Large Neck Research Articles

Free Flap Reconstruction and Its Management in Sickle Cell Trait: Lessons Learned from a Case.

Oral cancers are amongst the most common cancers in the Indian subcontinent; in India alone, an estimated 1.2 lakh new patients were diagnosed with it. Reconstruction with free flaps slowly gained popularity over time to become the standard for care for treating large head and neck defects. Flap selection is a complex process; more specifically, the preoperative conditions of patients, the extent of the disease, and the resources available are critical considerations to consider when selecting the best reconstructive technique. It is very well established that certain parts of India, especially the tribal area of Central and southern India, have high prevalence of sickle cell trait (SCT) and sickle cell disease compared to the rest of the country. The sickle cell trait poses a potential increase in morbidity in the perioperative care due to surgical stress. Unfortunately, there are no published articles on the management of a free flap in a case of SCT. Here, in this article, we investigate the issues encountered during the perioperative care in a patient who undergone oral cavity composite resection with free fibula reconstruction. SCT screening must be undertaken mainly to identify, mitigate, and manage the adverse events in the perioperative period. The screening test is very inexpensive and has good sensitivity to detect the heterozygous and homozygous disease. We would recommend screening of all the patients hailing from high-risk endemic areas. The free flap in a case of sickle cell trait is not a contraindication, but a surgeon must understand the nuances in the management of complications in such case. Screening for sickle cell trait followed by perioperative blood transfusions, anticoagulation seems beneficial in a patient undergoing free flaps with sickle cell trait.

Acute Mandibular Swelling Following Blunt Trauma

Submandibular trauma is rare, particularly in children or with an intact mandible. Clinical assessment of a child with a neck mass may need to be supplemented by diagnostic imaging. The optimal management of submandibular abscess is unclear, but an initially conservative approach is recommended. We report a case of a 10-year-old girl with a blunt injury 2 days following a fall who presented with a fever and a large lateral neck swelling. Inflammatory markers were raised and antibiotics were commenced. A magnetic resonance imaging (MRI) scan led to an initial working diagnosis of a submandibular abscess. Over time she remained systemically well, and an ultrasound could not radiologically differentiate infection from a collection. The final diagnosis was a submandibular post-traumatic hematoma with a secondarily infected collection. The initial management and decision to transfer to a higher level of service was significantly aided by the availability of MRI scanning. This case report illustrates the diagnostic and therapeutic dilemma in evaluating and treating acute mandibular swelling following blunt trauma. Int J Clin Pediatr. 2021;10(2-3):43-48 doi: https://doi.org/10.14740/ijcp442

Radial Forearm Free Flap Reconstruction of Glossectomy Defects Without Tracheostomy.

To assess the feasibility of radial forearm free flap (RFFF) reconstruction of glossectomy defects without tracheostomy tube (TT). Retrospective review of patients with at least oral tongue defects who underwent RFFF reconstruction. Pre- and intra-operative factors were documented. Post-operative respiratory complications included inability to extubate, pneumonia, or need for re-intubation or TT within 30 days. Twenty-one patients underwent RFFF reconstruction without TT, and 36 patients with TT. The average hospital length of stay was 1.5 days shorter in those without TT (P < .01). Two patients who underwent TT placement experienced a respiratory complication (P = .27). There were no respiratory complications among those without TT. After multivariate analyses, large tongue base defect (>25% resection, P < .001) and bilateral neck dissection (P < .001) were independently associated with TT placement. In our experience, RFFF reconstruction of glossectomy defects is feasible without TT among selected patients with small tongue base defects (≤25% resection) and unilateral neck dissection.

Comparison Between VMAT and IMRT in Remaining Volume at Risk for Large Volume Head and Neck Cancer Patients

Radiation therapy for advanced head and neck cancer has developed from the Three-Dimensional Conformal Radiotherapy 3DCRT to intensity modulated radiation therapy IMRT and Volumetric Modulated Arc Therapy VMAT.

