The paramedian forehead flap provides excellent aesthetic and functional results for the reconstruction of full-thickness maxillary defects. However, previous radiation therapy reduces elasticity of ...tissues and their healing capacity. We describe the use of Lyoplant, an absorbable biocompatible membrane derived from bovine pericardium, for full-thickness maxillary reconstruction after maxillectomy in an irradiated patient, providing a step-by-step description of the procedure. The Lyoplant membrane was sutured to the internal edge of the refreshed borders of the maxillary defect, to achieve a complete closure of the loss of sinonasal mucous membrane and to guarantee a support to the forehead flap. It can drive sinonasal mucosa regeneration with early resolution of nasal crusting. No complications, such as infection, extrusion, or subsidence of the flap, were observed. Lyoplant can be considered a safe and easily available support for locoregional flap and mucosa regeneration in post-operative defects of nasal cavity and central face in irradiated patients.
Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although ...the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic-pituitary-adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature.
We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered.
Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function.
CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.
To evaluate the role of clinical scores assessing the risk of disease severity in patients with clinical suspicion of obstructive sleep apnea syndrome (OSA). The hypothesis was tested by applying ...artificial intelligence (AI) to demonstrate its effectiveness in distinguishing between mild-moderate OSA and severe OSA risk.
A support vector machine model (SVM) was developed from the samples included in the analysis (N = 498), and they were split into 75% for training (N = 373) with the remaining for testing (N = 125). Two diagnostic thresholds were selected for OSA severity: mild to moderate (apnea-hypopnea index (AHI) ≥ 5 events/h and AHI < 30 events/h) and severe (AHI ≥ 30 events/h). The algorithms were trained and tested to predict OSA patient severity.
The sensitivity and specificity for the SVM model were 0.93 and 0.80 with an accuracy of 0.86; instead, the logistic regression full mode reported a value of 0.74 and 0.63, respectively, with an accuracy of 0.68. After backward stepwise elimination for features selection, the reduced logistic regression model demonstrated a sensitivity and specificity of 0.79 and 0.56, respectively, and an accuracy of 0.67.
Artificial intelligence could be applied to patients with symptoms related to OSA to identify individuals with a severe OSA risk with clinical-based algorithms in the OSA framework.
: This study aimed to assess the comparative effectiveness of continuous positive airway pressure (CPAP) therapy and sildenafil pharmacological therapy in improving sexual function among patients ...with obstructive sleep apnea (OSA) and erectile dysfunction (ED).
: Population: Patients affected by OSA and ED; Intervention: CPAP therapy vs. Comparison: Sildenafil pharmacological therapy; Outcomes: Improvement in erectile function, as measured by the International Index of Erectile Function 5 (IIEF-5) scoring system; Time: A systematic review of the literature from the past 20 years; Study Design: Observational studies comparing erectile function improvements after OSA treatment.
: A total of eight papers were included in the qualitative summary, involving four hundred fifty-seven patients with ED and OSA. Erectile function improvements were observed in both treatment groups. After sildenafil and CPAP treatment, the mean IIEF-5 domain scores were 37.7 and 27.3, respectively (
< 0.001). Sildenafil 100 mg demonstrated a higher therapeutic impact compared to CPAP treatment.
: CPAP therapy significantly improved sexual parameters in most studies for OSA patients with ED. The findings suggest that CPAP therapy effectively alleviates erectile dysfunction symptoms, resulting in improved sexual performance in OSA patients. The comparison of the two treatments indicates that sildenafil has a more substantial therapeutic impact on erectile function than CPAP therapy; however, a combined treatment will provide a cumulative effect.
The correlation between depressive and cognitive symptoms and OSAS (obstructive sleep apnea syndrome) is between 5 and 63%. We reported the case of two patients with severe OSAS and its associated ...depressive symptoms that were intolerant to continuous positive airway pressure (C-PAP) and underwent maxillomandibular advancement (MMA) surgery. The severity of cognitive and depressive symptoms was assessed using validated questionnaires (Beck Depression Inventory, Beck Anxiety Inventory, Epworth Sleepiness Scale, and quality of life), medical observation, and patient-reported symptoms. We performed pre- and post-treatment polysomnography. Six months after treatment, the value of the apnea–hypopnea index (AHI) had returned to the normal range and, together with it, the depressive component was considerably reduced and the patients’ overall quality of life (BDI, BAI, ESS, and qol) improved. Conclusion: We described significant improvement in all the analyzed parameters, such as physical and mental functioning, and depression and anxiety rates.
Purpose
To evaluate the efficacy of barbed reposition pharyngoplasty (BRP) on sleepiness, anxiety, and depression o adult patients with obstructive sleep apnea (OSA).
Methods
We performed a ...prospective multicentric study to assess functional outcomes in 20 OSA patients treated with BRP and compare the results with an observational group of 20 subjects. All recruited subjects performed at baseline and 6-months postoperative follow-up Polysomnography (PSG), daytime sleepiness scoring using the Epworth Sleepiness Scale (ESS), and anxiety and depression evaluation via the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) questionnaires.
Results
At follow-up the BRP demonstrated greater improvements in AHI (8.92 ± 2.29 vs. 30.66 ± 2.56;
p
< 0.001) and ODI (7.65 ± 2.39 vs. 24.55 ± 3.20;
p
< 0.001) than control at intergroup analysis. Surgical group reported significant data in daytime sleepiness (5.15 ± 1.19 vs. 13.15 ± 1.35;
p
< 0.001), anxiety (12.65 ± 3.11 vs. 24.2 ± 2.37;
p
< 0.001), and depression domains (5.85 ± 1.19 vs. 17.55 ± 3.24;
p
< 0.001). AHI, ODI, and advanced age have been shown to multiple regression as independent predictors of treatment response for mood domains (
p
< 0.001;
p
= 0.02;
p
= 0.041, respectively).
Conclusions
Patients with OSA may benefit from palate surgery, reducing not only the apnea and hypopnea index, daytime sleepiness but also associated mood comorbidities. However, further studies are needed to confirm our preliminary results to validate the evidence to date reported.
Objectives
To compare the efficacy and success rates of lateral pharyngoplasty techniques (LP) vs. uvulopalatopharyngoplasty (UPPP) among adult patients surgically treated for obstructive sleep ...apnea.
Methods
A systematic literature review of the last 20 years’ papers was conducted using PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library until April 2021. Only full-text English articles comparing LP and UPPP outcomes in adult patients with objective outcomes were included in the study.
Results
We included 9 articles for a total of 312 surgically treated patients with OSA. LP techniques for obstructive sleep apnea were used on 186 (60%) subjects, while 126 patients (40%) were treated with UPPP. Both surgical procedures resulted in significant improvements in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and lowest oxygen saturation (LOS) (
p
< 0.001 in all cases). Although better outcomes were reported with lateral pharyngoplasty, the differences were not significant compared to UPPP post-operative results (
p
> 0.05 in all cases).
Conclusions
UPPP and LP are both effective surgical procedures in treating OSA in adults. Although not significant, LPs demonstrated improved post-operative outcomes. However, further evidence comparing the surgical effect on patients with OSA is needed to discriminate post-operative outcomes.
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