Removal Of Adenoids Research Articles

Cancer risk following surgical removal of tonsils and adenoids — a population-based, sibling-controlled cohort study in Sweden

BackgroundRemoval of tonsils and adenoids is among the most common surgical procedures worldwide. Evidence of increased risk of cancer following such surgery is, however, inconclusive.MethodsWe conducted a population-based, sibling-controlled cohort study of 4,953,583 individuals in Sweden with a follow-up during 1980–2016. History of tonsillectomy, adenotonsillectomy, and adenoidectomy was identified from the Swedish Patient Register whereas incident cases of cancer during follow-up were identified from the Swedish Cancer Register. We used Cox models to calculate hazard ratios (HR) with 95% confidence intervals (CI) of cancer in both a population and a sibling comparison. The sibling comparison was used to assess the potential impact of familial confounding, due to shared genetic or non-genetic factors within a family.ResultsWe found a modestly increased risk for any cancer following tonsillectomy, adenoidectomy, or adenotonsillectomy in both the population (HR 1.10; 95%CI 1.07–1.12) and sibling (HR 1.15; 95%CI 1.10–1.20) comparisons. The association did not differ greatly by type of surgery, age at surgery, or potential indication for surgery, and persisted more than two decades after surgery. An excess risk was consistently observed for cancer of the breast, prostate, thyroid, and for lymphoma in both population and sibling comparisons. A positive association was observed for pancreatic cancer, kidney cancer, and leukemia in the population comparison whereas a positive association was observed for esophageal cancer in the sibling comparison.ConclusionsSurgical removal of tonsils and adenoids is associated with a modestly increased risk of cancer during the decades following the surgery. The association is unlikely attributed to confounding due to shared genetic or non-genetic factors with a family.

THE IMPORTANCE OF ALLERGIC FACTOR IN THE ETIOPATHOGENESIS OF CHRONIC ADENOIDITIS IN CHILDREN

The article presents the features of the course of chronic adenoiditis in children with allergic rhinitis. Allergic diseases of the upper respiratory tract and pathology of the pharyngeal tonsil today remain one of the most common diseases in pediatric practice and their pathogenetic mechanisms are often interrelated. The choice of treatment mode for this group of children is currently being actively discussed. The aim of the study is scientific-literary and practical consideration of the problem of the influence of an allergic factor on the pathogenesis of nasopharyngeal tonsil hypertrophy as a cause of chronic adenoiditis in children. The study examined 30 children with stage 2 adenoid hypertrophy, including 18 boys and 12 girls. A number of authors insist on the need to prioritize conservative management, while more and more evidence is emerging that there may often be indications for surgery. The prevalence of allergic diseases and adenoid vegetations in childhood has determined the relevance of studying the research problem. It is established that adenoids in allergic rhinitis become a kind of shock organ, on the surface of which inhaled allergens are delayed. It has been determined that in allergic rhinitis removal of adenoids has the ability to improve the general condition of the patient and relieve symptoms (including nasal congestion) and reduce the risk of various chronic pathologies (namely chronic otitis), and in obstructive sleep apnea — reduce the risk of suffocation. The algorithm of management of children with pathology of the pharyngeal tonsil in concomitant allergic diseases, where the first stage it is necessary to recommend treatment by an allergist, and only in the ineffectiveness of conservative therapy to perform surgery. It has been shown that most of the studied children (60–70%) with stage II nasopharyngeal tonsil hypertrophy showed allergic rhinitis and elevated levels of anti-inflammatory cytokines, which indicates the relationship of the disease with inflammatory diseases of the nasopharynx and immune system. It is determined that the problems of correct diagnosis of the causes of inflammation and hypertrophy of the nasopharyngeal tonsil and the strategy, tactics and correctness of their treatment deserve scientific attention.

