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Biomedical subjects

S A Mickelson

Publications and source records attributed to S A Mickelson.

At least 19 recordsLinked to original sources
PubMed2000

Pharyngeal suspension suture with repose bone screw for obstructive sleep apnea.

OBJECTIVE: Multilevel surgery for obstructive sleep apnea syndrome (OSA) may improve success. This study's goal is to prospectively evaluate the feasibility and short-term subjective effectiveness of a new tongue-suspension technique. METHODS: A multicenter nonrandomized open enrollment trial used the Repose device to treat tongue obstruction in 39 snoring and OSA patients. Outcomes include 1- and 2-month subjective reports of general health, snoring, and sleep. RESULTS: Twenty-three patients completed 1 month and 19 completed 2 months of follow-up. In OSA patients, activity level, energy/fatigue, and sleepiness improved. Two-month outcomes were less (activity level, energy/fatigue, and sleepiness). Fewer changes were observed in snorers than in OSA patients. There were 6 complications (18%), including sialadenitis (4), gastrointestinal bleeding (1), and dehydration (1) after the procedure. CONCLUSION: A pharyngeal suspension suture changes subjective outcomes. Improvement is incomplete. The procedure is nonexcisional, but significant complications may occur. Further evaluation is required to demonstrate effectiveness.

Adult↗
PubMed1999

Effect of uvulopalatopharyngoplasty and genial and hyoid advancement on swallowing in patients with obstructive sleep apnea syndrome.

OBJECTIVE: Uvulopalatopharyngoplasty (UPPP) and genial and hyoid advancement (GHA) are surgical techniques for the treatment of obstructive sleep apnea. These techniques enlarge the oropharyngeal and hypopharyngeal airway, reducing collapse at these levels. This study evaluated the effect of these procedures on swallowing. METHODS: Fifteen patients who had undergone UPPP and GHA were evaluated with a modified barium swallow to assess biomechanical changes in swallowing. Specifically, velopharyngeal insufficiency; changes in tongue-base movement, laryngeal elevation, and closure; epiglottic movement; and pharyngoesophageal opening were examined. A brief swallowing questionnaire was administered to assess for subjective changes in swallowing. RESULTS: Nine of 15 patients demonstrated abnormal objective swallow, of whom 5 reported normal subjective swallowing. Six of 15 demonstrated normal objective swallowing. Of these, 5 reported subjective change. CONCLUSION: UPPP with GHA may alter biomechanical events during deglutition. However, little correlation exists between subjective symptoms and objective findings. Further studies that include preoperative and postoperative modified barium swallows are needed to identify a cause-and-effect relationship.

Adult↗
PubMed1999

Short-term objective and long-term subjective results of laser-assisted uvulopalatoplasty for obstructive sleep apnea.

OBJECTIVES: To determine the short-term and long-term effects of laser-assisted uvulopalatoplasty (LAUP) on symptoms and polysomnographic measures in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective assessment of outcomes after LAUP in patients with OSAS. METHODS: Fifty-nine patients with OSAS underwent LAUP, and 36 completed postoperative sleep studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP, 6 to 12 weeks after LAUP, and in the long term (> 2 years). RESULTS: The apnea index decreased from 14.4 to 5.8 (P = .0012), respiratory disturbance index (RDI) decreased from 28.1 to 7.9 (P = .0046), and the mean lowest oxyhemoglobin saturation increased from 80.6% to 84.0% (P = .055). The RDI was reduced to 10 or less in 44.4% of patients. Subjective questionnaires showed statistically significant improvements in snoring, morning fatigue, morning headaches, daytime somnolence, and daytime psychometric measures. The symptomatic improvement persisted in the long term. CONCLUSIONS: LAUP is an effective method for the management of OSAS. We have demonstrated short-term improvement in polysomnographic measures and short-term and long-term improvement in subjective measures.

Adult↗
PubMed1999

The use of sleep tests for suspected sleep disordered breathing.

