1/8. sleep disturbances detected by a sleep apnea monitor in craniofacial surgical patients.sleep apnea in craniofacial surgery was investigated. Between January 1999 and December 2003, 18 patients were measured at an at least 6-month interval before and after surgery. Eight patients underwent palatoplasty for cleft palate, and the other 10 patients underwent orthognathic surgery, syndromic craniosynostosis, and postpharyngeal flap surgery. All patients included in the study demonstrated clinical signs of obstructive sleep apnea, such as snoring and cessation of breathing during sleep. An apnomonitor was used for presurgical and postsurgical sleep apnea status by measuring: 1) position during sleep; 2) percutaneous oxygen saturation; 3) respiratory analysis, such as the type of apnea-hypopnea, frequency of the events, and duration of apnea-hypopnea; 4) heart rate; and 5) snore analysis, such as trains, time, mean, and minimal and maximal amplifications.The apnea-hypopnea index (AHI) was significantly improved after surgery, especially in cases other than palatoplasty (7.4 /- 8.73/h and 1.6 /- 0.43/h, before and after surgery, respectively; P < 0.05 excluding palatoplasty). The percentage of snoring to total sleep was also improved significantly (22.4 /- 19.74% and 9.0 /- 8.54%, before and after surgery, respectively; P < 0.01 in all patients).Therefore, changes in sleep apnea parameters were elucidated in craniofacial surgery. Palatoplasty did not necessarily worsen the sleep apnea status, although there were snoring and anatomic abnormalities. Detachment of the pharyngeal flaps improved sleep apnea, and bimaxillary advancement was effective in normalizing sleep apnea.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
2/8. Risks and benefits of adenotonsillectomy for children with down syndrome.A questionnaire survey of 74 parents of children with down syndrome was conducted. Results indicated that adenotonsillectomy benefited their children by eliminating or reducing the symptoms of snoring, sleep apnea, nasal drainage, and mouth breathing. On the basis of parental responses, it appears that in the absence of nasal obstruction, adenotonsillectomy fails to improve drooling or tongue protrusion. Adenoid tissue is physiologically important to the child with down syndrome and its removal can result in hypernasality. Two children in the survey sample who underwent adenoidectomy and/or tonsillectomy developed this complication. They were given complete speech and language testing and evaluated with cinefluoroscopy. Both structural and functional causes of hypernasality were identified. Structural abnormalities included a high-arched short hard palate and a short soft palate. Hypotonia, slowed motor learning, and oral motor developmental delay were confounding functional factors in these patients. The incidence of postoperative hypernasality found in these patients is higher than in the general population and should be an important consideration before performing an adenoidectomy.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
3/8. Obstructive sleep apnea following treatment of velopharyngeal incompetence by Teflon injection.From 1967 to 1974 a clinical trial of Teflon injection into the posterior pharyngeal wall for correction of velopharyngeal incompetence (VPI) was conducted in thirty-six patients. Six years after Teflon injection, one of the patients reported the onset of severe snoring punctuated by silences when he seemed not to be breathing, daytime hypersomnolence, and tiredness severe enough to interfere with work and studies. The diagnosis of obstructive sleep apnea (OSA) was confirmed by polysomnographic sleep monitoring, and the dynamics of the obstruction elucidated by cinefluoroscopy performed with the patient asleep. Resection of the lower 3/4 of the Teflon pad, leaving the upper rim to avoid recurrence of his VPI, has eliminated the symptoms of OSA and produced an improvement in his polysomnographic findings.- - - - - - - - - - ranking = 1.0008464982608keywords = breathing, upper (Clic here for more details about this article) |
4/8. sleep apnea precipitated by pharyngeal surgery in a patient with myotonic dystrophy.A patient was seen for evaluation of excessive daytime sleepiness, which was exacerbated following complications secondary to surgical reconstruction of the pharynx for a submucous cleft palate. She underwent recordings in the sleep laboratory and was found to have sleep apnea. Also, a thorough clinical and laboratory assessment established the diagnosis of myotonic dystrophy. Following tracheostomy, both the patient's sleep apnea and daytime hypersomnia were eliminated. Our case demonstrates that surgical procedures involving the upper airway should be approached with considerable caution in patients with myotonic dystrophy and only after the presence of associated sleep apnea has been carefully excluded. An original finding is the suggestion of a decrease in the number of T-cell lymphocytes in a patient with myotonic dystrophy.- - - - - - - - - - ranking = 0.00084649826076827keywords = upper (Clic here for more details about this article) |