400 A Comparative Study of Intracapsular & Extracapsular Coblation Paediatric Tonsillectomy in A Tertiary Centre

Abstract Background Intracapsular tonsillectomy has emerged as a novel alternative to traditional tonsillectomy where the tonsillar capsule is left intact with a small amount of overlying tonsillar tissue. There is growing evidence to suggest that intracapsular tonsillectomy is associated with reduced post-operative pain, haemorrhage and readmission rates. The aim of this study was to assess the reported benefits of intracapsular tonsillectomy within the ENT department at a tertiary paediatric hospital. Method Retrospective analysis comparing two cohorts of 72 consecutive paediatric patients undergoing coblation intracapsular and extracapsular tonsillectomy between March-2019 and November-2020. Patient age at procedure, removal of adenoids, indication, surgeon grade, and discharge time were recorded. Post-tonsillectomy bleeding and 30-day readmission rates were used as the main outcome measures. Results The median age in both groups was 5 years. The intracapsular cohort demonstrated a lower 30-day readmission rate (8.3% vs. 15.3%), lower primary (<24 hours) post-op bleed rate (0% vs. 2.78%) and lower secondary (>24hours) post-op bleed rate (4.2% vs. 12.5%) when compared to the extracapsular cohort. Eight cases were conducted as day cases in total, all Intracapsular, with none of these patients requiring readmission within 30 days. Discussion Coblation Intracapsular tonsillectomy is an effective and low-risk alternative to extracapsular techniques. It is hoped with the reduced associated risks and morbidity associated with the procedure, the department can move towards day case tonsillectomy procedures resulting in a reduction in overall healthcare costs and improved patient experience.

Adenotonsillectomy may increase the risk of alopecia areata in childhood: A nationwide population-based cohort study

Adenotonsillectomy may increase the risk of alopecia areata in childhood: A nationwide population-based cohort study

Chronic diseases of the lymphopharyngeal ring in children: etiology, diagnosis, clinic, principles of treatment

Conservative therapy of chronic pathology of the pharyngeal tonsil allows achieving a clinical and immunological effect in 80 % of cases. It is recommended to adhere to the tactics of maximizing the preservation of the organs of the lymphoepithelial pharyngeal ring. Removal of adenoids up to the age of three is carried out only according to absolute indications.

Pediatric Adenoidectomy: A Comparative Study Between Cold Curettage and Coblation Technique.

The objective of the study was to assess endoscopic coblation adenoidectomy and conventional cold curettage adenoidectomy in terms of safety and efficacy in pediatric patients. Study included 40 pediatric patients, aged between 4-17years. 20 patients underwent cold curettage adenoidectomy and 20 underwent Coblation adenoidectomy. The 2 procedures were compared on various parameters like duration of surgery, intra-operative blood loss, and post -operative pain. To further the comparison, follow -up Nasal Endoscopy was done after 1week and after 1month to assess for injury to peripheral tissues and completeness of removal of adenoids. There was statistically significant difference, favouring Coblation adenoidectomy in terms of lesser intra-operative blood loss (mean blood loss of 19mL Vs 28.5mL) and lesser post -operative pain measured on Visual Analogue Scale (median VAS score of 2 Vs 2.67). Shorter duration of surgery (mean operative time of 10.3min Vs 15.5min) was the only parameter in favour of conventional cold curettage method. Injury to peripheral tissue and residual adenoid were seen in patients who underwent curettage adenoidectomy. The overall advantages of Coblation adenoidectomy when compared with cold curettage adenoidectomy are less intra-operative bleeding, less post -operative pain, completeness and preciseness of adenoid removal with minimal injury to adjacent tissues. For these reasons, Coblation adenoidectomy should be the standard technique adopted for adenoidectomy.

Comparison of Conventional Curettage Adenoidectomy Versus Endoscopic Powered Adenoidectomy: A Randomised Single-Blind Study.

