[Diagnosis and correction of the obstructive sleep apnea syndrome in children with tonsillar ring pathological conditions]

OBJECTIVE

To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.

[Features of the histological structure shell of the maxillary sinus cyst with various diseases of the nasal cavity and paranasal sinuses.]

The authors examined and operated on 64 patients with a diagnosis of cystic peritoneal cyst, with various concomitant diseases of the nose and SNP, in order to identify the peculiarities of the histological structure of cysts of percussion. In 18 patients, concomitant disease was allergic rhinitis, in patients with a violation of the aerodynamics of the nasal cavity, 14 patients with recurrent bacterial sinusitis. According to the histological structure, characteristic features of the structure of maxillary sinus cysts were revealed in various diseases of the nose and paranasal sinuses. Based on the histological structure of the maxillary sinus cysts, 3 types of the structure of cysts characteristic of a certain pathology were identified.

[Uvulopalatoplasty with a severe form of obstructive sleep apnea: long-term results]

OBJECTIVE

To assess the severity of daytime sleepiness and the level of sleep apnea/hypopnea index (AHI), as well as the possibility of their correction, in the long-term period after uvulopalatoplasty (UPP) in patients suffering from obesity and obstructive sleep apnea syndrome (OSAS).

MATERIAL AND METHODS

We retrospectively analyzed the data of the patients, who requested a consultation due to nighttime snoring, witnessed sleep apneas and daytime drowsiness. We included men and women of ages 40 to 65 (24 male, 17 female) without cardiac or lung insufficiency. Group 1 consisted of 19 patients, who underwent UPP 3-5 years prior to current consultation. Group 2 consisted of 22 patients, who underwent UPP 6-12 earlier, despite prior diagnosis of severe OSAS. We performed cardiorespiratory sleep monitoring, additionally patients completed the Epworth scale and sleep quality scale. Patients were re-interviewed 2 months after initiation of CPAP therapy and or intraoral device treatment.

RESULTS

Group 1 (n=19) displayed obesity (Body Mass Index 34.2±6.1 kg/m²), severe OSAS (AHI 55.2±18.5), high level of daytime drowsiness (Epworth score 18.7±6.3) and low sleep quality (13.0±6.8 sleep quality score). Group 2 (n=22) displayed reduction in AHI level - significant statistically, but not clinically without changes in daytime drowsiness and sleep quality, which were improved in 29 cases out of 41 with the help of CPAP-therapy (18 cases) or intraoral fixation devices (11 cases).

CONCLUSION

UPP does not exert a clinically significant affect the severity of sleep disturbance in patients with obesity and severe OSAS. Night sleep study is essential before making a decision about UPP. Clinical state correction of patients in the long-term period of UPP is possible with the help of CPAP therapy or intraoral fixation devices.

[Angioedema of the upper airways during a routine surgery]

The article describes a rare clinical case of the development of angioedema of the larynx and pharynx in a patient during a surgery under endotracheal anesthesia. The authors of the article indicate that in the practice of clinic is 1 case for 32011 people, which is 0.003% of all hospitalized in the hospital for the elective surgical treatment of diseases of the upper respiratory tract. After removal of the tonsils and cyst of the nasopharynx, the surgeon noted a pronounced edema of the uvula, the mucous membrane of the soft palate, the lateral walls of the laryngopharynx and larynx. The patient was not taken out of the anesthesia. The mechanical ventilation was continued and the patient was transferred to the intensive care unit and intensive care unit where antiedematous and symptomatic therapy was conducted. On the 3rd day of treatment, the upper respiratory tract edema reduced, the patient was extubated. The authors present an algorithm for the examination and treatment of patients with angioedema.

[Retention cysts: a new approach to treatment]

In 2017-2018, the authors examined and operated on 35 patients aged 20 to 39 years (19 women, 16 men) with cystic maxillary sinusitis. The study included patients who were diagnosed with retention cyst of the maxillary sinus, located on the lower walls of the maxillary sinus and dealing with no more than ²/₃ of the maxillary sinus volume, according to CT of the paranasal sinuses. The operation was performed using the following method: two punctures of the sinus were performed simultaneously in a typical place in the lower nasal passage - using a Kulikovsky needle and using a 2.8 mm trocar. The fiber of the Ho-laser was inserted into the Kulikovsky needle, and an endoscope was inserted into the trocar in parallel with the 0, 30 or 45°. Then, under the control of the endoscope, the fiber was inserted into the cyst and given a series of impulses before its 'explosion'. The parameters Ho:YAG-radiation had the following values: power - 14.4 W, pulse energy - 1.2 Jol, pulse frequency - 12.0 Hz. All patients were discharged from the hospital on the 2^nd day. In the long-term period (up to 14 months), according to the endoscopic examination, an objective examination and CT of the paranasal sinuses showed no recurrence of the cyst in any patient, no pathological changes were recorded in the area of the lower nasal passage.

