Snoring Imaging Fajdiga, Igor
Chest,
August 2005, 20050801, 2005-08-00, Letnik:
128, Številka:
2
Journal Article
Recenzirano
To identify upper airway changes in snoring using CT scanning, to clarify the snoring mechanism, and to identify the key structures involved
Forty patients underwent CT examination of the head and ...neck region according to snoring habits; patients were classified into nonsnoring (n = 14), moderately loud snoring (n = 13), and loud snoring (n = 13) groups
Comparative analysis
Using CT images, areas, the anteroposterior and transversal distances of the pharyngeal space at different levels, and the thickness and length of the soft palate and uvula and their angle against the hard palate were measured; evidence of impaired nasal passages was noted; the extent of pharyngeal inspiratory narrowing was the ratio between the area at the hard palate level and most narrow area; and expiratory narrowing was the ratio between the area behind the root of the tongue and the most narrow area
Greater pharyngeal inspiratory narrowing (p = 0.0015) proportional to the loudness of snoring (p = 0.0016), and a longer soft palate with uvula (p = 0.0173) were significant for snoring. Impaired nasal breathing was significantly related (p = 0.029) only to the loud snoring group. The body mass index and age of snoring persons were also significantly higher
Snoring is associated with typical changes that can be revealed by CT scanning. Greater pharyngeal narrowing is the most important factor. Given the “Venturi tube” shape of the pharynx, the Bernoulli pressure principle plays a major role in snoring. The key structure in snoring is the soft palate: it defines the constriction and is sucked into vibrating by negative pressure that develops at this site. Its repetitive closures present an obstruction to breathing, producing the snoring sound, and should therefore be the target for causal treatment of snoring. Obstacles in the upper airway that increase negative inspiratory pressure could not be confirmed as important for the development of snoring, although they may increase its loudness
Abstract Obstructive sleep apnoea syndrome (OSAS) is a breathing disorder in sleep developed as a consequence of upper airway anatomical characteristics and sleep-related muscle relaxation. ...Fluid-structure interaction (FSI) simulation was adopted to explain the mechanism of pharyngeal collapse and snoring. The focus was put on the velopharyngeal region where the greatest level of upper airway compliance was estimated to occur. The velopharyngeal tissue was considered in a way that ensures proper boundary conditions, at the regions where the tissue adheres to the bone structures. The soft palate with uvula was not cut out from the surrounding tissue and considered as an isolated structure. Both, soft palate flutter as well as airway narrowing have been obtained by 3D FSI simulations which can be considered as a step forward to explain snoring and eventual occlusion. It was found out that during the inspiratory phase of breathing, at given elastic properties of the tissue and without taking gravity into consideration, velopharyngeal narrowing due to negative suction pressure occurs. Furthermore, soft palate flutter as the main attribute of snoring was predicted during the expiratory phase of breathing. The evaluated flutter frequency of 17.8 Hz is in close correlation with the frequency of explosive peaks of sound that are produced in palatal snoring in inspiratory phase, as reported in literature.
The long term results and patterns of failure in patients with squamous cell head and neck carcinoma (SCHNC) treated in a prospective randomized trial in which concomitant postoperative ...radiochemotherapy with Mitomycin C and Bleomycin (CRT) was compared with radiotherapy only (RT), were analyzed.
Between March 1997 and December 2001, 114 eligible patients with Stage III or IV SCHNC were randomized. Primary surgical treatment was performed with curative intent in all patients. Patients in both groups were postoperatively irradiated to the total dose of 56-70 Gy. Chemotherapy included Mitomycin C 15 mg/m2 after 10 Gy and 5 mg of Bleomycin twice weekly during irradiation. Median follow-up was 76 months (48-103 months).
At 5 years in the RT and CRT arms, the locoregional control was 65% and 88% (p = 0.026), disease-free survival 33% and 53% (p = 0.035), and overall survival 37% and 55% (p = 0.091) respectively. Patients who benefited from chemotherapy were those with high-risk factors. The probability of distant metastases was 22% in RT and 20% in CRT arm (p = 0.913), of grade III or higher late toxicity 19% in RT and 26% in CRT arm (p = 0.52) and of thyroid dysfunction 36% in RT and 56% in CRT arm (p = 0.24). The probability to develop a second primary malignancy (SPM) was 34% in the RT and 8% in the CRT arm (p = 0.023). One third of deaths were due to infection, but there was no difference between the 2 groups.
