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Objective: To assess the efficacy of an author-modified LAUP technique using the principles of UPPP surgery. This new one-stage method of LAUP is described in detail., Design: A retrospective review of all one-stage LAUPs performed., Setting: The Division of Otolaryngology, University of British Columbia, Vancouver, BC., Method: This one-stage LAUP was performed on all patients., Main Outcome Measures: Improvement of snoring, postoperative pain, polysomnography, home oximetry, the Respiratory Disturbance Index, and the need for a second treatment., Results: Two hundred twenty patients have undergone this more aggressive excisional approach, and only 10 needed a second treatment. A 75 to 100% improvement in snoring was noted by 83% of cases. In patients with some residual noise, 78% described only heavy breathing when lying on their back. Postoperative pain was mild (7 days) to moderate (7-10 days) in 79% of cases. Eighty-three percent of patients missed no work after treatment. Documented sleep-apnea was present in 74 people (33%), and 96% of these reported a more restful sleep with less daytime fatigue postoperatively. Ten of 14 patients (71%) with postoperative sleep studies had apneas eliminated or reduced by more than 50%. Overall patient satisfaction was 97%. A low-level laser from Europe (LLLT) has been introduced as an adjunct to help control postoperative pain. A clinical trial on its use in UPPP surgery is also described.

The purpose of this retrospective review is to study the management of a rare malignant tumor of the parotid gland, the acinic cell carcinoma. Incidence, pathology, clinical findings, and diagnosis are reviewed. Twenty-five patients were seen at the British Columbia Cancer Agency (BCAA) for initial treatment, recurrent disease or follow-up during the period 1958-1990. Twenty-two acinic cell carcinomas (ACC) occurred in the parotid gland. Surgical treatment regimens for parotid ACC ranged from local excision to radical excision. Local excision is not advised but superficial parotidectomy alone appears to have been adequate treatment for small superficial tumors. Eleven of 22 patients received radiotherapy. Indications for adjuvant postoperative radiotherapy are given. Nine patients with primary tumors treated with combined therapy are alive and disease-free with a mean follow-up of 10.7 years. Postoperative radiotherapy appears to be effective in eradicating microscopic residual disease although long-term follow-up is necessary to make these results clinically significant.

Acute sphenoid sinusitis is an uncommon disease with a significant morbidity. This paper reviews 14 patients presenting with acute sphenoid sinusitis between 1978 and 1987. Fifty-seven percent of patients had signs of neurological or ophthalmological complications, and 29% were left with permanent disabilities. Delay in diagnosis and treatment resulted in a morbidity of 80%. The organism most commonly cultured was Staphylococcus aureus, followed by Streptococcus pneumoniae. Haemophilus influenza, and other streptococci. While a trial of medical therapy for 24 hours is warranted in uncomplicated cases, we recommend surgical drainage of the sinus if medical therapy fails, and for all patients with complications.

In a retrospective study of 348 patients receiving radiotherapy as the primary treatment for carcinoma involving the laryngeal region, perichondritis developed in 52--an incidence of 15%. Of these 52 cases of clinically diagnosed perichondritis, 50% had residual or recurrent carcinoma. A controversy exists regarding the value of frequent and multiple biopsies in these patients; disease will be missed if this is not done, but perichondritis and cartilage necrosis may result from infection introduced by repeated laryngeal manipulation. On the basis of this study the authors recommend an aggressive approach with close follow-up and multiple frequent biopsies as the data indicate an incidence of 50% recurrent or residual tumor when perichondritis is present.