymph node metastases subsequently. Whereas twenty six patients(25%) of one hundred and five patients who had positive lymph nodes clinically proved to be false positive. The incidence of osteoradionecrosis was 6.0% in patients treated with the combination of external irradiation(30Gy) and brachytherapy(60Gy), while it was 1.7% in patients treated with brachtherapy alone(70Gy). Brachytherapy is a fairly good therapeutic technique for the majority of the patients with tongue cancers. The multicombined treatment modality could provide the chance for cure of advanced lesions.