Globally adenoidectomy is increasingly being performed in isolation for children who have middle ear effusion or chronic otitis media, chronic rhinosinusitis and nasopharyngeal obstruction causing sleep apnoea and mouth breathing. Several techniques have been described lately including endoscopic powered adenoidectomy with debrider. The present study was undertaken to compare the effectiveness of endoscopic powered adenoidectomy (EA) with respect to conventional adenoidectomy (CA). It is a prospective study of 60 patients requiring adenoidectomy consisting of 33 males and 27 females randomized into group A with 30 patients undergoing conventional adenoidectomy with curette and 30 patients undergoing endoscopic powered adenoidectomy with micro-debrider. The demographic data (age, sex, adenoid hypertrophy grade assessed by Clemens and Mcmurray scale) in both groups were not statistically significant (p > 0.05). However, significant differences were observed in mean operative time of both groups (CA-29.12 ± 6.70, EA-37.80 ± 6.90min, p < 0.05). The intra-operative blood volume loss was 21.30 ± 5.80ml, 28.24 ± 6.93ml in CA and EA respectively. No significant difference was seen in post-operative pain assessed by Visual Analogue Scale (VAS) (p-0.39). Complete removal of adenoids was seen in 83.3% cases with EA versus 53.3% with CA (p < 0.05). The residual adenoids noted after the CA and EA in Grade I was 23.3% and 13.3% respectively while in CA, grade II with 16.7% and grade III with 6.7% cases had residual adenoids. Injury to surrounding structure was seen in 16.7% and 10% of CA and EA respectively. However, no difference in complication rate was observed between the study groups (p > 0.05). We conclude that endoscopic powered adenoidectomy is more complete, accurate, with less post-operative pain and lower incidence of recurrence in comparison with conventional adenoidectomy.

Inhaled glucocorticosteroids in otorhinolaryngology

Currently, there is a wide introduction of inhaled glucocorticosteroids (InGCS) into otorhinolaryngological practice, which is explained by their local impact and low bioavailability, as well as proven high therapeutic effectiveness in various forms of rhinosinusitis (RS), adenoiditis and allergic rhinitis (AR). The feasibility of using InGCS enshrined in international consensus documents. Thus, this group of drugs is recommended for use in acute postviral and bacterial MS, chronic MS, polypous chronic rhinosinusitis, and in the postoperative period when intervening in the nasal cavity and in the paranasal sinuses. Recently, due to the deterioration of the environmental situation in the world and in connection with the improvement of the diagnosis of sensitization, the number of patients suffering from AR has increased. InGCS are included in the complex of treatment of moderate and severe course of intermittent and persistent AR. The effectiveness of InGCS in non-allergic eosinophilic rhinitis has been proved. In the complex therapy of adenoids and chronic adenoiditis, InGCS is also used with a high degree of efficiency, which allows such patients to avoid invasive treatment methods, including adenotomy. Particularly severe course of RS and adenoids is observed in patients with allergies. In this situation, the feasibility of using InGCS has been proven. One of the most effective and safe drugs in this group is fluticasone propionate (FP) - Flixonase, especially if the patient is sensitized to inhaled allergens. The advantages and possible side effects of FP are described. The authors cite the results of their own research, which used FP in the complex treatment of children with nasal breathing difficulties caused by adenoids and various forms of AR. As a result of 3 months of treatment and follow-up, 95.2% of patients recovered nasal breathing and no need for surgical removal of adenoids. The authors consider the feasibility and effectiveness of using inhaled glucocorticosteroids in the treatment of major diseases of the ENT organs, such as various forms of rhinosinusitis (RS), allergic and non-allergic rhinitis, and adenoiditis. It is emphasized that this group of drugs has an evidence base and is included in the main concession documents on otorhinolaryngology. Their advantages, pharmacotherapy and possible side effects are noted. The advantages of the drug fluticasone propionate (Flixonase), the relevance and advantages of its use are highlighted. The paper presents the authors own observations in the treatment of patients with nasal polypous chronic RS with this drug.

Anti-inflammatory medications for obstructive sleep apnoea in children.

Anti-inflammatory medications for obstructive sleep apnoea in children.