Association of Demographic Factors and Infantile Hemangioma Characteristics With Risk of PHACE Syndrome

A 2010 prospective study of 108 infants estimated the incidence of PHACE (posterior fossa malformations, hemangioma, arterial anomalies, cardiac defects, eye anomalies) syndrome to be 31% in children with facial infantile hemangiomas (IHs) of at least 22 cm2. There is little evidence regarding the associations among IH characteristics, demographic characteristics, and risk of PHACE syndrome. To evaluate demographic characteristics and comorbidities in a large cohort of patients at risk for PHACE syndrome and assess the clinical features of large head and neck IH that may be associated with a greater risk of a diagnosis of PHACE syndrome. This multicenter, retrospective cohort study assessed all patients with a facial, head, and/or neck IH who were evaluated for PHACE syndrome from August 1, 2009, to December 31, 2014, at 13 pediatric dermatology referral centers across North America. Data analysis was performed from June 15, 2017, to February 29, 2020. The main outcome was presence or absence of PHACE syndrome. Data included age at diagnosis, sex, patterns of IH presentation (including size, segment location, and depth), diagnostic procedures and results, and type and number of associated anomalies. A total of 238 patients (mean [SD] age, 2.96 [4.71] months; 184 [77.3%] female) were included in the analysis; 106 (44.5%) met the criteria for definite (n = 98) or possible (n = 8) PHACE syndrome. A stepwise linear regression model found that a surface area of 25 cm2 or greater (odds ratio [OR] 2.99; 95% CI, 1.49-6.02) and involvement of 3 or more locations (OR, 17.96; 95% CI, 6.10-52.85) to be statistically significant risk factors for PHACE syndrome. Involvement of the parotid gland (OR, 0.39; 95% CI, 0.18-0.85) and segment S2 (OR, 0.38; 95% CI, 0.16-0.91) was associated with a lower risk. Race and ethnicity may also be associated with PHACE syndrome risk, although more studies are needed. This cohort study further described factors associated with both a higher and lower risk of PHACE syndrome. The presence of multiple anatomical sites and large surface area were associated with greater risk, whereas S2 or parotid IHs were associated with lower, but still potential, risk. These findings can help in counseling families and decision-making regarding evaluation of infants with large head and neck IHs.

Terraces of the Ohře River in Žatec Area, Czech Republic: When Models of Holocene Fluvial Development Are Not Sufficient

The development of the Ohře River near Žatec between the Late Glacial Maximum (LGM) and present time was studied to obtain its natural trajectory and thus to understand the role of human impact on floodplain development. The study was based on geomorphic research, sampling and dating fluvial sediments by optically stimulated luminescence (OSL) and anthropogenic contamination by Sn since 16th century. During the LGM and the Pleistocene/Holocene transition (P/H), the river valley was shaped by large, incising meanders creating the entire valley floor. The Holocene river, due to decreased channel forming discharges, only slowly continued the LGM and P/H trajectory by cut-offs of the large palaeomeander necks and channel belt narrowing and incision. The last Holocene incision step was likely triggered by hydrological extremes of the Little Ice Age. The LGM and P/H Ohře River consequently changed from meandering to low sinuous, incised in the valley floor; this incision was completed by river engineering in the 20th century. The Ohře River development can thus be rationalised neither by traditional terrace-step formation model nor by model of the Anthropogenic aggradation.

Sellar Plasmacytoma: An Unusual Presentation of Anaplastic Multiple Myeloma

Abstract Background: Anaplastic multiple myeloma (AMM) is an extremely rare morphological subtype of multiple myeloma that has been reported only sporadically. Furthermore, pituitary involvement by multiple myeloma is rare and can be misdiagnosed as a nonfunctioning pituitary adenoma, due to its radiological and clinical similarities. Clinical Case: A 46-year-old man with no past medical history presented with a 3-month history of left shoulder pain. Initial physical exam revealed a large left neck mass, which prompted a left shoulder x-ray remarkable for left supraclavicular mass. Chest CT scan showed a bony mass (7 x 4 x 4 cm) in the left anterior second rib with extra osseous soft tissue involvement. CT also noted left supraclavicular/infraclavicular and left axillary adenopathy. Patient also reported lightheadedness and double vision for a few months and found to have diplopia with upward gaze on exam. Brain MRI revealed uniformly enhancing mass in right sphenoid sinus involving the sella measuring 2.3x2.6x3.2cm. With exception of low Hemoglobin (10.5, 13.5 - 17.7 g/dL) and mildly elevated prolactin (29.9, 2.0 - 20.0 ng/mL), laboratory testing was within normal limits including complete blood count, metabolic panel and pituitary hormone levels. Patient underwent fine needle aspiration of the supraclavicular node, which showed anaplastic plasma cell neoplasm. Further work up noted elevated M-spike, Kappa light chain 92.7 (0.3-2.0 mg/dl), kappa/lamda ratio 23 (0.3-1.6) and beta-2 microglobulin 4324 (600-2,200 ng/mL). Bone marrow biopsy confirmed 70% myeloma involvement with kappa monotypic plasma cell population expressing CD20, CD138, CD38, and CD117. Patient underwent endoscopic endonasal trans-sphenoidal biopsy of the mass. Frozen section pathology revealed a plasma cell neoplasm, and a subtotal resection was performed. Final surgical pathology confirmed anaplastic plasma cell neoplasm. He was started on systemic chemotherapy and external beam radiation. Conclusion: Sellar involvement by myeloma is very rare with less than 50 cases reported in the literature. While rare, these tumors should be considered in the differential diagnosis for lesions involving the sella as the therapeutic approach is different from other sellar masses. While the radiographic appearance can be similar, pituitary plasmacytomas typically present with headache and neurological signs such as cranial nerve palsies and visual changes, with preserved pituitary function. Close attention to physical exam and lab parameters can provide clues to this rare diagnosis.

