What is the impact of distraction osteogenesis on the upper airway of hemifacial microsomia patient with obstructive sleep apnea: a case report

Abstract Background: Current researches about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes. This case report shows the outcome of DO on the upper airway of a HFM patient with obstructive sleep apnea (OSA) based on the use of computational fluid dynamics (CFD).Case presentation: A boy of 11-year-old was diagnosed as HFM with OSA, and underwent unilateral DO. Polysomnography and CT scans were performed before and six months after treatment. After DO, lowest blood oxygen saturation increased from 81% to 95% and apnea and hypopnea index decreased from 6.4 events/hour to 1.2 events/hour. The oropharynx and nasopharynx were obviously expanded. We observed apparently increased average pressure, decreased average velocity and pressure drop in all cross-sections, and largely decreased airflow resistance and maximum velocity entirely in the airway.Conclusions: The results suggest that DO might be effective for the treament of OSA by expanding the upper airway and reducing the resistance of inspiration.

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What Is the Impact of Distraction Osteogenesis on the Upper Airway of Hemifacial Microsomia Patient With OSA: a Case Report

10.21203/rs.3.rs-147431/v1 ◽

2021 ◽

Author(s):

Rongyang Wang ◽

Shixing Xu ◽

Ruimei Yang

Keyword(s):

Case Report ◽

Distraction Osteogenesis ◽

Cross Sections ◽

Maximum Velocity ◽

Upper Airway ◽

Hemifacial Microsomia ◽

Blood Oxygen Saturation ◽

Obstructive Sleep ◽

Computational Fluid Dynamics Cfd ◽

The Impact

Abstract Background: Current researches about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes. This case report shows the outcome of DO on the upper airway of a HFM patient with obstructive sleep apnea (OSA) based on the use of computational fluid dynamics (CFD).Case presentation: A boy of 11-year-old was diagnosed as HFM with OSA, and underwent unilateral DO. Polysomnography and CT scans were performed before and six months after treatment. After DO, lowest blood oxygen saturation increased from 81% to 95% and apnea and hypopnea index decreased from 6.4 events/hour to 1.2 events/hour. The oropharynx and nasopharynx were obviously expanded. We observed apparently increased average pressure, decreased average velocity and pressure drop in all cross-sections, and largely decreased airflow resistance and maximum velocity entirely in the airway.Conclusions: The results suggest that DO might be effective for the treament of OSA by expanding the upper airway and reducing the resistance of inspiration.

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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Diagnosis and treatment of snoring and sleep apnea syndrome

Kazan medical journal ◽

10.17816/kmj2306 ◽

2012 ◽

Vol 93 (2) ◽

pp. 273-276

Author(s):

R G Batyrshin ◽

L Ya Shagiakhmetova ◽

T R Batyrshin ◽

T A Gaysina

Keyword(s):

Obstructive Sleep Apnea ◽

Surgical Treatment ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Blood Oxygen Saturation ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

Radiofrequency Coagulation

Aim. To assess the effectiveness of modern methods of diagnosis and surgical treatment of night snoring. Methods. Conducted was polysomnography in 117 patients suffering from snoring at night. In the case of evident signs of obstruction, patients were offered surgical treatment. Results. Out of 117 people with snoring polysomnography revealed obstructive sleep apnea syndrome: in 35 - mild form, 11 - moderate severity, 1 - severe. In 69 patients benign snoring was revealed, which does not lead to a decrease in blood oxygen saturation. Simultaneous complex surgical treatment was performed in 38 patients who according to polysomnography revealed upper airway obstruction. The obstruction was eliminated by endoscopic surgical correction of the intranasal structures and the nasopharynx, and minimally invasive uvuloplasty using the method of radiofrequency coagulation. Postoperatively the patients received local medications biclotymol (hexaspray), fusafungine (bioparox), rinsing of the pharynx with antiseptics. Positive effect (disappearance of snoring) was achieved in 29 patients after an average of 1.5-2 months after surgery, in 6 patients with obstructive sleep apnea syndrome of the II and III degree of severity and co-morbidities the episodes of apnea and hypopnea decreased significantly. In 3 patients with recurrent polypous rhinosinusitis secondary to bronchial asthma (2 patients) and encephalopathy (1 patient), surgical intervention (endoscopic polysinusotomy, radiofrequency uvuloplasty) did not achieve the desired effect and the patients were referred for conservative treatment. Conclusion. The method of polysomnography and surgical treatment strategy of night snoring meet the modern requirements and in most cases have shown to be effective.