SYM9.9E Necker Experience of Frontofacial Monobloc Advancement with Distraction (FFMBA): 145 cases in faciocraniosynostotic children

Introduction: in faciocraniosynostotic children, simultaneous correction of raised intracranial pressure, frontal retrusion, exorbitism, and facial retrusion causing sleep apnea syndrome can be achieved by frontofacial monobloc advancement. Methods: Since year 2000, 145 children aged between 9 months and 17 years were operated on by the same surgeon (EA) of a frontofacial Monobloc osteotomy. Frontal bone elevation was performed in all cases. Main group of 138 patients underwent insertion of 4 internal distractors (KLS Martin, Arnaud and Marchac distractors). A subgroup of 7 patients aged under 15 months underwent postoperative external traction (3kg) applied to a zygomatic transfacial pin (K-wire 2mm in diameter). In the subgroup of young patients, a prolongated sedation was necessary during one week. In all primary patients (never operated of a frontoorbital advancement before), transposition periosteal flaps were used to seal the anterior fossa.A systematic simple protocol of lumbar puncture during 3 days was used in case of suspicion of postoperative CSF leak. In a subgroup of 109 patients who were prospectively evaluated for respiratory outcome, 44% had a systematical removal of adenoids and tonsils prior to Monobloc. Results: in 95% of patients exorbitism was corrected. Class I occlusion was obtained only in 75% of the cases at the end of distraction. The mean OSAS measured on AHI was reduced from 19.1 (+/-17.2) to a mean 12.5 (+/-13.6). But, only the patients in whom adenoids and tonsils were removed preoperatively benefited frankly from the Monobloc.The rate of major infections was 2% (3 out of 145) mostly in secondary patients. The rate of mortality was 1,3 % (2 patients out of 145): one was due to an untreated preoperative Chiari, the other to very severe venous malformations (both these complications occurred at the beginning of our experience). Minor complications included frequently contaminations of internal distractors (30%), and CSF leaks requiring temporary treatment in 8%. The use of transfacial pin was detrimental to tooth buds but helped correction of airways obstruction in severe patients around one year of age. Postoperative OSAS was significantly lower when premonobloc ENT surgery was performed (tonsils and adenoids) Conclusions: Recommendations for surgical management of FFMBA include the following: - Preoperative screening including CT scan, MRI with venous analysis, polysomnography and ophthalmologic examination. - Preliminary systematic ENT removal of tonsils and adenoids (if significally present). - Preliminary management of Chiari by posterior vault distraction associated to foramen magnum decompression if necessary - Prefer primary cases for FFMBA allowing systematic closure of anterior cranial fossa by bilateral anteriorly based pericranial flaps (those flaps rarely available in previously operated patients)- This step necessitates frontal bone elevation - Use 4 internal distractors with consolidation time of 4–6 months. - Sedation of 2–4 days useful in the immediate post-operative period. - Slow distraction rate to 0,5mm/day starting at day 3 until completion (20–25 mm). - Obtain overcorrection at orbital level, and at dental level if possible. - In the very young and very severe, a very early FFMBA could be performed with adjunction of transfacial pin and external traction during one week. - Postoperatively, reeducate mouth opening to prevent trismus

S3-17 SESSION 3: FACIOCRANIOSYNOSTOSIS – PART I FRONTO-FACIAL MONOBLOC ADVANCEMENT WITH DISTRACTION REDUCES SEVERE OBSTRUCTIVE SLEEP APNEA IN FACIOCRANIOSYNOSTOSES: PROSPECTIVE ASSESSMENT OF 109 CASES