Atypical Parathyroid Adenoma in a Young Man

Patient is a 38-year-old man who developed sudden onset of pain in the upper left arm while carrying a case of water. The pain recurred periodically over the next few months. He presented to the emergency department where imaging showed a pathologic fracture in the proximal left humerus through a lytic lesion. Laboratory testing showed: calcium 13.8 mg/dL (8.5–10.1 mg/dL), 25-OH vitamin D 8 ng/mL (31–100 ng/mL), parathyroid hormone 1583.1 pg/mL (18.5–88 pg/mL). Neck ultrasound showed a complex nodule in the left neck measuring 4.2 x 1.7 x 2.5 cm. Subsequent biopsy of the left arm lesion showed a Brown tumor. The patient was referred to endocrinology. There was concern for parathyroid carcinoma given the elevated parathyroid hormone and large neck lesion. Technetium-99m sestamibi scan showed a 4.1 x 2.6 x 2.5 cm mass posterior to the left thyroid lobe. He subsequently underwent left hemithyroidectomy and parathyroidectomy. Pathology revealed a 3.1 cm parathyroid mass with scattered fibrous bands, foci of prominent nucleoli and foci of sheet-like trabecular and spindled architecture. It was without necrosis, lymphovascular invasion, perineural invasion, increased mitotic activity, atypical mitoses or invasion into adjacent structures. Thus, it was classified as an atypical parathyroid adenoma.Primary hyperparathyroidism is the third most common endocrine disorder, but fewer than 2% occur as a result of an atypical parathyroid adenoma. Patients with an atypical parathyroid adenoma tend to have a more dramatic clinical presentation compared to those with classic adenoma. We see higher calcium and parathyroid hormone levels. Atypical parathyroid adenomas are classified as such due to other features which place the lesion at a higher risk for malignant behavior including higher mitotic activity, adherence to adjacent structures, banding fibrosis and a growth pattern that is either solid or trabecular. In contrast to parathyroid carcinoma, atypical parathyroid adenomas do not show invasion into the surrounding tissues or lymphatic/vascular vessels, and there should be no evidence of metastatic disease. The exact definition of an atypical parathyroid adenoma varies among institutions, and recognition of the defining features (or lack thereof) necessitates an experienced endocrine pathologist.Due to their uncertain malignant potential, patients with an atypical parathyroid adenoma should undergo routine surveillance for recurrence. Routine follow-up of calcium, parathyroid hormone and imaging is indicated to detect for recurrence. A CDC73 germline mutation is associated with recurrence compared to CDC73-negative patients. Parafibromin expression is also thought to play a role although studies so far have had discrepant results.