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The impact of upper airway surgery on the pathophysiological traits causing obstructive sleep apnea (OSA)

Sleep Medicine ◽

10.1016/j.sleep.2019.11.1170 ◽

2019 ◽

Vol 64 ◽

pp. S421

Author(s):

A.-M. Wong ◽

S. Landry ◽

S. Joosten ◽

L. Thomson ◽

S. Sands ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Upper Airway Surgery ◽

Airway Surgery ◽

Obstructive Sleep ◽

The Impact

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Retropharyngeal Tuberculous Abscess: A Rare Cause of Upper Airway Obstruction and Obstructive Sleep Apnea in Children: A Case Report

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmz018 ◽

2019 ◽

Vol 65 (6) ◽

pp. 642-645

Author(s):

Abate Yeshidinber Weldetsadik ◽

Alemayehu Bedane ◽

Frank Riedel

Keyword(s):

Obstructive Sleep Apnea ◽

Case Report ◽

Sleep Apnea ◽

Airway Obstruction ◽

Case Reports ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Obstructive Sleep ◽

Tuberculous Abscess ◽

Rare Manifestation

Abstract Retropharyngeal tuberculous abscess (RPTBA) is a rare manifestation of tuberculosis (TB) even in high TB burden areas. It rarely manifests as a cause of upper airway obstruction and obstructive sleep apnea (OSA) in children with few case reports in the literature. We report a 22 months old toddler who presented with upper airway obstruction and OSA and was diagnosed with RPTBA. The child recovered completely and growing normally after intra-oral aspiration and 6 months of anti-tuberculosis treatment.

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The Impact of Obstructive Sleep Apnea on Clinical, Perioperative, and Cost Outcomes in Patients Who Underwent Posterior Cervical Discectomy and Fusion: A Single Center Retrospective Analysis from 2008 to 2016

Neurosurgery ◽

10.1093/neuros/nyz310_817 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Alejandro Carrasquilla ◽

Dominic A Nistal ◽

John M Caridi

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Regression Analyses ◽

Cervical Discectomy ◽

Prolonged Intubation ◽

Airway Narrowing ◽

Icu Admission ◽

Obstructive Sleep ◽

The Impact

Abstract INTRODUCTION Obstructive sleep apnea (OSA) is a chronic condition that results from upper airway narrowing during sleep, with an increasing prevalence estimated to be around 9% to 24%. The combination of an unstable, recently fused or immobile cervical spine and OSA may reasonably lead to special considerations, although this topic has not been well studied. METHODS We retrospectively obtained 1191 posterior cervical discectomy and fusion (PCDF) cases, of which 93 subjects (7.81%) had a history of OSA and 1098 subjects (92.19%) did not. The primary outcome selected was prolonged intubation. Secondary outcomes included intensive care unit (ICU) admission, overall complications, extended hospitalization, nonhome discharge, readmission within 30 and 90 d, emergency room visit within 30 and 90 d, and higher total costs. Univariate and multivariate logistic regression analyses were conducted to assess OSA-affected clinical and perioperative outcome measures. RESULTS Compared to the control cohort, the OSA cohort had more subjects with body mass index (BMI) >30 (P < .0001) and ASA status >2 (P < .0001). After controlling for age, sex, obesity, and ASA status, multivariate regression analyses revealed no difference in the odds of a prolonged intubation (P = .4092). However, a difference was noted in the odds of ICU admission (P = .0038), extended hospitalization (P = .0223), and nonhome discharge (P = .0218). Variables predictive of higher direct cost included a higher ASA status (<0.0001), higher Elixhauser Comorbidities Index (ECI) score (P = .004), and more segments involved in the procedure (P < .0001). Conversely, our models suggested that the 2 cohorts did not differ significantly in the odds of increased complications, readmission at 30 and 90 d, and ER visit at 30 or 90 d. CONCLUSION This study is the largest retrospective review, to our knowledge, of patients who have undergone PCDF with a specific focus on OSA. The results from this study suggest that OSA status is an important determinant of primary and secondary clinical outcomes following posterior cervical fusion procedures.

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