With concomitant radiochemotherapy, locoregional control and disease free survival were significantly improved. Second primary malignancies in the CRT arm compared to RT arm were significantly less frequent. The high probability of post treatment hypothyroidism in both arms warrants regular laboratory evaluation.
To identify upper airway changes in snoring using CT scanning, to clarify the snoring mechanism, and to identify the key structures involved.
Forty patients underwent CT examination of the head and ...neck region according to snoring habits; patients were classified into non-snoring (n = 14), moderately loud snoring (n = 13), and loud snoring (n = 13) groups.
Comparative analysis.
Using CT images, areas, the anteroposterior and transversal distances of the pharyngeal space at different levels, and the thickness and length of the soft palate and uvula and their angle against the hard palate were measured; evidence of impaired nasal passages was noted; the extent of pharyngeal inspiratory narrowing was the ratio between the area at the hard palate level and most narrow area; and expiratory narrowing was the ratio between the area behind the root of the tongue and the most narrow area.
Greater pharyngeal inspiratory narrowing (p = 0.0015) proportional to the loudness of snoring (p = 0.0016), and a longer soft palate with uvula (p = 0.0173) were significant for snoring. Impaired nasal breathing was significantly related (p = 0.029) only to the loud snoring group. The body mass index and age of snoring persons were also significantly higher.
Snoring is associated with typical changes that can be revealed by CT scanning. Greater pharyngeal narrowing is the most important factor. Given the "Venturi tube" shape of the pharynx, the Bernoulli pressure principle plays a major role in snoring. The key structure in snoring is the soft palate: it defines the constriction and is sucked into vibrating by negative pressure that develops at this site. Its repetitive closures present an obstruction to breathing, producing the snoring sound, and should therefore be the target for causal treatment of snoring. Obstacles in the upper airway that increase negative inspiratory pressure could not be confirmed as important for the development of snoring, although they may increase its loudness.
To evaluate the toxicity and efficacy of concomitant chemoradiotherapy with mitomycin C and cisplatin in the treatment of advanced unresectable squamous cell carcinoma of the head and neck.
Treatment ...consisted of conventional radiotherapy (70 Gy in 35 fractions), mitomycin C 15 mg/m(2) IV, applied after the delivery of 10 Gy, and cisplatin at an initial dose of 10 mg/m(2)/d IV, applied during the last 10 fractions of irradiation ("chemoboost"). The cisplatin dose was escalated with respect to the toxic side effects by 2 mg/m(2)/d up to the maximum tolerated dose (MTD) or at the most 14 mg/m(2)/d (Phase I study), which was tested in the subsequent Phase II study.
All 36 patients had Stage T4 and/or N3 disease, and the majority had oropharyngeal (50%) or hypopharyngeal (39%) primary tumors. Six patients were treated at each of the three cisplatin dose levels tested (Phase I study). Dose-limiting toxicity was not reached even at 14 mg/m(2)/d of cisplatin, which was determined as the MTD and tested in an additional 18 patients (Phase II study). After a median follow-up time of 48 months, 4-year locoregional control, failure-free, and overall survival rates were 30%, 14%, and 20%, respectively. In 24 patients treated at the cisplatin dose level of 14 mg/m(2)/d, the corresponding rates were 40%, 20%, and 22%, respectively.
Concomitant chemoradiotherapy with mitomycin C and cisplatin "chemoboost" at 14 mg/m(2)/d is feasible, with encouraging survival results if the extremely poor disease profile of the treated patients is considered.
Myxoglobulosis is a rare histologic variant of mucocele that is characterized by transformation of mucin into eosinophilic globules. The globules frequently demonstrate a lamellar pattern and are ...surrounded by an inflammatory cell infiltrate. Myxoglobulosis has not yet been described in laryngeal mucosa. A 62 year old man presented for a check-up with hoarseness of 2 months duration. He was a current smoker and reported a 40 year habit. An asymmetrical swelling along the length of both vocal cords was consistent with a clinical diagnosis of Reinke’s edema. The histopathologic examination demonstrated bilateral pseudocyst formation within Reinke’s space. Extravasated mucin was present in the form of eosinophilic globules that filled the left Reinke’s space almost entirely and were also seen on the right side. The pseudocyst, mucinous globules, and accompanying inflammatory cells were characteristic of myxoglobulosis. The sequelae of nicotine abuse, including inflammation, increased mucous secretion, and a rasping cough, are considered to be the main etiological factors of laryngeal myxoglobulosis. The patient had no evidence of voice disorder at 18 month follow-up. This case report contributes to the recognition of an exceptionally rare histologic variant of laryngeal mucocele.