Large neck metastasis with unknown primary tumor: A case report

Introduction. Metastatic head and neck carcinoma (HNC) from an unknown primary tumor is defined as a metastatic disease in the neck?s lymph nodes without evidence of a primary tumor after appropriate investigation. Multiple national guidelines recommend taking essential steps in diagnostic protocols which involve a detailed clinical exam with radiological imaging, fine-needle aspiration (FNA) biopsy of the cervical tumor, esophagogastroduodenoscopy (EGD) with palatine and lingual tonsillectomy, immunohistochemical staining, and human papillomavirus (HPV) detection. Treatment of HNCs of unknown primary origin involves surgery (neck dissection) with radiotherapy (RT), while some authors recommend chemo-radiotherapy in cases of advanced regional disease. Case report. A 44-year-old male was referred to the tertiary medical center because of a large ulcero-infiltrative cervical mass on the right side. Examination of the head and neck and flexible nasopharyngolaryngeal endoscopy was conducted, followed by computed tomography (CT) of the head, neck, and thorax with intravenous contrast. The primary localization of the tumor was not confirmed by these diagnostic methods. An open biopsy of the neck mass established a histopathology diagnosis of metastatic squamous cell carcinoma (SCC). Results of EGD with biopsies and bilateral tonsillectomy were negative for malignancy. Treatment included extended radical neck dissection with reconstruction and postoperative ipsilateral RT. The patient presented with an extensive pharyngolaryngeal tumor five years after the first surgery. Biopsy with histopathology examination confirmed the diagnosis of SCC. Conclusion. A structured step-by-step diagnostic approach to identifying the primary site of the metastatic HNC is mandatory. Substantial advances in diagnostics and operative techniques have increased the likelihood of primary tumor identification and detection of the disease's regional and systemic spread. The purpose of adherence to guidelines results in higher overall survival and longer regional disease-free survival in these patients.

Monitoring patients with head and neck cancer for flu-like symptoms during the COVID-19 pandemic.

To capture and monitor flu-like symptoms in relation to the clinical characteristics and the oncologic treatment of a large head and neck cancer (HNC) patient cohort during the Coronavirus disease 2019 (COVID-19) pandemic. Patients were monitored through by 2 rounds of interviews. Clinical characteristics of patients with no symptoms (group 0) and of those reporting ⩾1 (group A), ⩾3 (group B), or ⩾5 symptoms (group C) were analyzed. Patients with ⩾1 symptom at both interviews were defined as group A2. Five hundred patients with HNC were analyzed. A higher frequency of patients with the following characteristics was observed in group A vs group 0: active treatment (40% vs 24%, p = 0.0002), gastrostomy (6% vs 2%, p = 0.027), recent active treatment (48% vs 29%, p < 0.0001), and higher number of concomitant medications (p = 0.01). A lower median age was observed in group B vs group no-B (patients with fewer than three symptoms) (59 vs 63.55 years, p = 0.016) and in group A2 vs group no-A2 (patients without at least one symptom at both interviews) (56 vs 63 years, p = 0.021); patients in group B received more recent active treatment than those in group no-B and in group A2 vs those in group no-A2 (p = 0.024 and 0.043, respectively); patients in group B had a lower body mass index than those in group no-B (22.4 vs 23.93 kg/m2, p = 0.0066). This work is based on patient-reported symptoms and signs independently of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. In the future, these results might serve as a a benchmark for clinicians triaging and managing patients with HNC during infectious outbreaks involving flu-like symptoms.

Large Neck Teratoma in a Newborn with Respiratory Distress Syndrome.

Neonatal tumours in the neck region are a rare finding. Teratomas typically comprise all three germ cell layers with tissues usually foreign to the anatomic site of origin. Head and neck teratomas account a smaller part of congenital teratomas. They can cause major airway obstruction due to the external compression that oropharyngeal or neck masses produce. In addition, there can be an intrinsic lesion in the larynx or trachea. We describe a premature, 30-gestational week-old newborn with large subcutaneous neck mass. Pre-delivery ultrasound showed heterogeneous tumor structure and displaced larynx. The intubation was successful. The newborn developed respiratory distress syndrome immediately after birth which rendered the surgical removal of the neck tumor impossible. An autopsy was done, and the histopathology revealed mature teratoma comprising muscle, brain, salivary and pulmonary tissues, as well as well-developed hyaline membranes in the alveoli. The combination of the respiratory distress syndrome and the neck tumor compression proved fatal. Prenatal diagnosis, therapeutic options and ex utero intrapartum treatment (EXIT) procedures are discussed for the diagnosis and management of this very rare tumor.

637 Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series

Abstract Introduction Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and may become a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction. Methods Four patients presented for reconstruction: two patients had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect resulting from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one patient had a large central face defect post-cancer resection. All four patients underwent an abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction. Results All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency. Conclusions Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a novel method of reconstruction of large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.