Rapid advancements in technology have expanded the range of available methods for testing patients with sleep disordered breathing. This article reviews the components of a sleep test and the currently available technologies that are used in standard attended, laboratory (level 1) studies. This paper also reviews the advantages and limitations of unattended at-home evaluations (level 2, 3, and 4 studies) for patients with suspected sleep disordered breathing.

Diagnostic Tests, Routine↗
PubMed1999

Thyroid testing and thyroid hormone replacement in patients with sleep disordered breathing.

The current literature recommends that patients who have symptoms of sleep disordered breathing should be evaluated for hypothyroidism. Thyroid hormone replacement therapy has been reported by some authors to be effective in treating obstructive sleep apnea in hypothyroid patients. The present study prospectively evaluated the prevalence of hypothyroidism in 1,000 consecutively presenting patients who came to the office for evaluation of snoring or obstructive sleep apnea syndrome. The authors also examined the efficacy of treatment for hypothyroidism on sleep apnea in patients with both disorders. Of the 1,000 patients, routine thyroid testing was performed on 834; only 10 of these patients (1.2%) were discovered to have previously undiagnosed clinical hypothyroidism. Four of the 10 patients with newly diagnosed clinical hypothyroidism had obstructive sleep apnea syndrome, and they received thyroid hormone replacement therapy. Once these four patients achieved a euthyroid state, repeat polysomnography showed that there was no significant difference between their pre- and posttreatment respiratory disturbance index. Based on the results of our study, we conclude the following: 1) The prevalence of hypothyroidism in patients who are evaluated for sleep disordered breathing is no greater than that of the general population. 2) Thyroid replacement therapy results in little or no improvement in sleep apnea in patients with clinical hypothyroidism. 3) Routine thyroid function screening is not indicated for patients who are being evaluated for sleep disordered breathing.

Adult↗
PubMed1998

Upper airway bypass surgery for obstructive sleep apnea syndrome.

This article reviews the history of tracheostomy for sleep apnea syndrome along with current indications for temporary and permanent tracheostomy in these patients. Because most patients requiring tracheostomy for obstructive sleep apnea syndrome are morbidly obese and have a short thick neck, a skin-lined technique has been developed. This technique is described along with preoperative and postoperative care necessary to allow uneventful healing and prevent complications. Surgical techniques available for tracheostomy closure are also described.

Humans↗
PubMed1998

Is postoperative intensive care monitoring necessary after uvulopalatopharyngoplasty?

We conducted a retrospective review of 347 consecutive patients who underwent surgical treatment for obstructive sleep apnea syndrome. We analyzed perioperative data to identify the nature and rate of complications in an attempt to determine whether intensive care unit monitoring is needed after uvulopalatopharyngoplasty (UPPP) and associated procedures including septoplasty, tonsillectomy, turbinate reduction, geniohyoid advancement, and tracheostomy. In the 347 cases, 14 complications occurred (4%), including 5 involving the airway, 5 postoperative hemorrhages, and 4 complications classed as "other," including dehiscence of a tracheostomy flap, abdominal ileus, urine retention, and increased creatinine concentration. We found no difference between preoperative lowest oxygen saturation and oxygen-saturation readings in the postoperative period and no correlation between complication rate and apnea severity. An association was detected between multiple simultaneous procedures and the development of complications: 50% of the patients in whom complications developed had undergone nasal procedures along with UPPP, compared with only 15% of the patients without complications. Except for one patient, all complications that occurred on the surgical ward were treated without transfer to the intensive care unit. Although surgery on the upper airway must be performed with caution in patients with sleep apnea, our findings suggest that UPPP is a safe procedure and that postoperative monitoring in an intensive care setting is not necessary for most patients.

Chin↗
PubMed1997

Closure of permanent tracheostomy in patients with sleep apnea: a comparison of two techniques.