5/8. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence.We have observed three children who developed obstructive sleep apnea immediately following construction of pharyngeal flaps designed to improve the speech of these patients with velopharyngeal incompetence. Postoperatively the patients were noted to have repeated episodes during sleep of strong respiratory efforts without airflow. sleep apnea can be debilitating and lethal, and should be looked for following surgery of the upper airway. Respiratory depressants should be avoided. Airway intubation, revision of the surgery, or tracheostomy may be necessary.- - - - - - - - - - ranking = 0.00084649826076827keywords = upper (Clic here for more details about this article) |
6/8. Acute obstructive sleep apnea as a complication of sphincter pharyngoplasty.This report describes postoperative airway compromise following sphincter pharyngoplasty (SP) for treatment of post-palatoplasty velopharyngeal dysfunction. A retrospective review of 58 SPs performed for post-palatoplasty velopharyngeal dysfunction, on 30 male, and 28 female patients, over a 5-year study period was undertaken at a tertiary referral academic institution (washington University School of medicine), at the St. Louis Children's Hospital, cleft palate and Craniofacial Deformities Institute. Eight patients were identified who had the following inclusion criteria: overt perioperative and/or postoperative airway dysfunction, identifiable syndromes, or microretrognathia. Items reviewed were patient demographic factors, associated medical problems, genetics evaluations, nasendoscopic characteristics of velopharyngeal closure, anesthetic evaluation of the patients, and the incidence and severity of perioperative complications. Particular attention was paid to factors contributing to the airway obstruction. Of the eight subjects with perioperative and/or postoperative upper airway dysfunction following SP, five patients had Pierre Robin sequence/micrognathia, while three patients had a history of perinatal respiratory and/or feeding difficulties without micrognathia or an identified genetic disorder. All but two episodes of airway dysfunction resolved within 3 days postoperatively. These patients were discharged home with apnea monitors; both were readmitted with recurrent airway dysfunction. continuous positive airway pressure (CPAP) was utilized successfully in all instances, and no patients required take-down of the SP to relieve airway dysfunction. CPAP is an effective, noninvasive treatment strategy for management of iatrogenically induced apnea following SP, without sacrificing the surgical benefit of improved speech intelligibility.- - - - - - - - - - ranking = 0.00084649826076827keywords = upper (Clic here for more details about this article) |
7/8. Aerodynamic and acoustic characteristics of a speaker with turbulent nasal emission: a case report.Aerodynamic and acoustic characteristics were determined from the speech of an adult female with mild mental retardation and severe velopharyngeal inadequacy. The speaker's productions of /s/ were characterized by consistent nasal grimacing and turbulent air emission. Aerodynamic assessment estimated the size of the velopharyngeal orifice to exceed 200 mm2 during plosive production. Nasal cross-sectional area was estimated to be 35 mm2 during quiet breathing. Nasometric evaluation indicated nasalance of 63% associated with the "Zoo" passage. Acoustic analysis of the separately recorded oral and nasal speech signals indicated spectral energies in the region of approximately 2.5 to 7.0 kHz associated with nasal emission during /s/ production. The occurrence of these frequencies suggested an acoustic/perceptual function of the nasal grimace. Pressure-flow evidence also suggested that the nasal grimace, perhaps with lingual assistance, functioned to enhance speech aerodynamics.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
8/8. A possible sequela of transoral approach to the upper cervical spine. Velopharyngeal incompetence.The authors describe a case of velopharyngeal incompetence (VPI), as a consequence to the neurosurgical treatment for a complex malformation of the cranio-spinal junction. A 61-year-old woman underwent a transoral-transvelar surgical approach for odontoid resection. One month later surgical fixation of the posterior spine with autologous iliac bone graft was performed. Following these operations the patient presented a marked alteration of speech intellegibility due to hypernasal voice resonance and through incapability to articulate the oral phonemes correctly. She also complained of nasal regurgitation of fluids and solids while swallowing. She underwent a clinical phoniatric assessment of voice and speech. Videonasopharyngoscopy allowed us to inspect the velopharyngeal sphincter and to show clearly the type and morphology of its closure defect. Correction of VPI was achieved by means of a velopharyngoplasty (pharyngeal flap), in spite of technical difficulties due to local scarring and to a problematic exposure of the surgical field.- - - - - - - - - - ranking = 0.0033859930430731keywords = upper (Clic here for more details about this article) |