scholarly journals Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Emanuela Sitzia ◽  
Sara Santarsiero ◽  
Filippo Maria Tucci ◽  
Giovanni De Vincentiis ◽  
Angela Galeotti ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Balloon Dilation ◽  
Nasal Bone ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Sleep Apnoea ◽  
Maxillary Expansion ◽  
Feeding Difficulties ◽  
Obstructive Sleep ◽  
Pyriform Aperture

Abstract Background Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that may occur alone or as part of a multi-formative syndrome. Management remains difficult. There is no specific treatment protocol. Traditional surgery would be anachronistic; a non-invasive or minimally invasive therapeutic option is required. However, the rarity of the disease and the infantile context render randomised clinical trials difficult. Case presentation We present the case of a one-month-old Caucasian boy with CNPAS. He presented to the Emergency Department of the Bambino Gesù Pediatric Hospital with nasal obstruction, noisy breathing, feeding difficulties, and suspected sleep apnoea. During hospitalisation, he underwent overnight pulse oximetry, airway endoscopy, and maxillofacial computed tomography (CT); the final diagnosis was CNPAS with moderate obstructive sleep apnoea syndrome. We successfully treated the patient using an innovative strategy that involved collaboration between ear-nose-and-throat surgeons and orthodontists. Conclusions A combination of minimally invasive balloon surgery and placement of a palatal device may successfully treat CNPAS; it may also treat other types of nasal bone stenosis. Future studies may allow the development of practice consensus treatment strategies.

scholarly journals Balloon Dilatation and Rapid Maxillary Expansion: A Novel, Combined Treatment for Congenital Nasal Pyriform Aperture Stenosis in an Infant

2021 ◽  
Author(s):  
Sara Santarsiero
Keyword(s):  
Sleep Apnea ◽  
Minimally Invasive ◽  
Combined Treatment ◽  
Nasal Bone ◽  
Specific Treatment ◽  
Maxillary Expansion ◽  
Treatment Protocols ◽  
Feeding Difficulties ◽  
Obstructive Sleep ◽  
Pyriform Aperture

Abstract BackgroundCongenital nasal pyriform aperture stenosis (CNPAS) is a rare condition isolated or inserted in a multi-formative syndrome, which still encounters management difficulties. There are no specific treatment protocols and the use of traditional surgery represents an anachronism since cognitive assumptions and non-invasive or minimally invasive therapeutic innovations would currently be available. However, the rarity of the disease and the infantile context makes RCTs difficult to process. Case presentationWe expose the case of a one-month-old caucasian male infant suffering from CNPAS. The patient presented to the Emergency Department of the Bambino Gesù Pediatric Hospital with a clinical picture characterized by nasal obstruction, noisy breathing, feeding difficulties and suspected sleep apnea. During hospitalization he underwent overnight pulse oximetry, airway endoscopy and maxillofacial CT with a final diagnosis of CNPAS with moderate obstructive sleep apnea. We treated him successfully through an innovative therapeutic strategy that required the collaboration of a team of ENT surgeons and orthodontists.ConclusionsThe combination of minimally invasive balloon surgery and the application of a palatal device may represent a successful strategy for patients with CNPAS, probably also applicable to other types of nasal bone stenosis. Future studies may allow the definition of treatment strategies of these pathologies, we hope in the context of novel practical guidelines.

Minimally invasive tongue base surgery for obstructive sleep apnoea

2002 ◽  
Vol 116 (9) ◽  
pp. 716-721 ◽  
Author(s):  
David J. Terris ◽  
Larisa D. Kunda ◽  
Marie C. Gonella
Keyword(s):  
Minimally Invasive ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
The Body ◽  
Tongue Base ◽  
Velopharyngeal Insufficiency ◽  
Invasive Technique ◽  
Obstructive Sleep ◽  
The Individual ◽  
Individual Scores

Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose™ system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed.There were 16 men and three women, with a mean (±SD) age of 44.9 years (±14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 ± 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p < 0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p < 0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 ± 7.2 to 31.2 ± 7.6, p > 0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 ± 5.4 to 5.4 ± 3.8 (p < 0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications.The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.

The severity of obstructive sleep apnoea does not influence ambient IGF-I levels

2017 ◽  
Author(s):  
Julie Lynch ◽  
Nikolaos Kyriakakis ◽  
Mark Elliott ◽  
Dipansu Ghosh ◽  
Mitchell Nix ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Igf I

Requirement of staged interventions in a complex case of Acromegaly and Obstructive Sleep Apnoea

2020 ◽  
Author(s):  
Mili Dhar ◽  
Jennifer Elias ◽  
Benjamin Field ◽  
Sunil Zachariah ◽  
Julian Emmanuel
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Complex Case ◽  
Obstructive Sleep

Obstructive sleep apnoea is highly prevalent in a bariatric surgical population

2020 ◽  
Author(s):  
Rachel Agius ◽  
Claudia Coelho ◽  
James Crane ◽  
Piya Sen Gupta ◽  
Barbara McGowan
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep
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