A "permanent" skin-lined tracheostomy is used for patients with severe obstructive sleep apnea syndrome who fall, refuse, or can't tolerate continuous positive airway pressure. Closure of the stoma may be performed if the apnea has been controlled by surgeries that enlarge and stabilize the upper airway, if adequate weight loss occurs, or if the patient decides to accept continuous positive airway pressure. Two different closure techniques are compared. Sixty-nine three-layer closures were performed in 66 patients from 1980 to 1990. Postoperative complications, including stridor, subcutaneous emphysema, pneumomediastinum, tracheal granuloma, hematoma, and respiratory arrest, occurred in 30% of patients, and three required reopening of their tracheostomy sites. After 1990 a simple deepithelialization technique was used in 10 patients without any major complications. This technique is simpler and quicker and can be performed with the patient under local anesthesia.

Adult↗
PubMed1997

Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is caused by narrowing of the pharyngeal airway and loss of dilator tone during sleep. In patients with severe apnea surgical correction often requires attention to both the oropharynx and hypopharynx. Tongue reduction surgery has been described for persistent apnea after failure of palatal surgery. We describe our experience with midline glossectomy with epiglottidectomy in 12 patients with a mean age of 48.8 +/- 14.2 years and body mass index of 36.0 +/- 8.8 kg/m2. Response to treatment was defined as a postoperative respiratory disturbance index (RDI) below 20. Three patients (25%) responded to treatment. The mean apnea index decreased from 48.9 to 35.7, RDI decreased from 73.3 to 46.6, and lowest oxygen saturation increased from 65.9 to 77.9%. RDI in responders decreased from 69.7 to 10. Midline glossectomy with epiglottidectomy has variable results, yet is effective in selected patients with hypopharyngeal narrowing related to macroglossia.

Adult↗
PubMed1996

Laser-assisted uvulopalatoplasty for obstructive sleep apnea.

Laser-assisted uvulopalatoplasty (LAUP) can reduce snoring by sequentially removing excessive vibratory tissue of the velopharynx. The procedure can be performed under local anesthesia in an office setting. Since the appearance of the soft palate is similar after both LAUP and uvulopalatopharyngoplasty, LAUP may also be efficacious in the management of obstructive sleep apnea syndrome (OSAS). LAUP was performed in 34 consecutive prospectively evaluated patients with OSAS. Of the 34 patients, 28 (82%) were male; the mean age was 53 years, and the mean body mass index was 31.1. In the study population of 13 patients who completed preoperative and postoperative sleep studies, the apnea index decreased from 19.4 to 4.2 (P = .006), the respiratory disturbance index (RDI) decreased from 31.2 to 15.7 (P = .092), and mean lowest oxyhemoglobin saturation increased from 82.3% to 85.0% (P = .581). The RDI fell to 10 or lower in 38.5% of patients and was reduced by at least 50% in 53.8% of the study group. Snoring was significantly reduced in 92.3% of patients (P < .001). These early results suggest that LAUP may be efficacious in the management of OSAS.

Adolescent↗
PubMed1994

Obstructive sleep apnea syndrome and acromegaly.

Obstructive sleep apnea syndrome is a complex disorder that has been associated with a variety of abnormalities of the upper airway, including tonsil and adenoid hypertrophy, nasal obstruction, retrognathia, and macroglossia. The cause of the airway obstruction in acromegaly is believed to be related to osseous and soft-tissue changes surrounding the upper airway, which lead to narrowing and subsequent collapse during sleep. We describe the results of treatment in seven patients with both sleep apnea and acromegaly. Four patients were treated by transsphenoidal hypophysectomy alone with a resolution of sleep apnea syndrome. One underwent hypophysectomy followed by postoperative radiation therapy, which reduced his apnea. Three patients underwent unsuccessful uvulopalatopharyngoplasty. Successful treatment of the primary disorder, in this case acromegaly, resulted in improved breathing during sleep in five patients. This series would suggest that acromegalic patients with sleep apnea should be treated for their pituitary tumor to reduce growth hormone before consideration of surgery to enlarge or bypass the upper airway.

Acromegaly↗
PubMed1991

Partial laryngectomy after irradiation failure.