Introduction: Obstructive sleep apnea syndrome (OSAS) is prevalent in children with faciocraniosynostoses and is associated with poor cognitive outcome and risk for increased intracranial pressure. Fronto-facial monobloc advancement (FFMBA) with distraction advances the midface and is performed for OSAS management. Here we aimed to provide a quantitative and prospective assessment of the effects of FFMBA on OSAS in faciocraniosynostoses. Methods: We prospectively included all patients managed for faciocraniosynostoses over a period of 18 years and followed-up their apnea-hyponea index (AHI) based on polysomnographic (PSG) studies, before and after FFMBA with internal distraction. AHI was assessed using several linear and logistic multivariate models, in order to quantify (1) pre-operative AHI values, (2) absolute decrease in AHI values after FFBMA, (3) AHI normalization (AHI<5) after FFMBA, (4) need for a secondary facial advancement and (5) genotype-phenotype correlations. In the second half of the experience, systematical removal of adenoids and tonsils were performed prior to monobloc surgery Results: A total of 109 patients were included and 407 PSG at different time points were collected. We showed a global and significant decrease in AHI after FFMBA: mean pre-operative AHI was 19.11+/-17.25 (19.31+/-18.31 in Crouzon, 17.00+/-11.87 in Apert and 21.82+/-19.38 in Pfeiffer syndrome). The mean post-operative AHI value for all patients was 12.47+/-13.58, which corresponded to a significant decrease from the mean pre-operative value of 19.11+/-17.25 (p<0.05); the decrease from pre-operative values was significant for all three syndromes (p<0.05). Pre-operative lateral and/or posterior decompression was associated with more AHI decrease in absolute value. FFMBA at older ages, Pfeiffer syndrome and pre-operative tonsillectomy and/or adenoidectomy were associated with more AHI normalization. In this subgroup with premonobloc ENT surgery, the intermediate OSAS (AHI between 10–20) the mean pre-op was 16/h and mean post-op was 11/h. In the severe OSAS patients (pre op AHI >20), the mean pre op was 43/h and mean post op was 15/h. Conclusion: FFMBA is efficient in reducing OSAS in faciocraniosynostoses. Pre-operative adenoido-tonsillectomy and lateral and/or posterior skull decompression are recommended before FFMBA in order to improve the respiratory results of the fronto-facial advancement. Delaying surgery when allowed by the neurosurgical and respiratory medicine teams is also a parameter favoring better respiratory outcomes.

Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood

Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system. To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood. A population-based cohort study of up to 1 189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery. Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life. The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born. A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1 157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher. In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.

Adenoids and Its Management: A Review of Surgical Methods

Adenoids remained unrecognized because of their inaccessible location and the fact that most adenoidal pathology occurred in young children. Adenoidectomy is the surgical procedure in which the adenoids are removed. Removal of the adenoids is indicated when they are chronically infected or causing obstruction. Since the earliest descriptions of adenoidectomy, numerous techniques have been described and used successfully. All techniques are based on the principle of adequate visualization and removal of the adenoids without damage to the surrounding structures. The advent of endoscopic sinus surgery has popularized the use of endoscopes. The aim of this paper is to review various surgical techniques of adenoidectomy.

Combined Conventional and Endoscopic Microdebrider-Assisted Adenoidectomy: A Tertiary Centre Experience.

Adenoidectomy is one of the most commonly performed surgical procedures in children. Conventional adenoidectomy is associated with incomplete adenoid tissue removal with persistence of symptoms. The advent of rigid nasal endoscopes, cold light source, fiber optics and powered instruments used in functional endoscopic sinus surgery helped in the development of endoscopic microdebrider-assisted adenoidectomy. To establish the safety and efficacy of combined conventional and endoscopic microdebrider-assisted adenoidectomy procedure. This is a prospective study of 60 child patients who underwent combined conventional and endoscopic microdebrider-assisted adenoidectomy. The study was conducted from September 2013 to September 2015. Only child patients with grade 3 and grade 4 Adenoid Hypertrophy (AH) was included in the study. At the end of conventional adenoidectomy and after combined procedure, the AH was graded again. Post-operative complications like neck pain, hypernasality and swallowing problems were noted. Their symptom score was reviewed before surgery and after one month and one year of surgery. The duration of surgery and amount of blood loss was recorded. By this technique, complete clearance of adenoid tissue was obtained in all 60 (100%) cases. The mean pre-operative symptom score for AH was 3.7, which improved to 0 after one month of combined conventional and endoscopic microdebrider-assisted adenoidectomy. All child patients were symptom-free at the end of one month and one year. The duration of conventional adenoidectomy was 5 minutes 12 seconds while total duration of the combined conventional and endoscopic microdebrider-assisted adenoidectomy was 14 minutes 45 seconds. There was no significant blood loss (15±3 ml approximately). There were no major complications in this study. The combined approach of conventional curette along with endoscopic microdebrider-assisted adenoidectomy is a safe and effective method for complete and accurate removal of large adenoids.