[The radicular cyst in the maxillary sinus encountered in the clinical otorhinolaryngological practice]

This article was designed to report the clinical case of the radicular cyst localized in the maxillary sinus of the 23 year-old man that had been detected before the surgical intervention was undertaken for its treatment. In the preceding visits of the patient to other medical settings, this condition was misinterpreted as a genuine (rhinogenic) cyst. It accounted for the choice of the inadequate surgical strategy for the management of this pathology. As a result, the patient experienced two relapse episodes of the disease. The thorough analysis of the patient's medical history and CT images of the sinus obtained during the 4 year follow up period allowed to establish the definitive diagnosis of odontogenic cyst of the upper jaw. The authors present a brief overview of the relevant scientific literature concerning etiology and pathogenesis as well as the methods of diagnostics and treatment of radicular cyst of the upper jaw.

[The role of persistent viral infections with Herpes viridae and Papilloma viridae associated with chronic inflammatory pathology of the oropharynx]

The high prevalence of chronic inflammatory oropharyngeal pathologies and a large variety of specific pathogenetic features of the persistent viral infections caused by the species of the families Herpesviridae and Papillomaviridae as etiological agents of the disease suggest the necessity of investigations with a view to evaluating the clinical significance of persistent viral infections with Herpesviridae and Papillomaviridae species in the patients presenting with chronic inflammatory oropharyngreal pathology. The objective of the present study was to elucidate the prevalence and clinical significance of viral infections caused by the pathogenic agents belonging to the families Herpesviridae and Papillomaviridae in the patients presenting with chronic inflammatory pathology of the oropharynx. We examined two groups of patients one of which was comprised of 174 subjects suffering from chronic inflammatory oropharyngeal pathologies while the other consisted of 31 healthy people. All the patients in both groups underwent the general clinical examination, real-time PCR diagnostics of the viral infections with Herpes viridae and Papilloma viridae using the scrapings of oropharyngeal mucosa, and the microbiological study of the oropharynx secretion. The study has demonstrated the high frequency of viral infections caused by Herpesviridae and Papillomaviridae species in the patients with chronic inflammatory pathology of the oropharynx in comparison with the control group of healthy subjects (81.03% and 45.16% respectively). It was shown that the certain types of pathological conditions were specifically associated with the concrete forms of viral infections. The results of the cytological study give evidence that all (100%) the patients with chronic inflammatory oropharyngeal pathologies had the specific changes in epithelium in the combination with the non-specific alterations. 63.6% of the patients with chronic inflammatory oropharyngeal pathologies and negative results of viral diagnostics using the real-time PCR technology were found to have non-specific changes in epithelium as opposed to 25.8% of the healthy subjects. The correlation analysis of the results of real-time PCR diagnostics and the bacteriological study showed that 45.1% of the carriers of the Epstein-Barr virus were infected with S. pneumoniae and 23.2% with Kl..pneumoniae whereas the mixed infection was documented in 31.1% of the EBV carriers. Moreover, 10.98% of such patients presented with Candida albicans infection whereas. 54.5% and 27.3% of the patients with HHV-6 were diagnosed as having S. aureus and S. pneumoniae infection respectively; the combined flora was found in 18.2% of such patients.

[The clinical observation of NK/T-cell lymphoma of the nasal type]

The objective of the present work was to present the results of the clinical analysis of the patient presenting with natural killer (NK)/T-cell lymphoma of the nasal type. We undertook the analysis of the medical documentation concerning the case of interest. It was shown that the development of progressive perforation of the nasal septum and the pronounced destructive changes in the intranasal and adjacent structures following the endonasal surgical interventions made necessary differential diagnostics between the condition under consideration and certain latent disorders (such as Wegener's granulomatosis, leprosy, syphilis, leishmaniasis, dirofilariasis tuberculosis, etc.). The study has demonstrated that the negative results of the analysis imply the necessity of special attention to the possibility of development of oncological diseases including hematological disorders (e.g. NK/T-cell lymphoma) and the repeat careful follow-up examination of the patients by the experienced experts.