Forty-three patients who had partial laryngectomies after radiotherapy were evaluated. Forty-two had failed irradiation for laryngeal carcinoma. Nine had supraglottic procedures, 3 endoscopic, and 31 vertical partial. Twelve (28%) required subsequent completion laryngectomy. Major complications included laryngeal stenosis in 1, incompetent laryngeal sphincters in 2, mucocutaneous fistulas in 3, and delayed deglutition in 3. Six patients had positive permanent section margins. In 5 of those, intraoperative frozen sections had been taken and were negative. Recurrent or persistent disease was eventually demonstrated in all patients with positive margins. The 2-year determinant disease-free survival rate for stage I and II disease was 85%. Three-year disease-free survival was 50% for stage III and IV disease. Partial laryngectomies, including supraglottic, can be done after irradiation failure with a high expectation of cure and acceptable morbidity. Immediate additional operation should be considered in patients with positive margins.

Adult↗
PubMed1990

Denker rhinotomy for inverted papilloma of the nose and paranasal sinuses.

Inverted papilloma of the nose and paranasal sinuses is an unusual benign neoplasm that has the propensity for local tissue destruction and an association with malignant degeneration. The tumor represents an inverted growth of epithelium rather than outward proliferation. It most commonly arises from the lateral nasal wall with growth into the nose and paranasal sinuses and only rarely originates from the septum. Presenting symptoms are usually unilateral nasal obstruction and clear rhinorrhea. Surgical excision is the recommended treatment though the aggressiveness of the approach has varied. Transnasal local excision has been associated with a high recurrence rate. Lateral rhinotomy with removal of the lateral nasal wall and wide local excision has a low recurrence rate and has been the recommended treatment by most authors since 1980. However, the poor cosmetic results in some patients due to the visible external scar is especially undesirable in young females. We present a series of 23 patients treated over a ten-year period. Fifteen underwent a Denker rhinotomy and medial maxillectomy through a sublabial approach without an external incision. The recurrence rate in our group is 27% with a mean 4.7 year follow-up. This recurrence rate lies between that reported for lateral rhinotomy and local transnasal excision.

Adult↗
PubMed1990

Hemangiomas of the nasal septum and paranasal sinuses.

Hemangiomas of the nasal septum and paranasal sinuses are rare; only 62 cases of septal hemangiomas and 32 cases of maxillary sinus/maxilla hemangiomas have been reported in the English literature. Hemangiomas should be considered in the differential diagnosis of any nasal mass lesion because biopsy may result in profuse bleeding and even death. We report the clinical presentation, differential diagnosis, etiology, and histologic appearance of paranasal sinus hemangiomas occurring in four of our patients.

Adolescent↗
PubMed1990

Abnormal coagulation profiles in tonsillectomy and adenoidectomy patients.

Preoperative coagulation profile screening is routinely performed in otolaryngology before tonsillectomy and adenoidectomy surgery in the United States. Recently there has been controversy as to whether this routine testing is necessary. To evaluate the need for this testing, we reviewed a series of patients with particular attention to abnormal coagulation profiles. Of 91 consecutive patients undergoing tonsillectomy, adenoidectomy, or both, four had abnormal preoperative coagulation profiles. Of these patients, one had von Willebrand disease, one had hypofibrinoginemia, and two had a transient acquired lupus-like anticoagulant. The latter condition, which causes a temporary prolongation of the activated partial thromboplastin time, is discussed in detail along with a review of the pertinent literature. We conclude that coagulopathies occur frequently enough to justify preoperative screening even in the absence of a positive history.

Adenoidectomy↗
PubMed1990

Functional endoscopic sinus surgery: morbidity and early results.

Functional endoscopic sinus surgery is a new alternative to conventional sinus surgery as a means of managing recalcitrant sinus disease. This approach to sinus pathology focuses on the importance of the functional ostiomeatal complex and anterior ethmoid sinuses in the pathogenesis of sinus disease. In an effort to assess the morbidity and initial results of this procedure, 85 cases were reviewed. A total of 82% of the patients had bilateral maxillary and ethmoid sinusitis, and 45% had pansinusitis, frequently associated with allergic rhinitis (56%) and nasal polyps (58%). A total of 82% of the patients were operated on as outpatients under local anesthesia. There were no major complications associated with the surgery and minor complications were rare. Disease control was achieved in 88% of patients with short-term follow-up.

Adolescent↗