Endoscopic assisted adenoidectomy versus conventional curettage adenoidectomy: a meta-analysis of randomized controlled trials

Adenoidectomy, surgical removal of hypertrophic adenoids, is a common operation in children worldwide. The purpose of this study was to compare the operative effectiveness, and included total operative time, blood loss and complications, between endoscopic assisted adenoidectomy and conventional curettage adenoidectomy. EMBASE, PubMed, Cochrane Library, and China National Knowledge Infrastructure and symposiums and review articles were used to choose relevant randomized controlled trials. A meta-analysis was performed to analyze the data for total operative time, blood loss and complications. Seven studies fit the inclusion criteria, and included 331 patients treated with endoscopic assisted adenoidectomy, and 251 patients treated with conventional curettage adenoidectomy. The meta-analysis demonstrated that compared with conventional curettage adenoidectomy, endoscopic assisted adenoidectomy had a shorter operative time (SMD −1.09; 95 % CI −1.29 to −0.90; p < 0.00001), less blood loss (MD −19.74; 95 % CI −22.75 to −16.73; p < 0.00001), and fewer complications (OR 0.15; 95 % CI 0.07–0.35; p < 0.0001). Endoscopic assisted adenoidectomy has advantages over conventional curettage adenoidectomy with regard to total operative time, blood loss and complications.

Defining the Surgical Limits of Adenoidectomy so as to Prevent Recurrence of Adenoids.

This study aims to define the surgical boundaries of adenoidectomy by demonstrating that recurrence of adenoids and its symptoms can be avoided if a complete adenoidectomy is performed, by following these surgical limits. A prospective descriptive study was carried out at Speciality ENT Hospital, Mumbai, India. Endoscopic adenoidectomy was performed in 83 patients using coblation technology. In all patients, adenoids were removed superiorly till the periosteum over the body of sphenoid; posteriorly till the pharyngobasilar fascia; laterally till fossa of Rosenmuller in the posterior part and till the torus tubarius in the anterior part; and inferiorly till the Passavant's ridge. The patients were followed up postoperatively and a nasal endoscopy was done at the end of 1year to look for any recurrence or regrowth of adenoids, so as to determine the efficacy of the procedure. A total of 83 patients underwent adenoidectomy with a mean age of 12.80years. 12 patients were lost to follow up. Of the remaining 71 patients, no patient showed any evidence of recurrence of adenoid on follow-up nasal endoscopy done at the end of 1year. Recurrence of adenoid post adenoidectomy is not seen if there is complete removal of adenoids. So it is essential that all adenoid tissue be removed during adenoidectomy. The complete removal of adenoids can be ensured by following the surgical limits of adenoidectomy.

Multidisciplinary Approach for Correction of Obstructive Sleep Apnea

ABSTRACTObstructive sleep apnea (OSA) is the most common type of sleep apnea and is caused by complete or partial obstructions of the upper airway. In this study we are presenting a case report of 11-year-old male patient with enlarged adenoids and tonsils, convex profile, receded chin, lower lip trap, class II skeletal and dental relationship with increased overjet. Surgical removal of enlarged adenoids was done before commencement of twinblock therapy. After this, two-step advancement with expansion in both arches utilizing twin blocks was planned. Four months into the treatment, patient reported with history of facial trauma with avulsed maxillary left central incisor. Twin block was then modified with pontic as replacement for maxillary left central incisor. Sagittal correction resulting in class I molar relationship was achieved in next 6 months. Fixed appliance therapy was followed. The design of the appliance and the results achieved after the postfunctional therapy are presented in this case report.How to cite this articleMadhaswar AB, Ravindranath VK, Daga PN. Multidisciplinary Approach for Correction of Obstructive Sleep Apnea. J Contemp Dent 2016;6(3):189-193.