Objective
To evaluate the mechanism and level of upper airway obstruction in obstructive sleep apnea (OSA) patients during natural sleep, together with synchronous electroencephalogram and ...respiratory events registration at 3‐Tesla magnetic resonance imaging (MRI) platform with high spatial and temporal resolution.
Study Design
A prospective cohort study of 20 randomly selected OSA patients.
Methods
Fifteen of 20 patients were able to complete spontaneous sleep during MRI. While asleep, dynamic MR images of pharynx were obtained in the midline sagittal view. During the scan, nasal and oral airflow, thoracoabdominal wall effort, and electroencephalogram were synchronously recorded. The physiologic data were retrospectively scored to identify periods of apneas and synchronized with dynamic MR images.
Results
In all 15 patients, the site of complete airway obstruction occurred at the retropalatal space. We noticed different positions of the soft palate during apneic events. In seven of 15 patients (47%), the soft palate was attached to the tongue base and moved backward, compressing the airway. In five of 15 patients (33%), the soft palate was detached from the tongue base and solely moved backward, compressing the airway. In three patients (20%), we recorded both mechanisms of complete airway obstruction. In cases with attached soft palate to the tongue base, we noticed significant narrowing of the retrolingual space during apneic events.
Conclusion
We describe a novel mechanism of obstruction dependent on the position of soft palate. This mechanism might play an important role in selecting candidates for surgery or treatment with hypoglossal nerve stimulation.
Level of Evidence
2b. Laryngoscope, 125:1485–1490, 2015
Soft palate-tongue contact and automatically calculated pharyngeal narrowing ratio (PNR), defined as a ratio between the airway cross-section at the hard palate level and the narrowest cross-section ...from the hard palate to the epiglottis, could assist in earlier identification of potential obstructive sleep apnea syndrome (OSA) patients even on awake individuals. Parameters were studied on carotid CTA images from 67 consecutively included awake Caucasians who were later classified by second independent physician into the primary snorers (SNORE,
n
= 34) or obstructive sleep apnea syndrome patient (OSA,
n
= 33) group according to the clinical examination, laboratory testing and a full-night video polysomnography (PSG) in the sleep laboratory. Imaging and clinical data were statistically compared between groups. The odd’s ratio calculation showed a 2.95 (
P
= 0.0354) higher risk for OSA development in snoring person with a PNR greater than 8.6. The loose-contact subgroup among OSA patients showed significantly (
P
= 0.002) higher values of AHI in contrast to the in-contact subgroup.
Objectives
We present a novel use of sliding epiglottoplasty as an alternative method for closing mucosal defects in selected laryngectomies with partial pharyngectomy.
Methods
Sliding ...epiglottoplasty as described and advocated by Sedlaček, Bouche, Kambiě, and Tucker for reconstruction in partial laryngectomies was used to close the defects after laryngectomy with partial pharyngectomy in 17 patients with advanced hypopharyngeal cancers as primary therapy (16 patients) and as post-radiochemotherapy therapy (1 patient).
Results
All reconstructions were successful. Primary closures were achieved without additional morbidity, there were no pharyngocutaneous fistulas, and all patients resumed deglutition. Ten patients acquired esophageal speech, speech valves were inserted in 5 cases, and 2 patients required the use of an electrolarynx.
Conclusions
If the oncological circumstances allow its preservation in laryngectomy with partial pharyngectomy, the epiglottis is an ideal structure for closing the defect; it is a local tissue with shape, thickness, rigidity, and borders that match the recipient site. In comparison to distant pedicled or free microvascular flaps, the epiglottoplasty is a shorter procedure, requires a smaller surgical team, results in less trauma, has a lower incidence of complications, and enables faster recovery. It is surprising that this elegant, successful, and generally accepted larynx preservation procedure has not been recognized as useful for larger reconstructions.
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