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Prosthetic mandibular advancement (PMA) prosthesis was based on the Esmarch maneuver, to advance the mandible and its attached muscles forwards about 5–6 mm. It causes improvement of apnea/hypopnea index (AHI) and intraesophageal pressure ( P eso ) in patients with Obstructive Sleep Apnea Syndrome (OSAS). The effect of PMA on AHI, P eso , lowest oxygen saturation (SaO 2 %) and intensity of snoring sound was studied in 15 male patients proven to have OSAS. Their mean age was 56±13 years. Polysomnographic recording was done for 2 h in the afternoon whilst the patients slept in the supine position without PMA and 2 h with the patient wearing the prefabricated PMA prosthesis. Evaluation of the intraluminal negative pressure was done after the introduction of a soft silicone Gaeltec catheter® with four barosensors, adjusted at the epipharynx (S1), just below the uvula (S2), at the tip of the epiglottis (S3) and (S4) at the mid esophagus. Four patients (26.7%) showed a reduction in both AHI and P eso by more than 50% and six patients (40%) presented a reduction in AHI only by more than 50%, whereas five cases (33.3%) presented poor response. We concluded that PMA could be used conservatively alone or as an adjuvant to sleep apnea surgery in some cases according to their cephalometric measurements as well as their response on polysomnographic study.

The relationship between upper airway obstruction and nocturnal enuresis (NE) was studied in 25 children with adenotonsillar hypertrophy. There were 11 males and 14 females. Their ages ranged from 4 to 10 years. Most of them received medical therapy for NE with unsatisfactory response. They were classified according to the presence or absence of diurnal voiding into two groups: monosymptomatic NE (16 children) and polysymptomatic NE (9 children). Obvious neurological abnormalities were excluded. All patients had been subjected to adenotonsillectomy and reevaluated 3–6 months later for their clinical response. Our results revealed (1) no significant differences between the two groups as far as age, sex, and manifestations of upper airway obstruction were concerned; (2) body mass index was significantly higher in group 2 (polysymptomatic) compared to group 1 (p

Preoperative embolization was performed in 34 patients with nasopharyngeal angiofibroma (NAF). Thirty-seven embolization procedures were done in those patients (three patients had tumor recurrence and repeated embolizations were performed). Embolization was done using Gelfoam (seven embolizations), contour particles (24 embolizations) and Ivelon (six embolizations). The internal maxillary artery (IMA) was embolized bilaterally in four patients (four embolizations), and unilaterally in 30 patients (33 embolizations). In 25 patients, intraoperative blood loss at primary surgery was insignificant (no blood transfusion was required) while in nine patients, the intraoperative blood loss ranged from 400 to 1500 ml (average 650 ml), and the average blood transfusion was 944.4 ml. Only three patients showed recurrence of the tumor after primary surgery (8.8%). Minor complications were seen in most of the patients in the form of mild to moderate local pain in the vascular territory of the embolized artery and slight temperature elevation. Other minor complications included nausea in three patients and local subcutaneous edema in only one patient. A major complication was encountered in only one patient who had left retinal artery occlusion and temporary visual loss due to embolization of the left ophthalmic artery. The results indicated that pre-operative embolization of the internal maxillary artery in patients with nasopharyngeal angiofibroma is a relatively safe technique, effective in reducing intraoperative blood loss and contributes to improving surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Many methods have been reported to select the proper candidates for uvulopalatopharyngoplasty (UPPP) among obstructive sleep apnea patients. Polysomnography with intraluminal pressure recordings in the upper airway was found useful to predict obstructive site(s) and hence the success of surgery. According to the pressure analysis, 11 cases with high negative pressure at the mesopharynx were selected for UPPP, while UPPP combined with midline partial glossectomy (UPPP-MLG) was done in 18 cases proved to have high negative pressure difference between the mesopharynx and esophagus. A reduction of the apnea/hypopnea index (AHI) of more than 50% after UPPP was found in 8 cases (72.7%) and in 11 cases (61.1%) after UPPP-MLG. It was found that the response rate was lower among the second group if compared to that of the first because of other aggravating factors rather than simple obstruction at the level of the soft palate and/or tonsils-tongue base level.