A Rare Case of Cervical Epidural Abscess Post Posterior Cervical Laminotomy with Isolation of Neisseria Meningitides Bacteria

Spinal epidural abscess is a rare condition, although it requires an urgent surgery to decrease the pressure onthe epidural sac in addition to the other structures of the spinal cannel cord and nerve roots.A 29 years old female entered the clinic with large neck swelling. She also had a history of headache withneck pain, both arm paresthesia with mild fever. Her MRI showed an epidural collection at level of cervical5 to cervical 7 compressing the dural sac narrowing the spinal cannel and extending to the paraspinalintramuscular area in the neck.She had undergone a surgery with a 2cm mid line incision above the swelling mass in order to suck out thepus. In addition, the intermittent Valsalva maneuver was performed to enhance the epidural pus gat out.The culture and sensitivity test to pus indicated a Neisseria meningitides bacterial growth. Penicillin G andcefotaxime as antibiotics were prescribed. Improvement occurred within 2 weeks.Although rare, the isolated Neisseria meningitides spinal epidural abscess requires an urgent treatmentthrough evacuating and decompressing. Spondylodiscitis or collapse may occur, therefore, a surgery forspine correction may be needed, fellow up is recommended in all forms of epidural abscesses.

Neck circumference as an independent predictor for NAFLD among postmenopausal women with normal body mass index

BackgroundNeck circumference, a proxy for upper-body subcutaneous fat, is a unique and pathogenic fat depot that confers additional metabolic risk. The purpose of present study was to determine whether neck circumference associates with nonalcoholic fatty liver disease (NAFLD) in postmenopausal women with normal body mass index.MethodsA cross-sectional survey (n = 2492) and a 3.1-year follow-up investigation (n = 1354) were conducted among Chinese postmenopausal women with normal BMI (18.5 to < 25 kg/m2). Neck circumference was measured horizontally at the lower margin of the laryngeal prominence.ResultsIn the cross-sectional analysis, large neck circumference was associated with the presence of NAFLD (odds ratio 2.28; 95% CI 1.74–2.98; highest tertile versus lowest tertile) after adjustment for confounding factors. Among 1354 subjects without the NAFLD at baseline, 429 (31.7%) incident NAFLD cases occurred at 3.1 years. Neck circumference was positively associated with triglycerides, homeostasis model assessment of insulin resistance, C-reactive protein, and negatively associated with high-density lipoprotein cholesterol and adiponectin. Individuals with large baseline neck circumference had a significantly higher risk of NAFLD than those with small neck circumference. The multivariable adjusted hazard ratio was 1.42 (95% CI 1.15–1.97; p for trend = 0.004) for the highest versus the lowest tertile of neck circumference, and was 1.22 (95% CI 1.10–1.41; p = 0.006) per 1-standard deviation increment in neck circumference.ConclusionsAmong postmenopausal women with normal BMI, relatively large neck circumference levels are associated with an increased risk of NAFLD.

Oropharyngeal squamous cell carcinomas: Can imaging findings predict HPV status?

This is first Australian population-based retrospective study in HPV-induced OPSCCs utilising CT. Contrast enhanced computed tomography (CECT) was utilised to assess if imaging findings of metastatic cystic lymph nodes (LNs) can predict human papillomavirus (HPV) status, as defined by p16 immunostaining of oropharyngeal squamous cell carcinomas (OPSCCs). The location and p16 status of primary tumours and LNs were recorded. Metastatic LNs were assessed for size, shape, margins and cystic changes. Hounsfield Units (HU) value of primary tumours and LNs were measured and tabulated. p16-positive and p16-negative groups were compared with respect to these variables. The two-sample t test and two-sample Mann-Whitney test was used. A total of 364 CECT scans were reviewed with 209 patients (187 p16 positive and 22 p16 negative). Primary sites of OPSCCs were tonsils (58.8%), base of tongue (37.4%) and other oropharyngeal sites (3.8%). The HU values of p16-positive OPSCCs with mean of 78.6HU; 95% CI (76.5-80.8) were lower for p16-negative tumours, mean 96.0 HU CI 95% (85.5-106.6) for all oropharyngeal sub-sites. The mean HU values of p16-positive and p16-negative metastatic LNs were 38.8 HU 95% CI: (13-103 HU) versus 88.7 HU 95% CI: (54-131) (P<0.0001). The association between p16-positive status and the tonsillar cancer site is very high. Imaging features of p16-positive metastatic LNs include relatively large cystic neck nodes with low HU values. This is an imaging signature of p16-positive OPSCCs and can potentially influence patient's early diagnosis and prognosis.

