Search

Introduction: Treatment of obstructive sleep apnoea-hypopnoea syndrome in children with adenotonsillectomy is effective but has a moderate rate of persistent disease., Objectives: To analyse the rate of persistence of sleep apnoea-hypopnoea syndrome in a group of adenotonsillectomy-treated paediatric patients and to assess the possible prognostic factors., Methods: Prospective study of 80 patients aged between 2 and 13 years who had obstructive sleep apnoea-hypopnoea syndrome, treated with adenotonsillectomy. All patients had been followed up clinically and by polysomnography for 1 year after surgery. We analysed the epidemiological and clinical factors that could negatively affect the outcome of surgery., Results: The median age was 5.25 ± 2.05 years and the mean apnoea-hypopnoea index (AHI) was 8.13 ± 6.06. One year after surgery, all clinical parameters improved significantly and the mean AHI was 2.50. Persistent disease (AHI≥3) was present in 21 of the patients (26.3%). The comparative analysis of clinical and epidemiological factors between the group of non-persistence and persistence did not obtain statistically-significant differences in age, sex, tonsillar size, Friedman degree or severity of preoperative disease. The only significant factor was that patients without persistence were more obese., Conclusion: The results of our study about the persistence of obstructive sleep apnoea-hypopnoea syndrome after adenotonsillectomy are significant enough to recommend follow-up with polysomnography, especially in high-risk groups. In the series presented here, we were not able to demonstrate these risk factors. Our results are probably conditioned by the characteristics of the population studied: Low age, low obesity rate and less severe levels of apnoea-hypopnoea index., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Continuous positive airway pressure (CPAP) is the first choice in the treatment of apnea-hypopnea syndrome in adults and, in recent years, is considered the second option after surgery in children. CPAP is the best option in children if apnea-hypopnea syndrome persists after surgery. For many professionals in the field, the use of CPAP in all ages of children and adolescents is safe, effective and well tolerated. Follow-up visits are required every 6-12 months, since the mask pressure and size requirements will change depending on children's growth and development. The success of the use of CPAP is closely related to children's tolerance of the CPAP mask. Many professionals have described strategies to improve this tolerance. One of these strategies is to use behavioral therapy, which has been shown be effective in increasing tolerance and performance of the CPAP., (Copyright © 2010 Elsevier España S.L. All rights reserved.)

Laryngeal chondroradionecrosis is a complication following radiotherapy for laryngeal tumours that may appear many years after the treatment. We present the case of a 78 year old man, that come to the Accident and Emergency department with a prelaryngeal mass and hemoptysis. He had been treated 17 years before with radiotherapy for a vocal cond carcinoma. Posteriorly the lesion did a cutaneous fistula with complete laryngeal exposition and torpid evolution. Post-radiotherapy necrosis in the larynx is a serious complication though not a common one. A tumour recurrence needs to be excluded and even in this case a total laryngectomy is mandatory as it will end in total loss of laryngeal function.

As an alternative to end-to-end facial nerve microsurgery, we propose anastomosis of the sectioned nerve ends and wrapping with ipsilateral masseter fascia. This intervention was performed on the right facial nerve of 20 Wistar rats and compared with classical end-to-end anatomosis performed on the left nerve of the same rats. At the end of the experiment, histological studies were made of each nerve removed "en bloc" with the ipsilateral lip orbicular muscle. Five micra-thick sections were stained using conventional and immunohistochemical methods. We analyzed truncal integrity, fibroblast proliferation, demyelination, lymphocyte proliferation, granulomatous reaction, and muscle degeneration in both types of anastomosis. The differences between the two types of anastomosis were statistically non-significant, and both interventions produced similar functional results. Small differences between the techniques might condition the use of one or the other in selected cases.