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INTER-PTERYGOID DISTANCE AS A PREDICTOR OF SUCCESS IN MODIFIED EXPANSION SPHINCTER PHARYNGOPLASTY
No full textIntroduction
Modified expansion sphincter pharyngoplasty (MESP) is a novel surgical technique designed to improve both retro-palatal
collapse and lateral pharyngeal wall stability in OSAS patients. Although no plane indications for this procedure have been
reported in the literature, the current main indications are retro-palatal obstruction and lateral pharyngeal collapse pattern.
Objective
The aim of the study was to identify possible clinical indicators of post-operative success.
Methods
Data of patients undergoing MESP at our institution were collected prospectively during the period february 2009 – October
2011 and included clinical features, sleep endoscopy features, Cephalometric measures, CT scan measures, pre and postoperative
polysomnographic data. Success was defined as RDI<15 in patients without co-morbidity and RDI<5 in patients with
co-morbidity. Univariate analysis was conducted to identify possible predictors of success. Pearson correlation between
continuous clinical variables and reduction of the preoperative RDI were explored as well.
Results
39 patients underwent MESP alone and 30 patients MESP plus hyoid suspension. Total success rate was 65.8% (patients not
requiring CPAP). No single predictor of success resulted from univariate analysis. Pre-operative RDI (p<0.001), pre-operative
supine AHI (p=0.001), tonsil grade (p=0.001) and inter-pterygoid distance measured on CT scan (p=0.008) showed a
significant direct correlation with the post-operative RDI improvement. Age showed a significant inverse correlation with RDI
improvement (p=0.038). Interestingly, inter-pterygoid distance maintained a significant correlation with RDI improvement
when controlled for hyoid suspension, tonsil grade, age, supine AHI and preoperative RDI.
Conclusions
No significant predictors of success were identified. However, several variables appear significantly correlated to the postoperative
RDI improvement. Among these, inter-pterygoid distance measured on CT scan is a promising lateral anatomical
parameter not commonly assessed in the routine diagnostic workup, that may be included in the selection criteria of patients
fitting the current clinical indications for MESP. Further study on a wider population is needed to confirm these results and to
validate a cut-off value for the clinical practice
Intra-operative Neuromonitoring and Neurostimulation of the Recurrent Laryngeal Nerve in Thyroid Surgery: A Randomized Clinical Trial
No full textIntroduction: Intra-operative functional testing of the nerve
is gaining a wide diffusion, particularly neurostimulation (NS)
and introperative neuromonitoring (IONM). The impact of these
methods on avoiding recurrent laringeal nerve (RLN) injury is still
controversial. The aim of our study was to compare the efficacy of
RLN direct stimulation alone to direct stimulation in association
to intra-operative neuromonitoring.
Materials and Methods: The study was designed as a
randomized clinical trial. Between January 2008 and April 2009
were included 250 patients (455 nerve at risk) randomized into 2
groups: control group of 125 patients (229 nerves at risk) assigned
to NS with palpatory feedback, and the study group comprising
125 patients (229 nerves at risk) assigned to IONM and NS. The
prevalence of RLN palsy and accuracy of the feedback signals were
compared between the groups.
Results: The overall RLN injury incidence for nerve at risk
was 2.7% in the study group and 2.6% in the control group. No
statistically significant difference was found between the groups.
Either palpatory feedback or IONM feed back to RLN direct
neurostimulation obtained an elevated negative predictive value
(respectively 98.2% and 99%) and a poor positive predictive value
(26.7% and 22.2%). The accuracy of the two methods resulted to
be similar (respectively 95.8% and 92.7%).
Conclusions: The IONM, compared to NS alone, did not
significantly reduce the incidence of nerve injury after thyroid
surgery. Furthermore the two methods showed a similar accuracy
in predicting postoperative paralysis
Vocal fold augmentation in patients with unilateral vocal fold paralysis by VOX IMPLANT Tm . Our experience
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Drug Induced Sleep Endoscopy in children with cranio-facial anomalies.
No full textThe applications of drug Induced Sleep Endoscopy in children with cranio-facial anomalies are described
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