The essential role of the COM in the management of sleep-disordered breathing: A literature review and discussion

The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 30 Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered breathing for healthcare professionals seeking education in orofacial myology.

Choanal adenoid in adults with persistent nasal symptoms: endoscopic management to avoid misdiagnosis and unsuccessful surgeries

Our objective was to confirm the necessity of nasal endoscopy in the diagnosis and treatment of choanal adenoid in adult patients with persistent bilateral nasal obstruction and recurrent nasal infections that may lead to repeated unsuccessful medical and surgical procedures. We present a series of 64 adult patients (18-37 years: 40 males, 24 females). All patients had persistent bilateral nasal obstruction and recurrent nasal infections. There was history of repeated medical and surgical unsuccessful procedures. Choanal adenoid was confirmed by nasal endoscopy and CT scanning. Absence of adenoid tissues in the nasopharynx was confirmed in all cases. Surgical removal of choanal adenoids was undertaken in all cases endoscopically. Some other surgical procedures like straightening of a deviated septum or reduction of a hypertrophied turbinate were undertaken in some indicated cases. Most of the cases experienced complete relief from obstruction and return of a patent nasal airway, and improvement of associated complaints such as dry mouth and persistent cough. A thorough review of this phenomenon and its clinical relevance, and methods of diagnosis and management are presented. We recommend a thorough nasal endoscopy as a routine in cases of persistent nasal obstruction even in the presence of an apparent cause of obstruction.

Anti-inflammatory medications for obstructive sleep apnea in children

Obstructive sleep apnea (OSA) is characterized by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy the most common underlying risk factor. Surgical removal of enlarged tonsils and adenoids is the most commonly used treatment for OSA. Given the perioperative risk of the intervention and an estimated recurrence rate of up to 20%, there has recently been an increased interest in non-surgical treatment modalities. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory agents have been proposed as a useful non-invasive treatment option in children with OSA. To assess the efficacy of anti-inflammatory drugs for the treatment of OSA in children. We identified trials using searches of the Cochrane Airways Group Specialized Register, MEDLINE (1950 to 2010), EMBASE (1988 to 2010), CINAHL (1982 to 2010), CENTRAL (1964 to 2010), Web of Science (1900 to 2010), LILACS (1982 to 2010) and International Pharmaceutical Abstracts (IPA) (1970 to 2010). Randomized controlled trials (RCTs) comparing anti-inflammatory drugs against placebo, other anti-inflammatory drugs, or other treatment in children between one and 16 years with objectively diagnosed OSA (Apnea Hypopnea Index (AHI) ≥ 1/hour (h)). Both authors independently performed data extraction and quality assessment. It was not possible to combine data from the included studies; we summarized data in a narrative fashion. We included three RCTs. The first study was a six-week parallel-group trial (25 participants, mean age 3.8 years, mean AHI 10.8/h) of intranasal fluticasone versus placebo showed a statistically significant effect of the drug on improving the AHI. The second study compared intranasal budesonide with placebo in a six-week cross-over trial (62 participants, mean age 8.2 years, mean AHI 3.7/h). The authors reported an advantage of the drug over placebo in reducing the AHI. However, the patients were not analyzed as randomized so the result must be interpreted with caution. No valid group comparisons were reported for the third trial (30 participants, oral montelukast versus placebo in a 12-week parallel-group trial), which has so far only been published as an abstract. A single small study has found a short-term beneficial effect on the AHI in children with mild to moderate OSA. However, long-term safety and efficacy data are not available yet. Further RCTs are needed to evaluate anti-inflammatory drugs for OSA in children.