Metastasis of prostate carcinoma to the thyroid cartilage presenting with airway obstruction

It is generally presumed that large neck masses resulting in airway obstruction are associated with a primary neoplastic problem in the upper aero-digestive tract mucosa, usually a carcinoma. Metastasis into...

Fetal MRI assessment of head &amp; neck vascular malformation in predicting outcome of EXIT-to-airway procedure

Abstract Objectives The objective of this clinical case report is to highlight the MRI features and staging system which may guide clinicians in determining further management. Case presentation Three different cases with fetal head and neck vascular malformation diagnosed during prenatal screening were presented. MRI demonstrates large cystic neck masses which may compromise fetal airway during delivery. Thus, this required multidisciplinary team management among obstetricians, otolaryngologists, pediatricians, anesthesiologists, and radiologists. A decision for complex birth delivery through the cesarean section aided with EXIT-to-airway procedure was made. Each of these procedures demonstrates the different challenges and outcomes of the neonates which correlated with the characterization and staging based on prenatal MRI. Conclusions EXIT-to-airway procedure in head and neck malformation may be beneficial in transiting complicated and potentially catastrophic delivery situations to a more controlled environment. However, it also needs to align with prenatal MRI evaluation, which provides a more objective assessment guide for the clinicians.

Morphometric measurements for sexual dimorphism in the Campolina horse breed

Abstract: The objective of this work was to distinguish the sexual dimorphism of horses of the Campolina breed, by morphometric measurements, and to classify them according to sex, using discriminating functions. Two-hundred and fifteen horses were measured, and 39 morphometric measurements were evaluated. The analysis of covariance and the discriminant analysis were performed. Males were taller and showed a wider chest, a greater scapular-humeral angle, and a larger neck, both in length and circumference. Females had a larger heart girth, wider hips, and a greater opening of the coxal-ground and femorotibial angles. Regarding classification, circumference measurements (85.58%) were more accurate in sexual differentiation than the linear (83.26%) and angular (73.02%) ones. As to classification error, of the total animals measured, 10 to 20% of the females were categorized as males. In addition, 11 to 38% of the males were categorized as females. It can be concluded that of the 39 morphometric measurements evaluated, 22 are responsible for sexual dimorphism in the Campolina horse breed. Circumference and linear measurements provide a more assertive classification to determine sexual dimorphism. Angular measurements show greater classification errors regarding the gender of the horses.

An update on joint ill in sheep.

This focus article has been prepared by Vanessa Swinson of the APHA Small Ruminant Expert Group.

Prevalence of Sleep Disordered Breathing in an African General Population: The Benin Society and Sleep (BeSAS) Study

Background: There are currently no data on the prevalence of sleep-disordered breathing (SDB) in the African general population. This study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large population-based sample in Benin, West Africa. Methods: The Benin Society and Sleep (BeSAS) population-based study was conducted from April 2018 to January 2021. Participants were recruited from both urban and rural areas. Subjects underwent polygraphy at home using a type III device. Clinical and morphometric data were also collected. SBD severity categories were defined according to apnoea-hypopnoea index (AHI): mild-to-severe (AHI ≥5/h, moderate-to-severe (AHI ≥15/h) or severe (AHI ≥30/h). Findings: For the 1810 participants with complete polygraphic data (age 46±15 years, 64·2% women), the prevalence (95% confidence interval [CI]) of mild-to-severe SDB (AHI ≥5/h) was 43·2% (40·9–45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2–13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0-3·5). Factors independently associated with SBD were advanced age, large neck circumference, and snoring in both sexes. After multivariable adjustment, severe SDB was independently associated with hypertension (odds ratio 3·99 [95% CI 1·04–15·33]; p trend =0·044) in women but not in men. Interpretation: The BeSAS study provides the first objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries. Funding Information: Ligue Pulmonaire Vaudoise, Switzerland. Declaration of Interests: RH is member of the medical advisory board of Dreem and Nightbalance (Philips) and received honorariums, grants or speakers’ fees from ResMed, Jazz, Inspire, Philips and Dreem. All the other authors have no conflict of interest to disclose. Ethics Approval Statement: The study was approved by the National Ethics Committee of Benin (reference No. 45, 25 October 2017) with regular annual approval renewal throughout the course of the research project. Participants were enrolled on a voluntary basis and provided written informed consent. If a subject was unable to read or write, a family member able to read was asked to assist with providing information.